CLINICAL, RADIOLOGICAL, AND EPIDEMIOLOGICAL EVALUATION OF LOWER RESPIRATORY TRACT INFECTIONS OF CHILDREN
Yıl 2024,
Cilt: 12 Sayı: 1, 20 - 25, 31.03.2024
İlknur Bağrul
,
Bulent Alioglu
,
Ali Kudret Adiloğlu
,
Yıldız Dallar Bilge
Öz
Aim: In this study, we aimed to determine the etiology of lower respiratory tract infection in patients aged 1 month to 5 years with a clinical, radiological, and epidemiological study.
Materials and method: We investigated 150 patients between 1 month to 5 years of age who required hospitalization and those who were admitted to pediatrics clinics and pediatric emergency services of Ankara Training and Research Hospital who had the clinical diagnosis of lower respiratory tract infection and 50 patients who had no pathological physical examination findings. Blood samples for acute phase reactants and nasopharyngeal swap samples for detection of bacterial etiologies were taken. Initial posteroanterior chest X-rays of all patients were checked.
Results: The most common pathogens were Streptococcus pneumoniae in 77 (51.3%) and Haemophilus influenzae in 71 (% 47.3) patients. Three groups of patients compared with C-reactive protein values; patients with alveolar pneumonia were statistically higher than those with normal radiography and interstitial infiltrates (P= 0.012, P= 0.008). Erythrocyte sedimentation rates in patients with alveolar pneumonia were statistically significantly higher than the patients with interstitial infiltrates and normal radiology (P = 0.015, P= 0.016).
Conclusion: In patients suspected of lower respiratory tract infection, the beginning of appropriate antibiotic treatment should be supported with clinical, radiological, and laboratory tests. We think laboratory tests of acute phase reactants should be used with multiplex PCR to detect viral and bacterial agents. Still, to deal with this issue, advanced studies are needed.
Etik Beyan
Ethics Committee Approval: The study protocol was approved by the Clinical Research Ethics Committee of the Ankara Training and Research Hospital (Decision dated 26th January 2011, numbered 402/3357)
Destekleyen Kurum
Support and Acknowledgment: No financial support was received from any institution or person.
Teşekkür
Thanks to Ülkü Tıraş and Ayfer Özışık for their contributions to the manuscript.
Kaynakça
- 1. Organization WH. The World Health Report 2005: Make every mother and child count. World Health Organization; 2005.
- 2. Williams BG, Gouws E, Boschi-Pinto C, et al. Estimates of world-wide distribution of child deaths from acute respiratory infections. The Lancet infectious diseases 2002;2(1):25-32.
- 3. Ünüvar N, Mollahaliloğlu S, Yardım N. TC Sağlık Bakanlığı adına Refik Saydam Hıfzıssıhha Merkezi, Hıfzıssıhha Mektebi Müdürlüğü. Türkiye Hastalık Yükü Çalışması 2004;1:1-56.
- 4. Kocabaş E, Ersöz D, Karakoç F, et al. Türk Toraks Derneği çocuklarda toplumda gelişen pnömoni tanı ve tedavi uzlaşı raporu. Türk Toraks Dergisi 2009;10(3):1-26.
- 5. Kocabas E, Yalcin E, Akin L, et al. Cocukluk Caginda Toplum Kokenli Pnomoni Tani ve Tedavi Rehberi 2002. Toraks Dergisi 2002;3:17-27.
- 6. Jokinen C, Heiskanen L, Juvonen H, et al. Incidence of community-acquired pneumonia in the population of four municipalities in eastern Finland. Am J Epidemiol 1993;137(9):977-988.
- 7. Juvén T, Ruuskanen O, Mertsola J. Symptoms and signs of community-acquired pneumonia in children. Scand J Prim Health Care 2003;21(1):52-56.
- 8. Korppi M, Don M, Valent F, et al. The value of clinical features in differentiating between viral, pneumococcal and atypical bacterial pneumonia in children. Acta Paediatr 2008;97(7):943-947.
- 9. JM BG, JA LS, editors. Clinicoepidemiological characteristics of community-acquired pneumonia in children aged less than 6 years old. Anales de Pediatria (Barcelona, Spain: 2003); 2007.
- 10. Cevey-Macherel M, Galetto-Lacour A, Gervaix A, et al. Etiology of community-acquired pneumonia in hospitalized children based on WHO clinical guidelines. Eur J Pediatr 2009;168:1429-1436.
