Viruses in community-acquired pneumonia in children aged less than 3 years old: High rate of viral coinfection

Abstract Background Long regarded as the second most common cause of community-acquired pneumonia (CAP), Haemophilus influenzae has recently been identified with almost equal frequency as pneumococcus in patients hospitalized for CAP. The literature lacks a detailed description of the presentation, clinical features, laboratory and radiologic findings, and outcomes in Haemophilus pneumonia. Methods During 2 prospective studies of patients hospitalized for CAP, we identified 33 patients with Haemophilus pneumonia. In order to provide context, we compared clinical findings in these patients with findings in 36 patients with pneumococcal pneumonia identified during the same period. We included and analyzed separately data from patients with viral coinfection. Patients with coinfection by other bacteria were excluded. Results Haemophilus pneumonia occurred in older adults who had underlying chronic lung disease, cardiac conditions, and alcohol use disorder, the same population at risk for pneumococcal pneumonia. However, in contrast to pneumococcal pneumonia, patients with Haemophilus pneumonia had less severe infection as shown by absence of septic shock on admission, less confusion, fewer cases of leukopenia or extreme leukocytosis, and no deaths at 30 days. Viral coinfection greatly increased the severity of Haemophilus, but not pneumococcal pneumonia. Conclusions We present the first thorough description of Haemophilus pneumonia, show that it is less severe than pneumococcal pneumonia, and document that viral coinfection greatly increases its severity. These distinctions are lost when the label CAP is liberally applied to all patients who come to the hospital from the community for pneumonia.

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P54 KIDS-STEP: a swiss multi-centre RCT on effectiveness of adjunct betamethasone therapy in hospitalised children with community acquired pneumonia

Archives of Disease in Childhood ◽

10.1136/archdischild-2019-esdppp.92 ◽

2019 ◽

Vol 104 (6) ◽

pp. e39.2-e39

Author(s):

M Kohns Vasconcelos ◽

R Santoro ◽

M Coslovsky ◽

J van den Anker ◽

JA Bielicki

Keyword(s):

Hospital Discharge ◽

Community Acquired Pneumonia ◽

High Rate ◽

Oral Steroid ◽

List Type ◽

Serious Adverse Events ◽

Adjunct Treatment ◽

Oral Steroids ◽

Meta Analyses ◽

Clinical Stability

BackgroundThe incidence of community-acquired pneumonia (CAP) in young children is high (20- 30/1000 child-years) and is associated with a high rate of hospitalisation (around 10/1000 child-years). In adults, a benefit of adjunct corticosteroids on time to clinical stability and hospital discharge has been observed and confirmed in systematic reviews and meta-analyses. In contrast, only few small trials have addressed the potential impact of oral steroid treatment in CAP during childhood. The purpose of this study is to concurrently evaluate whether adjunct treatment with corticosteroids in children hospitalised with CAP is more effective in terms of the proportion of children reaching clinical stability and whether such adjunct treatment is no worse in terms of CAP relapse.MethodsChildren in KIDS-STEP1 receive either oral betamethasone or oral placebo dosed once daily for two consecutive days. We include 700 children from age 1 weighing at least 7 kilograms and up to a body weight of 35 kilograms and age below 10 years hospitalised for CAP using a clinical diagnosis.Co-primary outcomes are(a) The proportion of children clinically stable at 48 hours after randomisation. (b) The proportion of children with CAP-related readmission within 28 days after randomization. Secondary outcomes will be captured to further evaluate the efficacy and safety of adjunct oral steroids in the management of childhood CAP, including proportion of children experiencing solicited side effects of the trial treatment and/or serious adverse events, time to hospital discharge after index hospitalisation in days, time away from routine child care and away from work (for parents) in days up to 28 days after randomisation and total antibiotic exposure in days up to 28 days after randomisation.ResultsEnrolment started in November 2018 and is currently proceeding at approximately 1 participant per participating hospital per week.ReferencesStudy registration: BASEC - EKNZ 2018–00563Disclosure(s)Nothing to disclose

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Impact of bacterial and viral coinfection in community-acquired pneumonia in adults

Diagnostic Microbiology and Infectious Disease ◽

10.1016/j.diagmicrobio.2018.11.014 ◽

2019 ◽

Vol 94 (1) ◽

pp. 50-54 ◽

Cited By ~ 10

Author(s):

Yong Kwan Lim ◽

Oh Joo Kweon ◽

Hye Ryoun Kim ◽

Tae-Hyoung Kim ◽

Mi-Kyung Lee

Keyword(s):

Community Acquired Pneumonia ◽

Viral Coinfection

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Limited Effect of Rehabilitation for Preventing a Decline in Functional Status after Community-Acquired Pneumonia in Elderly Patients

10.21203/rs.3.rs-36714/v1 ◽

2020 ◽

Author(s):

Hao Chen ◽

Yu Hara ◽

Nobuyuki Horita ◽

Yusuke Saigusa ◽

Yoshihiro Hirai ◽

...

