Çocuklarda viral ve bakteriyel pnömoniyi ayırmada laboratuvar değerlendirmeleri arasındaki ilişki

Yıl 2020, , 397 - 405, 15.09.2020

Kamil Şahin , Murat Elevli , Ayhan Koçak , Funda Atash , Esma Yücetaş , Cihan Coşkun

https://doi.org/10.31832/smj.742661

Cited By: 1

Öz

Amaç

Alt
solunum yolu (ASY)' nun temel enfeksiyonları; bronşiyolit ve pnömonidir.
Çalışmamızdaki amacımız akciğer grafi bulgularına göre sınıflanmış
viral-bakteriyel ASY enfeksiyonlarının ayırımında, labaratuvar değerlerinin
önemini saptamaktır.

Gereç ve Yöntem

Hastanemizde
2017 yılında, ASY enfeksiyonu tanısı almış hastalar,  akciğer grafi bulgularına göre radyoloji
uzmanı tarafındandört gruba ayrıldı ve bu bulgulara göre viral veya bakteriyel
ASY enfeksiyonu olarak sınıflandı. Hastaların c reaktif protein (CRP), lökosit,
trombosit, hematokrit, nötrofil, lenfosit, nötrofil/lenfosit ve ortalama
trombosit hacmi oranları istatistik yöntemlerle karşılaştırılarak, akciğer
grafisi ve labaratuvar bulguları arasında korelasyon istatistik yöntemlerle
saptandı.

Bulgular

Çalışmaya
dahil edilen 344 hastanın akciğer grafi bulgularına göre lober segmental ve
yoğun yamalı ve peribronşiyal infiltrasyonu olan 43 adedi bakteriyel,
yamalı-peribronşiyal infiltrasyonu olan veya grafileri normal bulunan 301 ASY
enfeksiyonu viral olarak değerlendirildi. Viral ve bakteriyel grup arasında
sadece CRP değerleri arasında istatistiksel fark bulduk (p=.0,034).

Sonuç

Toplumdan
kazanılmış pnömonilerde, yatan hastalarda yaptığımız çalışmada, viral
bakteriyel ASY enfeksiyonu ayırımında akciğer grafisi ile CRP nin arasında  anlamlı ilişki görülmüştür. Çocuklarda, CRP
değerindeki yükseklik, pnömoni tedavisinde ampirik antibiyotik başlama kararını
vermede, akciğer grafisindeki bakteriyel bulguları destekleyen değerli bir
göstergedir.

Anahtar Kelimeler

antibiyotik, bronşiyolit, c reaktif protein, çocuk, pnömoni

Destekleyen Kurum

Destekleyen kurum yoktur.

The relationship between laboratory evaluations in the separation of viral and bacterial pneumonia in children

Öz

Abstract

Objective

Basic
infections of the lower respiratory tract (LRT) are bronchiolitis and pneumonia
in children. The aim our study that determines the guiding laboratory
parameters in discriminating between bacterial and viral LRT infections.

Materials and Methods

The
patients who were diagnosed with LRT infection were divided into four groups
based on the findings of chest radiography by radyologist in 2017. Their
disease was classified as either viral or bacterial LRT infection in line with
these findings. A correlation between chest radiography and laboratory findings
was found by comparing c reactive protein (CRP), leukocyte, platelet,
hematocrit, neutrophil, lymphocyte, neutrophil / lymphocyte and mean platelet
volume (MPV) ratios using statistical methods.

Results

Of
344 patients included in the study, 43 patients with lober segmental,
dense-patched and peribronchial infiltration and 301 patients with
patched-peribronchial infiltration or normal radiography were evaluated as
bacterial and viral according to the findings of chest radiography, respectively.
We found a statistically significant difference in only CRP values between the
viral and bacterial groups (p = 0.034).

Conclusion

It
is seen that CRP supports the findings of chest radiography in discrimination
of the bacterial cause in community-acquired LRT infections. In children, the
elevation in CRP value can be a valuable indicator in supporting bacterial
chest radiography finding and deciding to start empirically antibiotic
treatment of pneumonia.

