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Lin L, Chi H, Chiu NC, Huang CY, Wang JY, Huang DTN. Assessing the utilization of antimicrobial agents in pediatric pneumonia during the era of the 13-valent pneumococcal conjugate vaccine: A retrospective, single-center study. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2023; 56:1226-1235. [PMID: 37758541 DOI: 10.1016/j.jmii.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 09/08/2023] [Accepted: 09/11/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND AND PURPOSE Pneumonia and bronchopneumonia are the most common infectious diseases in children. This study aimed to analyze changes in causative pathogens and antibiotic use for bronchopneumonia or pneumonia after the introduction of the 13-valent pneumococcal conjugate vaccine (PCV13) in children. METHODS This retrospective study was conducted from 2009 to 2019. Hospitalized children aged 6 months-3 years with a discharge diagnosis of bronchopneumonia or pneumonia were included to analyze changes in the potential mismatch between the diagnosed pathogen and antibiotic use. RESULTS The cohort comprised 1100 patients, including 648 (59%) and 452 (41%) with a discharge diagnosis of bronchopneumonia and pneumonia, respectively. The trend of viral pneumonia increased every year (rs = 0.101, p < 0.05) Antibiotics were administered in 97% patients, with an increasing annual trend in macrolide use (rs = 0.031, p = 0.009). Regarding antibiotic utilization, no significant variations were observed in the days of therapy (DOT) (rs = 0.076, p = 0.208) or length of therapy (LOT) (rs = -0.027, p = 0.534) per patient-year throughout the study duration. Interestingly, the LOT for combined therapy with macrolides and first-line beta-lactams was high (rs = 0.333, p = 0.028). In viral pneumonia treatment, neither the DOT nor LOT exhibited significant variations (rs = -0.006, p = 0.787 and rs = -0.156, p = 0.398). CONCLUSION After the introduction of PCV13 in Taiwan, no decrease in antibiotic use has been observed among children aged 6 months-3 years with a discharge diagnosis of bronchopneumonia and pneumonia.
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Affiliation(s)
- Leng Lin
- Department of Pediatric Infectious Diseases, MacKay Children's Hospital, Taipei, Taiwan; Department of Pediatrics, Taiwan Adventist Hospital, Taipei, Taiwan
| | - Hsin Chi
- Department of Pediatric Infectious Diseases, MacKay Children's Hospital, Taipei, Taiwan; Department of Medicine, Mackay Medicine College, New Taipei, Taiwan
| | - Nan-Chang Chiu
- Department of Pediatric Infectious Diseases, MacKay Children's Hospital, Taipei, Taiwan; Department of Medicine, Mackay Medicine College, New Taipei, Taiwan
| | - Ching-Ying Huang
- Department of Pediatric Infectious Diseases, MacKay Children's Hospital, Taipei, Taiwan
| | - Jin-Yuan Wang
- Department of Pediatric Infectious Diseases, MacKay Children's Hospital, Taipei, Taiwan
| | - Daniel Tsung-Ning Huang
- Department of Pediatric Infectious Diseases, MacKay Children's Hospital, Taipei, Taiwan; Department of Medicine, Mackay Medicine College, New Taipei, Taiwan.
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Herrera AL, Potts R, Huber VC, Chaussee MS. Influenza enhances host susceptibility to non-pulmonary invasive Streptococcus pyogenes infections. Virulence 2023; 14:2265063. [PMID: 37772916 PMCID: PMC10566429 DOI: 10.1080/21505594.2023.2265063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 09/25/2023] [Indexed: 09/30/2023] Open
Abstract
Streptococcus pyogenes (group A streptococcus; GAS) causes a variety of invasive diseases (iGAS) such as bacteremia, toxic shock syndrome, and pneumonia, which are associated with high mortality despite the susceptibility of the bacteria to penicillin ex vivo. Epidemiologic studies indicate that respiratory influenza virus infection is associated with an increase in the frequency of iGAS diseases, including those not directly involving the lung. We modified a murine model of influenza A (IAV)-GAS superinfection to determine if viral pneumonia increased the susceptibility of mice subsequently infected with GAS in the peritoneum. The results showed that respiratory IAV infection increased the morbidity (weight loss) of mice infected intraperitoneally (i.p.) with GAS 3, 5, and 10 d after the initial viral infection. Mortality was also significantly increased when mice were infected with GAS 3 and 5 d after pulmonary IAV infection. Increased mortality among mice infected with virus 5 d prior to bacterial infection correlated with increased dissemination of GAS from the peritoneum to the blood, spleen, and lungs. The interval was also associated with a significant increase in the pro-inflammatory cytokines IFN-γ, IL-12, TNF-α, MCP-1 and IL-27 in sera. We conclude, using a murine model, that respiratory influenza virus infection increases the likelihood and severity of systemic iGAS disease, even when GAS infection does not originate in the respiratory tract.
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Affiliation(s)
- Andrea L. Herrera
- Division of Basic Biomedical Sciences, The Sanford School of Medicine of the University of South Dakota, Vermillion, SD, USA
| | - Rashaun Potts
- Division of Basic Biomedical Sciences, The Sanford School of Medicine of the University of South Dakota, Vermillion, SD, USA
| | - Victor C. Huber
- Division of Basic Biomedical Sciences, The Sanford School of Medicine of the University of South Dakota, Vermillion, SD, USA
| | - Michael S. Chaussee
- Division of Basic Biomedical Sciences, The Sanford School of Medicine of the University of South Dakota, Vermillion, SD, USA
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Distribution of Viral Respiratory Infections during the COVID-19 Pandemic Using the FilmArray Respiratory Panel. Biomedicines 2022; 10:biomedicines10112734. [DOI: 10.3390/biomedicines10112734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 10/25/2022] [Accepted: 10/25/2022] [Indexed: 11/16/2022] Open
Abstract
This study was conducted to evaluate the distribution of respiratory viral pathogens in the emergency department during the coronavirus disease 2019 (COVID-19) pandemic. Between May 2020 and September 2022, patients aged between 0.1 and 98 years arrived at the emergency department of Asia University Hospital, and samples from nasopharyngeal swabs were tested by the FilmArrayTM Respiratory Panel (RP). SARS-CoV-2 positivity was subsequently retested by the cobas Liat system. There were 804 patients for whom the FilmArrayTM RP was tested, and 225 (27.9%) of them had positive results for respiratory viruses. Rhinovirus/enterovirus was the most commonly detected pathogen, with 170 (61.8%) cases, followed by adenovirus with 38 (13.8%), SARS-CoV-2 with 16 (5.8%) cases, and coronavirus 229E, with 16 (5.8%) cases. SARS-CoV-2 PCR results were positive in 16 (5.8%) cases, and there were two coinfections of SARS-CoV-2 with adenovirus and rhinovirus/enterovirus. A total of 43 (5.3%) patients were coinfected; the most coinfection was adenovirus plus rhinovirus/enterovirus, which was detectable in 18 (41.9%) cases. No atypical pathogens were found in this study. Intriguingly, our results showed that there was prefect agreement between the detection of SARS-CoV-2 conducted with the cobas Liat SARS-CoV-2 and influenza A/B nucleic acid test and the FilmArrayTM RP. Therefore, the FilmArrayTM RP assay is a reliable and feasible method for the detection of SARS-CoV-2. In summary, FilmArrayTM RP significantly broadens our capability to detect multiple respiratory infections due to viruses and atypical bacteria. It provides a prompt evaluation of pathogens to enhance patient care and clinical selection strategies in emergency departments during the COVID-19 pandemic.
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Lee JT, Lin JW, Chen HM, Wang CY, Lu CY, Chang LY, Huang LM. Impact of pneumococcal conjugate vaccination on hospitalized childhood pneumonia in Taiwan. Pediatr Res 2022; 92:1161-1167. [PMID: 34937875 DOI: 10.1038/s41390-021-01772-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 09/11/2021] [Accepted: 09/17/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND A national 13-valent pneumococcal conjugate vaccine (PCV13) catch-up program among children aged 2-5 years in 2013, before routine infant immunization in 2015, successfully reduced serotype 19A-related invasive pneumococcal diseases in Taiwan. We aimed to investigate its impact on hospitalized childhood pneumonia. METHODS We analyzed the National Health Insurance Research Database, 2001-2017, for hospitalized children aged <18 years with the diagnoses of all-cause pneumonia, lobar/pneumococcal pneumonia, and pneumococcal parapneumonic diseases. The study period was divided into 2001-2005 (pre-PCV), 2006-2012 (private sectors), and 2013-2017 (universal PCV13 vaccination). RESULTS On pneumococcal parapneumonic diseases, the national PCV13 vaccination program was associated with an immediate decline in 2-4-year-old children and significant decreasing trends in all ages. The incidence rate ratios of 2016-2017/2011-2012 were 0.16 (95% confidence interval [CI], 0.06-0.40) and 0.18 (95% CI, 0.13-0.23) in children aged < 2 and 2-4 years, respectively. We observed an increase of lobar/pneumococcal pneumonia cases after an early decline. The intensive/invasive medical needs and the fatality of all-cause pneumonia decreased significantly in children of all ages. CONCLUSIONS Pneumococcal parapneumonic diseases and the disease burden of lobar/pneumococcal pneumonia and lower respiratory tract infections declined after the national PCV13 vaccination program. IMPACT The impact study of the PCV13 immunization program on childhood pneumonia in Asian countries remained limited. The unique PCV13 immunization program in Taiwan, catch-up before primary infantile series, reduced severe childhood pneumococcal pneumonia at 5 years post PCV13. The intensive and invasive medical needs and fatality of all-cause pneumonia decreased significantly in children of all ages. We observed an increase in lobar/pneumococcal pneumonia after an early decline.
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Affiliation(s)
- Jian-Te Lee
- National Taiwan University Hospital, Yunlin Branch, Yunlin, Taiwan
| | - Jou-Wei Lin
- National Taiwan University Hospital, Yunlin Branch, Yunlin, Taiwan
| | | | - Chen-Yu Wang
- National Taiwan University Hospital, Yunlin Branch, Yunlin, Taiwan
| | - Chun-Yi Lu
- National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Luan-Yin Chang
- National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan.
| | - Li-Min Huang
- National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
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Refractory Mycoplasma pneumoniae Pneumonia in Children: Early Recognition and Management. J Clin Med 2022; 11:jcm11102824. [PMID: 35628949 PMCID: PMC9144103 DOI: 10.3390/jcm11102824] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 05/10/2022] [Accepted: 05/12/2022] [Indexed: 11/17/2022] Open
Abstract
Refractory Mycoplasma pneumoniae pneumonia (RMPP) is a severe state of M. pneumoniae infection that has attracted increasing universal attention in recent years. The pathogenesis of RMPP remains unknown, but the excessive host immune responses as well as macrolide resistance of M. pneumoniae might play important roles in the development of RMPP. To improve the prognosis of RMPP, it is mandatory to recognize RMPP in the early stages, and the detection of macrolide-resistant MP, clinical unresponsiveness to macrolides and elevated proinflammatory cytokines might be clues. Timely and effective anti-mycoplasmal therapy and immunomodulating therapy are the main strategies for RMPP.
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Roh EJ, Lee MH, Lee JY, Kim HB, Ahn YM, Kim JK, Kim HY, Jung SS, Kim M, Kang EK, Yang EA, Lee SJ, Park Y, Seo JH, Lee E, Yang ES, Park KS, Shin M, Chung HL, Jang YY, Choi BS, Jung JA, Yu ST, Sung M, Kim JT, Kim BS, Hwang YH, Sol IS, Yang HJ, Han MY, Yew HY, Cho HM, Kim HY, Ahn YH, Lee ES, Kim DH, Hwang K, Jung SO, Shim JY, Chung EH. Analysis of national surveillance of respiratory pathogens for community-acquired pneumonia in children and adolescents. BMC Infect Dis 2022; 22:330. [PMID: 35379181 PMCID: PMC8977558 DOI: 10.1186/s12879-022-07263-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 03/11/2022] [Indexed: 12/03/2022] Open
Abstract
Background Respiratory infections among children, particularly community-acquired pneumonia (CAP), is a major disease with a high frequency among outpatient and inpatient visits. The causes of CAP vary depending on individual susceptibility, the epidemiological characteristics of the community, and the season. We performed this study to establish a nationwide surveillance network system and identify the causative agents for CAP and antibiotic resistance in Korean children with CAP. Methods The monitoring network was composed of 28 secondary and tertiary medical institutions. Upper and lower respiratory samples were assayed using a culture or polymerase chain reaction (PCR) from August 2018 to May 2020. Results A total of 1023 cases were registered in patients with CAP, and PCR of atypical pneumonia pathogens revealed 422 cases of M. pneumoniae (41.3%). Respiratory viruses showed a positivity rate of 65.7% by multiplex PCR test, and human rhinovirus was the most common virus, with 312 cases (30.5%). Two hundred sixty four cases (25.8%) were isolated by culture, including 131 cases of S. aureus (12.8%), 92 cases of S. pneumoniae (9%), and 20 cases of H. influenzae (2%). The cultured, isolated bacteria may be colonized pathogen. The proportion of co-detection was 49.2%. The rate of antibiotic resistance showed similar results as previous reports. Conclusions This study will identify the pathogens that cause respiratory infections and analyze the current status of antibiotic resistance to provide scientific evidence for management policies of domestic respiratory infections. Additionally, in preparation for new epidemics, including COVID-19, monitoring respiratory infections in children and adolescents has become more important, and research on this topic should be continuously conducted in the future. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-022-07263-z.