Keyword(s):

Hospital Stay ◽

Functional Status ◽

Propensity Score Analysis ◽

Pneumonia Severity Index ◽

Length Of Hospital Stay ◽

Severity Index ◽

Community Acquired Pneumonia ◽

High Rate ◽

Limited Effect ◽

Factors Affecting

Abstract Background: Functional status is often decreased after hospitalization in elderly community-acquired pneumonia (CAP) survivors. This study investigated factors contributing to decreased functional status.Methods: This retrospective, observational study was conducted in two medical facilities from January 2016 to December 2018. Hospitalized CAP patients >64 years of age were divided into two groups: a maintained group, without decreased functional status, and a decreased group, with decreased functional status. Functional status was evaluated by the Barthel Index (BI) (range, 0–100, in 5-point increments) and graded into three categories: independent, BI 80–100; semi-dependent, BI 30–75; and dependent, BI 0–25. A decreased functional status was considered as a decline of at least one category. The primary outcome was the length of hospital stay. Results: The maintained group included 400 patients, and the decreased group included 138 patients (median age: 77 vs 82 years; p < 0.001). The decreased group had a longer hospital stay (13 vs 27; p<0.001), with a high rate of rehabilitation [189(47.3%) vs 104(75.4%); p<0.001]. Multivariable regression analysis showed that factors affecting functional status were length of hospital stay, aspiration, age, and pneumonia severity index (PSI) category V (odds ratio 1.05, 95%CI 1.04–1.07; 2.66, 95%CI 1.58–4.49; 1.05, 95%CI 1.02–1.09; and 1.92, 95%CI 1.29-3.44; respectively). Rehabilitation showed a limited effect in preventing a decreased functional status on propensity score analysis (p=0.327).Conclusions: Length of hospital stay, aspiration, age, and PSI V were independent contributors to decreased functional status. Rehabilitation showed a limited effect in preventing decreased functional status.

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Etiology of severe community - acquired pneumonia in adults: results of the first Russian multicenter study

Terapevticheskii arkhiv ◽

10.26442/00403660.2020.01.000491 ◽

2020 ◽

Vol 92 (1) ◽

pp. 36-42

Author(s):

I A Zakharenkov ◽

S A Rachina ◽

N N Dekhnich ◽

R S Kozlov ◽

A I Sinopalnikov ◽

...

Keyword(s):

Bacterial Pathogens ◽

Respiratory Viruses ◽

Community Acquired Pneumonia ◽

Influenza Viruses ◽

High Rate ◽

Endotracheal Aspirate ◽

Causative Agents ◽

Antigen Tests ◽

Severe Community Acquired Pneumonia ◽

Positive Results

Aim: to study the etiology of severe community - acquired pneumonia (SCAP) in adults in Russian Federation. SCAP is distinguished by high mortality and socio - economic burden. Both etiology and antimicrobial resistance are essential for appropriate antibiotic choice. Materials and methods. A prospective cohort study recruited adults with confirmed diagnosis of SCAP admitted to multi - word hospitals of six Russian cities in 2014-2018. Etiology was confirmed by routine culture of blood, respiratory (sputum, endotracheal aspirate or bronchoalveolar lavage) and when appropriate, autopsy samples, urinary antigen tests (L. pneumophila serogroup 1, S. pneumoniae); real - time PCR for identification of “atypical” bacterial pathogens (M. pneumoniae, C. pneumoniae, L. pneumophila) and respiratory viruses (influenza viruses A and B, parainfluenza, human metapneumovirus, etc.) was applied. Results. Altogether 109 patients (60.6% male; mean age 50.8±18.0 years old) with SCAP were enrolled. Etiological agent was identified in 65.1% of patients, S. pneumoniae, rhinovirus, S. aureus and K. pneumoniae were the most commonly isolated pathogens (found in 43.7, 15.5, 14.1 and 11.3% of patients with positive results of microbiological investigations, respectively). Bacteriemia was seen in 14.6% of patients and most commonly associated with S. pneumoniae. Co - infection with 2 or more causative agents was revealed in 36.6% of cases. Combination of bacterial pathogens (mainly S. pneumoniae with S. aureus or/and Enterobacterales) prevailed - 57.7% of cases; associations of bacteria and viruses were identified in 38.5% of patients, different viruses - in one case. Conclusion. S. pneumoniae was the most common pathogen in adults with SCAP. A high rate of respiratory viruses (mainly rhinovirus and influenza viruses) identification both as mixt infection with bacteria and mono - infection should be taken into account.

