scholarly journals Community-Acquired Pneumonia in Children-An Update

2018 ◽  
Vol 42 (1) ◽  
pp. 38-42
Author(s):  
Md Kamruzzaman ◽  
Mirza Md Ziaul Islam ◽  
Probir Kumar Sarkar
Keyword(s):  
Antimicrobial Resistance ◽  
Signs And Symptoms ◽  
Community Acquired Pneumonia ◽  
Oral Antibiotics ◽  
Older Children ◽  
Streptococcus Pneumonia ◽  
Serious Infection ◽  
Severe Infections ◽  
Viral Testing ◽  
Respiratory Signs And Symptoms

Community-acquired pneumonia (CAP) is a potentially serious infection in children and often results in hospitalization.CAP symptoms are nonspecific in younger infants, but cough and tachypnea are usually present in older children. The diagnosis can be based on the history and physical examination results in children with fever plus respiratory signs and symptoms. Chest radiography and rapid viral testing may be helpful when the diagnosis is unclear. The most likely etiology depends on the age of the child. Viral and Streptococcus pneumonia infections are most common in preschoolaged children, whereas Mycoplasmapneumoniaeis common in older children.Most children can be managed empirically with oral antibiotics as outpatients without specific laboratory investigations.The decision to treat with antibiotics is challenging, especially with the increasing prevalence of viral and bacterial coinfections. Those with severe infections or with persistent or worsening symptoms need more intensive investigations and may need admission to hospital. The choice and dosage of antibiotics should be based on the age of the patient, severity of the pneumonia and knowledge of local antimicrobial resistance patterns.Bangladesh J Child Health 2018; VOL 42 (1) :38-42

scholarly journals Lung ultrasound in the diagnosis of pneumonia in children: proposal for a new diagnostic algorithm

PeerJ ◽  
2015 ◽  
Vol 3 ◽  
pp. e1374 ◽  
Author(s):  
Giulio Iorio ◽  
Maria Capasso ◽  
Giuseppe De Luca ◽  
Salvatore Prisco ◽  
Carlo Mancusi ◽  
...  
Keyword(s):  
Likelihood Ratio ◽  
Medical Records ◽  
Positive Likelihood Ratio ◽  
Negative Likelihood Ratio ◽  
Diagnostic Algorithm ◽  
Signs And Symptoms ◽  
Community Acquired Pneumonia ◽  
Radiographic Findings ◽  
Alternative Test ◽  
Respiratory Signs And Symptoms

Background.Despite guideline recommendations, chest radiography (CR) for the diagnosis of community-acquired pneumonia (CAP) in children is commonly used also in mild and/or uncomplicated cases. The aim of this study is to assess the reliability of lung ultrasonography (LUS) as an alternative test in these cases and suggest a new diagnostic algorithm.Methods.We reviewed the medical records of all patients admitted to the pediatric ward from February 1, 2013 to December 31, 2014 with respiratory signs and symptoms. We selected only cases with mild/uncomplicated clinical course and in which CR and LUS were performed within 24 h of each other. The LUS was not part of the required exams recorded in medical records but performed independently. The discharge diagnosis, made only on the basis of history and physical examination, laboratory and instrumental tests, including CR (without LUS), was used as a reference test to compare CR and LUS findings.Results.Of 52 selected medical records CAP diagnosis was confirmed in 29 (55.7%). CR was positive in 25 cases, whereas LUS detected pneumonia in 28 cases. Four patients with negative CR were positive in ultrasound findings. Instead, one patient with negative LUS was positive in radiographic findings. The LUS sensitivity was 96.5% (95% CI [82.2%–99.9%]), specificity of 95.6% (95% CI [78.0%–99.9%]), positive likelihood ratio of 22.2 (95% CI [3.2–151.2]), and negative likelihood ratio of 0.04 (95% CI [0.01–0.25]) for diagnosing pneumonia.Conclusion.LUS can be considered as a valid alternative diagnostic tool of CAP in children and its use must be promoted as a first approach in accordance with our new diagnostic algorithm.

scholarly journals Community-Acquired Pneumonia Requiring Hospitalization among French Guianese Children

2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Alexandre Cannesson ◽  
Narcisse Elenga
Keyword(s):  
Haemophilus Influenzae ◽  
French Guiana ◽  
Whooping Cough ◽  
Signs And Symptoms ◽  
Community Acquired Pneumonia ◽  
Vaccine Preventable Diseases ◽  
Syncytial Virus ◽  
Respiratory Signs And Symptoms ◽  
Epidemiological Characteristics ◽  
The Impact

