Danilo Buonsenso1,2,3, Annamaria Musolino4, Valentina Ferro4, Cristina De Rose5, Rosa Morello5, Chiara Ventola5, Flora Marzia Liotti6, Rita De Sanctis5, Antonio Chiaretti5, Daniele Guerino Biasucci7, Teresa Spanu6,8, Maurizio Sanguinetti6,8, Piero Valentini5. 1. Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli, Largo A. Gemelli 8, 00168, Rome, Italy. danilobuonsenso@gmail.com. 2. Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy. danilobuonsenso@gmail.com. 3. Global Health Research Institute, Istituto di Igiene, Università Cattolica del Sacro Cuore, Roma, Italia. danilobuonsenso@gmail.com. 4. Department of Pediatric Emergency Medicine, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy. 5. Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli, Largo A. Gemelli 8, 00168, Rome, Italy. 6. Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy. 7. Department of Anesthesia and Intensive Care, Fondazione Policlinico Universitario "A.Gemelli", Rome, Italy. 8. Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
Abstract
OBJECTIVE AND DESIGN: Our prospective study assesses the role of detailed lung ultrasound (LUS) features to discriminate the etiological diagnosis of acute lower respiratory tract infection (ALRTI) in children. METHODOLOGY: We analyzed patients aged from 1 month to 17 years admitted between March 2018 and April 2020 who were hospitalized for ALRTI. For all patients, history, clinical parameters, microbiological data, and lung ultrasound data were collected. Patients were stratified into three main groups ("bacterial", "viral", "atypical") according to the presumed microbial etiology and LUS findings evaluated according to the etiological group. Nasopharyngeal swabs were obtained from all patients. A qualitative diagnostic test developed by Nurex S.r.l. was used for identification of bacterial and fungal DNA in respiratory samples. The Seegene Allplex™ Respiratory assays were used for the molecular diagnosis of viral respiratory pathogens. In addition, bacterial culture of blood and respiratory samples were performed, when indicated. RESULTS: A total of 186 children with suspected ALRTI (44% female) with an average age of 6 were enrolled in the study. We found that some ultrasound findings as size, number and distribution of consolidations, the position and motion of air bronchograms, pleural effusions and distribution of vertical artifacts significantly differ (p < 0.05) in children with bacterial, viral and atypical ALRTI. CONCLUSION: Our study provides a detailed analysis of LUS features able to predict the ALRTI ethology in children. These findings may help the physicians to better manage a child with ALRTI and to offer personalized approach, from diagnosis to treatment and follow-up.
OBJECTIVE AND DESIGN: Our prospective study assesses the role of detailed lung ultrasound (LUS) features to discriminate the etiological diagnosis of acute lower respiratory tract infection (ALRTI) in children. METHODOLOGY: We analyzed patients aged from 1 month to 17 years admitted between March 2018 and April 2020 who were hospitalized for ALRTI. For all patients, history, clinical parameters, microbiological data, and lung ultrasound data were collected. Patients were stratified into three main groups ("bacterial", "viral", "atypical") according to the presumed microbial etiology and LUS findings evaluated according to the etiological group. Nasopharyngeal swabs were obtained from all patients. A qualitative diagnostic test developed by Nurex S.r.l. was used for identification of bacterial and fungal DNA in respiratory samples. The Seegene Allplex™ Respiratory assays were used for the molecular diagnosis of viral respiratory pathogens. In addition, bacterial culture of blood and respiratory samples were performed, when indicated. RESULTS: A total of 186 children with suspected ALRTI (44% female) with an average age of 6 were enrolled in the study. We found that some ultrasound findings as size, number and distribution of consolidations, the position and motion of air bronchograms, pleural effusions and distribution of vertical artifacts significantly differ (p < 0.05) in children with bacterial, viral and atypical ALRTI. CONCLUSION: Our study provides a detailed analysis of LUS features able to predict the ALRTI ethology in children. These findings may help the physicians to better manage a child with ALRTI and to offer personalized approach, from diagnosis to treatment and follow-up.
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