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Hospitalization for Community Acquired Pneumonia in Alberta First Nations Aboriginals Compared with Non-First Nations Albertans

Canadian Respiratory Journal ◽

10.1155/2004/625848 ◽

2004 ◽

Vol 11 (5) ◽

pp. 336-342 ◽

Cited By ~ 10

Author(s):

Thomas J Marrie ◽

Keumhee C Carriere ◽

Yan Jin ◽

David H Johnson

Keyword(s):

Hospital Admission ◽

First Nations ◽

Odds Ratio ◽

Discharge Rate ◽

Hospital Costs ◽

Severe Pneumonia ◽

Community Acquired Pneumonia ◽

High Rate ◽

Hospital Length Of Stay ◽

Age And Sex

BACKGROUND:The rates and outcomes of hospital admission for community-acquired pneumonia between First Nations Aboriginal and non-First Nations groups were compared.METHODS:Alberta administrative hospital abstracts from April 1, 1997, to March 31, 1999, were analyzed, and each case of a First Nations Aboriginal person with pneumonia was matched by age and sex with three non-First Nations persons with pneumonia.RESULTS:The First Nations Aboriginal age and sex-adjusted hospital discharge rate was 22 per 1000 (95% CI 20.7 to 23.6) compared with 4.4 per 1000 (95% CI 4.4 to 4.5) for the general population of Alberta. After accounting for comorbidity and severity of pneumonia, in-hospital mortality and hospital length of stay were lower for First Nations Aboriginals compared with the matched non-First Nations group (odds ratio 0.49; 95% CI 0.37 to 0.66, and odds ratio 0.87; 95% CI 0.79 to 0.97, respectively). The odds for 30-day hospital readmission were higher in First Nations Aboriginals compared with the non-First Nations group (odds ratio 1.42; 95% CI 1.21 to 1.68). The cost per hospital admission for First Nations Aboriginals was 94% of the average cost for the matched non-First Nations group (CDN$4,206). However, their median daily cost was 1.25 times higher (95% CI 1.14 to 1.36) than the matched non-First Nations group.CONCLUSIONS:First Nations Aboriginals had higher rates of hospitalization, rehospitalization and hospital costs for community-acquired pneumonia than non-First Nations Albertans. It was unlikely that the high rate of hospitalizations in First Nations Aboriginals was due to more severe pneumonia or greater comorbidity. Other unexplained factors increase the burden of this disease in First Nation Aboriginals.

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Impact of bacterial and viral coinfection on mycoplasmal pneumonia in childhood community-acquired pneumonia

Journal of Microbiology Immunology and Infection ◽

10.1016/j.jmii.2013.06.006 ◽

2015 ◽

Vol 48 (1) ◽

pp. 51-56 ◽

Cited By ~ 27

Author(s):

Chih-Yung Chiu ◽

Chih-Jung Chen ◽

Kin-Sun Wong ◽

Ming-Han Tsai ◽

Cheng-Hsun Chiu ◽

...

Keyword(s):

Community Acquired Pneumonia ◽

Mycoplasmal Pneumonia ◽

Viral Coinfection

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Community-Acquired Pneumonia Due to Virus and Mycoplasma pneumoniae Infection in Children Younger than 5 Years

Journal of Pediatric Infectious Diseases ◽

10.1055/s-0039-1683388 ◽

2019 ◽

Vol 14 (04) ◽

pp. 155-160

Author(s):

Huiming Sun ◽

Wenqing Zhu ◽

Zhengrong Chen ◽

Wei Ji ◽

Chuangli Hao ◽

...

Keyword(s):

Clinical Features ◽

Mycoplasma Pneumoniae ◽

Viral Infections ◽

Respiratory Viruses ◽

Community Acquired Pneumonia ◽

Direct Immunofluorescence ◽

Symptom Duration ◽

Viral Pathogens ◽

Duration Of Symptoms ◽

Viral Coinfection

AbstractThe purpose of this study was to determine the clinical features of viral pathogens and Mycoplasma pneumoniae in children hospitalized with community-acquired pneumonia (CAP). M. pneumoniae infection was diagnosed by both serology and polymerase chain reaction (PCR). Respiratory viruses were detected by direct immunofluorescence or PCR. Medical records of children younger than 5 years diagnosed with 5-day-old CAP were reviewed. Viral pathogens and/or M. pneumoniae were detected in 388 (15.59%) children in the following three groups: viral monoinfection (n = 321), M. pneumoniae with viral coinfection (n = 17), and M. pneumoniae monoinfection (n = 50). M. pneumoniae monoinfection was characterized by older age, fever, higher neutrophil count, and chest X-ray showing lobar consolidation. Wheezing was more common in children with viral infections. Elevated alanine aminotransferase and aspartate aminotransferase were commonly seen in children with Mycoplasma infections. The median symptom duration in children with viral coinfection was shorter than in the other two groups (both p < 0.05). M. pneumoniae and respiratory viruses are important etiologic agents for CAP in children younger than 5 years, with characteristic clinical features. M. pneumoniae and viral coinfection are associated with shorter duration of symptoms before admission.