- 11. Palafox M, Guiscafré H, Reyes H, et al. Diagnostic value of tachypnoea in pneumonia defined radiologically. Arch Dis Child 2000;82(1):41.
- 12. Berman S, Simoes E, Lanata C. Respiratory rate and pneumonia in infancy. Arch Dis Child 1991;66(1):81.
- 13. Taylor JA, Del Beccaro M, Done S, et al. Establishing clinically relevant standards for tachypnea in febrile children younger than 2 years. Arch Pediatr Adolesc Med 1995;149(3):283-287.
- 14. Grossman LK, Caplan SE. Clinical, laboratory, and radiological information in the diagnosis of pneumonia in children. Ann Emerg Med 1988;17(1):43-46.
- 15. Zukin DD, Hoffman JR, Cleveland RH, et al. Correlation of pulmonary signs and symptoms with chest radiographs in the pediatric age group. Ann Emerg Med 1986;15(7):792-796.
- 16. Bilkis MD, Gorgal N, Carbone M, et al. Validation and development of a clinical prediction rule in clinically suspected community-acquired pneumonia. Pediatr Emerg Care 2010;26(6):399-405.
- 17. Korppi M, Heiskanen‐Kosma T, Kleemola M. Incidence of community‐acquired pneumonia in children caused by Mycoplasma pneumoniae: serological results of a prospective, population‐based study in primary health care. Respirology 2004;9(1):109-114.
- 18. JUVéN T, Mertsola J, Waris M, et al. Etiology of community-acquired pneumonia in 254 hospitalized children. The Pediatric infectious disease journal 2000;19(4):293-298.
- 19. Michelow IC, Olsen K, Lozano J, et al. Epidemiology and clinical characteristics of community-acquired pneumonia in hospitalized children. Pediatrics 2004;113(4):701-707.
- 20. Madhi SA, Ludewick H, Kuwanda L, et al. Seasonality, incidence, and repeat human metapneumovirus lower respiratory tract infections in an area with a high prevalence of human immunodeficiency virus type-1 infection. The Pediatric infectious disease journal 2007;26(8):693-699.
- 21. Heiskanen-Kosma T, Korppi M, Jokinen C, et al. Etiology of childhood pneumonia: serologic results of a prospective, population-based study. The Pediatric infectious disease journal 1998;17(11):986-991.
- 22. Tajima T, Nakayama E, Kondo Y, et al. Etiology and clinical study of community-acquired pneumonia in 157 hospitalized children. Journal of infection and chemotherapy 2006;12:372-379.
- 23. van de Pol AC, Wolfs TF, Jansen NJ, et al. Diagnostic value of real-time polymerase chain reaction to detect viruses in young children admitted to the paediatric intensive care unit with lower respiratory tract infection. Critical Care 2006;10:1-7.
- 24. Virkki R, Juven T, Mertsola J, et al. Radiographic follow‐up of pneumonia in children. Pediatr Pulmonol 2005;40(3):223-227.
- 25. Hazir T, Nisar YB, Qazi SA, et al. Chest radiography in children aged 2-59 months diagnosed with non-severe pneumonia as defined by World Health Organization: descriptive multicentre study in Pakistan. BMJ 2006;333(7569):629.
- 26. Moustaki M, Nicolaidou P, Stefos E, et al. Is there an association between wheezing and pneumonia? Allergol Immunopathol (Madr) 2010;38(1):4-7.
- 27. Tumer RB, Lande AE, Chase P, et al. Pneumonia in pediatric outpatients: cause and clinical manifestations. The Journal of pediatrics 1987;111(2):194-200.
- 28. Courtoy I, Lande AE, Turner RB. Accuracy of radiographic differentiation of bacterial from nonbacterial pneumonia. Clin Pediatr (Phila) 1989;28(6):261-264.
- 29. Korppi M, Kiekara O, Heiskanen‐Kosma T, et al. Comparison of radiological findings and microbial aetiology of childhood pneumonia. Acta Paediatr 1993;82(4):360-363.
- 30. Campos J, Román F, Pérez-Vázquez M, et al. Infections due to Haemophilus influenzae serotype E: microbiological, clinical, and epidemiological features. Clin Infect Dis 2003;37(6):841-845.
