Etiology of community-acquired pneumonia in hospitalized children based on WHO clinical guidelines
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Community-acquired pneumonia (CAP) is a major cause of death in developing countries and of morbidity in developed countries. The objective of the study was to define the causative agents among children hospitalized for CAP defined by WHO guidelines and to correlate etiology with clinical severity and surrogate markers. Investigations included an extensive etiological workup. A potential causative agent was detected in 86% of the 99 enrolled patients, with evidence of bacterial (53%), viral (67%), and mixed (33%) infections. Streptococcus pneumoniae was accounted for in 46% of CAP. Dehydration was the only clinical sign associated with bacterial pneumonia. CRP and PCT were significantly higher in bacterial infections. Increasing the number of diagnostic tests identifies potential causes of CAP in up to 86% of children, indicating a high prevalence of viruses and frequent co-infections. The high proportion of pneumococcal infections re-emphasizes the importance of pneumococcal immunization.
KeywordsCommunity-acquired pneumonia Child WHO guidelines Pneumococcal infection Antibiotic Immunization
World Health Organization
British Thoracic Society
White blood cell
Upper respiratory symptoms
This study was supported in part by GlaxoSmithKline. We thank Dr. B. Vaudaux, infectious disease pediatrician at the University Hospital of Lausanne, for his advices. We are grateful to Mrs. J. Bersier and her laboratory staff, to Dr. Wunderli and his collaborators for the viral serology test, to Dr. K. Jaton and her collaborators for the M. pneumoniae and C. pneumoniae PCR tests, to S. Grillet for the pneumococcal serology analyses, to Prof. J. Schrenzel for pneumococcal PCR, and to Sabine Nobs-Grunenwald for viral PCR analysis.
Conflicts of interest
All the authors certify that they have no financial relationship with the organization that partly sponsored the research and no conflicts of interest.
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