Community-acquired pneumonia remains a leading cause of hospitalizations among children worldwide. The diagnosis is based on the history, the physical examination results in children with fever plus respiratory signs and symptoms, and chest radiography. The microbiological etiology is confirmed by viral testing and hemocultures. The most likely etiology depends on the age of the child. The features of childhood pneumonia vary between countries and territories. The purpose of this study was to describe the epidemiological characteristics and current microbial ecology of community-acquired pneumonia in children in French Guiana. We performed a retrospective, descriptive, and monocentric study between January 1, 2015, and December 31, 2017, in the pediatric ward of the Cayenne Hospital in French Guiana. The studied population was aged from 0 to 15 years and 3 months and hospitalized for acute community-acquired pneumonia. A total of 415 patients (mean age 3.62 years) were included. A pathogen was identifiable in 22.4% of cases, including bacteria in 61.3%, viruses in 43%, and coinfections in 14%. The main pathogens were respiratory syncytial virus (31.2%), Streptococcus pneumoniae (20.4%), Haemophilus influenzae (11.8%), and Mycoplasma pneumoniae (10.8%). The burden of hospitalization for children with community-acquired pneumonia was highest among less than 2 years, in whom respiratory viruses were the most commonly detected causes of pneumonia. The share of vaccine-preventable diseases (S. pneumoniae, H. influenzae, and influenza) remains high. With the vaccination requirement imposed since 1 January 2018 against pneumococcus, Haemophilus influenzae, and whooping cough and the possibility of practicing multiplex PCR in our hospital, it will be interesting to study the impact of this law enforcement on new child generations and compare these new data to our study.

Bacterial aetiology and antimicrobial resistance of community-acquired pneumonia in the elderly and younger adults

2010 ◽  
Vol 40 (2) ◽  
pp. 89-91 ◽  
Author(s):  
Seyyed Hamid Hashemi ◽  
Golnoosh Soozanchi ◽  
Shirin Jamal-Omidi ◽  
Rasoul Yousefi-Mashouf ◽  
Mojgan Mamani ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
General Trend ◽  
The Elderly ◽  
Community Acquired Pneumonia ◽  
Resistance Pattern ◽  
Age Group ◽  
Younger Adults ◽  
Streptococcus Pneumonia ◽  
Bacterial Aetiology ◽  
And Staphylococcus Aureus

This study was undertaken in order to compare the frequency of bacterial agents of community-acquired pneumonia (CAP) and their antimicrobial resistance in the elderly and younger adults admitted to a teaching hospital in Hamedan, Iran. A total of 150 cases of CAP, including 81 elderly and 69 younger adults, were evaluated. The most frequently identified pathogens in younger adults were Moraxella catarralis (11.5%), Streptococcus pneumonia (10.1%) and Staphylococcus aureus (10.1%); while in the elderly the most frequent were S. pneumonia (12.3%), S. aureus (6.1%) and Pseudomonas aeruginosa (6.1%). No significant differences were observed between the frequency and antimicrobial resistance pattern of isolated pathogens in either age group. We concluded that the cause of CAP in the elderly follows the general trend of infection in the younger population. Increased resistance of isolated bacteria to the current antibiotics highlights the need for further investigation of newer antibiotics for the treatment of CAP.

scholarly journals Severity of respiratory signs and symptoms and virus profiles in Japanese children with acute respiratory illness

2013 ◽  
Vol 57 (12) ◽  
pp. 811-821 ◽  
Author(s):  
Yumiko Miyaji ◽  
Miho Kobayashi ◽  
Kazuko Sugai ◽  
Hiroyuki Tsukagoshi ◽  
Shoichi Niwa ◽  
...  
Keyword(s):  
Signs And Symptoms ◽  
Respiratory Illness ◽  
Acute Respiratory Illness ◽  
Japanese Children ◽  
Respiratory Signs And Symptoms

Respiratory viral testing and antibacterial treatment in patients hospitalized with community-acquired pneumonia

2020 ◽  
pp. 1-9
Author(s):  
Michael Klompas ◽  
Peter B. Imrey ◽  
Pei-Chun Yu ◽  
Chanu Rhee ◽  
Abhishek Deshpande ◽  
...  
Keyword(s):  
Retrospective Cohort ◽  
Respiratory Virus ◽  
Respiratory Viruses ◽  
Community Acquired Pneumonia ◽  
Blood Cultures ◽  
Antibacterial Treatment ◽  
Viral Pathogens ◽  
Antimicrobial Utilization ◽  
Viral Testing ◽  
Virus Testing