Çocukluk Çağı Alt Solunum Yolu Enfeksiyonlarının Klinik, Radyolojik ve Epidemiyolojik Değerlendirmesi
Yıl 2024,
Cilt: 12 Sayı: 1, 20 - 25, 31.03.2024
İlknur Bağrul
,
Bulent Alioglu
,
Ali Kudret Adiloğlu
,
Yıldız Dallar Bilge
Öz
Amaç: Bu çalışmada alt solunum yolu enfeksiyonu klinik tanısıyla hastaneye yatırılan 1 ay-5 yaş arası hastalarda klinik, radyolojik ve epidemiyolojik çalışma ile etiyolojinin belirlenmesi amaçlandı.
Gereç ve yöntem: Ankara Eğitim ve Araştırma Hastanesi Çocuk Sağlığı ve Hastalıkları poliklinikleri ve çocuk acil servislerine başvuran, 1 ay-5 yaş arası, ASYE tanısı alan 150 hasta ile alt solunum yolu enfeksiyonu tanısı almayan 50 hastayı inceledik. Akut faz reaktanları için kan örnekleri ve bakteriyel etiyolojilerin tespiti için nazofarengeal swap örnekleri alındı. Tüm hastaların ilk postero-anterior akciğer grafileri kontrol edildi.
Bulgular: En sık görülen patojenler 77 (%51,3) hastada Streptococcus pneumoniae ve 71 (%47,3) hastada Haemophilus influenzae idi. Üç grup hasta C-reaktif protein değerleri açısından karşılaştırıldı; alveolar pnömonili hastalar, normal radyografisi ve interstisyel infiltrasyonu olan hasta grubundan istatistiksel olarak daha fazla idi (P = 0.012, P = 0.008). Alveoler pnömonili hastalarda eritrosit sedimantasyon hızı, interstisyel infiltrasyonu olan ve radyolojisi normal olan hastalara göre istatistiksel olarak anlamlı derecede yüksekti (P = 0.015, P = 0.016).
Sonuç: Alt solunum yolu enfeksiyonu şüphesi olan hastalarda uygun antibiyotik tedavisine başlanması klinik, radyolojik ve laboratuvar tetkikleriyle desteklenmelidir. Viral ve bakteriyel etkenlerin saptanmasında laboratuvar testlerinin multipleks polimeraz zincir reaksiyonu yöntemiyle birlikte kullanılabileceğini ancak bu konuyla ilgili ileri çalışmalara ihtiyaç olduğunu düşünüyoruz.
Kaynakça
- 1. Organization WH. The World Health Report 2005: Make every mother and child count. World Health Organization; 2005.
- 2. Williams BG, Gouws E, Boschi-Pinto C, et al. Estimates of world-wide distribution of child deaths from acute respiratory infections. The Lancet infectious diseases 2002;2(1):25-32.
- 3. Ünüvar N, Mollahaliloğlu S, Yardım N. TC Sağlık Bakanlığı adına Refik Saydam Hıfzıssıhha Merkezi, Hıfzıssıhha Mektebi Müdürlüğü. Türkiye Hastalık Yükü Çalışması 2004;1:1-56.
- 4. Kocabaş E, Ersöz D, Karakoç F, et al. Türk Toraks Derneği çocuklarda toplumda gelişen pnömoni tanı ve tedavi uzlaşı raporu. Türk Toraks Dergisi 2009;10(3):1-26.
- 5. Kocabas E, Yalcin E, Akin L, et al. Cocukluk Caginda Toplum Kokenli Pnomoni Tani ve Tedavi Rehberi 2002. Toraks Dergisi 2002;3:17-27.
- 6. Jokinen C, Heiskanen L, Juvonen H, et al. Incidence of community-acquired pneumonia in the population of four municipalities in eastern Finland. Am J Epidemiol 1993;137(9):977-988.
- 7. Juvén T, Ruuskanen O, Mertsola J. Symptoms and signs of community-acquired pneumonia in children. Scand J Prim Health Care 2003;21(1):52-56.
- 8. Korppi M, Don M, Valent F, et al. The value of clinical features in differentiating between viral, pneumococcal and atypical bacterial pneumonia in children. Acta Paediatr 2008;97(7):943-947.
- 9. JM BG, JA LS, editors. Clinicoepidemiological characteristics of community-acquired pneumonia in children aged less than 6 years old. Anales de Pediatria (Barcelona, Spain: 2003); 2007.