Anahtar Kelimeler

antibiotic, bronchiolitis, c reactive protein, children, pneumonia

Kaynakça

• 1.He C, Kang L, Miao L, Li Q, et al. Pneumonia Mortality among Children under5 in China from 1996 to 2013: An Analysis from National Surveillance System. PLoSOne 2015;10:e0133620.
• 2. Rudan I, Boschi-Pinto C, Biloglav Z, Mulholland K, Campbell H Epidemiology and etiology of childhood pneumonia. Bull World Health Organ 2008; 86: 408–416.
• 3. Walker CL, Rudan I, Liu L, Nair H, Theodoratou E, Bhutta ZA, et al. Global burden of childhood pneumonia and diarrhoea. Lancet 2013; 381: 1405–1416. 10.1016/S0140-6736(13)60222-6.
• 4. Hammitt LL, Kazungu S, Morpeth SC, Gibson DG, Mvera B, Brent AJ, et al. A preliminary study of pneumonia etiology among hospitalized children in Kenya. Clin Infect Dis 2012; 54 Suppl 2: S190–199.
• 5. Çocuk Enfeksiyon Hastalıkları Derneği Klinik Rehberleri, Hacımustafaoğlu M, Çelebi S, Alabaz D, Hatipoğlu N, at al. ve ÇEHAD Akut Bronşiyolit Çalışma Grubu. Akut Bronşiyolit; Tanı, Değerlendirme ve Yönetim, 2017.
• 6. Enarson PM, Gie RP, Mwansambo CC, Maganga ER, Lombard CJ, Enarson DA, et al. Reducing deaths from severe pneumonia in children in Malawi by improving delivery of pneumonia case management. PLoS One 2014; 9: e102955 10.1371/journal.pone.0102955.
• 7. Ayata A, Genç H, Sütçü R. The role of procalcitonin, neopterin and C-reactive protein for diagnosis and monitoring in infectious diseases of childhood. Tıp Araştırmaları Dergisi 2004; 2: 11-17.
• 8. Elzey BD, Sprague DL, Ratliff TL. The emerging role of platelets in adaptive immunity. Cell Immunol 2005;238:1-9.
• 9. Karadag-Oncel E, Ozsurekci Y, Kara A, Karahan S, et al. Thevalue of mean platelet volume in the determination of community acquired pneumonia in children. Ital J Pediatr 2013;39:16.
• 10. Zar HJ, Andronikou S, Nicol MP Advances in the diagnosis of pneumonia in children. Bmj 2017; 358: j2739 10.1136/bmj.j2739.
• 11. World Health Organization. IMCI Handbook: Integrated Management of Childhood Illness. Geneva: World Health Organisation; 2005.
• 12. Grady KF, Torzillo PJ, Frawley K and Chang AB, The radiological diagnosis of pneumonia in children. Pneumonia 2014 5:5010038,.
• 13. Swingler GH. Radiologic differentiation between bacterial and viral lower respiratory infection in children: a systematic literature review. Clin Pediatr (Phila) 2000;39(11):627–33. PMID:11110.
• 14. World HealthOrganization Pneumonia Vaccine Trial Investigators Group. Standardization of interpretation chest radiographs for the diagnosis of pneumonia in children. Geneva: World HealthOrganization; 2001. WHO/V&B/01.35.
• 15. Virkki R, Juven T, Rikalainen H, Svedström E, et al. Differentiation of bacterial and viral pneumonia in children. Thorax 2002;57(5):438–41.
• 16. Ralston S, Hill V, Waters A. Occult serious bacterial infection in infants younger than 60 to 90 days with bronchiolitis: a systematic review. Arch Pediatr Adolesc Med 2011; 165: 951-6.
• 17. Higdon MM, Le T, O'Brien KL, Murdoch DR, et al. Association of C-Reactive Protein With Bacterial and Respiratory Syncytial Virus-Associated Pneumonia Among Children Aged<5 Years in the PERCH Study. Clin Infect Dis. 2017;64(suppl_3):S378-S386.
• 18. Gupta, D, Agarwal R, Aggarwal AN, Singh N, at al. Pneumonia Guidelines Working Group (2012). Guidelines for diagnosis and management of community- and hospital-acquired pneumonia in adults: Joint ICS/NCCP (I) recommendations. Lung India : official organ of Indian Ches t Society, 29(Suppl 2), S27-62.
