COMMUNITY ACQUIRED PNEUMONIA IN CHILDREN

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Faten Tinsa
Khadija Boussetta
Ahmed Gharbi
Dorra Bousnina
Rim Abdelaziz
Ines Brini
Souad Bousnina

Abstract

Background: Community acquired pneumonia is responsible for a high morbidity in children. The etiological diagnosis is not always easy and treatment remains probabilistic.
Aim: To analysis clinical patterns and the outcome of community acquired pneumonia and to find arguments in favour of its origin.
Methods:Aprospective analysis of the files of 39 children ( 20 boys, 19 girls) hospitalized between (1december 2004 – 30 june 2005) for community acquired pneumonia was performed. Included dchildren whad between 6 months ad 15 years-old.
Results:
The mean age was of 3 years and three months. Germ was identified in 41% of cases: Mycoplasma pneumoniae was the most important germ found in 9 cases, pneumococcus was found in 4 cases and hemophilus in four cases. Coinfection pneumococcus and mycoplasma were found in two cases. None virus was identified. We have separated two groups: bacterial pneumonia and pneumoniae without definite etiology. Fat cough was associated to bacterial
pneumonia. mycoplama pneumoniae was significantly associated with high fever and dry cough. We haven’t found any others associations between clinical, biological or radiological patterns and the two groups of pneumonia. C-reactive protein more than 66 mg/l has sensitivity of 77 %, specificity of 73.3 %, positive predictive value of 46.7 % of and negative predictive value of 91.7%. The outcome was favourable in all cases.
Conclusion: Theses results showed the necessity to improve our microbiological methods to identify infectious agents of pneumonia. Mycoplasma pneumonia seems to be a frequent germ in preschool children.

Keywords:

Acquired pneumonia, Child, Germ

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References

  1. Snaniotis CA. Viral pneumonia in children: incidence and aetiology. Pediatr Respi Rev 2004;5: s197-s200.
  2. Bryce J, Boschi-Pinto C, Shibuya K, Black RE. WHO Child Health Epidemiology Reference Group. WHO estimates of the causes of death in children. Lancet 2005;365:1147-52.
  3. Williams B, Gows E, Boschi-Pinto C, et al. Estimtes of worldwie distribution of child deaths from acute respiratory infections. Lancet Infect Dis 2002;2:25-32
  4. Coste N, Kenzie MC. Diagnostic and investigation of bacterial pneumonias. Pediatr Respi Rev 2000 ;1 : 8-13.
  5. Marchac V. Différence de diagnostic des infections bronchopulmonaires virales ou bactériennes chez l'enfant. Arch Pediatr 2007;14: 202-6.
  6. Palafox M, Guiscafio H, Reyes H, et al. Diagnostic value of tachypnoea in pneumonia defined radiologically. Arch Dis Child 2000;82: 41-5.
  7. Margols P, Kenzie MC. Does this infact have pneumoniae. JAMA 1998;279:308-13.
  8. Lakhanpul M, Atkinson M, Stephenson T. Community-acquired pneumonia in children: a clinical update. Arch Dis Child Educ Pract Ed 2004;89: 29-34.
  9. British Thoracic Society. Guidelines for the management of community-acquired pneumoniae in childhood. Thorax 2002; 57:11-24.
  10. Mc Intosh K. Community acquired pneumonia in Western Sydney. Epidemiol. Infect 2002;346: 430-7.
  11. Korppi M, Katila ML, Jaaskelainen J, Leinonen M. Role of Moraxella (Branhammella) catarrhalis as a respiratory pathogen in children. Acta Paediatr 1992 ;81 : 993-6.
  12. Marguet C, Borquel N, Mallet E. Epidemiologie des pneumopathies communitaires de l'enfant. Données actuelles. Arch Pediatr 1998;5: S9-13.
  13. Michelow IC, Olsen K, Lozano J, et al. Epidemiology and clinical characteristics of community-acquired pneumoniae in hospitalized children. Pediatrics 2004;113:701-7.
  14. Burgner D, Richmond P. Mini symposium: The burden of pneumonia. The burden of pneumoniae in children an Australian perspective. Paediatr Resp Rev 2005;6:94-100.
  15. Bachur R, Perry H, Harper MB. Occult pneumoniae : ampiric chest radiographs in febrile children with leukocytosis. Ann Emerg Med 1999;33:166-73
  16. Kroppi M, Heiskanen-Kosma, Leinonen M. White blood cells, Creactive protein and erythrocyte sedimentation rate in pneumococcal pneumonia in children. Eur Resp J 1997;10:1125-9
  17. Block S, Hedrick J, Harnmerschlag MR, Cassel GH, Craft JC. Mycoplasma pneumoniae and chlamydia pneumoniae in pediatric community-acquired pneumonia: comparative efficacy and safety of clarithomycin versus erythromycin ethysuccinate. Pediatr Infect Dis J 1995; 14: 471-7.
  18. Claesson BA, Trollfors B, Bralin I, et al. Etiology of communityacquired pneumonia in children based on antibody responses to bacterial and viral antigens. Pediatr Infect Dis J 1989; 8: 856-62.
  19. Gendrel D, Raymond J, Moulin F, et al. Etiology and response to antibiotic therapy of community-acquired pneumonia in french children. Eur J Clin Microbiol Infect Dis 1997;16: 388-91.
  20. Juven T, Mertsola J, Waris ME, et al. Etiology of communityacquied pneumonia in 254 hospitalized children. Pediatr Infect Dis J 2000;19:293-8.
  21. Nacul LC, Kirkwood BR, Cameiro AC, Pannuti CS, Magalhaes M, Arthur P. Aetiology and clinical presentation of pneumoniae in hospitalised and out patient children in northeast Brazil and risk factors for severity. J Health Popul North 2005; 23: 6-15.
  22. Gendrel D. Procalcitonine aux urgencies pédiatriques. Arch Pediatr 2004;11:582-4.
  23. Hale CB. Respiratory syncytial virus ? N Engl J Med 2001;344:1917-28.
  24. Isaacs D. Problems in determining the etiology of communityacquired pneumonia. Pediatr Infect Dis J 1989;8:143-8.
  25. Jokinen C, Heiskanen L, Juvonen H. Incidence of community acquired pneumonia in the population of four municipalities in Eastern Finland. Am J Epidemiol 1993;137: 977-88.
  26. Korppi M, Heiskanen-Kosma T, Jalonen M, et al. Aetiology of community-acquired pneumonia in children treated in hospital. Eur J Pediatr 1993;152:24-30.
  27. Nohynek H, E Skola J, Laine E, et al. The cause of hospital treated lower respiratory tract infection in children. Am J Dis Child 1991;145: 618-22.
  28. Wubbel L, Muniz L, Ahmed A, et al. Etiology and treatment of community-acquired pneumonia in ambulatory children. Pediatr Infect Dis J1999;18: 98-104.
  29. Mc Cracken GH. Diagnosis and management of pneumonia in children. Pediatr Infect Dis J 2000;19: 948-8
  30. Tsolla MN, Psanas S, Besies A, Audi M, et al. Etiology of community-acquired pneumoniae in hospitalized school-age children. Evidence for high prevalence of viral infections. Clin Infect Dis 2004; 39: 681-6.
  31. Turner RB, Lande A, En Chase P, Hilton S, Weinberg D. Pneumonia in pediatric outpatient: cause and clinical manifestations. J Pediatr 1987; 111 :194-200
  32. AFSSAPS (Agence Française de Sécurité Sanitaires des Produits de Santé). Antibiothérapie par voie générale en pratique courante dans les infections respiratoires basses de l'adulte et de l'enfant. Argumentaire. Med Mal Infect. 2005;35: 635-94.
  33. Principal N, Esposito S. Emerging role of mycoplasma pneumoniae and chlamydia pneumoniae in paeditric respiratory tract infection. Lancet Infect Dis 2001;1: 334-44.