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Affiliation(s)
- Eui Jeong Roh
- Department of Pediatrics, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Mi-Hee Lee
- Department of Pediatrics, Incheon Medical Center, Incheon, Republic of Korea
| | - Ji Young Lee
- Department of Pediatrics, Hallym University Chuncheon Sacred Heart Hospital, Chuncheon, Republic of Korea
| | - Hyo-Bin Kim
- Department of Pediatrics, Inje University Sanggye Paik Hospital, Seoul, Republic of Korea
| | - Young Min Ahn
- Department of Pediatrics, Eulji University Hospital, Seoul, Republic of Korea
| | - Ja Kyoung Kim
- Department of Pediatrics, Kangwon National University School of Medicine, Chuncheon, Republic of Korea
| | - Hyoung Young Kim
- Department of Pediatrics, Pusan National University Children's Hospital, Yangsan, Republic of Korea
| | - Sung-Su Jung
- Department of Pediatrics, Pusan National University Children's Hospital, Yangsan, Republic of Korea
| | - Minji Kim
- Department of Pediatrics, Chungnam National University Sejong Hospital, Chungnam National University College of Medicine, Sejong, Republic of Korea
| | - Eun Kyeong Kang
- Department of Pediatrics, Dongguk University Ilsan Hospital, Goyang, Republic of Korea
| | - Eun-Ae Yang
- Department of Pediatrics, The Catholic University of Korea Daejeon's St. Mary's Hospital, Daejeon, Republic of Korea
| | - Soo Jin Lee
- Department of Pediatrics, Eulji University Hospital, Daejeon, Republic of Korea
| | - Yang Park
- Department of Pediatrics, Wonkwang University Sanbon Hospital, Gunpo, Republic of Korea
| | - Ju-Hee Seo
- Department of Pediatrics, Dankook University College of Medicine, Cheonan, Republic of Korea
| | - Eun Lee
- Department of Pediatrics, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Eun Seok Yang
- Department of Pediatrics, College of Medicine, Chosun University, Chosun University Hospital, Gwangju, Republic of Korea
| | - Kang Seo Park
- Department of Pediatrics, Presbyterian Medical Center, Jeonju, Republic of Korea
| | - Meeyong Shin
- Department of Pediatrics, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Hai Lee Chung
- Department of Pediatrics, Daegu Catholic University Medical Center, Daegu, Republic of Korea
| | - Yoon Young Jang
- Department of Pediatrics, Daegu Catholic University Medical Center, Daegu, Republic of Korea
| | - Bong Seok Choi
- Department of Pediatrics, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Jin-A Jung
- Department of Pediatrics, Dong-A University College of Medicine, Busan, Republic of Korea
| | - Seung Taek Yu
- Department of Pediatrics, Wonkwang University School of Medicine, Iksan, Republic of Korea
| | - Myongsoon Sung
- Department of Pediatrics, Soonchunhyang University Hospital, Gumi, Republic of Korea
| | - Jin Tack Kim
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Uijeongbu St. Mary's Hospital, Uijeongbu, Republic of Korea
| | - Bong-Seong Kim
- Department of Pediatrics, University of Ulsan College of Medicine, Gangneung Asan Hospital, Gangneung, Republic of Korea
| | - Yoon Ha Hwang
- Department of Pediatrics, Busan St. Mary's Hospital, Busan, Republic of Korea
| | - In-Suk Sol
- Department of Pediatrics, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, Republic of Korea
| | - Hyeon-Jong Yang
- Department of Pediatrics, Soonchunhyang University Hospital, Seoul, Republic of Korea
| | - Man Yong Han
- Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea
| | - Hae Young Yew
- Department of Pediatrics, Kogel Hospital, Daejeon, Republic of Korea
| | - Hyoung Min Cho
- Department of Pediatrics, Kwangju Christian Hospital, Kwangju, Republic of Korea
| | - Hye-Young Kim
- Department of Pediatrics, Pusan National University Hospital, Pusan, Republic of Korea
| | - Yeon-Hwa Ahn
- Department of Pediatrics, Bundang Jesaeng Hospital, Seongnam, Republic of Korea
| | - Eun Sil Lee
- Department of Pediatrics, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Dong Hyeok Kim
- Divison of Bacterial Diseases, Bureau of Infectious Disease Diagnosis Control, Korea Disease Control and Prevention Agency (KDCA), Sejong, Republic of Korea
| | - Kyujam Hwang
- Divison of Bacterial Diseases, Bureau of Infectious Disease Diagnosis Control, Korea Disease Control and Prevention Agency (KDCA), Sejong, Republic of Korea
| | - Sang Oun Jung
- Divison of Bacterial Diseases, Bureau of Infectious Disease Diagnosis Control, Korea Disease Control and Prevention Agency (KDCA), Sejong, Republic of Korea
| | - Jung Yeon Shim
- Department of Pediatrics, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, Republic of Korea.
| | - Eun Hee Chung
- Department of Pediatrics, Chungnam National University School of Medicine, Daejeon, Republic of Korea.
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Rueda ZV, Aguilar Y, Maya MA, López L, Restrepo A, Garcés C, Morales O, Roya-Pabón C, Trujillo M, Arango C, Copete ÁR, Vera C, Giraldo MR, Herrera M, Vélez LA. Etiology and the challenge of diagnostic testing of community-acquired pneumonia in children and adolescents. BMC Pediatr 2022; 22:169. [PMID: 35361166 PMCID: PMC8968093 DOI: 10.1186/s12887-022-03235-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 03/22/2022] [Indexed: 11/18/2022] Open
Abstract
Background Pneumonia is the leading cause of mortality in pediatric population. The etiology of pneumonia in this population is variable and changes according to age and disease severity and where the study is conducted. Our aim was to determine the etiology of community-acquired pneumonia (CAP) in children aged 1 month to 17 years admitted to 13 Colombian hospitals. Methods Prospective cohort study. Hospitalized children with radiologically confirmed CAP and ≤ 15 days of symptoms were included and followed together with a control group. Induced sputum (IS) was submitted for stains and cultures for pyogenic bacteria and Mycobacterium tuberculosis, and multiplex PCR (mPCR) for bacteria and viruses; urinary antigens for pneumococcus and Legionella pneumophila; nasopharyngeal swabs for viruses, and paired serology for atypical bacteria and viruses. Additional cultures were taken at the discretion of primary care pediatricians. Results Among 525 children with CAP, 71.6% had non-severe pneumonia; 24.8% severe and 3.6% very severe pneumonia, and no fatal cases. At least one microorganism was identified in 84% of children and 61% were of mixed etiology; 72% had at least one respiratory virus, 28% pyogenic bacteria and 21% atypical bacteria. Respiratory syncytial virus, Parainfluenza, Rhinovirus, Influenza, Mycoplasma pneumoniae, Adenovirus and Streptococcus pneumoniae were the most common etiologies of CAP. Respiratory syncytial virus was more frequent in children under 2 years and in severe pneumonia. Tuberculosis was diagnosed in 2.3% of children. IS was the most useful specimen to identify the etiology (33.6%), and blood cultures were positive in 3.6%. The concordance between all available diagnostic tests was low. A high percentage of healthy children were colonized by S. pneumoniae and Haemophilus influenzae, or were infected by Parainfluenza, Rhinovirus, Influenza and Adenovirus. Conclusions Respiratory viruses are the most frequent etiology of CAP in children and adolescents, in particular in those under 5 years. This study shows the challenges in making an etiologic diagnosis of CAP in pediatric population because of the poor concordance between tests and the high percentage of multiple microorganisms in healthy children. IS is useful for CAP diagnosis in pediatric population. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-022-03235-z.
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Affiliation(s)
- Zulma Vanessa Rueda
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Canada.
| | - Yudy Aguilar
- Grupo Investigador de Problemas en Enfermedades Infecciosas (GRIPE), Facultad de Medicina, Universidad de Antioquia UdeA, Medellín, Colombia.,Clínica Universitaria Bolivariana, Universidad Pontificia Bolivariana, Medellín, Colombia
| | - María Angélica Maya
- Unidad de Enfermedades Infecciosas, Hospital Universitario San Vicente Fundación, Medellín, Colombia
| | - Lucelly López
- Facultad de Medicina, Universidad Pontificia Bolivariana, Medellin, Colombia
| | - Andrea Restrepo
- Departamento de Pediatría, Hospital Pablo Tobón Uribe, Medellín, Colombia.,Departamento de Pediatría, Universidad CES, Medellín, Colombia
| | - Carlos Garcés
- Departamento de Pediatría y Puericultura, Grupo Pediaciencias, Universidad de Antioquia UdeA, Medellín, Colombia
| | - Olga Morales
- Departamento de Pediatría y Puericultura, Grupo Pediaciencias, Universidad de Antioquia UdeA, Medellín, Colombia.,Departamento de Pediatría, Hospital Universitario San Vicente Fundación, Medellín, Colombia
| | - Claudia Roya-Pabón
- Departamento de Pediatría y Puericultura, Grupo Pediaciencias, Universidad de Antioquia UdeA, Medellín, Colombia.,Departamento de Pediatría, Hospital Universitario San Vicente Fundación, Medellín, Colombia.,Tuberculosis Clinic, Pima County Health Department, Tucson, USA
| | - Mónica Trujillo
- Clínica Universitaria Bolivariana, Universidad Pontificia Bolivariana, Medellín, Colombia.,Departamento de Pediatría, Hospital Pablo Tobón Uribe, Medellín, Colombia.,Departamento de Pediatría, Universidad CES, Medellín, Colombia
| | - Catalina Arango
- Departamento de Pediatría y Puericultura, Grupo Pediaciencias, Universidad de Antioquia UdeA, Medellín, Colombia.,Departamento de Pediatría, Hospital Universitario San Vicente Fundación, Medellín, Colombia
| | - Ángela Rocio Copete
- Grupo Investigador de Problemas en Enfermedades Infecciosas (GRIPE), Facultad de Medicina, Universidad de Antioquia UdeA, Medellín, Colombia.,Laboratorio Integrado de Medicina Especializada, Universidad de Antioquia UdeA, IPS Universitaria, Medellin, Colombia
| | - Cristian Vera
- Facultad de Medicina, Universidad Pontificia Bolivariana, Medellin, Colombia
| | - Margarita Rosa Giraldo
- Secretaría Seccional de Salud y Protección Social de Antioquia, Gobernación de Antioquia, Medellín, Colombia
| | - Mariana Herrera
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Canada
| | - Lázaro A Vélez
- Grupo Investigador de Problemas en Enfermedades Infecciosas (GRIPE), Facultad de Medicina, Universidad de Antioquia UdeA, Medellín, Colombia.,Unidad de Enfermedades Infecciosas, Hospital Universitario San Vicente Fundación, Medellín, Colombia
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Liu YC, Cheng HY, Chang TH, Ho TW, Liu TC, Yen TY, Chou CC, Chang LY, Lai F. Evaluation of the Need for Intensive Care in Children With Pneumonia: Machine Learning Approach. JMIR Med Inform 2022; 10:e28934. [PMID: 35084358 PMCID: PMC8832265 DOI: 10.2196/28934] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 07/01/2021] [Accepted: 01/02/2022] [Indexed: 01/20/2023] Open
Abstract
Background Timely decision-making regarding intensive care unit (ICU) admission for children with pneumonia is crucial for a better prognosis. Despite attempts to establish a guideline or triage system for evaluating ICU care needs, no clinically applicable paradigm is available. Objective The aim of this study was to develop machine learning (ML) algorithms to predict ICU care needs for pediatric pneumonia patients within 24 hours of admission, evaluate their performance, and identify clinical indices for making decisions for pediatric pneumonia patients. Methods Pneumonia patients admitted to National Taiwan University Hospital from January 2010 to December 2019 aged under 18 years were enrolled. Their underlying diseases, clinical manifestations, and laboratory data at admission were collected. The outcome of interest was ICU transfer within 24 hours of hospitalization. We compared clinically relevant features between early ICU transfer patients and patients without ICU care. ML algorithms were developed to predict ICU admission. The performance of the algorithms was evaluated using sensitivity, specificity, area under the receiver operating characteristic curve (AUC), and average precision. The relative feature importance of the best-performing algorithm was compared with physician-rated feature importance for explainability. Results A total of 8464 pediatric hospitalizations due to pneumonia were recorded, and 1166 (1166/8464, 13.8%) hospitalized patients were transferred to the ICU within 24 hours. Early ICU transfer patients were younger (P<.001), had higher rates of underlying diseases (eg, cardiovascular, neuropsychological, and congenital anomaly/genetic disorders; P<.001), had abnormal laboratory data, had higher pulse rates (P<.001), had higher breath rates (P<.001), had lower oxygen saturation (P<.001), and had lower peak body temperature (P<.001) at admission than patients without ICU transfer. The random forest (RF) algorithm achieved the best performance (sensitivity 0.94, 95% CI 0.92-0.95; specificity 0.94, 95% CI 0.92-0.95; AUC 0.99, 95% CI 0.98-0.99; and average precision 0.93, 95% CI 0.90-0.96). The lowest systolic blood pressure and presence of cardiovascular and neuropsychological diseases ranked in the top 10 in both RF relative feature importance and clinician judgment. Conclusions The ML approach could provide a clinically applicable triage algorithm and identify important clinical indices, such as age, underlying diseases, abnormal vital signs, and laboratory data for evaluating the need for intensive care in children with pneumonia.