• 19. Garcia Vazquez E, Martinez JA, Mensa J, Sanchez F, et al. C-reactive protein levels in community-acquired pneumonia. Eur Respir J. 2003;21:702–5.
• 20. Flanders SA, Stein J, Shochat G, Sellers K, et al. Performance of a bedside C-reactive protein test in thediagnosis of community-acquired pneumonia in adults with acute cough. Am J Med. 2004;116:529–35.
• 21. Bafadhel M, Clark TW, Reid C, Medina MJ, et al. Procalcitonin and C-reactive protein in hospitalized adult patients with community-acquired pneumonia or exacerbation of asthma or COPD. Chest. 2011;139:1410–8.
• 22. Aydemir Y, Aydemir Ö, Pekcan S, Özdemir M.Value of multiplex PCR to determine the bacterial and viral aetiology of pneumonia in school-age children. Paediatr Int Child Health. 2017 Feb;37(1):29-34. doi: 10.1080/20469047.2015.1106080. Epub 2016 Jan 9.
• 23. Nathan AM, Teh CSJ, Jabar KA, et al. Bacterial pneumonia and its associated factors in children from a developing country: A prospective cohort study. PLoS One. 2020;15(2):e0228056. Published 2020 Feb 14. doi:10.1371/journal.pone.0228056.
• 24. Fernandes CD, Arriaga MB, Costa MCM, et al. Host Inflammatory Biomarkers of Disease Severity in Pediatric Community-Acquired Pneumonia: A Systematic Review and Meta-analysis. Open Forum Infect Dis. 2019;6(12):ofz520. Published 2019 Dec 6. doi:10.1093/ofid/ofz520.
• 25. Florin TA, Ambroggio L. Biomarkers for community-acquired pneumonia in the emergency department. Curr Infect Dis Rep 2014; 16:451.
• 26. Uwaezuoke SN, Ayuk AC. Prognostic scores and biomarkers for pediatric community-acquired pneumonia: how far have we come? Pediatric Health Med Ther 2017; 8:9–18.
• 27. Wu J, Jin YU, Li H, et al. . Evaluation and significance of C-reactive protein in the clinical diagnosis of severe pneumonia. Exp Ther Med 2015; 10:175–80.
• 28. Pepys MB, Hirschfield GM. C-reactive protein: a critical update. J Clin Invest 2003; 111:1805–12.
• 29. Falk G, Fahey T. C-reactive protein and community-acquired pneumonia in ambulatory care: Systematic review of diagnostic accuracy studies. Fam Pract. 2009;26:10–21.
• 30. Wang JL, Huang LT, Wu KH, Lin HW, et al. Associations of reactive thrombocytosis with clinical characteristics in pediatric diseases. Pediatr Neonatol 2011;52:261-6.
• 31. Mirsaeidi M, Peyrani P, Aliberti S, et al. Thrombocytopenia and thrombocytosis at time of hospitalization predict mortality in patients with community-acquired pneumonia. Chest 2010;137:416-20.
• 32. Wolach B, Morag H, Drucker M, Sadan N. Thrombocytosis after pneumonia with empyema and other bacterial infections in children. Pediatr Infect Dis J 1990;9:718-21.
• 33. Zheng SY, Xiao QY, Xie XH, et al. Association between secondary thrombocytosis and viral respiratory tract infections in children. SciRep 2016;6:22964.
• 34. Prina E, Ferrer M, Ranzani OT, Polverino E, et al. Thrombocytosis is a marker of poor outcome in community-acquiredpneumonia. Chest 2013;143:767-75.
• 35. Şahin M , Selçuk Duru N, Elevli M , Civilibal M, Pnömonili Çocuklarda Trombosit Parametrelerinin Değerlendirilmesi. J Pediatr Inf 2017; 11(3): 122-128.
• 36. Robbins G, Barnard DL. Mean platelet volume changes in infection. J ClinPathol 1983;36:1320.
• 37. Eser I, Günay Ş, Hasan Z, Sak A, et al. Mean Platelet Volume as a Diagnostic Indicator in Pneumonia Disease, Tıp Araştırmaları Dergisi; 2014: 12(1):12-14.
• 38. Brandt E, Ludwig A, Petersen F, Flad HD. Platelet derived CXC chemokines: Old players in new games. Immunol Rev; 2000, 177:204–16.
• 39. Mayssa M. Zaki. Parasite Platelet Interactions. PUJ; 2011, 4:127-136.