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Dian D, Zhang W, Lu M, Zhong Y, Huang Y, Chen G, Chen Z, Yu L, Sun J. Clinical Efficacy of Ulinastatin Combined with Azithromycin in the Treatment of Severe Pneumonia in Children and the Effects on Inflammatory Cytokines and Oxidative Stress: A Retrospective Cohort Study. Infect Drug Resist 2023; 16:7165-7174. [PMID: 38023407 PMCID: PMC10640813 DOI: 10.2147/idr.s428900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 10/17/2023] [Indexed: 12/01/2023] Open
Abstract
Purpose This retrospective cohort study aimed to evaluate the clinical efficacy of ulinastatin (UTI) and azithromycin (AZM) combination therapy in treating severe pneumonia in children and its impact on inflammatory cytokines and oxidative stress. Patients and Methods This retrospective cohort study was conducted from January 1, 2019, to January 1, 2021, involving pediatric patients diagnosed with severe mycoplasma pneumonia (SMPP). The pediatric patients were divided into two groups: those receiving UTI and AZM combination therapy (treatment group) and those receiving azithromycin alone (control group). We compared the two groups regarding clinical data, disease outcomes, inflammatory cytokines, and oxidative stress levels. Results Baseline characteristics did not significantly differ between the two groups. UTI, in combination with AZM, significantly improved blood oxygen levels, inflammatory infection markers, and relevant clinical symptoms in patients with SMPP on the 3rd day of treatment. Additionally, it significantly reduced the levels of inflammatory cytokines TNF-a, IL-6, IL-1β, and IL-10, as well as oxidative stress markers GSH and SOD. Conclusion Combining UTI and AZM can rapidly alleviate clinical symptoms and effectively control the progression of patients with SMPP. Therefore, this treatment approach deserves consideration for clinical promotion and utilization.
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Affiliation(s)
- Dongchun Dian
- The First Dongguan Affiliated Hospital, Guangdong Medical University, Guangdong, 523000, People’s Republic of China
| | - Weilong Zhang
- The First Dongguan Affiliated Hospital, Guangdong Medical University, Guangdong, 523000, People’s Republic of China
| | - Minjun Lu
- The First Dongguan Affiliated Hospital, Guangdong Medical University, Guangdong, 523000, People’s Republic of China
| | - Yong Zhong
- The First Dongguan Affiliated Hospital, Guangdong Medical University, Guangdong, 523000, People’s Republic of China
| | - Yurong Huang
- The First Dongguan Affiliated Hospital, Guangdong Medical University, Guangdong, 523000, People’s Republic of China
| | - Guiling Chen
- The First Dongguan Affiliated Hospital, Guangdong Medical University, Guangdong, 523000, People’s Republic of China
| | - Zhangquan Chen
- Guangdong Medical University, Guangdong, 510000, People’s Republic of China
| | - Luxin Yu
- Guangdong Medical University, Guangdong, 510000, People’s Republic of China
| | - Jianbo Sun
- The First Dongguan Affiliated Hospital, Guangdong Medical University, Guangdong, 523000, People’s Republic of China
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Gao J, Yue B, Li H, Chen R, Wu C, Xiao M. Epidemiology and clinical features of segmental/lobar pattern Mycoplasma pneumoniae pneumonia: A ten-year retrospective clinical study. Exp Ther Med 2015; 10:2337-2344. [PMID: 26668638 DOI: 10.3892/etm.2015.2818] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2014] [Accepted: 10/01/2015] [Indexed: 12/17/2022] Open
Abstract
Mycoplasma pneumoniae plays an important role in community-acquired pneumonia. However, epidemiological and clinical studies on the segmental/lobar pattern (S/L) radiographic-pathologic subtype of pediatric Mycoplasma pneumoniae pneumonia (MPP) are rare. The current study retrospectively analyzed the epidemiological and clinical characteristics of pediatric MPP patients. A total of 1,933 children with MPP received treatment at a single hospital between 2000 and 2009, of which 684 (35.4%) were diagnosed with S/L-MPP. The annual incidence of S/L-MPP in children with MPP increased throughout the duration of this study (from 6.4 to 59.6%, P<0.001), which was particularly evident after 2003. S/L-MPP was predominantly found in pre-school-aged children (4-6 years old; 56.6%). Compared with non-S/L-MPP, S/L-MPP was more closely associated with severe manifestations, including higher rates of fever (90.2 vs. 83.3%), pleural effusion (3.9 vs. 1.3%), extrapulmonary manifestations (26.2 vs. 21.2%), abnormal white blood cell counts (65.5 vs. 55.2%), abnormal C-reactive protein levels (30.9 vs. 23.7%) and bacterial co-infection (32.0 vs. 24.9%), as well as longer durations of fever (4.13±4.28 vs. 3.02±2.22 days) and hospitalization (12.70±4.54 vs. 9.22±5.12 days). Older S/L-MPP patients showed higher rates and longer durations of fever and cough; however, they also displayed a lower rate of extrapulmonary manifestations when compared with younger patients. In conclusion, the annual incidence of S/L-MPP has increased in recent years. Pre-school-aged children (4-6 years) with MPP are more likely to display a segmental/lobar pattern, which is associated with more severe clinical manifestations than other MPP infection patterns.