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Affiliation(s)
- Yun-Chung Liu
- Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei City, Taiwan.,Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei City, Taiwan
| | - Hao-Yuan Cheng
- Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei City, Taiwan.,Taiwan Centers for Disease Control, Taipei City, Taiwan
| | - Tu-Hsuan Chang
- Department of Pediatrics, Chi Mei Medical Center, Tainan City, Taiwan
| | - Te-Wei Ho
- Department of Surgery, College of Medicine, National Taiwan University, Taipei City, Taiwan
| | - Ting-Chi Liu
- Institute of Applied Mechanics, National Taiwan University, Taipei City, Taiwan.,Department of Civil Engineering, National Taiwan University, Taipei City, Taiwan
| | - Ting-Yu Yen
- Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei City, Taiwan
| | - Chia-Ching Chou
- Institute of Applied Mechanics, National Taiwan University, Taipei City, Taiwan
| | - Luan-Yin Chang
- Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei City, Taiwan
| | - Feipei Lai
- Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei City, Taiwan.,Department of Computer Science and Information Engineering, National Taiwan University, Taipei City, Taiwan.,Department of Electrical Engineering, National Taiwan University, Taipei City, Taiwan
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Epidemiology and clinical manifestations of children with macrolide-resistant Mycoplasma pneumoniae pneumonia in Southern Taiwan. Pediatr Neonatol 2021; 62:536-542. [PMID: 34147432 DOI: 10.1016/j.pedneo.2021.05.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 05/04/2021] [Accepted: 05/20/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Mycoplasma pneumoniae is a pneumonia-causing pathogen commonly found in pediatric patients in Taiwan. Recently, macrolide-resistant (MR) strains have been emerging globally. The prevalence of pneumonia due to MR-M. pneumoniae (hereafter, MPP) in northern Taiwan before 2017 has been reported to be 12.3-24%. The prevalence of MR-MPP within a specific location can vary. Hence, we investigated the prevalence of MR-MPP in southern Taiwan. METHODS Eighty-one children with PCR-confirmed MPP were enrolled between July 2016 and June 2019. They were assigned to macrolide-sensitive (MS) and MR groups based on their PCR results, and their clinical manifestations and laboratory data were compared. RESULTS The proportions of patients with MS-MPP and MR-MPP varied with time. The average ratio of the proportion of MR-MPP was 54.3% in this study. Patients with MR-MPP had lower neutrophil counts, higher lymphocyte counts, and higher platelet counts than those with MS-MPP. In contrast with the 40% of the MR-MPP group that still had a fever after three days of azithromycin treatment, only 11.8% of the MS-MPP group still had a fever. CONCLUSION Our study provided valuable epidemiological survey information for children with MR-MPP in southern Taiwan. The prevalence of MR-MPP was different from that reported in previous studies in northern Taiwan. Specific MR strains should be considered in children with MPP if they still have a fever after three days of macrolide treatment.
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Su M, Wang Q, Li D, Wang LL, Wang CY, Wang JL, Zhang Q, Du LY, Liu JY, Xie GC. Prevalence and clinical characteristics of hospitalized children with community-acquired Mycoplasma pneumoniae pneumonia during 2017/2018, Chengde, China. Medicine (Baltimore) 2021; 100:e23786. [PMID: 33592835 PMCID: PMC7870167 DOI: 10.1097/md.0000000000023786] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 11/13/2020] [Indexed: 01/05/2023] Open
Abstract
Community acquired-pneumonia (CAP) has varying causative pathogens and clinical characteristics. This study investigated the prevalence of Mycoplasma pneumoniae (M pneumoniae) and evaluated the clinical characteristics in infected hospitalized children by disease severity.From throat swabs of hospitalized children (5 months to 14 years) with CAP collected between November 2017 and May 2018, M pneumoniae and other CAP pathogens were identified using polymerase chain reaction (PCR). Differences in clinical and laboratory test data were compared between severe and mild case groups.Of 333 hospitalized children enrolled, 221/333 (66.4%) tested positive for M pneumoniae and 24/221 (10.9%) patients were (n = 9, aged <5 years vs n = 15, ≥5 years) single infection by PCR, however, only 170/333 (51.1%) patients were presented with M pneumoniae IgM-positive. M pneumoniae detection rate by PCR was higher than by immunoglobulin (IgM) serology. In 123/221 (55.7%) M pneumoniae infected patients, coinfection with bacterial pathogens (n = 61, <5 years vs n = 62, ≥5 years) occurred. Children (aged 3-8 years) had most M pneumoniae infection. Severe M pneumoniae pneumonia (MPP) in children occurred mostly in older age (7 [interquartile ranges {IQR}, 6-8] years; P < .0001), with longer cough days (14 [IQR, 10-19.5] days; P = .002) and hospitalization duration (9.5 [IQR, 7-12.3] days; P < .0001), lower lymphocyte ratio (24.1, [IQR, 20.0-31.1] %; P = .001), higher neutrophils ratio (66.0, [IQR, 60.2-70.3]%; P < .0001), and serum C-reactive protein (CRP) level (3.8, [IQR, 1.3-10.9] mg/L; P = .027).M pneumoniae is the most commonly detected pathogen in CAP. High coinfection prevalence increases diagnosis difficulty by clinically nonspecific characteristics. M pneumoniae detection by PCR with IgM may improve precise and reliable diagnosis of community-acquired MPP.
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Affiliation(s)
- Meng Su
- Department of Pathogenic Biology
| | - Qian Wang
- Department of Respiratory, Children′s Hospital of Hebei Province, Shijiazhuang
| | - Dan Li
- Department of Pathogenic Biology
| | - Ling-Ling Wang
- Department of Preventive Medicine, Chengde Medical University
| | - Chun-Yang Wang
- Clinical Medical College, Xi’an Medical University, Xi’an
| | - Jiang-Li Wang
- Chengde Center for Disease Control and Prevention, Department of Microbiology Laboratory
| | - Qing Zhang
- Chinese Center for Viral Disease Control and Prevention, National Institute for Viral Disease Control and Prevention, Beijing
| | | | - Jian-Ying Liu
- Department of Pediatrics, NO.2 Clinical Teaching Hospital Affiliated to Chengde Medical University, Chengde, China
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Tsai TA, Tsai CK, Kuo KC, Yu HR. Rational stepwise approach for Mycoplasma pneumoniae pneumonia in children. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2020; 54:557-565. [PMID: 33268306 DOI: 10.1016/j.jmii.2020.10.002] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 10/04/2020] [Accepted: 10/08/2020] [Indexed: 01/14/2023]
Abstract
Mycoplasma pneumoniae is a common pathogen that causes community-acquired pneumonia. In the past, M. pneumoniae was sensitive to macrolide antibiotics, and M. pneumoniae pneumonia (MPP) was usually a benign and self-limiting disease. However, despite use of the appropriate antibiotics, persistent fever and clinical deterioration may occur, leading to severe disease. Two major complicated conditions that may be clinically encountered are macrolide-resistant MPP and refractory MPP. Regarding the epidemics in Taiwan, before 2017, the mean rate of macrolide resistance was below 30%. Notably, since 2018, the prevalence of macrolide-resistant MPP in Taiwan has increased rapidly. Macrolide-resistant MPP shows persistent fever and/or no radiological regression to macrolide antibiotics and may even progress to severe and complicated pneumonia. Tetracyclines (doxycycline or minocycline) or fluoroquinolones are alternative treatments for macrolide-resistant MPP. Refractory MPP is characterized by an excessive immune response against the pathogen. In this context, corticosteroids have been suggested as an immunomodulator for downregulating the overactive host immune reaction. Overuse of macrolides may contribute to macrolide resistance, and thereafter, an increase in macrolide-resistant MPP. Delayed effective antimicrobial treatment is associated with prolonged and/or more severe disease. Thus, the appropriate prescription of antibiotics, as well as the rapid and accurate diagnosis of MPP, is important. The exact starting point, dose, and duration of the immunomodulator are yet to be established. We discuss these important issues in this review.
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Affiliation(s)
- Ti-An Tsai
- Department of Pediatrics, Chang Gung Memorial Hospital-Kaohsiung Medical Center; Graduate Institute of Clinical Medical Science, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chang-Ku Tsai
- Department of Pediatrics, Chang Gung Memorial Hospital-Kaohsiung Medical Center; Graduate Institute of Clinical Medical Science, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Kuang-Che Kuo
- Department of Pediatrics, Chang Gung Memorial Hospital-Kaohsiung Medical Center; Graduate Institute of Clinical Medical Science, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hong-Ren Yu
- Department of Pediatrics, Chang Gung Memorial Hospital-Kaohsiung Medical Center; Graduate Institute of Clinical Medical Science, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
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Clonal spread of macrolide-resistant Mycoplasma pneumoniae sequence type-3 and type-17 with recombination on non-P1 adhesin among children in Taiwan. Clin Microbiol Infect 2020; 27:1169.e1-1169.e6. [PMID: 33010445 DOI: 10.1016/j.cmi.2020.09.035] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 09/02/2020] [Accepted: 09/18/2020] [Indexed: 01/19/2023]
Abstract
OBJECTIVES Mycoplasma pneumoniae is currently the most commonly detected bacterial cause of childhood community-acquired pneumonia in several countries. Of note, clonal expansion of macrolide-resistant ST3 occurred in Japan and South Korea. An alarming surge in macrolide resistance complicates the treatment of pneumonia. We aimed to evaluate the clinical manifestation and clonal relatedness of M. pneumoniae circulating among children in Taiwan. METHODS We prospectively enrolled 626 children with radiologically confirmed pneumonia between 2017 and 2019. An M. pneumoniae infection was suspected on clinical grounds, and tested by real-time PCR and oropharyngeal swab cultures. We used multilocus sequence typing and whole-genome sequencing to characterize the genetic features of M. pneumoniae. RESULTS A total of 226 children with M. pneumoniae pneumonia were enrolled. Macrolide resistance was found in 77% (174/226) of patients. Multi-locus sequence typing revealed that ST3 (n = 93) and its single-locus variant ST17 (n = 84) were the predominant clones among macrolide-resistant strains. ST17 presented clinical characteristics comparable to its ancestor ST3. On multivariate analysis, macrolide resistance (OR 3.5; 95% CI 1.4-8.5; p 0.007) was independently associated with fever >72 hours after macrolide treatment. By whole-genome sequencing, prediction analysis of recombination sites revealed one recombination site in ST3 and ST17 compared with M29 (a macrolide-sensitive ST3 strain isolated from China in 2005) containing cytadhesin MgpC-like protein, RepMP4 and RepMP5. ST17 had another recombination site containing an adhesin and RepMP2/3. CONCLUSIONS In addition to macrolide resistance, ST3 and its ST17 variant might evolve through recombination between repetitive sequences and non-P1 cytadhesins for persistent circulation in Taiwan.
