Radiographic findings among children hospitalized with severe community-acquired pneumonia.

BACKGROUND: Community-acquired pneumonia (CAP) is a leading cause of childhood death. There are few published reports of radiographic findings among children with severe CAP. OBJECTIVE: To describe chest X-ray (CXR) findings and assess association between these radiographic findings and pneumococcal isolation in children with severe CAP. METHODS: A prospective, multicenter, observational study was conducted in 12 centers in Argentina, Brazil, and the Dominican Republic. Children aged 3-59 months, hospitalized with severe pneumonia, were included. On admission, blood and pleural effusion cultures were performed. Streptococcus pneumoniae was identified according to standard procedures in the respective national reference laboratory. Chest X-rays were taken on admission and read before the culture results were reported. RESULTS: Out of 2,536 enrolled patients, 283 (11.2%) had S. pneumoniae isolated, in 181 cases (7.1%) from blood. The follow radiographic patterns were observed: alveolar infiltrate (75.2%), pleural effusion (15.6%), and interstitial infiltrate (9.2%). Overall, pleural effusion was associated with pneumococcal isolation and pneumococcal bacteremia (P < 0.001). Infiltrates were unilateral (78.7%) or bilateral (21.3%), right-sided (76%) or left-sided (24%), in the lower lobe (53.6%) or the upper lobe (46.4%). Multivariate analysis including patients with affection of only one lobe showed that upper lobe affection and pleural effusion were associated with pneumococcal isolation (OR 1.8, 95% CI, 1.3-2.7; OR 11.0, 95% CI, 4.6-26.8, respectively) and with pneumococcal bacteremia (OR 1.7, 95% CI, 1.2-2.6; OR 3.1, 95% CI, 1.2-8.0, respectively). CONCLUSIONS: Three-quarters of the patients studied had alveolar infiltrates. Upper lobe compromising and pleural effusion were associated with pneumococcal invasive disease.

Enfermedades prevalentes de la infancia en las Américas / Diseases prevalent in childhood in the Americas

La presente publicación contiene información relevante acerca de la situación de los países de la Región de las Américas con relación a la salud infantil y, particularmente; con relación a la supervivencia de los niños y niñas menores de cinco años y la evolución de la mortalidad total, por enfermedades respiratorias y diarreicas durante los últimos decenios. Incluye capítulos generales que brindan un panorama de las enfermedades prevalentes de la infancia en América del Norte, América Central, Cono Sur, Área Andina y el Caribe Latino; y pone de manifiesto las diferencias existentes entre estas regiones y entre los países que las componen, que son una expresión de la brecha que aún existe en la distribución del acceso a y al uso de las intervenciones para la prevención, el tratamiento y la promoción de la salud infantil.

Evaluation of the degree of tachypnea for hospitalizing children with pneumonia.

This was a hospital based prospective study to determine the cut-off respiratory rates which can identify children (age < or =14.5 yr) with sever pneumonia with chest indrawing and to evaluate the validity of the cutoff respiratory rate so obtained in identifying sever pneumonia requiring hospitalization. All children diagnosed with pneumonia (radiologically proven) between September 1997 and October 1999 were enrolled. Of 1,665 cases, 54.7% were males; the median age was 1.8 yr (range 8 days-14.5 yr, mean 2.8 +/- 2.7 yr). Frequency of hospitalization, tachypnea and chest indrawing were 29.9%, 58.9% and 42.7%. In hospitalized children, cutoff respiratory rate > or =57, > or =48, and > or =36 were found to identify sever pneumonia requiring hospitalization in the age groups 2-11 mo, 12-59 mo and > or =5 yr, respectively.

Community acquired pneumonia among pediatric outpatients in Salvador, Northeast Brazil, with emphasis on the role of pneumococcus.

Pneumonia is one of the leading causes of hospitalization and death among children in developing countries, and mortality due to pneumonia has been associated with S. pneumoniae infection. This investigation was designed to describe the antimicrobial susceptibility and serotype patterns of pneumococcal strains recovered from the blood of children with community-acquired pneumonia (CAP) and to assess the clinical findings of pneumococcal bacteremic patients with pneumonia. In a 26 month prospective study, blood cultures were obtained as often as possible from children (<16 years of age) diagnosed with CAP in two emergency rooms. Antimicrobial drug susceptibility tests and serotyping were performed when pneumococcus was identified. We studied 3,431 cases and cultured blood samples from 65.5% of those. Pneumococcus was recovered from 0.8% of the blood samples. The differences in age, somnolence, wheezing and hospitalization among children with and without pneumococcal bacteremia were statistically significant. Pneumococcal bacteremia was age-related (mean 1.63 +/- 1.55; median 0.92) and associated with somnolence and hospitalization among children with CAP. One strain was recovered from pleural fluid. Penicillin resistance was detected in 21.0% (4/19) of the strains at an intermediate level, whereas 63.0% of the strains were resistant to trimethoprim-sulfamethoxazole. The most common serotypes were 14 and 6B, and these serotypes included the resistant strains. Eight of our 18 isolates from blood were of types included in the heptavalent conjugate pneumococcal vaccine, recently licensed in the USA.

[Magnitude and control of acute respiratory infections in children]. / Magnitud y control de las infecciones respiratorias agudas en los niños.

PIP: Acute respiratory infections of viral or bacterial origin represent 1 of the 3 main causes of morbidity and mortality in children of developing countries, where they typically are responsible for 15-20% of deaths in children under 5. Mortality rates are higher in children under 1 year and decline with age. Fewer than 2% of children with pneumonia in developed countries die, vs. an estimated 10-20% in developing countries. Operational studies indicate that children dying of acute respiratory infections are those who do not receive health services or receive them too late, and those whose moderate infections are inadequately treated. Determining factors include inaccessibility of health services, socioeconomic problems, cultural factors limiting the frequency and acceptance of formal health services, and inadequate management of acute respiratory infections by the general health services. Immunizations, better case management and health education are 3 interventions for control of respirator infections that offer immediate potential benefits for primary health care in developing countries. Vaccinations against whooping cough, measles, and diphtheria are part of the Expanded Program of Immunization. Anti-pneumococcal vaccines and flu shots are not appropriate for use in children in developing countries. Health personnel should be trained to use antibiotics more rationally and efficiently and to make referrals to higher levels of care when needed. Oxygen treatment should be available in secondary and tertiary care centers. Health personnel should be trained to administer simple treatments for other possible complications of respiratory infections. Such measures have been applied sporadically in developing countries and data on their efficacy remain sparse. But mortality rates declined greatly in 1 rural community of India after introduction of the measures, and more proofs of their efficacy will become available as programs develop. It will be necessary to train health agents in differentiation of cases according to gravity, to recommend and apply treatment, to administer antimicrobial drugs, and to refer cases to hospitals. The main decision of the health agent concerns the gravity of the case and not the diagnosis of pneumonia or bronchitis. A classification based on the few most important signs and symptoms will facilitate the 2 principal decisions about treatment; whether to administer antimicrobial and whether to treat at home or refer to a higher level of care. A 3-part classification of acute respiratory infections if suggested for all outpatient care and community health agents: serious cases requiring hospitalization 2) moderate cases requiring antimicrobial but not hospitalization and 3) mild cases not requiring antimicrobial.^ieng