Abstract Objective: Viruses are more common than bacteria in patients hospitalized with community-acquired pneumonia. Little is known, however, about the frequency of respiratory viral testing and its associations with antimicrobial utilization. Design: Retrospective cohort study. Setting: The study included 179 US hospitals. Patients: Adults admitted with pneumonia between July 2010 and June 2015. Methods: We assessed the frequency of respiratory virus testing and compared antimicrobial utilization, mortality, length of stay, and costs between tested versus untested patients, and between virus-positive versus virus-negative patients. Results: Among 166,273 patients with pneumonia on admission, 40,787 patients (24.5%) were tested for respiratory viruses, 94.8% were tested for influenza, and 20.7% were tested for other viruses. Viral assays were positive in 5,133 of 40,787 tested patients (12.6%), typically for influenza and rhinovirus. Tested patients were younger and had fewer comorbidities than untested patients, but patients with positive viral assays were older and had more comorbidities than those with negative assays. Blood cultures were positive for bacterial pathogens in 2.7% of patients with positive viral assays versus 5.3% of patients with negative viral tests (P < .001). Antibacterial courses were shorter for virus-positive versus -negative patients overall (mean 5.5 vs 6.4 days; P < .001) but varied by bacterial testing: 8.1 versus 8.0 days (P = .60) if bacterial tests were positive; 5.3 versus 6.1 days (P < .001) if bacterial tests were negative; and 3.3 versus 5.2 days (P < .001) if bacterial tests were not obtained (interaction P < .001). Conclusions: A minority of patients hospitalized with pneumonia were tested for respiratory viruses; only a fraction of potential viral pathogens were assayed; and patients with positive viral tests often received long antibacterial courses.

Recognition and management of neonatal sepsis

2021 ◽  
Vol 30 (7) ◽  
pp. 410-415
Author(s):  
Luke William Crocker ◽  
Ayesha White ◽  
Paul Anthony Heaton ◽  
Débora Pascoal Horta ◽  
Siba Prosad Paul
Keyword(s):  
Neonatal Sepsis ◽  
Early Recognition ◽  
Signs And Symptoms ◽  
Evidence Based ◽  
Suspected Sepsis ◽  
Serious Illness ◽  
Prompt Treatment ◽  
Serious Infection ◽  
Common Causes ◽  
Red Flag

Neonatal sepsis results from acute bacterial or viral infection occurring in the first 28 days of life. It causes significant morbidity and mortality, although the outcome can be improved by early recognition and prompt treatment by health professionals. This article describes the most common causes of sepsis, and explains why neonates are particularly vulnerable to infection. It highlights the non-specific way in which an infant with a serious infection may present, indicating the crucial features to elicit during history taking and examination, and emphasising the ‘red-flag’ signs and symptoms that should increase suspicion of a serious illness. The authors have adapted National Institute for Health and Care Excellence guidelines to produce an evidence-based approach to the management of an infant with suspected sepsis, and describe the roles of nurses in ensuring effective treatment and best outcomes for these babies.

Cross-sectional associations between ambient air pollution and respiratory signs and symptoms among young children in Tehran

2020 ◽  
Vol 223 ◽  
pp. 117268 ◽  
Author(s):  
Zahra Namvar ◽  
Masud Yunesian ◽  
Mansour Shamsipour ◽  
Mohammad Sadegh Hassanvand ◽  
Kazem Naddafi ◽  
...  
Keyword(s):  
Air Pollution ◽  
Young Children ◽  
Signs And Symptoms ◽  
Ambient Air ◽  
Ambient Air Pollution ◽  
Cross Sectional ◽  
Respiratory Signs And Symptoms

Healthcare associated pneumonia: An old concept at a hospital with high prevalence of antimicrobial resistance

MedPharmRes ◽  
2021 ◽  
Vol 5 (2) ◽  
pp. 17-21
Author(s):  
Lam Nguyen-Ho ◽  
Duong Hoang-Thai ◽  
Vu Le-Thuong ◽  
Ngoc Tran-Van
Keyword(s):  
Risk Factor ◽  
Antimicrobial Resistance ◽  
Multidrug Resistant ◽  
Community Acquired Pneumonia ◽  
Resistant Organism ◽  
Healthcare Associated Infection ◽  
Female Ratio ◽  
High Prevalence ◽  
Need To Evaluate ◽  
Healthcare Associated

Background: One of several reasons that the concept of healthcare-associated pneumonia (HCAP) was dismissed was the same presence of multidrug resistant organism (MDRO) between community-acquired pneumonia and HCAP at countries with the low prevalence of antimicrobial resistance (AMR). However, this finding could be unsuitable for countries with the high rates of AMR. Methods: A prospective observational study was conducted at the respiratory department of Cho Ray hospital from September 2015 to April 2016. All adult patients suitable for community acquired pneumonia (CAP) with risk factor for healthcare-associated infection were included. Results: We found out 130 subjects. The median age was 71 years (interquartile range 57-81). The male/female ratio was 1.55:1. Prior hospitalization was the most common risk factor for healthcare-associated infection. There were 35 cases (26.9%) with culture-positive (sputum and/or bronchial lavage). Isolated bacteria included Pseudomonas aeruginosa (9 cases), Klebsiella pneumoniae (9 cases), Escherichia coli (4 cases), Acinetobacter baumannii (6 cases), and Staphylococcus aureus (7 cases) with the characteristic of AMR similar to the bacterial spectrum associated with hospital-acquired pneumonia. Conclusion: MDROs were detected frequently in CAP patients with risk factor for healthcare-associated infection at the hospital with the high prevalence of AMR. This requires the urgent need to evaluate risk factors for MDRO infection in community-onset pneumonia when the concept of HCAP is no longer used.

