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1.
PLoS One ; 9(8): e106051, 2014.
Article in English | MEDLINE | ID: mdl-25148361

ABSTRACT

INTRODUCTION: World Health Organization (WHO) radiological classification remains an important entry criterion in epidemiological studies of pneumonia in children. We report inter-observer variability in the interpretation of 169 chest radiographs in children suspected of having pneumonia. METHODS: An 18-month prospective aetiological study of pneumonia was undertaken in Northern England. Chest radiographs were performed on eligible children aged ≤16 years with clinical features of pneumonia. The initial radiology report was compared with a subsequent assessment by a consultant cardiothoracic radiologist. Chest radiographic changes were categorised according to the WHO classification. RESULTS: There was significant disagreement (22%) between the first and second reports (kappa = 0.70, P<0.001), notably in those aged <5 years (26%, kappa = 0.66, P<0.001). The most frequent sources of disagreement were the reporting of patchy and perihilar changes. CONCLUSION: This substantial inter-observer variability highlights the need for experts from different countries to create a consensus to review the radiological definition of pneumonia in children.


Subject(s)
Observer Variation , Pneumonia/diagnostic imaging , Radiography, Thoracic , Adolescent , Child , Child, Preschool , England , Female , Humans , Infant , Male , Pneumonia/diagnosis , Pneumonia/etiology , Prospective Studies , World Health Organization
2.
Eur Respir J ; 42(6): 1595-603, 2013 Dec.
Article in English | MEDLINE | ID: mdl-23598951

ABSTRACT

We describe the aetiology of community-acquired pneumonia in children before and after the introduction of the pneumococcal conjugate vaccination (PCV) programme in 2006. Prospective studies were conducted in 2001-2002 (pre-vaccine) and 2009-2011 (post-vaccine) of children aged 0-16 years with radiologically confirmed pneumonia seen in hospital. Investigations included culture, serology, immunofluorescence antibody and urine antigen testing, with an increased use of PCR assays and expanded panels of pathogens in the post-vaccine study. 241 and 160 children were enrolled in the pre- and post-vaccine studies, respectively (73% aged <5 years). Identification of a causative pathogen was higher post-vaccination (61%) than pre-vaccination (48.5%) (p=0.019). Rates of bacterial infections were not different between post- and pre-vaccine studies (17.5% versus 24%, p=0.258). Viral (31%) and mixed (12.5%) infections were found more often post-vaccination (19.5%, p=0.021) than pre-vaccination (5%, p=0.015). Rates of identified pneumococcal infections were comparable between pre- and post-vaccine studies (14.7% versus 17.4%, p=0.557). Diagnosis of pneumococcal infection post-vaccination improved when PCR was used compared to culture (21.6% versus 6%, p=0.0004). Serotypes included in PCV13 but not PCV7 were identified in 75% (18 out of 24) post-vaccination. Infection with nonvaccine pneumococcal serotypes continues to be a significant cause of pneumonia in children in the UK.


Subject(s)
Pneumococcal Vaccines/therapeutic use , Pneumonia/complications , Adolescent , Child , Child, Preschool , Female , Humans , Infant , Infant, Newborn , Male , Pneumonia/epidemiology , Pneumonia/prevention & control , Pneumonia, Pneumococcal/epidemiology , Pneumonia, Pneumococcal/prevention & control , Polymerase Chain Reaction , Prospective Studies , Serologic Tests , Streptococcal Infections/epidemiology , Streptococcal Infections/prevention & control , United Kingdom/epidemiology , Vaccines, Conjugate/therapeutic use , Virus Diseases/epidemiology , Virus Diseases/prevention & control
3.
Diagn Microbiol Infect Dis ; 76(2): 129-32, 2013 Jun.
Article in English | MEDLINE | ID: mdl-23537785

ABSTRACT

The 7-valent pneumococcal conjugate vaccine (PCV7) was introduced routinely in the UK from September 2006 and replaced by PCV13 in 2010. In a prospective study from 2009 to 2011 of 160 children aged ≤16 years with radiologically confirmed pneumonia, likely pneumococcal infections were identified in 26%. Detection of pneumococci was improved with polymerase chain reaction compared to culture (21.6% versus 6% of children tested, P = 0.0004). Where serotyping was possible, all (n = 23) were non-PCV7 but PCV13 serotypes; 1 (43.5%), 3 (21.7%), 7A/F, and 19A (17.4% each).