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Management and outcome of community acquired pneumonia: hospital based study

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20182404 ◽

2018 ◽

Vol 6 (7) ◽

pp. 2271

Author(s):

Avinash Lamb ◽

Amol Harinathrao Patil

Keyword(s):

Respiratory Tract Infections ◽

Prospective Observational Study ◽

Tertiary Hospital ◽

Community Acquired Pneumonia ◽

High Rate ◽

Response To Treatment ◽

Lower Respiratory Tract Infections ◽

Gujarat State ◽

Tract Infections ◽

Complications And Mortality

Background: Lower Respiratory Tract infections are responsible for one-fifth of the deaths caused due to infectious diseases in India and Pneumonia is a major culprit. Timely and appropriate empirical treatment based on knowledge of local etiological factors is important in the management of the disease. Data related to investigation profile and therapy as well as morbidity and mortality is available from different geographic regions. Present study describes the management and outcome of disease data from a tertiary hospital at Rajkot in Gujarat state during the study period.Methods: The present prospective observational study was completed in the study duration (November 2014 to April 2016) at tuberculosis and chest diseases Department of PDU Hospital at Rajkot, Gujarat. 50 patients above 12 years of age with CAP on clinical diagnosis assisted by radiology were included in the study. The haematology profile, therapy, complications and mortality were described.Results: Haemoglobin was below 10gm percent in 22% cases. Leucocytosis was observed in 72% cases. Ten percent patients were seropositive for HIV. There was a moderate response to treatment with penicillin group of drugs (approximately 22%). Many patients had to be offered other group of drugs like Cephalosporins, macrolides and quinolones for clinical response. Most common complications observed were: Delayed resolution in 12 (24%) patients, synpneumonic effusion in 6 (12%) and septicaemia in 3 (6%) patients. Mortality rate was 6% during the study period.Conclusions: The results indicate a low response to treatment by penicillin group antibiotics and a high rate of complications. Mortality is similar to reports from India.

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Legionellosis Caused by Non-Legionella pneumophila Species, with a Focus on Legionella longbeachae

Microorganisms ◽

10.3390/microorganisms9020291 ◽

2021 ◽

Vol 9 (2) ◽

pp. 291

Author(s):

Stephen T. Chambers ◽

Sandy Slow ◽

Amy Scott-Thomas ◽

David R. Murdoch

Keyword(s):

New Zealand ◽

Legionella Pneumophila ◽

Community Acquired Pneumonia ◽

High Rate ◽

Surveillance Systems ◽

Secretion Systems ◽

Public Health Response ◽

Cell Functions ◽

Worldwide Distribution ◽

Legionella Species

Although known as causes of community-acquired pneumonia and Pontiac fever, the global burden of infection caused by Legionella species other than Legionella pneumophila is under-recognised. Non-L. pneumophila legionellae have a worldwide distribution, although common testing strategies for legionellosis favour detection of L. pneumophila over other Legionella species, leading to an inherent diagnostic bias and under-detection of cases. When systematically tested for in Australia and New Zealand, L. longbeachae was shown to be a leading cause of community-acquired pneumonia. Exposure to potting soils and compost is a particular risk for infection from L. longbeachae, and L. longbeachae may be better adapted to soil and composting plant material than other Legionella species. It is possible that the high rate of L. longbeachae reported in Australia and New Zealand is related to the composition of commercial potting soils which, unlike European products, contain pine bark and sawdust. Genetic studies have demonstrated that the Legionella genomes are highly plastic, with areas of the chromosome showing high levels of recombination as well as horizontal gene transfer both within and between species via plasmids. This, combined with various secretion systems and extensive effector repertoires that enable the bacterium to hijack host cell functions and resources, is instrumental in shaping its pathogenesis, survival and growth. Prevention of legionellosis is hampered by surveillance systems that are compromised by ascertainment bias, which limits commitment to an effective public health response. Current prevention strategies in Australia and New Zealand are directed at individual gardeners who use potting soils and compost. This consists of advice to avoid aerosols generated by the use of potting soils and use masks and gloves, but there is little evidence that this is effective. There is a need to better understand the epidemiology of L. longbeachae and other Legionella species in order to develop effective treatment and preventative strategies globally.

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