scholarly journals Diagnosis and treatment of community-acquired pneumonia in patients with acute cough: a quantitative study of decision thresholds in primary care

2018 ◽  
Vol 68 (676) ◽  
pp. e765-e774 ◽  
Author(s):  
Mark H Ebell ◽  
Isabella Locatelli ◽  
Yolanda Mueller ◽  
Nicolas Senn ◽  
Kathryn Morgan
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Signs And Symptoms ◽  
Clinical Decision ◽  
Community Acquired Pneumonia ◽  
Multivariate Model ◽  
Clinical Decisions ◽  
Acute Cough ◽  
Treatment Thresholds ◽  
Rule Out

BackgroundTest and treatment thresholds have not yet been described for decision-making regarding the likelihood of pneumonia in patients with acute cough.AimTo determine decision thresholds in the management of patients with acute cough.Design and settingSet among primary care physicians attending meetings in the US and Switzerland, using data from a prospective cohort of primary care patients.MethodClinical vignettes were used to study the clinical decisions of physicians regarding eight patients with cough that varied by six signs and symptoms. The probability of community-acquired pneumonia (CAP) was determined for each vignette based on a multivariate model. A previously published approach based on logistic regression was used to determine test and treatment thresholds.ResultsIn total, 256 physicians made 764 clinical decisions. Initial physician estimates systematically overestimated the likelihood of CAP; 75% estimating a higher probability than that predicted by the multivariate model. Given the probability of CAP from a multivariate model, 16.7% (125 of 749) changed their decision from ‘treat’ to ‘test’ or ‘test’ to ‘rule out’, whereas only 3.5% (26/749) changed their decision from ‘rule out’ to ‘test’ or ‘test’ to ‘treat’. Test and treatment thresholds were 9.5% (95% confidence interval (CI) = 8.7 to 10.5) and 43.1% (95% CI = 40.1 to 46.4) and were updated to 12.7% (95% CI = 11.7 to 13.8) and 51.3% (95% CI = 48.3 to 54.9) once the true probability of CAP was given. Test thresholds were consistent between subgroups. Treatment thresholds were higher if radiography was available, for Swiss physicians, and for non-primary care physicians.ConclusionTest and treatment thresholds for CAP in patients with acute cough were 9.5% and 43.1%, respectively. Physicians tended to overestimate the likelihood of CAP, and providing information from a clinical decision rule (CDR) changed about 1 in 6 clinical decisions.

scholarly journals Foreign Body Aspiration in Infants and Older Children: A Comparative Study

2019 ◽  
Vol 99 (1) ◽  
pp. 47-51 ◽  
Author(s):  
Shorook Na’ara ◽  
Igor Vainer ◽  
Moran Amit ◽  
Arie Gordin
Keyword(s):  
Foreign Body ◽  
Medical Center ◽  
Age Groups ◽  
Signs And Symptoms ◽  
Foreign Body Aspiration ◽  
Preschool Age ◽  
Small Airways ◽  
Older Children ◽  
X Ray ◽  
Young Infants

Background: Foreign body aspiration (FBA) is a major cause of morbidity and mortality in children. It is a preventable event that predominates in preschool age. The signs and symptoms mimic respiratory diseases common in the same age-group. We compared FBA in infants to FBA in older children. Methods: Retrospective analysis of all the cases of suspected FBA of children under the age of 18 years hospitalized at one medical center during 2002 to 2016. We analyzed the data according to age: up to 1 year (infants) and 1 to 18 years. Results: One hundred seventy-five children with suspected FBA were admitted; of whom, 27 (15%) were infants and 148 (85%) were older children (age 1-18 years). For the 2 age groups, adults witnessed 85% and 73%, respectively, of the incidents ( P = .4). In the neonate group, 48% presented with normal X-ray findings compared to only 20% in the older group; 15% of the older group had a positive chest X-ray for a foreign body, while none had such in the infants’ group ( P = .01). For the 2 age groups, the majority of the FBs found were from organic origin. About half of the patients were diagnosed and managed within 24 hours of the aspiration event. In 10%, repeated bronchoscopy was performed due to a retained FB remnant. In a multivariate analysis, signs and symptoms ( P < .05), location of the FB ( P < .001), and witnessed aspiration ( P < .001) were independent prognostic factors for the length of hospitalization. Conclusion: Foreign body aspiration is not uncommon in young infants; the management is challenging due to small airways, the need to use smaller bronchoscopes, and the lack of working channel forces in pediatric bronchoscopes.

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