Subject(s)
Community-Acquired Infections/diagnosis , Pneumonia, Pneumococcal/diagnosis , Streptococcus pneumoniae/isolation & purification , Adolescent , Child , Child, Preschool , Community-Acquired Infections/prevention & control , Female , Humans , Male , Pneumococcal Vaccines/administration & dosage , Pneumococcal Vaccines/therapeutic use , Pneumonia, Pneumococcal/immunology , Pneumonia, Pneumococcal/prevention & control , Polymerase Chain Reaction , Prospective Studies , Serotyping , Streptococcus pneumoniae/immunology , Vaccines, Conjugate/administration & dosage , Vaccines, Conjugate/immunology
4.
Plast Reconstr Surg ; 127(5): 2031-2044, 2011 May.
Article in English | MEDLINE | ID: mdl-21532430

ABSTRACT

BACKGROUND: The authors present their experience using an established chemotherapeutic agent as a scarless treatment for vascular birthmarks. One hundred sixty-four of more than 600 patients seen in the authors' center received intralesional bleomycin injection over 5 years. METHODS: Patient demographics, clinical response, treatment, and complication details were recorded prospectively. Respiratory surveillance was provided by adult and pediatric pulmonologists. Eighty-one venous malformations, 39 hemangiomas, 26 lymphatic malformations, 10 mixed malformations, two arteriovenous malformations, two cystic hygromas, two capillary malformations, and two angiokeratomas underwent intralesional bleomycin injection. RESULTS: The authors observed that 45.7 percent of patients completed treatment in a mean of 3.8 sessions and mean duration of 107 days. Complete resolution occurred in 56.0 percent, with a 93.3 percent overall response rate, and 82.7 percent of lesions demonstrated complete response or significant improvement. Three patients developed transient skin hyperpigmentation. One patient each developed skin ulceration, blistering, infection, swelling, headache, bruising, and rash. One patient required intubation following treatment of a panfacial and thoracic lymphatic malformation. A full recovery ensued. No patients developed pulmonary fibrosis. One venous malformation recurred. CONCLUSIONS: The authors' single-site multidisciplinary team has successfully treated complex and recurrent vascular anomalies with acceptable complication and recurrence profiles. These findings represent the authors' experience and provide a reference for the management of these challenging lesions.


Subject(s)
Bleomycin/administration & dosage , Hemangioma/drug therapy , Lymphangioma, Cystic/drug therapy , Lymphatic Abnormalities/drug therapy , Skin Neoplasms/drug therapy , Vascular Malformations/drug therapy , Antibiotics, Antineoplastic/administration & dosage , Buttocks , Child , Child, Preschool , Female , Follow-Up Studies , Humans , Infant , Infant, Newborn , Injections, Intralesional , Male , Time Factors , Treatment Outcome , United Kingdom
6.
Arch Dis Child ; 92(5): 394-8, 2007 May.
Article in English | MEDLINE | ID: mdl-17261579

ABSTRACT

OBJECTIVE: To describe the spectrum of clinical features and management of community acquired pneumonia in the UK. DESIGN: Prospectively recorded clinical details for all children with possible pneumonia and chest x ray (CXR) changes in 13 hospitals in the North of England between 2001 and 2002. RESULTS: 89% of 711 children presenting to hospital with pneumonia were admitted; 96% received antibiotics, 70% intravenously. 20% had lobar CXR changes, 3% empyema and 4% required intensive care. Respiratory rate (RR), hypoxia and dyspnoea all correlated with each other and prompted appropriate interventions. Admission in children, not infants, was independently associated with RR, oxygen saturation, lobar CXR changes and pyrexia. Neither C-reactive protein, lobar CXR changes or pyrexia were associated with severity. Children over 1 year old with perihilar CXR changes more often had severe disease (p = 0.001). Initial intravenous antibiotics were associated with lobar CXR changes in infants and children and with dyspnoea, pyrexia and pleural effusion in children. The presence of pleural effusion increased duration of antibiotic treatment (p<0.001). Cefuroxime was the most often used intravenous antibiotic in 61%. Oral antibiotics included a penicillin in 258 (46%), a macrolide in 192 (34%) and a cephalosporin in 117 (21%). Infants stayed significantly longer (p<0.001) as did children with severe disease (p<0.01), effusions (p = 0.005) or lobar CXR changes (p< or =0.001). CONCLUSIONS: There is a high rate of intravenous antibiotic administration in hospital admissions for pneumonia. Despite lobar CXR changes not being independently associated with severe disease, initial lobar CXR changes and clinical assessment in children independently influenced management decisions, including admission and route of antibiotics.


Subject(s)
Pneumonia, Bacterial/diagnosis , Pneumonia, Bacterial/drug therapy , Professional Practice/statistics & numerical data , Adolescent , Anti-Bacterial Agents/administration & dosage , Biomarkers/blood , C-Reactive Protein/analysis , Child , Child, Preschool , Community-Acquired Infections/diagnosis , Community-Acquired Infections/drug therapy , Community-Acquired Infections/epidemiology , Drug Administration Schedule , England/epidemiology , Female , Hospitalization/statistics & numerical data , Humans , Infant , Infant, Newborn , Injections, Intravenous , Length of Stay/statistics & numerical data , Male , Oxygen/blood , Pleural Effusion/microbiology , Pneumonia, Bacterial/epidemiology , Prospective Studies , Respiratory Mechanics , Severity of Illness Index
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