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Affiliation(s)
- Jian Gao
- Department of Pediatrics, Weifang Maternal and Child Health Hospital, Weifang, Shandong 261011, P.R. China
| | - Baozhu Yue
- Department of Pediatrics, Weifang Maternal and Child Health Hospital, Weifang, Shandong 261011, P.R. China
| | - Haitao Li
- Pulmonary Department, Weifang Chest Hospital, Weifang, Shandong 261011, P.R. China
| | - Rong Chen
- Department of Pediatrics, Weifang Maternal and Child Health Hospital, Weifang, Shandong 261011, P.R. China
| | - Chunlian Wu
- Department of Pediatrics, Weifang Maternal and Child Health Hospital, Weifang, Shandong 261011, P.R. China
| | - Mili Xiao
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai 201102, P.R. China
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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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Wang H, Tang J, Xiong Y, Li X, Gonzalez F, Mu D. Neonatal community-acquired pneumonia: pathogens and treatment. J Paediatr Child Health 2010; 46:668-72. [PMID: 20796185 DOI: 10.1111/j.1440-1754.2010.01814.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM To analyse the bacterial pathogens and drug sensitivities for neonatal community-acquired pneumonia. METHODS Seven hundred sixty sputum samples from newborns with community-acquired pneumonia were cultured to determine microbial organisms present and their drug sensitivities. RESULTS Of the 760 specimens, 425 grew pathogens for a 55.9% positive rate. Among the 425 positive cultures, 278 grew gram-negative organisms (65.4%), 142 grew gram-positive organisms (33.3%), while 5 grew fungus (1.3%). The most common gram-negative organisms were Escherichia coli, Klebsiella pneumoniae and Hemophilus influenzae, while the most common gram-positive organisms were Staphylococcus aureus, Staphylococcus epidermidis and Staphylococcus haemolyticus. To the gram-negative organisms, the most sensitive drugs were meropenem, imipenem and amikacin, while to the gram-positive ones were vancomycin, teicoplanin and quinupristin/dalfopristin. CONCLUSIONS The most common causative bacteria were gram-negative organisms, which were highly sensitive to Meropenem, Imipenem and Amikacin, yet often treatable with more focused antibiotic coverage, which depended on the bacterium identified.
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Affiliation(s)
- Hua Wang
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Sichuan, China
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5
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Roh EJ, Chang YP, Kim JK, Rheem IS, Park KS, Chung EH. Clinical significance of codetection of the causative agents for acute respiratory tract infection in hospitalized children. KOREAN JOURNAL OF PEDIATRICS 2009. [DOI: 10.3345/kjp.2009.52.6.661] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Eui Jung Roh
- Department of Pediatrics, College of Medicine, Dankook University, Cheonan, Korea
| | - Young Pyo Chang
- Department of Pediatrics, College of Medicine, Dankook University, Cheonan, Korea
| | - Jae Kyung Kim
- Department of Laboratory Medicine, College of Medicine, Dankook University, Cheonan, Korea
| | - In Soo Rheem
- Department of Laboratory Medicine, College of Medicine, Dankook University, Cheonan, Korea
| | - Kwi Sung Park
- Chungcheongnam-Do Health and Environment Research Institute, Daejeon, Korea
| | - Eun Hee Chung
- Department of Pediatrics, College of Medicine, Dankook University, Cheonan, Korea
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Takahashi T, Asami R, Takahashi T, Morozumi M, Okada T, Chiba N, Murayama SY, Ubukata K. Prolonged Mycoplasma pneumoniae infection in an elderly patient with community-acquired pneumonia. J Infect Chemother 2009; 15:243-7. [DOI: 10.1007/s10156-009-0692-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2008] [Accepted: 04/01/2009] [Indexed: 11/30/2022]
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Abstract
In the beginning of this 21st century, community-acquired pneumonias (CAP) are still responsible for a significant number of deaths among young children in many developing countries. Public health initiatives such as those proposed by the World Health Organization (WHO) for the management of CAP by means of identifying highly predictable signs and symptoms have had great positive impact in some communities. Still, this approach induces an overdiagnosis and overtreatment of CAP in children below the age of 5 years due to the misclassification of pneumonia in children with fast breathing associated with viral bronchiolitis. Even among children of developed countries, CAP is an important public health problem and many aspects of current diagnostic and management measures are discussed here. In this article, we review the epidemiology and basic concepts of CAP and update current information on clinical evaluation and management of the disease.
