Influenza: Underestimated in Children Below 2 Years of Age.

Children under 2 years of age may receive antiviral therapy when influenza is suspected. Signs of influenza are frequently unclear and testing is indicated. The aim of the study was to assess the usefulness of clinical signs and the rapid influenza diagnostic test (RIDT) in diagnosing influenza and in choosing the appropriate treatment. In the 2015-2016 influenza season, 89 children under 2 years of age (56.7% of 157 children diagnosed with influenza) were hospitalized. There were 74 RIDT and 70 reverse transcription polymerase chain reactions (RT-PCR) performed for the purpose of diagnosis, either test per child. Eighty-three percent of children (74/89) presented with fever, 55.1% (49/89) with cough, and 39.3% (35/89) with both cough and fever. The RIDT was positive in 31.1% (23/74) of cases. The highest percentage of positive RIDT was within the first 24 h of disease, decreasing dramatically thereafter (70% vs. 13-17%, respectively). The RIDT shortened the time to diagnosis by 43.8 h/patient (an average €149 gain in treatment costs). The mean delay for RT-PCR-based diagnosis was 33.5 h/patient (an average €114 loss in treatment costs). We conclude that clinical signs have a low diagnostic sensitivity in children under 2 years of age. Likewise, RIDT is of low sensitivity, being diagnostically useful only in the first 24 h. The PCR is recommended for the diagnosis, but that requires a constant access to the method.

The role of the soluble urokinase plasminogen activator (suPAR) in children with pneumonia.

Although pneumonia is one of the most important health problems in children, there is still no widely accepted disease severity score, the data on the correlation between the conventional inflammatory markers or chest X-ray and the disease severity remain disputable, and thus, there is an urgent need for a new pneumonia biomarker. The soluble urokinase plasminogen activator (suPAR) is a soluble form of the urokinase plasminogen activator that plays an important role in the innate host defense in the pulmonary tissue. suPAR levels have been associated with a general activation of the immune system rather than with a particular etiological factor. suPAR has a high prognostic value in critically ill patients, especially with sepsis, but there is a growing number of studies focusing on suPAR in respiratory diseases. The aim of this review is to summarize the knowledge on the role of the suPAR/uPAR in lung pathology and its possible use in pneumonia in children.

Soluble urokinase plasminogen activator receptor: an indicator of pneumonia severity in children.

Enhanced level of soluble urokinase plasminogen activator receptor (suPAR) level has been associated with activation of the immune system. It may be a novel biomarker for pneumonia severity, yet data on this subject are limited. In the present study we seek to determine the suPAR level in hospitalized children with community-acquired pneumonia (CAP), its correlation with pneumonia severity, and to compare the suPAR level between pneumonia and healthy conditions. The study encompassed a total of 596 children: 447 with pneumonia and 119 healthy. suPAR was measured in 227 out of the 447 pneumonia patients and in all healthy subjects. We used clinical indicators (fever, time for defeverscence, heart and breath rate, saturation, and length of antibiotic treatment and of hospitalization) and laboratory indicators (CRP, procalcitonin, white blood cell count, and sodium) to assess the CAP severity. The finding were that the suPAR concentration in children with pneumonia was significantly higher (median 7.11 ng/mL) than in healthy individuals (4.68 ng/mL). We found a positive correlation between the suPAR and the following factors: fever, time for defeverscence, length of hospital stay, and elevated CRP and procalcitonin levels. There was a reverse correlation with sodium concentration and capillary blood saturation. Moreover, the suPAR level was significantly higher in children with a severe course of pneumonia compared with those having non-severe pneumonia (7.79 vs. 6.87 ng/mL; p = 0.006). In conclusion, suPAR elevation is observed in pneumonia and may reflect its severity.

Hyponatremia in children hospitalized due to pneumonia.

The aim of this study was to evaluate the relation between hyponatremia (HN) and severity of community-acquired pneumonia (CAP) in children. The study consisted of a retrospective analysis of medical records of 312 children (165 boys, 147 girls) aged 33 days to 16 years, hospitalized with CAP. The children were divided into two age-groups: under and over the age of four. Clinical findings such as breath frequency, heart rate, capillary blood saturation, body temperature, time for defeverscence, duration of antibiotic treatment and hospital stay, and the serum inflammatory markers WBC, neutrophil count, CRP, and procalcitonin level were used as the disease severity predictors. The results demonstrate that hyponatremia was observed in 104/312 (33.3 %) patients. Children with HN of both age-groups had higher neutrophil counts (6.96 vs. 5.73*10(3)/µL; p < 0.05 and 12.46 vs. 8.22*10(3)/µL; p = 0.01), those aged > 4 had higher WBC (15.85 vs. 11.0*10(3)/µL; p = 0.02), and those aged < 4 had a lower lymphocyte count (3.74 vs. 4.75*10(3)/µL; p = 0.02) than children without HN. Hyponatremic children had higher CRP (28.82 mg/L vs. 9.18 mg/L; p < 0.01) and tended to have higher procalcitonin (0.31 vs. 0.19 ng/mL) than children without HN. Body temperature was higher (38.6 vs. 37.6 °C; p < 0.01) and duration of hospitalization was longer (9 vs. 8 days, p = 0.01) in hyponatremic compared with non-hyponatremic children. There was no correlation between the sodium level and either breath frequency, heart rate, capillary blood saturation, time for defeverscence, or time of antibiotic treatment. We conclude that hyponatremia is a frequent finding in CAP and seems associated with the disease severity.

Soluble receptor for urokinase plasminogen activator in community-acquired pneumonia in children.

Community-acquired pneumonia (CAP) is a leading single cause of mortality in children under 5 years of age. In search of new diagnostic markers, soluble urokinase plasminogen activator receptor (suPAR) seems to offer promise as a novel clinical tool. The goal of the present study was to assess the relation between suPAR and the severity of CAP. suPAR was measured in 74 (39 males, 35 females) patients aged from 1 month to about 15 years. Correlation between the level of suPAR and inflammatory markers (white blood cell, neutrophil count, C-reactive protein-CRP, and procalcitonin-PCT) was assessed by Spearmann's rank coefficient. We found that the median suPAR level in children with pneumonia was 8.29 ng/mL (range 2.44-18.31 ng/mL). In the multivariate logit model, age and CRP level were statistically important. The older children (age above the median value) had higher suPAR (above the median value) less frequently than the younger children (OR = 0.31), whereas the children with greater CRP values (above the median value) had higher suPAR levels than the children with lower CRP concentration (under the median value) (OR = 4.54). There was also a positive correlation between suPAR and PCT levels. In conclusion, we demonstrate a positive correlation between serum suPAR and the non-specific inflammatory markers CRP and PCT in the community acquired pneumonia in children.