- 10. Cevey-Macherel M, Galetto-Lacour A, Gervaix A, et al. Etiology of community-acquired pneumonia in hospitalized children based on WHO clinical guidelines. Eur J Pediatr 2009;168:1429-1436.
- 11. Palafox M, Guiscafré H, Reyes H, et al. Diagnostic value of tachypnoea in pneumonia defined radiologically. Arch Dis Child 2000;82(1):41.
- 12. Berman S, Simoes E, Lanata C. Respiratory rate and pneumonia in infancy. Arch Dis Child 1991;66(1):81.
- 13. Taylor JA, Del Beccaro M, Done S, et al. Establishing clinically relevant standards for tachypnea in febrile children younger than 2 years. Arch Pediatr Adolesc Med 1995;149(3):283-287.
- 14. Grossman LK, Caplan SE. Clinical, laboratory, and radiological information in the diagnosis of pneumonia in children. Ann Emerg Med 1988;17(1):43-46.
- 15. Zukin DD, Hoffman JR, Cleveland RH, et al. Correlation of pulmonary signs and symptoms with chest radiographs in the pediatric age group. Ann Emerg Med 1986;15(7):792-796.
- 16. Bilkis MD, Gorgal N, Carbone M, et al. Validation and development of a clinical prediction rule in clinically suspected community-acquired pneumonia. Pediatr Emerg Care 2010;26(6):399-405.
- 17. Korppi M, Heiskanen‐Kosma T, Kleemola M. Incidence of community‐acquired pneumonia in children caused by Mycoplasma pneumoniae: serological results of a prospective, population‐based study in primary health care. Respirology 2004;9(1):109-114.
- 18. JUVéN T, Mertsola J, Waris M, et al. Etiology of community-acquired pneumonia in 254 hospitalized children. The Pediatric infectious disease journal 2000;19(4):293-298.
- 19. Michelow IC, Olsen K, Lozano J, et al. Epidemiology and clinical characteristics of community-acquired pneumonia in hospitalized children. Pediatrics 2004;113(4):701-707.
- 20. Madhi SA, Ludewick H, Kuwanda L, et al. Seasonality, incidence, and repeat human metapneumovirus lower respiratory tract infections in an area with a high prevalence of human immunodeficiency virus type-1 infection. The Pediatric infectious disease journal 2007;26(8):693-699.
- 21. Heiskanen-Kosma T, Korppi M, Jokinen C, et al. Etiology of childhood pneumonia: serologic results of a prospective, population-based study. The Pediatric infectious disease journal 1998;17(11):986-991.
- 22. Tajima T, Nakayama E, Kondo Y, et al. Etiology and clinical study of community-acquired pneumonia in 157 hospitalized children. Journal of infection and chemotherapy 2006;12:372-379.
- 23. van de Pol AC, Wolfs TF, Jansen NJ, et al. Diagnostic value of real-time polymerase chain reaction to detect viruses in young children admitted to the paediatric intensive care unit with lower respiratory tract infection. Critical Care 2006;10:1-7.
- 24. Virkki R, Juven T, Mertsola J, et al. Radiographic follow‐up of pneumonia in children. Pediatr Pulmonol 2005;40(3):223-227.
- 25. Hazir T, Nisar YB, Qazi SA, et al. Chest radiography in children aged 2-59 months diagnosed with non-severe pneumonia as defined by World Health Organization: descriptive multicentre study in Pakistan. BMJ 2006;333(7569):629.
- 26. Moustaki M, Nicolaidou P, Stefos E, et al. Is there an association between wheezing and pneumonia? Allergol Immunopathol (Madr) 2010;38(1):4-7.
- 27. Tumer RB, Lande AE, Chase P, et al. Pneumonia in pediatric outpatients: cause and clinical manifestations. The Journal of pediatrics 1987;111(2):194-200.
- 28. Courtoy I, Lande AE, Turner RB. Accuracy of radiographic differentiation of bacterial from nonbacterial pneumonia. Clin Pediatr (Phila) 1989;28(6):261-264.
- 29. Korppi M, Kiekara O, Heiskanen‐Kosma T, et al. Comparison of radiological findings and microbial aetiology of childhood pneumonia. Acta Paediatr 1993;82(4):360-363.
- 30. Campos J, Román F, Pérez-Vázquez M, et al. Infections due to Haemophilus influenzae serotype E: microbiological, clinical, and epidemiological features. Clin Infect Dis 2003;37(6):841-845.