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Lee KL, Lee CM, Yang TL, Yen TY, Chang LY, Chen JM, Lee PI, Huang LM, Lu CY. Severe Mycoplasma pneumoniae pneumonia requiring intensive care in children, 2010-2019. J Formos Med Assoc 2020; 120:281-291. [PMID: 32948415 DOI: 10.1016/j.jfma.2020.08.018] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 07/30/2020] [Accepted: 08/09/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND/PURPOSE Despite the high prevalence of Mycoplasma pneumoniae infections, reports on severe life-threatening M. pneumoniae pneumonia (MPP) in children are limited. METHODS We retrospectively enrolled pediatric patients with PCR-positive MPP requiring ICU admission in a children's hospital in Taipei, Taiwan from Jun 2010 to October 2019. Clinical manifestations and laboratory data of severe MPP were analyzed. Macrolide susceptibility was determined by genotyping, and its relationship with clinical manifestations was also analyzed. RESULTS Approximately 5% (34/658) children hospitalized for MPP required ICU admission. Compared with non-ICU cases (n = 291), ICU cases (n = 34) were associated with more underlying conditions, more pleural effusion, longer fever duration, longer hospital stay, the requirement of second-line antibiotic treatment, and delayed effective and second-line antibiotic treatment. Macrolide resistance was similar in ICU and non-ICU groups (53% vs 53%; p = 0.986). In severe MPP, patients requiring endotracheal intubation were associated with more septic shock, empyema, ARDS, prolonged fever after effective antibiotic treatment, delayed second-line and effective antibiotic treatment. In 18 of the 22 patients with pleural fluid analysis, the pleural effusion was alkaline (pH > 7.7) and lymphocyte-predominant. CONCLUSION M. pneumoniae infection can cause severe life-threatening pneumonia in children. Delayed effective and second-line antibiotic treatments are associated with severe life-threatening MPP.
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Affiliation(s)
- Kuan-Lin Lee
- Division of Pediatric Infectious Diseases, Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Chieh-Ming Lee
- Division of Pediatric Infectious Diseases, Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan; Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Te-Liang Yang
- Division of Pediatric Infectious Diseases, Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Ting-Yu Yen
- Division of Pediatric Infectious Diseases, Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Luan-Yin Chang
- Division of Pediatric Infectious Diseases, Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Jong-Min Chen
- Division of Pediatric Infectious Diseases, Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Ping-Ing Lee
- Division of Pediatric Infectious Diseases, Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Li-Min Huang
- Division of Pediatric Infectious Diseases, Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Chun-Yi Lu
- Division of Pediatric Infectious Diseases, Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan.
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Characteristics and etiology of hospitalized pediatric community-acquired pneumonia in Taiwan. J Formos Med Assoc 2020; 119:1490-1499. [PMID: 32682702 PMCID: PMC7363436 DOI: 10.1016/j.jfma.2020.07.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 06/24/2020] [Accepted: 07/09/2020] [Indexed: 11/20/2022] Open
Abstract
Background/purpose The purpose of this study was to determine the pathogens and to estimate the incidence of pediatric community-acquired pneumonia (CAP) in Taiwan. Methods This prospective study was conducted at eight medical centers from November 2010 to September 2013. Children aged 6 weeks to 18 years who met the radiologic criteria for pneumonia were enrolled. To detect classical and atypical bacteria and viruses, blood and pleural fluids were cultured, and respiratory specimens were examined by multiple conventional and molecular methods. Results At least one potential pathogen was identified in 705 (68.3%) cases of 1032 children enrolled, including bacteria in 420 (40.7%) cases, virus in 180 (17.4%) cases, and mixed viral-bacterial infection in 105 (10.2%) cases. Streptococcus pneumoniae (31.6%) was the most common pathogen, followed by Mycoplasma pneumoniae (22.6%). Adenovirus (5.9%) was the most common virus. RSV was significantly associated with children aged under 2 years, S. pneumoniae in children aged between 2 and 5 years, and M. pneumoniae in children aged >5 years. The annual incidence rate of hospitalization for CAP was highest in children aged 2–5 years (229.7 per 100,000). From 2011 to 2012, significant reduction in hospitalization rates pertained in children under 5 years of age, in pneumonia caused by pneumococcus, adenovirus or co-infections and complicated pneumonia. Conclusion CAP related pathogens have changed after increased conjugated pneumococcal vaccination rates. This study described the latest incidences and trends of CAP pathogens, which are crucial for prompt delivery of appropriate therapy.
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Xu Y, Li S, Liu J, Zhou J, Jin F, Chen X, Wang Y, Jiang Y, Chen Z. Impact of Epstein-Barr virus coinfection in Mycoplasma pneumoniae pneumonia. Medicine (Baltimore) 2020; 99:e19792. [PMID: 32311992 PMCID: PMC7440268 DOI: 10.1097/md.0000000000019792] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Mycoplasma pneumoniae (MP) is one of the most common pathogens of respiratory infection in children, while Epstein-Barr virus (EBV) infection is usually subclinical in immunocompetent children. Although single MP infection is common enough, MP and EBV coinfection have received little attention. Especially, the pathogenic role of EBV in lung when coinfection with MP, has not been clarified. The purpose of this study was to investigate the impact of EBV on MP pneumonia (MPP) in hospitalized children. We retrospectively reviewed the clinical data of MPP children who underwent screening for EBV by polymerase chain reaction in bronchoalveolar lavage fluid during hospitalization in 2014. Of total 147 patients, 68 patients were in the MP group and 79 were in the MP/EBV coinfection group. We found longer fever duration and higher CRP, IgA, IgG, interleukin-2 (IL-2), percentage of peripheral neutrophils levels, higher incidence of pulmonary consolidation and percentage of refractory MPP in coinfection group, when compared to those in MP group. In ROC curve analysis, IL-2 was useful for differentiating patients with coinfection from those with MP infection. Logistic regression analysis showed that the IL-2 ≥ 3.35 pg/ml (OR = 3.677) was a significant predictor regarding to MP/EBV coinfection. In conclusion, coinfection of EBV and MP poses a higher risk for prolonged symptoms. IL-2 could be used as a good predictor of coinfection.
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Affiliation(s)
- Yingchun Xu
- Department of Pulmonology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou
| | - Shuxian Li
- Department of Pulmonology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou
| | - Jinling Liu
- Department of Pulmonology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou
| | - Junfen Zhou
- Department of Pulmonology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou
- Department of Pediatrics, Wenling Maternal and Child Health Care Hospital, Wenling
| | - Fang Jin
- Department of Pulmonology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou
| | - Xiaoyang Chen
- Department of Developmental and Behavioral, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, China
| | - Yingshuo Wang
- Department of Pulmonology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou
| | - Yuan Jiang
- Department of Pulmonology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou
| | - Zhimin Chen
- Department of Pulmonology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou
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Zhao MC, Wang L, Qiu FZ, Zhao L, Guo WW, Yang S, Feng ZS, Li GX. Impact and clinical profiles of Mycoplasma pneumoniae co-detection in childhood community-acquired pneumonia. BMC Infect Dis 2019; 19:835. [PMID: 31601192 PMCID: PMC6788033 DOI: 10.1186/s12879-019-4426-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 08/29/2019] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Increasing number of hospitalized children with community acquired pneumonia (CAP) is co-detected with Mycoplasma pneumoniae (Mp). The clinical characteristics and impact of Mp co-detected with other bacterial and/or viral pathogens remain poorly understood. The purpose of this study was to evaluate the demographic and clinical features of CAP children with Mp mono-detection and Mp co-detection. METHODS A total of 4148 hospitalized children with CAP were recruited from January to December 2017 at the Children's Hospital of Hebei Province, affiliated to Hebei Medical University. A variety of respiratory viruses, bacteria and Mp were detected using multiple modalities. The demographic and clinical features of CAP children with Mp mono-detection and Mp co-detection were recorded and analyzed. RESULTS Among the 110 CAP children with Mp positive, 42 (38.18%) of them were co-detected with at least one other pathogen. Co-detection was more common among children aged ≤3 years. No significant differences were found in most clinical symptoms, complications, underlying conditions and disease severity parameters among various etiological groups, with the following exceptions. First, prolonged duration of fever, lack of appetite and runny nose were more prevalent among CAP children with Mp-virus co-detection. Second, Mp-virus (excluding HRV) co-detected patients were more likely to present with prolonged duration of fever. Third, patients co-detected with Mp-bacteria were more likely to have abnormal blood gases. Additionally, CAP children with Mp-HRV co-detection were significantly more likely to report severe runny nose compared to those with Mp mono-detection. CONCLUSION Mp co-detection with viral and/or bacterial pathogens is common in clinical practice. However, there are no apparent differences between Mp mono-detection and Mp co-detections in terms of clinical features and disease severity.
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Affiliation(s)
- Meng-chuan Zhao
- Institute of Pediatric Research, Children’s Hospital of Hebei Province, affiliated to Hebei Medical University, 133 Jianhua South Street, Shijiazhuang, 050031 Hebei Province China
| | - Le Wang
- Institute of Pediatric Research, Children’s Hospital of Hebei Province, affiliated to Hebei Medical University, 133 Jianhua South Street, Shijiazhuang, 050031 Hebei Province China
| | - Fang-zhou Qiu
- Graduate School of Hebei Medical University, 361 Zhongshan East Road, Shijiazhuang, 050017 Hebei Province China
| | - Li Zhao
- Graduate School of Hebei Medical University, 361 Zhongshan East Road, Shijiazhuang, 050017 Hebei Province China
| | - Wei-wei Guo
- Institute of Pediatric Research, Children’s Hospital of Hebei Province, affiliated to Hebei Medical University, 133 Jianhua South Street, Shijiazhuang, 050031 Hebei Province China
| | - Shuo Yang
- Institute of Pediatric Research, Children’s Hospital of Hebei Province, affiliated to Hebei Medical University, 133 Jianhua South Street, Shijiazhuang, 050031 Hebei Province China
| | - Zhi-shan Feng
- Department of Laboratory Medicine, People’s Hospital of Hebei Province, 384 Heping West Road, Shijiazhuang, 050051 Hebei Province China
| | - Gui-xia Li
- Institute of Pediatric Research, Children’s Hospital of Hebei Province, affiliated to Hebei Medical University, 133 Jianhua South Street, Shijiazhuang, 050031 Hebei Province China
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Chou CC, Shen CF, Chen SJ, Chen HM, Wang YC, Chang WS, Chang YT, Chen WY, Huang CY, Kuo CC, Li MC, Lin JF, Lin SP, Ting SW, Weng TC, Wu PS, Wu UI, Lin PC, Lee SSJ, Chen YS, Liu YC, Chuang YC, Yu CJ, Huang LM, Lin MC. Recommendations and guidelines for the treatment of pneumonia in Taiwan. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2019; 52:172-199. [PMID: 30612923 DOI: 10.1016/j.jmii.2018.11.004] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 11/27/2018] [Accepted: 11/28/2018] [Indexed: 01/19/2023]
Abstract
Pneumonia is a leading cause of death worldwide, ranking third both globally and in Taiwan. This guideline was prepared by the 2017 Guidelines Recommendations for Evidence-based Antimicrobial agents use in Taiwan (GREAT) working group, formed under the auspices of the Infectious Diseases Society of Taiwan (IDST). A consensus meeting was held jointly by the IDST, Taiwan Society of Pulmonary and Critical Care Medicine (TSPCCM), the Medical Foundation in Memory of Dr. Deh-Lin Cheng, the Foundation of Professor Wei-Chuan Hsieh for Infectious Diseases Research and Education and CY Lee's Research Foundation for Pediatric Infectious Diseases and Vaccines. The final guideline was endorsed by the IDST and TSPCCM. The major differences between this guideline and the 2007 version include the following: the use of GRADE methodology for the evaluation of available evidence whenever applicable, the specific inclusion of healthcare-associated pneumonia as a category due to the unique medical system in Taiwan and inclusion of recommendations for treatment of pediatric pneumonia. This guideline includes the epidemiology and recommendations of antimicrobial treatment of community-acquired pneumonia, hospital-acquired pneumonia, ventilator-associated pneumonia, healthcare-associated pneumonia in adults and pediatric pneumonia.
