Etiology and the challenge of diagnostic testing of community-acquired pneumonia in children and adolescents

Zulma Vanessa Rueda, Yudy Aguilar, María Angélica Maya, Lucelly López, Andrea Restrepo, Carlos Garcés, Olga Morales, Claudia Roya-Pabón, Mónica Trujillo, Catalina Arango, Ángela Rocio Copete, Cristian Vera, Margarita Rosa Giraldo, Mariana Herrera, Lázaro A. Vélez

    Research output: Contribution to journalArticlepeer-review

    Abstract

    Background: Pneumonia is the leading cause of mortality in pediatric population. The etiology of pneumonia in this population is variable and changes according to age and disease severity and where the study is conducted. Our aim was to determine the etiology of community-acquired pneumonia (CAP) in children aged 1 month to 17 years admitted to 13 Colombian hospitals. Methods: Prospective cohort study. Hospitalized children with radiologically confirmed CAP and ≤ 15 days of symptoms were included and followed together with a control group. Induced sputum (IS) was submitted for stains and cultures for pyogenic bacteria and Mycobacterium tuberculosis, and multiplex PCR (mPCR) for bacteria and viruses; urinary antigens for pneumococcus and Legionella pneumophila; nasopharyngeal swabs for viruses, and paired serology for atypical bacteria and viruses. Additional cultures were taken at the discretion of primary care pediatricians. Results: Among 525 children with CAP, 71.6% had non-severe pneumonia; 24.8% severe and 3.6% very severe pneumonia, and no fatal cases. At least one microorganism was identified in 84% of children and 61% were of mixed etiology; 72% had at least one respiratory virus, 28% pyogenic bacteria and 21% atypical bacteria. Respiratory syncytial virus, Parainfluenza, Rhinovirus, Influenza, Mycoplasma pneumoniae, Adenovirus and Streptococcus pneumoniae were the most common etiologies of CAP. Respiratory syncytial virus was more frequent in children under 2 years and in severe pneumonia. Tuberculosis was diagnosed in 2.3% of children. IS was the most useful specimen to identify the etiology (33.6%), and blood cultures were positive in 3.6%. The concordance between all available diagnostic tests was low. A high percentage of healthy children were colonized by S. pneumoniae and Haemophilus influenzae, or were infected by Parainfluenza, Rhinovirus, Influenza and Adenovirus. Conclusions: Respiratory viruses are the most frequent etiology of CAP in children and adolescents, in particular in those under 5 years. This study shows the challenges in making an etiologic diagnosis of CAP in pediatric population because of the poor concordance between tests and the high percentage of multiple microorganisms in healthy children. IS is useful for CAP diagnosis in pediatric population.

    Original languageEnglish
    Article number169
    JournalBMC Pediatrics
    Volume22
    Issue number1
    DOIs
    StatePublished - Dec 2022

    Bibliographical note

    Funding Information:
    We want to thank to Drs. Ana Mar?a Hern?ndez, Antonio Mac?as, Marcela Berm?dez, Dimas Berm?dez and Santiago Giraldo for their hard working to recruit and follow-up all children participating in the study. Thanks to Luisa Fernanda Carmona, Mar?a Cecilia Oquendo, Dr. Carlos Muskus, Diego Bastidas, Enith Knuth, Dr. Angela Cardona, Dr. Alejandro D?az, Dr. Marta Morales, Dr. Marta Valencia, Dr. Juan Gonzalo Mesa, Isabel Cristina Vallejo. Thanks to Lina Ruiz, Lizeth Urrea, Sara Mej?a, Sebastian Osorio. In addition, thanks to all participating institutions for their support with the study. To all children and their families to agree participate in the study. Finally, to all hospitals that approved the execution of this research: E.S.E. Metrosalud Unidad Hospitalaria San Javier, Cl?nica Infantil Santa Ana, Cl?nica Sagrado Coraz?n, Cl?nica Le?n XIII, Hospital Universitario San Vicente Fundaci?n, Hospital General de Medell?n, Hospital Pablo Tob?n Uribe, Cl?nica Las Am?ricas, Hospital San Rafael de Itag??, Cl?nica CES, Hospital Marco Fidel Su?rez, Cl?nica SOMA and Hospital Manuel Uribe ?ngel.

    Funding Information:
    Colombian Administrative Department of Science, Technology and Innovation – Colciencias, Grant number: 111551929199, and Universidad de Antioquia. This research was also supported, in part, by Canada Research Chairs Program for Z.V.R. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

    Publisher Copyright:
    © 2022, The Author(s).

    Keywords

    • Children
    • Diagnosis
    • Etiology
    • Induced sputum
    • Multiplex PCR
    • Nasopharyngeal swab
    • Pneumonia
    • Serology
    • Urine antigen

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