Dafne C Andrade1, Igor C Borges2, Ana Luísa Vilas-Boas2, Maria S H Fontoura3, César A Araújo-Neto4, Sandra C Andrade5, Rosa V Brim4, Andreas Meinke6, Aldina Barral7, Olli Ruuskanen8, Helena Käyhty9, Cristiana M Nascimento-Carvalho10. 1. Universidade Federal da Bahia (UFBA), Faculdade de Medicina, Programa de Pós-Graduação em Ciências da Saúde, Salvador, BA, Brazil. Electronic address: andradedafne@yahoo.com.br. 2. Universidade Federal da Bahia (UFBA), Faculdade de Medicina, Programa de Pós-Graduação em Ciências da Saúde, Salvador, BA, Brazil. 3. Universidade Federal da Bahia (UFBA), Faculdade de Medicina, Departamento de Pediatria, Salvador, BA, Brazil. 4. Universidade Federal da Bahia (UFBA), Faculdade de Medicina, Departamento de Medicina Interna e Apoio Diagnóstico, Salvador, BA, Brazil. 5. Universidade Federal da Bahia (UFBA), Complexo Hospitalar Professor Edgard Santos (HUPES), Salvador, BA, Brazil. 6. Valneva Austria GmbH, Campus Vienna Biocenter 3, Vienna, Austria. 7. Universidade Federal da Bahia (UFBA), Faculdade de Medicina, Departamento de Patologia, Salvador, BA, Brazil; Centro de Pesquisa Gonçalo Moniz, Fundação Oswaldo Cruz (FIOCRUZ), Salvador, BA, Brazil. 8. Turku University and University Hospital, Department of Pediatrics, Turku, Finland. 9. National Institute for Health and Welfare, Helsinki, Finland. 10. Universidade Federal da Bahia (UFBA), Faculdade de Medicina, Programa de Pós-Graduação em Ciências da Saúde, Salvador, BA, Brazil; Universidade Federal da Bahia (UFBA), Faculdade de Medicina, Departamento de Pediatria, Salvador, BA, Brazil.
Abstract
OBJECTIVE: Community-acquired pneumonia is an important cause of morbidity in childhood, but the detection of its causative agent remains a diagnostic challenge. The authors aimed to evaluate the role of the chest radiograph to identify cases of community-aquired pneumonia caused by typical bacteria. METHODS: The frequency of infection by Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis was compared in non-hospitalized children with clinical diagnosis of community acquired pneumonia aged 2-59 months with or without radiological confirmation (n=249 and 366, respectively). Infection by S. pneumoniae was diagnosed by the detection of a serological response against at least one of eight pneumococcal proteins (defined as an increase ≥2-fold in the IgG levels against Ply, CbpA, PspA1 and PspA2, PhtD, StkP-C, and PcsB-N, or an increase ≥1.5-fold against PcpA). Infection by H. influenzae and M. catarrhalis was defined as an increase ≥2-fold on the levels of microbe-specific IgG. RESULTS: Children with radiologically confirmed pneumonia had higher rates of infection by S. pneumoniae. The presence of pneumococcal infection increased the odds of having radiologically confirmed pneumonia by 2.8 times (95% CI: 1.8-4.3). The negative predictive value of the normal chest radiograph for infection by S. pneumoniae was 86.3% (95% CI: 82.4-89.7%). There was no difference on the rates of infection by H. influenzae and M. catarrhalis between children with community-acquired pneumonia with and without radiological confirmation. CONCLUSIONS: Among children with clinical diagnosis of community-acquired pneumonia submitted to chest radiograph, those with radiologically confirmed pneumonia present a higher rate of infection by S. pneumoniae when compared with those with a normal chest radiograph.
OBJECTIVE: Community-acquired pneumonia is an important cause of morbidity in childhood, but the detection of its causative agent remains a diagnostic challenge. The authors aimed to evaluate the role of the chest radiograph to identify cases of community-aquired pneumonia caused by typical bacteria. METHODS: The frequency of infection by Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis was compared in non-hospitalized children with clinical diagnosis of community acquired pneumonia aged 2-59 months with or without radiological confirmation (n=249 and 366, respectively). Infection by S. pneumoniae was diagnosed by the detection of a serological response against at least one of eight pneumococcal proteins (defined as an increase ≥2-fold in the IgG levels against Ply, CbpA, PspA1 and PspA2, PhtD, StkP-C, and PcsB-N, or an increase ≥1.5-fold against PcpA). Infection by H. influenzae and M. catarrhalis was defined as an increase ≥2-fold on the levels of microbe-specific IgG. RESULTS:Children with radiologically confirmed pneumonia had higher rates of infection by S. pneumoniae. The presence of pneumococcal infection increased the odds of having radiologically confirmed pneumonia by 2.8 times (95% CI: 1.8-4.3). The negative predictive value of the normal chest radiograph for infection by S. pneumoniae was 86.3% (95% CI: 82.4-89.7%). There was no difference on the rates of infection by H. influenzae and M. catarrhalis between children with community-acquired pneumonia with and without radiological confirmation. CONCLUSIONS: Among children with clinical diagnosis of community-acquired pneumonia submitted to chest radiograph, those with radiologically confirmed pneumonia present a higher rate of infection by S. pneumoniae when compared with those with a normal chest radiograph.
Authors: Claire von Mollendorf; Sophie La Vincente; Mukhchuluun Ulziibayar; Bujinlkham Suuri; Dashtseren Luvsantseren; Dorj Narangerel; John de Campo; Margaret de Campo; Cattram Nguyen; Sodbayar Demberelsuren; Tuya Mungun; E Kim Mulholland Journal: PLoS One Date: 2019-09-11 Impact factor: 3.240