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Affiliation(s)
- Chih-Chen Chou
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Ching-Fen Shen
- Division of Infectious Diseases, Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Su-Jung Chen
- Division of Infectious Diseases, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Faculty of Medicine, School of Medicine, National Yang Ming University, Taipei, Taiwan
| | - Hsien-Meng Chen
- Division of Infectious Diseases, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan
| | - Yung-Chih Wang
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Wei-Shuo Chang
- Division of Infectious Diseases, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Ya-Ting Chang
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Chung-Ho Memorial Hospital, Kaohsiung, Taiwan
| | - Wei-Yu Chen
- Division of Infectious Diseases, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Ching-Ying Huang
- Department of Pediatrics, MacKay Children's Hospital and MacKay Memorial Hospital, Taipei, Taiwan
| | - Ching-Chia Kuo
- Division of Infectious Diseases and Pediatric General Medicine, Department of Pediatrics, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Ming-Chi Li
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Jung-Fu Lin
- Division of Infectious Diseases, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Shih-Ping Lin
- Division of Infectious Diseases, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Shih-Wen Ting
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Tzu-Chieh Weng
- Division of Holistic Care Unit, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Ping-Sheng Wu
- Division of Infectious Diseases, Department of Pediatrics, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan
| | - Un-In Wu
- Division of Infectious Diseases, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Pei-Chin Lin
- Department of Medical Education and Research, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Department of Pharmacy, School of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Susan Shin-Jung Lee
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Faculty of Medicine, School of Medicine, National Yang Ming University, Taipei, Taiwan.
| | - Yao-Shen Chen
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Faculty of Medicine, School of Medicine, National Yang Ming University, Taipei, Taiwan
| | - Yung-Ching Liu
- Division of Infectious Diseases, Taipei Medical University Shuang Ho Hospital, Taipei, Taiwan
| | - Yin-Ching Chuang
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan
| | - Chong-Jen Yu
- National Taiwan University College of Medicine and National Taiwan University Hospital, Taipei, Taiwan
| | - Li-Ming Huang
- Division of Pediatric Infectious Diseases, Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Meng-Chih Lin
- Division of Pulmonary and Critical Care Medicine, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung, Taiwan
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Kurade A, Dhanawade S, Shetti S. Induced Sputum as a Diagnostic Tool in Pneumonia in Under Five Children-A Hospital-based Study. J Trop Pediatr 2018; 64:510-515. [PMID: 29415185 DOI: 10.1093/tropej/fmx106] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The objective of this articlewas to study the success, tolerability of sputum induction and the bacterial isolates of induced sputum in children aged <5 years. METHODS The cross-sectional study included 120 hospitalized children aged 1-59 months meeting WHO criteria for pneumonia. Sputum induction was performed using hypertonic (3%) saline. RESULTS Mean age of the subjects was 19.5 months (2-59 months). Overall success of sputum induction was 53.3% and highest (64.28%) in 37-59 months age group. Adverse events such as tachypnea, hypoxemia (SpO2 <90) and vomiting were observed in 41.6, 17.5 and 15.8%, respectively. A potential pathogen was isolated in 45 (70.3%) of 64 cases with good quality sputum. Klebsiella pneumoniae was the commonest (38.2%) followed by Streptococcus pneumoniae (14.8%) and others. CONCLUSION Sputum induction in young children is safe and feasible in Indian settings. While the success was limited, bacterial yield was high.
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Affiliation(s)
- Aditya Kurade
- Department of Pediatrics, Bharati Vidyapeeth Deemed University Medical College and Hospital, Sangli, Maharashtra 416416, India
| | - Sara Dhanawade
- Department of Pediatrics, Bharati Vidyapeeth Deemed University Medical College and Hospital, Sangli, Maharashtra 416416, India
| | - Sachin Shetti
- Department of Physiotherapy, Bharati Vidyapeeth Deemed University Medical College and Hospital, Sangli, Maharashtra 416416, India
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Yang TI, Chang TH, Lu CY, Chen JM, Lee PI, Huang LM, Chang LY. Mycoplasma pneumoniae in pediatric patients: Do macrolide-resistance and/or delayed treatment matter? JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2018; 52:329-335. [PMID: 30341022 DOI: 10.1016/j.jmii.2018.09.009] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 09/03/2018] [Accepted: 09/18/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Mycoplasma pneumoniae is a common pathogen for pneumonia in children, especially in the post-pneumococcal conjugate vaccination era. Though self-limited disease was found in the majority of the patients, severe diseases occurred occasionally. The emergence of macrolide resistance was reported worldwide. It is important to delineate whether macrolide resistance or delayed treatment affects outcome. METHODS We retrospectively collected pediatric patients with M. pneumoniae infection confirmed by positive PCR in a tertiary medical center in Taiwan from 2010 to 2017. Patients' clinical characteristics, bacterial load, macrolide resistance and treatment outcome were analyzed. RESULTS Among 471 children with positive M. pneumoniae PCR, 95% were diagnosed with pneumonia. Seventeen percent of patients had extrapulmonary complications, and 1.5% had respiratory failure. Delayed treatment was associated with prolonged fever after appropriate treatment, fulminant disease, and extrapulmonary manifestations (p < 0.05). The mean rate of macrolide resistance was 24% and macrolide resistance was related to longer febrile duration, longer hospital stay, lung consolidation and impaired liver function tests (P < 0.05). CONCLUSIONS Macrolide resistance was fairly common and might lead to delayed appropriate antibiotic treatment. Delayed appropriate antimicrobial treatment, no matter macrolide resistance or not, was associated with more severe and/or prolonged diseases. Early diagnosis of M. pneumoniae as well as the awareness of macrolide resistance make early effective antibiotic treatment possible and may improve clinical outcomes.
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Affiliation(s)
- Tzu-I Yang
- Division of Pediatric Infectious Diseases, Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Tu-Hsuan Chang
- Department of Pediatrics, Chi-Mei Medical Center, Tainan, Taiwan
| | - Chun-Yi Lu
- Division of Pediatric Infectious Diseases, Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Jong-Min Chen
- Division of Pediatric Infectious Diseases, Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Ping-Ing Lee
- Division of Pediatric Infectious Diseases, Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Li-Min Huang
- Division of Pediatric Infectious Diseases, Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Luan-Yin Chang
- Division of Pediatric Infectious Diseases, Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan.
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Yu-Qing W, Chuang-Li H, Wei J, Zheng-Rong C, Xin-Xin Z, Wen-Jing G. Etiology and Clinical Characteristics of Community-Acquired Pneumonia with Airway Malacia in Children. J Trop Pediatr 2018; 64:317-325. [PMID: 29036724 DOI: 10.1093/tropej/fmx071] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The objective of this article is to study the etiology of community-acquired pneumonia in children with airway malacia. METHODS We retrospectively reviewed the medical records of 428 pneumonia patients. All patients underwent bronchoscopy, and bronchoalveolar lavage samples were processed for microbiological assessment. RESULTS In a total of 428 cases reviewed, 60 were found to have airway malacia. Pathogens were identified in 44 of the 60 specimens (73.3%), with 32 being single-pathogen infections. The most common pathogen was respiratory syncytial virus (RSV; 20%). Mixed-pathogen infections were observed in 12 patients. Airway malacia patients were younger than those without malacia (10.5 vs. 50 months, respectively; p < 0.001). Compared with those without airway malacia, wheezing, cyanosis and admission to the pediatric intensive care unit were more common in children with airway malacia and their hospital stay was longer. CONCLUSION RSV was the most common pathogen in those with airway malacia. Airway malacia was found to aggravate infectious pneumonia.
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Affiliation(s)
- Wang Yu-Qing
- Department of Respiratory Disease, Children's Hospital Soochow University, Suzhou 215003, China
| | - Hao Chuang-Li
- Department of Respiratory Disease, Children's Hospital Soochow University, Suzhou 215003, China
| | - Ji Wei
- Department of Respiratory Disease, Children's Hospital Soochow University, Suzhou 215003, China
| | - Chen Zheng-Rong
- Department of Respiratory Disease, Children's Hospital Soochow University, Suzhou 215003, China
| | - Zhang Xin-Xin
- Department of Respiratory Disease, Children's Hospital Soochow University, Suzhou 215003, China
| | - Gu Wen-Jing
- Department of Respiratory Disease, Children's Hospital Soochow University, Suzhou 215003, China
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Oumei H, Xuefeng W, Jianping L, Kunling S, Rong M, Zhenze C, Li D, Huimin Y, Lining W, Zhaolan L, Xinmin L, Hua X, Zhiyan J, Yanning L, Yan H, Baoqing Z, Xiaochun F, Chunhui H, Yonghong J, Xue Z, Wei W, Zi W. Etiology of community-acquired pneumonia in 1500 hospitalized children. J Med Virol 2017; 90:421-428. [PMID: 28975629 PMCID: PMC7166354 DOI: 10.1002/jmv.24963] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Revised: 07/28/2017] [Accepted: 09/01/2017] [Indexed: 12/11/2022]
Abstract
Childhood community‐acquired pneumonia (CAP) is a common illness; however, comprehensive studies of hospitalizations for CAP among children in China based on prospective and multicenter data collection are limited. The aim of this investigation was to determine the respiratory pathogens responsible for CAP in hospitalized children. From January to December 2015, oropharyngeal swabs and blood serum were collected from hospitalized children with CAP symptoms ranging in age from 6 months to 14 years at 10 hospitals across China. We used immunofluorescence to detect antibodies for eight respiratory viruses and passive agglutination to detect specific IgM against Mycoplasma pneumoniae (M. pneumoniae). Of 1500 children presenting with CAP, 691 (46.1%) tested positive for at least one pathogen (virus or M. pneumoniae). M. pneumoniae (32.4%) was detected most frequently, followed by respiratory syncytial virus (11.5%), adenovirus (5.0%), influenza A virus (4.1 %), influenza B virus (3.4%), parainfluenza virus types 2 and 3 type (3.1 %), parainfluenza virus type 1 (2.9%), and human metapneumovirus (0.3%). Co‐infections were identified in 128 (18.5%) of the 691 cases. These data provide a better understanding of viral etiology and M. pneumoniae in CAP in children between 6 months and 14 years in China. More study of the etiologic investigations that would further aid the management of pneumonia is required. With effective immunization for RSV, ADV, and M. pneumoniae infections, more than one‐half of the pneumonia cases in this study could have been prevented.
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Affiliation(s)
- Hao Oumei
- Affiliated Hospital to Liaoning University Traditional Chinese Medicine, Shenyang, China
| | - Wang Xuefeng
- Affiliated Hospital to Liaoning University Traditional Chinese Medicine, Shenyang, China
| | - Liu Jianping
- Evidence-Based Medicine Centre, Beijing University of Chinese Medicine, Beijing, China
| | - Shen Kunling
- Beijing Children's Hospital to Capital Medical University, Beijing, China
| | - Ma Rong
- Affiliated Hospital to Tianjin University Traditional Chinese Medicine, Tianjin, China
| | - Cui Zhenze
- Dalian Children's Hospital, Dalian, China
| | - Deng Li
- Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Yan Huimin
- Beijing Children's Hospital to Capital Medical University, Beijing, China
| | - Wang Lining
- Affiliated Hospital to Guangxi University Traditional Chinese Medicine, Guangxi, China
| | - Liu Zhaolan
- Evidence-Based Medicine Centre, Beijing University of Chinese Medicine, Beijing, China
| | - Li Xinmin
- Affiliated Hospital to Tianjin University Traditional Chinese Medicine, Tianjin, China
| | - Xu Hua
- Affiliated Hospital to Guangzhou University Traditional Chinese Medicine, Guangzhou, China
| | - Jiang Zhiyan
- Long Hua Hospital to Shanghai University of Traditional Chinese, Shanghai, China
| | - Li Yanning
- Affiliated Hospital of Shandong University of Traditional Chinese, Shandong, China
| | - Huang Yan
- Dalian Children's Hospital, Dalian, China
| | - Zhang Baoqing
- Affiliated Hospital of Shandong University of Traditional Chinese, Shandong, China
| | - Feng Xiaochun
- Affiliated Hospital to Changchun University Traditional Chinese Medicine, Changchun, China
| | - He Chunhui
- Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Jiang Yonghong
- Long Hua Hospital to Shanghai University of Traditional Chinese, Shanghai, China
| | - Zhao Xue
- Affiliated Hospital to Liaoning University Traditional Chinese Medicine, Shenyang, China
| | - Wei Wei
- Affiliated Hospital to Liaoning University Traditional Chinese Medicine, Shenyang, China
| | - Wang Zi
- Affiliated Hospital to Liaoning University Traditional Chinese Medicine, Shenyang, China
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Invasive pneumococcal pneumonia caused by 13-valent pneumococcal conjugate vaccine types in children with different schedules. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2017; 51:199-206. [PMID: 29021105 DOI: 10.1016/j.jmii.2017.08.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 08/17/2017] [Accepted: 08/27/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND In Taiwan, the age group with the greatest incidence of invasive pneumococcal disease is 2-5 years of age, which is different from other countries. This study was conducted to identify risk factors and different 13-valent pneumococcal conjugate vaccine (PCV13) schedules associated with vaccine-type invasive pneumococcal pneumonia (IPP) despite prior vaccination. METHODS A case-control study was conducted prospectively between August 2012 and December 2015 at five participating medical centers. The study enrolled children <15 years of age who were admitted to one of the five medical centers for CAP. Blood samples and acute-phase serum specimens were collected and Streptococcus pneumoniae was identified by using a real-time polymerase-chain-reaction (RT-PCR) assay targeting the lytA gene. RESULTS A total of 25 children diagnosed with vaccine-type IPP and 124 controls were enrolled. Vaccine-type IPP occurred in 6 (28.6%), 14 (24.1%), and 5 (7.1%) children receiving vaccines on a not-age-appropriate schedule (n = 21), primary infant schedule (n = 58), and toddler catch-up schedule (n = 70) (P = 0.008), respectively. Of 25 children, the mean age at disease onset was 36 ± 11 months; serotype 19A was responsible for 84% (21/25). CONCLUSION After adjustment for confounding factors, the risk of vaccine-type IPP was significantly higher among children receiving vaccines on a not-age-appropriate schedule, or on a primary infant schedule, compared with children receiving vaccines on a toddler catch-up schedule. Duration of vaccine immunity should be investigated to direct strategies for maintaining individual and population immunity against pneumococcal disease.
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Huang Y, Fu L, Yang Y. Age-Related Vitamin D Deficiency Is Associated with the Immune Response in Children with Community-Acquired Pneumonia. J Nutr Sci Vitaminol (Tokyo) 2017; 63:1-7. [PMID: 28367920 DOI: 10.3177/jnsv.63.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
To investigate vitamin D status in children with community-acquired pneumonia (CAP) and explore the association between vitamin D deficiency and the immune response in CAP children, 77 children with CAP were retrospectively analyzed. The baseline characteristics of patients were obtained from medical records. Based on the blood samples collected during diagnosis of CAP, the routine blood examination results and proportions of lymphocyte subsets were assessed. There were 71.4% (55/77) of patients with vitamin D deficiency among CAP children. The serum 25(OH)D level significantly decreased with age. Patients with vitamin D deficiency had a significantly higher neutrophil percentage, but significantly lower lymphocyte percentage and count as well as proportion of CD19 positive lymphocytes (CD19+). Spearman's rho test further confirmed these positive correlations and negative correlations. Moreover, significant associations of vitamin D deficiency with age and the above immune markers were also confirmed by univariate logistic regression analysis. However, only age entered the backward stepwise regression model in multivariate analysis. Vitamin D status in CAP children was negatively associated with age. Age-related vitamin D deficiency may affect the immune response in children with CAP.
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Affiliation(s)
- Yun Huang
- Department of Pediatrics, Shanghai Xuhui Central Hospital/Shanghai Clinical Center, Chinese Academy of Sciences
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24
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Kim JH, Kim E, Kwon JH, Seo WH, Yoo Y, Choung JT, Song DJ. Clinical characteristics of respiratory viral coinfection in pediatric Mycoplasma pneumoniaepneumonia. ALLERGY ASTHMA & RESPIRATORY DISEASE 2017. [DOI: 10.4168/aard.2017.5.1.15] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Jong Hyun Kim
- Department of Pediatrics, Korea University College of Medicine, Seoul, Korea
| | - Eunji Kim
- Department of Pediatrics, Korea University College of Medicine, Seoul, Korea
| | - Jung Hyun Kwon
- Department of Pediatrics, Korea University College of Medicine, Seoul, Korea
| | - Won Hee Seo
- Department of Pediatrics, Korea University College of Medicine, Seoul, Korea
| | - Young Yoo
- Department of Pediatrics, Korea University College of Medicine, Seoul, Korea
- Environmental Health Center, Korea University Anam Hospital, Seoul, Korea
| | - Ji Tae Choung
- Department of Pediatrics, Korea University College of Medicine, Seoul, Korea
- Environmental Health Center, Korea University Anam Hospital, Seoul, Korea
| | - Dae Jin Song
- Department of Pediatrics, Korea University College of Medicine, Seoul, Korea
- Environmental Health Center, Korea University Anam Hospital, Seoul, Korea
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25
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Bacterial co-infection in hospitalized children with Mycoplasma pneumoniae pneumonia. Indian Pediatr 2016; 53:879-882. [DOI: 10.1007/s13312-016-0951-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Crotty MP, Meyers S, Hampton N, Bledsoe S, Ritchie DJ, Buller RS, Storch GA, Micek ST, Kollef MH. Epidemiology, Co-Infections, and Outcomes of Viral Pneumonia in Adults: An Observational Cohort Study. Medicine (Baltimore) 2015; 94:e2332. [PMID: 26683973 PMCID: PMC5058945 DOI: 10.1097/md.0000000000002332] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Advanced technologies using polymerase-chain reaction have allowed for increased recognition of viral respiratory infections including pneumonia. Co-infections have been described for several respiratory viruses, especially with influenza. Outcomes of viral pneumonia, including cases with co-infections, have not been well described. This was observational cohort study conducted to describe hospitalized patients with viral pneumonia including co-infections, clinical outcomes, and predictors of mortality. Patients admitted from March 2013 to November 2014 with a positive respiratory virus panel (RVP) and radiographic findings of pneumonia within 48 h of the index RVP were included. Co-respiratory infection (CRI) was defined as any organism identification from a respiratory specimen within 3 days of the index RVP. Predictors of in-hospital mortality on univariate analysis were evaluated in a multivariate model. Of 284 patients with viral pneumonia, a majority (51.8%) were immunocompromised. A total of 84 patients (29.6%) were found to have a CRI with 48 (57.6%) having a bacterial CRI. Viral CRI with HSV, CMV, or both occurred in 28 patients (33.3%). Fungal (16.7%) and other CRIs (7.1%) were less common. Many patients required mechanical ventilation (54%) and vasopressor support (36%). Overall in-hospital mortality was high (23.2%) and readmissions were common with several patients re-hospitalized within 30 (21.1%) and 90 days (36.7%) of discharge. Predictors of in-hospital mortality on multivariate regression included severity of illness factors, stem-cell transplant, and identification of multiple respiratory viruses. In conclusion, hospital mortality is high among adult patients with viral pneumonia and patients with multiple respiratory viruses identified may be at a higher risk.
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Affiliation(s)
- Matthew P Crotty
- From the Pharmacy St. Louis College of Pharmacy (STLCOP) (MPC); STLCOP and Dept of Pharmacy, Barnes-Jewish Hospital (DJR); STLCOP (SM); STLCOP and Dept of Pharmacy, Barnes-Jewish Hospital (STM); Center for Clinical Excellence, BJC Healthcare (NH); Department of Pediatrics, Washington University School of Medicine (RSB, GAS); and Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine (MHK)
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27
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Crotty MP, Meyers S, Hampton N, Bledsoe S, Ritchie DJ, Buller RS, Storch GA, Kollef MH, Micek ST. Impact of antibacterials on subsequent resistance and clinical outcomes in adult patients with viral pneumonia: an opportunity for stewardship. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2015; 19:404. [PMID: 26577540 PMCID: PMC4650137 DOI: 10.1186/s13054-015-1120-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 10/28/2015] [Indexed: 02/04/2023]
Abstract
Introduction Respiratory viruses are increasingly recognized as significant etiologies of pneumonia among hospitalized patients. Advanced technologies using multiplex molecular assays and polymerase-chain reaction increase the ability to identify viral pathogens and may ultimately impact antibacterial use. Method This was a single-center retrospective cohort study to evaluate the impact of antibacterials in viral pneumonia on clinical outcomes and subsequent multidrug-resistant organism (MDRO) infections/colonization. Patients admitted from March 2013 to November 2014 with positive respiratory viral panels (RVP) and radiographic findings of pneumonia were included. Patients transferred from an outside hospital or not still hospitalized 72 hours after the RVP report date were excluded. Patients were categorized based on exposure to systemic antibacterials: less than 3 days representing short-course therapy and 3 to 10 days being long-course therapy. Results A total of 174 patients (long-course, n = 67; short-course, n = 28; mixed bacterial-viral infection, n = 79) were included with most being immunocompromised (56.3 %) with active malignancy the primary etiology (69.4 %). Rhinovirus/Enterovirus (23 %), Influenza (19 %), and Parainfluenza (15.5 %) were the viruses most commonly identified. A total of 13 different systemic antibacterials were used as empiric therapy in the 95 patients with pure viral infection for a total of 466 days-of-therapy. Vancomycin (50.7 %), cefepime (40.3 %), azithromycin (40.3 %), meropenem (23.9 %), and linezolid (20.9 %) were most frequently used. In-hospital mortality did not differ between patients with viral pneumonia in the short-course and long-course groups. Subsequent infection/colonization with a MDRO was more frequent in the long-course group compared to the short-course group (53.2 vs 21.1 %; P = 0.027). Conclusion This study found that long-course antibacterial use in the setting of viral pneumonia had no impact on clinical outcomes but increased the incidence of subsequent MDRO infection/colonization.
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Affiliation(s)
- Matthew P Crotty
- Pharmacy Department, Barnes-Jewish Hospital, One Barnes Jewish Hospital Plaza, St. Louis, MO, 63110, USA.
| | - Shelby Meyers
- St. Louis College of Pharmacy, 4588 Parkview Place, St. Louis, MO, 63110, USA.
| | - Nicholas Hampton
- Center for Clinical Excellence, BJC Healthcare, 8300 Eager Road, St. Louis, MO, 63144, USA.
| | - Stephanie Bledsoe
- Department of Pediatrics, Washington University School of Medicine, 4523 Clayton Avenue, Campus Box 8116, St. Louis, MO, 63110, USA.
| | - David J Ritchie
- Pharmacy Department, Barnes-Jewish Hospital, One Barnes Jewish Hospital Plaza, St. Louis, MO, 63110, USA. .,St. Louis College of Pharmacy, 4588 Parkview Place, St. Louis, MO, 63110, USA.
| | - Richard S Buller
- Department of Pediatrics, Washington University School of Medicine, 4523 Clayton Avenue, Campus Box 8116, St. Louis, MO, 63110, USA.
| | - Gregory A Storch
- Department of Pediatrics, Washington University School of Medicine, 4523 Clayton Avenue, Campus Box 8116, St. Louis, MO, 63110, USA.
| | - Marin H Kollef
- Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, 4523 Clayton Avenue, Campus Box 8052, St. Louis, MO, 63110, USA.
| | - Scott T Micek
- St. Louis College of Pharmacy, 4588 Parkview Place, St. Louis, MO, 63110, USA.
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Galván JM, Rajas O, Aspa J. Review of Non-Bacterial Infections in Respiratory Medicine: Viral Pneumonia. Arch Bronconeumol 2015; 51:590-7. [PMID: 25957460 PMCID: PMC7105177 DOI: 10.1016/j.arbres.2015.02.015] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Revised: 02/23/2015] [Accepted: 02/23/2015] [Indexed: 11/30/2022]
Abstract
Although bacteria are the main pathogens involved in community-acquired pneumonia, a significant number of community-acquired pneumonia are caused by viruses, either directly or as part of a co-infection. The clinical picture of these different pneumonias can be very similar, but viral infection is more common in the pediatric and geriatric populations, leukocytes are not generally elevated, fever is variable, and upper respiratory tract symptoms often occur; procalcitonin levels are not generally affected. For years, the diagnosis of viral pneumonia was based on cell culture and antigen detection, but since the introduction of polymerase chain reaction techniques in the clinical setting, identification of these pathogens has increased and new microorganisms such as human bocavirus have been discovered. In general, influenza virus type A and syncytial respiratory virus are still the main pathogens involved in this entity. However, in recent years, outbreaks of deadly coronavirus and zoonotic influenza virus have demonstrated the need for constant alert in the face of new emerging pathogens. Neuraminidase inhibitors for viral pneumonia have been shown to reduce transmission in cases of exposure and to improve the clinical progress of patients in intensive care; their use in common infections is not recommended. Ribavirin has been used in children with syncytial respiratory virus, and in immunosuppressed subjects. Apart from these drugs, no antiviral has been shown to be effective. Prevention with anti-influenza virus vaccination and with monoclonal antibodies, in the case of syncytial respiratory virus, may reduce the incidence of pneumonia.
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Affiliation(s)
- José María Galván
- Servicio de Medicina Interna, Hospital Universitario de la Princesa, IIS-IP, Madrid, España
| | - Olga Rajas
- Servicio de Neumología, Hospital Universitario de la Princesa, IIS-IP, Madrid, España
| | - Javier Aspa
- Servicio de Neumología, Hospital Universitario de la Princesa, IIS-IP, Madrid, España.
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Cao B, Qu JX, Yin YD, Eldere JV. Overview of antimicrobial options for Mycoplasma pneumoniae pneumonia: focus on macrolide resistance. CLINICAL RESPIRATORY JOURNAL 2015; 11:419-429. [PMID: 26365811 DOI: 10.1111/crj.12379] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Revised: 08/20/2015] [Accepted: 09/07/2015] [Indexed: 01/15/2023]
Abstract
BACKGROUND AND AIMS Community-acquired pneumonia (CAP) is a common infectious disease affecting children and adults of any age. Mycoplasma pneumoniae has emerged as leading causative agent of CAP in some region, and the abrupt increasing resistance to macrolide that widely used for management of M. pneumoniae has reached to the level that it often leads to treatment failures. OBJECTIVE We aim to discuss the drivers for development of macrolide-resistant M. pneumoniae, antimicrobial stewardship and also the potential treatment options for patients infected with macrolide-resistant M. pneumonia. METHODS The articles in English and Chinese published in Pubmed and in Asian medical journals were selected for the review. RESULTS M. pneumoniae can develop macrolide resistance by point mutations in the 23S rRNA gene. Inappropriate and overuse of macrolides for respiratory tract infections may induce the resistance rapidly. A number of countries have introduced the stewardship program for restricting the use of macrolide. Tetracyclines and fluoroquinolones are highly effective for macrolide-resistant strains, which may be the substitute in the region of high prevalence of macrolide-resistant M. pneumoniae. CONCLUSION The problem of macrolide resistant M. pneumonia is emerging. Antibiotic stewardship is needed to inhibit the inappropriate use of macrolide and new antibiotics with a more acceptable safety profile for all ages need to be explored.
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Affiliation(s)
- Bin Cao
- Department of Infectious Diseases and Clinical Microbiology, Beijing Chao-Yang Hospital, Beijing Institute of Respiratory Medicine, Capital Medical University, Beijing, China
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Jiu-Xin Qu
- Department of Infectious Diseases and Clinical Microbiology, Beijing Chao-Yang Hospital, Beijing Institute of Respiratory Medicine, Capital Medical University, Beijing, China
| | - Yu-Dong Yin
- Department of Infectious Diseases and Clinical Microbiology, Beijing Chao-Yang Hospital, Beijing Institute of Respiratory Medicine, Capital Medical University, Beijing, China
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Iroh Tam PY, Bernstein E, Ma X, Ferrieri P. Blood Culture in Evaluation of Pediatric Community-Acquired Pneumonia: A Systematic Review and Meta-analysis. Hosp Pediatr 2015; 5:324-36. [PMID: 26034164 DOI: 10.1542/hpeds.2014-0138] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND OBJECTIVE Current guidelines strongly recommend collection of blood cultures (BCs) in children requiring hospitalization for presumed moderate to severe bacterial community-acquired pneumonia (CAP). Our objective was to systematically review the international pediatric literature to evaluate how often BCs are positive in hospitalized children with CAP, identify the most commonly isolated pathogens, and determine the impact of positive BCs on clinical management. METHODS We identified articles in PubMed and Scopus published from January 1970 through December 2013 that addressed BCs in children with CAP. We extracted total number of BCs collected and prevalence of positive BCs and used meta-regression to evaluate whether subgroups had any impact on prevalence. RESULTS Meta-analysis showed that the overall prevalence of positive BCs was 5.14% (95% confidence interval 3.61-7.28). Studies focusing on severe CAP had a significant effect on prevalence (P=.008), at 9.89% (95% CI 6.79-14.19) compared with 4.17% (95% confidence interval 2.79-6.18) for studies not focusing on severe CAP. The most commonly isolated organisms were Streptococcus pneumoniae (76.7%) followed by Haemophilus influenzae (3.1%) and Staphylococcus aureus (2.1%). Contaminants accounted for 14.7%. Only 3 studies reported on BC-driven change in management, with contrasting findings. CONCLUSIONS BCs in pediatric CAP identified organisms in only a small percentage of patients, predominantly S. pneumoniae. False-positive BC rates can be substantial. The 3 studies that examined BC-driven changes in management had conflicting results. This systematic review was limited by heterogeneous case definitions, which may overestimate the true prevalence of positive BCs in hospitalized children.
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Affiliation(s)
- Pui-Ying Iroh Tam
- Department of Pediatrics, Division of Pediatric Infectious Diseases and Immunology, University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota;
| | - Ethan Bernstein
- University of Minnesota Medical School, Minneapolis, Minnesota
| | - Xiaoye Ma
- Department of Biostatistics, University of Minnesota School of Public Health, Minneapolis, Minnesota; and
| | - Patricia Ferrieri
- Department of Pediatrics, Division of Pediatric Infectious Diseases and Immunology, University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota; Department of Laboratory Medicine and Pathology, University of Minnesota Medical Center, Minneapolis, Minnesota
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Abstract
Although bacteria are the main pathogens involved in community-acquired pneumonia, a significant number of community-acquired pneumonia are caused by viruses, either directly or as part of a co-infection. The clinical picture of these different pneumonias can be very similar, but viral infection is more common in the pediatric and geriatric populations, leukocytes are not generally elevated, fever is variable, and upper respiratory tract symptoms often occur; procalcitonin levels are not generally affected. For years, the diagnosis of viral pneumonia was based on cell culture and antigen detection, but since the introduction of polymerase chain reaction techniques in the clinical setting, identification of these pathogens has increased and new microorganisms such as human bocavirus have been discovered. In general, influenza virus type A and syncytial respiratory virus are still the main pathogens involved in this entity. However, in recent years, outbreaks of deadly coronavirus and zoonotic influenza virus have demonstrated the need for constant alert in the face of new emerging pathogens. Neuraminidase inhibitors for viral pneumonia have been shown to reduce transmission in cases of exposure and to improve the clinical progress of patients in intensive care; their use in common infections is not recommended. Ribavirin has been used in children with syncytial respiratory virus, and in immunosuppressed subjects. Apart from these drugs, no antiviral has been shown to be effective. Prevention with anti-influenza virus vaccination and with monoclonal antibodies, in the case of syncytial respiratory virus, may reduce the incidence of pneumonia.
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Affiliation(s)
- José María Galván
- Servicio de Medicina Interna, Hospital Universitario de la Princesa, IIS-IP, Madrid, España
| | - Olga Rajas
- Servicio de Neumología, Hospital Universitario de la Princesa, IIS-IP, Madrid, España
| | - Javier Aspa
- Servicio de Neumología, Hospital Universitario de la Princesa, IIS-IP, Madrid, España.
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Brealey JC, Sly PD, Young PR, Chappell KJ. Viral bacterial co-infection of the respiratory tract during early childhood. FEMS Microbiol Lett 2015; 362:fnv062. [PMID: 25877546 DOI: 10.1093/femsle/fnv062] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2015] [Indexed: 12/21/2022] Open
Abstract
Acute respiratory infection (ARI) is an important cause of morbidity in children. Mixed aetiology is frequent, with pathogenic viruses and bacteria co-detected in respiratory secretions. However, the clinical significance of these viral/bacterial co-infections has long been a controversial topic. While severe bacterial pneumonia following influenza infection has been well described, associations are less clear among infections caused by viruses that are more common in young children, such as respiratory syncytial virus. Although assessing the overall contribution of bacteria to disease severity is complicated by the presence of many confounding factors in clinical studies, understanding the role of viral/bacterial co-infections in defining the outcome of paediatric ARI will potentially reveal novel treatment and prevention strategies, improving patient outcomes. This review summarizes current evidence for the clinical significance of respiratory viral/bacterial co-infections in young children, discusses possible mechanisms of cooperative interaction between these pathogens and highlights areas that require further investigation.
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Affiliation(s)
- Jaelle C Brealey
- School of Chemistry and Molecular Biosciences, The University of Queensland, St Lucia, QLD 4072, Australia
| | - Peter D Sly
- Queensland Children's Medical Research Institute, The University of Queensland, Brisbane, QLD 4006, Australia Australian Infectious Diseases Research Centre, The University of Queensland, St Lucia, QLD 4072, Australia
| | - Paul R Young
- School of Chemistry and Molecular Biosciences, The University of Queensland, St Lucia, QLD 4072, Australia Australian Infectious Diseases Research Centre, The University of Queensland, St Lucia, QLD 4072, Australia Institute for Molecular Bioscience, The University of Queensland, St Lucia, QLD 4072, Australia
| | - Keith J Chappell
- School of Chemistry and Molecular Biosciences, The University of Queensland, St Lucia, QLD 4072, Australia Australian Infectious Diseases Research Centre, The University of Queensland, St Lucia, QLD 4072, Australia
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Huang WC. Serotype transition in invasive pneumococcal infection in postvaccine era. J Formos Med Assoc 2015; 114:565. [PMID: 25800504 DOI: 10.1016/j.jfma.2015.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 02/07/2015] [Indexed: 11/17/2022]
Affiliation(s)
- Wen-Chan Huang
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan.
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Chiu CY, Chen CJ, Wong KS, Tsai MH, Chiu CH, Huang YC. Impact of bacterial and viral coinfection on mycoplasmal pneumonia in childhood community-acquired pneumonia. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2015; 48:51-6. [DOI: 10.1016/j.jmii.2013.06.006] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Revised: 06/06/2013] [Accepted: 06/24/2013] [Indexed: 11/26/2022]
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Ma YJ, Wang SM, Cho YH, Shen CF, Liu CC, Chi H, Huang YC, Huang LM, Huang YC, Lin HC, Ho YH, Mu JJ. Clinical and epidemiological characteristics in children with community-acquired mycoplasma pneumonia in Taiwan: A nationwide surveillance. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2014; 48:632-8. [PMID: 25311405 DOI: 10.1016/j.jmii.2014.08.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 07/18/2014] [Accepted: 08/07/2014] [Indexed: 11/20/2022]
Abstract
BACKGROUND Community-acquired pneumonia (CAP) is the leading cause of hospitalization of children. Mycoplasma pneumoniae is one of the most common pathogens. The disease severity is diverse, and the diagnosis remains a challenge to clinical pediatricians. The aims of this study are to provide a nationwide surveillance of the epidemiology and clinical manifestations of community-acquired mycoplasma pneumonia (CAMP) in children in Taiwan. METHODS The medical records of children enrolled by the Taiwan Pediatric Infectious Disease Alliance (TPIDA) project during 2010-2011 were reviewed. Hospitalized children with segmental or lobar pneumonia were included. The demographic, clinical, laboratory and radiographic data were analyzed. Nasopharyngeal swabs, pleural effusion, and serum were collected for multiplex viral and bacterial polymerase chain reaction (PCR), mycoplasma immunoglobulin M (IgM), or paired immunoglobulin G (IgG) titer. RESULTS There were overall 127 children with CAMP. Among them, 16 (12.6%) children had PCR and IgM positivity, 74 (58.3%) children had a positive serologic study, 34 (27.8%) children had positive PCR detection, and three (2.4%) children had paired IgG above a four-fold increase. Enrolled patients were divided into two groups before and after the age of 5 years. Children younger than 5 years or younger had a significantly longer hospitalization, higher intensive care unit (ICU) admission rates, and more complications. They were more frequent to receive oxygen supplementation and even surgical intervention. The white blood cell counts and C-reactive protein levels were higher in children 5 years old or younger. CONCLUSION Mycoplasma pneumoniae is an important etiology of CAP in children 5 years or younger. They had a longer length of hospitalization, higher inflammatory responses, and more complications, compared to children older than 5 years.
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Affiliation(s)
- Yun-Ju Ma
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City, Taiwan
| | - Shih-Min Wang
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City, Taiwan; Center of Infectious Disease and Signaling Research, National Cheng Kung University, Tainan City, Taiwan; Taiwan Pediatric Infectious Disease Alliance, Taiwan
| | - Yu-Hao Cho
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City, Taiwan
| | - Ching-Fen Shen
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City, Taiwan; Taiwan Pediatric Infectious Disease Alliance, Taiwan
| | - Ching-Chuan Liu
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City, Taiwan; Center of Infectious Disease and Signaling Research, National Cheng Kung University, Tainan City, Taiwan; Taiwan Pediatric Infectious Disease Alliance, Taiwan.
| | - Hsin Chi
- Taiwan Pediatric Infectious Disease Alliance, Taiwan; Department of Pediatrics, Mackay Memorial Hospital, Taipei City, Taiwan
| | - Yi-Chuan Huang
- Taiwan Pediatric Infectious Disease Alliance, Taiwan; Division of Infectious Diseases, Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung City, Taiwan
| | - Li-Min Huang
- Taiwan Pediatric Infectious Disease Alliance, Taiwan; Department of Pediatrics, National Taiwan University and Hospital, Taipei City, Taiwan
| | - Yhu-Chering Huang
- Taiwan Pediatric Infectious Disease Alliance, Taiwan; Department of Pediatrics, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Hsiao-Chuan Lin
- Taiwan Pediatric Infectious Disease Alliance, Taiwan; School of Medicine, China Medical University, Taichung City, Taiwan; Department of Pediatrics, China Medical University Hospital, Taichung City, Taiwan
| | - Yu-Huai Ho
- Taiwan Pediatric Infectious Disease Alliance, Taiwan; Division of Infectious Disease, Department of Medicine, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - Jung-Jung Mu
- Taiwan Pediatric Infectious Disease Alliance, Taiwan; Centers for Disease Control, Taiwan
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Reply-etiology of pediatric community-acquired pneumonia in Taiwan. Pediatr Neonatol 2014; 55:416-7. [PMID: 24970604 DOI: 10.1016/j.pedneo.2014.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 03/21/2014] [Accepted: 03/25/2014] [Indexed: 11/21/2022] Open
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Chiu SS, Ho PL, Khong PL, Ooi C, So LY, Wong WHS, Chan ELY. Population-based incidence of community-acquired pneumonia hospitalization in Hong Kong children younger than 5 years before universal conjugate pneumococcal immunization. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2014; 49:225-9. [PMID: 25070281 DOI: 10.1016/j.jmii.2014.05.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 04/07/2014] [Accepted: 05/24/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVES We sought to document the incidence of pediatric hospitalization for bacterial pneumonia before universal childhood conjugate pneumococcal vaccination using two different methods of diagnosis. METHODS By following the World Health Organization (WHO) chest radiography (CXR) protocol, two radiologists independently read the CXRs of a cohort of systematically recruited children younger than 5 years. The children had acute respiratory infections and were admitted to one of two hospitals that care for 72.5% of all pediatric admissions on Hong Kong Island. Medical records were reviewed for clinical manifestation and to identify bacterial pneumonia diagnosed by pediatricians. RESULTS In children younger than 5 years, the incidences of bacterial pneumonia, as diagnosed by pediatricians and by the WHO CXR standard, were 775.7 per 100,000 population [95% confidence interval (CI, 591.8-998.3)] and 439.5 per 100,000 population (95% CI, 304.6-614.5), respectively. The study period was from 2002 to 2004. CONCLUSION This study provided a reliable baseline estimate of the hospitalization burden of pneumococcal pneumonia in Hong Kong children before the advent of universal conjugate pneumococcal vaccination.
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Affiliation(s)
- Susan S Chiu
- Department of Pediatrics and Adolescent Medicine, University of Hong Kong, Hong Kong SAR, China.
| | - Pak-Leung Ho
- Department of Microbiology, University of Hong Kong, Hong Kong SAR, China
| | - Pek-Lan Khong
- Department of Diagnostic Radiology, University of Hong Kong, Hong Kong SAR, China
| | - Clara Ooi
- Department of Diagnostic Radiology, University of Hong Kong, Hong Kong SAR, China
| | - Lok Yee So
- Department of Pediatrics and Adolescent Medicine, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong SAR, China
| | - Wilfred H S Wong
- Department of Pediatrics and Adolescent Medicine, University of Hong Kong, Hong Kong SAR, China
| | - Eunice L Y Chan
- Department of Pediatrics and Adolescent Medicine, University of Hong Kong, Hong Kong SAR, China
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Scotta MC, Veras TN, Klein PC, Tronco V, Polack FP, Mattiello R, Pitrez PMC, Jones MH, Stein RT, Pinto LA. Impact of 10-valent pneumococcal non-typeable Haemophilus influenzae protein D conjugate vaccine (PHiD-CV) on childhood pneumonia hospitalizations in Brazil two years after introduction. Vaccine 2014; 32:4495-4499. [PMID: 24958703 DOI: 10.1016/j.vaccine.2014.06.042] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2013] [Revised: 04/26/2014] [Accepted: 06/11/2014] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Pneumococcal disease is a major public health problem worldwide. From March to September of 2010, 10-valent pneumococcal non-typeable Haemophilus influenzae protein conjugate vaccine (PHiD-CV) was introduced in the Brazilian childhood National Immunization Program (NIP) in all 27 Brazilian states. The aim of the present study is to report national time-trends in incidence of hospital admissions for childhood pneumonia in Brazil before and after two years of introduction of this new pneumococcal conjugate vaccine. METHODS Analysis of hospitalization data of children aged 0-4 years in Brazilian public health system with an admission diagnosis of pneumonia from 2002 to 2012 was performed comparing pre (2002-2009) and post-vaccination periods (2011-2012). Hospital number of admission due to pneumonia and all non-respiratory diseases were obtained from DATASUS, the Brazilian government open-access public health database system. Incidence of pneumonia hospitalization was compared to incidence of all non-respiratory admissions. RESULTS Admission rates for pneumonia decreased steadily from 2010 to 2012. In children aged less than four years, incidence of pneumonia hospitalizations decreased 12.65% when pre (2002-2009) and post-vaccination introduction periods (2011-2012) were compared and adjusted for seasonality and secular-trend (p<0.001). On the other hand, non-respiratory admission rates remained stable comparing both periods (p=0.39). CONCLUSION Childhood pneumonia hospitalization rates were fluctuating prior to 2010 and decreased significantly in the two years after PHiD-CV introduction. Conversely, rate of non-respiratory admissions has shown no decrease. These data are an evidence of the effectiveness and public health impact of this new pneumococcal vaccine.
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Affiliation(s)
- Marcelo Comerlato Scotta
- Centro Infant, Biomedical Research Institute, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Avenida Ipiranga 6690, 2nd floor, Porto Alegre 90610-000, RS Brazil; Aliança Infant, Argentina-Brasil (Comprises partnership between institutions "a" and "c").
| | - Tiago Neves Veras
- Jeser Amarante Faria Children's Hospital, Araranguá Street, 554, Joinville 89204-310, SC, Brazil.
| | - Paula Colling Klein
- Centro Infant, Biomedical Research Institute, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Avenida Ipiranga 6690, 2nd floor, Porto Alegre 90610-000, RS Brazil.
| | - Virgínia Tronco
- Centro Infant, Biomedical Research Institute, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Avenida Ipiranga 6690, 2nd floor, Porto Alegre 90610-000, RS Brazil.
| | - Fernando P Polack
- Fundacion INFANT, Gavilán 94, (C1234BAA), Ciudad de Buenos Aires, Argentina; Vanderbilt University, 2201 West End Ave, Nashville 37235, TN, USA; Aliança Infant, Argentina-Brasil (Comprises partnership between institutions "a" and "c").
| | - Rita Mattiello
- Centro Infant, Biomedical Research Institute, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Avenida Ipiranga 6690, 2nd floor, Porto Alegre 90610-000, RS Brazil; Aliança Infant, Argentina-Brasil (Comprises partnership between institutions "a" and "c").
| | - Paulo M C Pitrez
- Centro Infant, Biomedical Research Institute, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Avenida Ipiranga 6690, 2nd floor, Porto Alegre 90610-000, RS Brazil; Aliança Infant, Argentina-Brasil (Comprises partnership between institutions "a" and "c").
| | - Marcus H Jones
- Centro Infant, Biomedical Research Institute, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Avenida Ipiranga 6690, 2nd floor, Porto Alegre 90610-000, RS Brazil; Aliança Infant, Argentina-Brasil (Comprises partnership between institutions "a" and "c").
| | - Renato T Stein
- Centro Infant, Biomedical Research Institute, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Avenida Ipiranga 6690, 2nd floor, Porto Alegre 90610-000, RS Brazil; Aliança Infant, Argentina-Brasil (Comprises partnership between institutions "a" and "c").
| | - Leonardo A Pinto
- Centro Infant, Biomedical Research Institute, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Avenida Ipiranga 6690, 2nd floor, Porto Alegre 90610-000, RS Brazil.
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Oskooee MB, Karimi A, Shiva F, Fallah F, Tabatabaei SR, Shirvani F, Shamshiri AR, Adabian S, Rahbar M. Detection of Mycoplasma pneumoniae and Chlamydia trachomatis in Iranian children with acute lower respiratory infections by polymerase chain reaction. ASIAN PACIFIC JOURNAL OF TROPICAL DISEASE 2014. [DOI: 10.1016/s2222-1808(14)60460-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Hsu CL, Lee YS, Chen CJ, Lee ML, Yang CF, Soong WJ, Jeng MJ, Wu KG. A population-based analysis of children with pneumonia among intensive care units in Taiwan. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2013; 48:153-9. [PMID: 24064295 DOI: 10.1016/j.jmii.2013.07.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Revised: 06/27/2013] [Accepted: 07/19/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Pneumonia is a major diagnosis in children that requires intensive care and is a major cause of mortality in critically ill children. A survey on current epidemiology and case fatality-associated conditions is crucial for the care of critically ill children with pneumonia in an intensive care unit (ICU). METHODS The sex, age, seasonality of admission, area of distribution, and case fatality rate of children younger than 18 years who had pneumonia and were admitted to an ICU during the period 2006-2010 were obtained from the National Health Insurance Research Database (NHIRD) of Taiwan. The enrolled children were grouped by age (0-2 years, 3-5 years, 6-11 years, and 12-17 years). The need for invasive procedures such as endotracheal tube (ET) insertion, mechanical ventilation (MV), tracheostomy, central venous catheter (CVC) insertion, chest tube insertion/drainage, chest surgery, and extracorporeal membranous oxygenation (ECMO) were analyzed to clarify their association with case fatality in critically ill children with pneumonia. RESULTS Of the 12,577 children enrolled, 7131 (56.7%) were boys and 5446 (43.3%) were girls. The younger age groups had more cases of pneumonia, but less often required invasive procedures. Children 0-2 years old (n = 6083) accounted for approximately one-half (48.4%) of all enrolled children. This group had the lowest case fatality rate (3.1%; 187/6083 children) and lowest need for invasive procedures (31.1%; 1892/6083 children), whereas children in the 12-17 year-old group had the highest case fatality rate (9.9%; 140/1417 children) and the highest need for invasive procedures (59.8%; 847/1417 children) (p < 0.001). The percentage of pneumonia cases was highest in the spring (30.1%) and lowest in the summer (21.7%). The invasive procedures associated with case fatality were ET/MV (OR, 14.31; p < 0.001), CVC insertion (OR, 7.46; p < 0.001), ECMO intervention (OR, 4.59; p < 0.001), and chest tube insertion/drainage (OR, 1.87; p < 0.001). CONCLUSION The number of cases of pneumonia that required ICU admission was greater among younger children than among older children. Factors associated with the higher case fatality rate included older age at presentation, the need for invasive procedures (e.g., ET/MV, CVC insertion, chest tube insertion/drainage, and ECMO), underlying comorbidities and complications.
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Affiliation(s)
- Chien-Lun Hsu
- Division of Infectious Diseases, Department of Pediatrics, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan
| | - Yu-Sheng Lee
- Division of General Pediatrics, Department of Pediatrics, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan
| | - Chun-Jen Chen
- Division of Infectious Diseases, Department of Pediatrics, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan
| | - Ming-Luen Lee
- Division of Infectious Diseases, Department of Pediatrics, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan
| | - Chia-Feng Yang
- Division of General Pediatrics, Department of Pediatrics, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan; Institute of Emergency and Critical Care Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Wen-Jue Soong
- Division of General Pediatrics, Department of Pediatrics, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan
| | - Mei-Jy Jeng
- Division of General Pediatrics, Department of Pediatrics, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan; Institute of Emergency and Critical Care Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
| | - Keh-Gong Wu
- Division of Infectious Diseases, Department of Pediatrics, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan.
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Hsieh YC. Community-acquired pneumonia among children in Taiwan. Pediatr Neonatol 2013; 54:1-2. [PMID: 23445735 DOI: 10.1016/j.pedneo.2012.12.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Accepted: 12/04/2012] [Indexed: 10/27/2022] Open
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McCullers JA. Do specific virus-bacteria pairings drive clinical outcomes of pneumonia? Clin Microbiol Infect 2012; 19:113-8. [PMID: 23231363 DOI: 10.1111/1469-0691.12093] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Revised: 10/27/2012] [Accepted: 10/30/2012] [Indexed: 12/01/2022]
Abstract
Bacterial pneumonia is a common contributor to severe outcomes of influenza. Epidemiological data suggest that the incidence, severity and associated bacterial pathogens differ between epidemics and by geographical location within epidemics. Data from animal models demonstrate that differences in both viral and bacterial strains alter the incidence and outcomes of pneumonia. For influenza viruses, evolutionary changes to specific virulence factors appear to alter the ability of viruses within particular lineages to prime the host for secondary bacterial infection. Although bacterial strains differ considerably in disease potential in the setting of viral co-infection, the bacterial virulence factors underlying this finding are currently unknown. The hypothesis that geographical variation exists in the prevalence of bacterial strains expressing factors that enable efficient disease potentiation during viral epidemics should be considered as one explanation for regional differences in severity. This would have implications for surveillance, vaccine development, and the conduct of clinical trials for the prevention or treatment of pneumonia.
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Affiliation(s)
- J A McCullers
- Department of Pediatrics, University of Tennessee Health Sciences Center, Memphis, TN 38103, USA.
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