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Affiliation(s)
- Renato T Stein
- Department of Pediatrics, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil.
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del Mar García-Suárez M, Cima-Cabal MD, Villaverde R, Espinosa E, Falguera M, de Los Toyos JR, Vázquez F, Méndez FJ. Performance of a pneumolysin enzyme-linked immunosorbent assay for diagnosis of pneumococcal infections. J Clin Microbiol 2007; 45:3549-54. [PMID: 17728474 PMCID: PMC2168496 DOI: 10.1128/jcm.01030-07] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A pneumolysin-specific enzyme-linked immunosorbent assay (PLY-ELISA) for the detection of pneumolysin in urine was developed and evaluated in comparison with the commercially available Binax Now Streptococcus pneumoniae test (Binax, Portland, ME) for the diagnosis of pneumococcal infections. Assay sensitivity was evaluated using urine from 108 patients with culture-confirmed pneumococcal infections. In adults, the sensitivity and specificity of the PLY-ELISA were 56.6% and 92.2%, respectively. In children with nasopharyngeal pneumococcal carriage, PLY-ELISA and Binax Now S. pneumoniae test sensitivities were 62.5% and 87.5%, respectively, while specificities were 94.4% and 27.8%, respectively. In children with nonnasopharyngeal pneumococcal carriage, PLY-ELISA and Binax Now S. pneumoniae test sensitivities were 68.7% and 93.7%, respectively, and test specificities were 94.1% and 41.2%, respectively. The persistence of pneumolysin in urine of pneumococcal pneumonia patients decreased significantly after 4 to 6 days of treatment. Our data suggest that combining the high specificity of the PLY-ELISA with the high sensitivity of the Binax Now S. pneumoniae test would enable pneumococcal infections to be accurately diagnosed in children.
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Atkinson M, Yanney M, Stephenson T, Smyth A. Effective treatment strategies for paediatric community-acquired pneumonia. Expert Opin Pharmacother 2007; 8:1091-101. [PMID: 17516873 PMCID: PMC7103692 DOI: 10.1517/14656566.8.8.1091] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Pneumonia is the leading cause of death in children under 5 years of age worldwide and a cause of morbidity in a considerable number of children. A number of studies have sought to identify the ideal choice of antibiotics, route of administration and optimum duration of treatment based on the most likely aetiological agents. Emerging bacterial resistance to antibiotics is also an important consideration in treatment. However, inconsistent clinical and radiological definitions of pneumonia make comparison between studies difficult. There is also a lack of well designed adequately powered randomised controlled trials. This review describes the difficulties encountered in diagnosing community-acquired pneumonia, aetiology, treatment strategies with recommendations and highlights areas for further research.
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Affiliation(s)
- Maria Atkinson
- Specialist Registrar, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Michael Yanney
- Specialist Registrar, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Terence Stephenson
- Professor of Child Health, Division of Child Health, University of Nottingham, Nottingham, UK
| | - Alan Smyth
- Senior Lecturer in Child Health, Division of Respiratory Medicine, Clinical Sciences Building, Nottingham City Hospital, Hucknall Road, Nottingham, NG5 1PB, UK.
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Corne P, Grieu T, Olivier J. Co-infection pulmonaire à Streptococcus pyogenes et Mycoplasma pneumoniae ou artefact sérologique ? Presse Med 2005; 34:801-2. [PMID: 16097383 DOI: 10.1016/s0755-4982(05)84047-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
INTRODUCTION How should Mycoplasma pneumoniae seroconversion be interpreted in a patient with community-acquired Streptococcus pyogenes pneumonia? CASE A 21-year-old man with cerebral palsy was hospitalized with acute pneumonia and fever. The bronchoalveolar lavage fluid contained Streptococcus pyogenes, and serological testing for Mycoplasma pneumoniae was positive. At 4 weeks, measurements of anti-M. pneumoniae and antistreptolysin O antibodies were positive. DISCUSSION Two hypotheses should be considered: the patient has either a coinfection of S. pyogenes and M. pneumoniae or a nonspecific antibody response during a severe S. pyogenes infection.
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Affiliation(s)
- Philippe Corne
- Service de réanimation médicale-assistance respiratoire, Hôpital Gui de Chauliac, 80, av. Augustin Fliche, 34295 Montpellier 5.
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11
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Abstract
The treatment of community-acquired pneumonia (CAP) in children is empirical, being based on the knowledge of the etiology of CAP at different ages. As a result of currently available methods in everyday clinical practice, a microbe-specific diagnosis is not realistic in the majority of patients. Even the differentiation between viral, 'atypical' bacterial (Mycoplasma pneumoniae or Chlamydia pneumoniae) and 'typical' bacterial (Streptococcus pneumoniae) CAP is often not possible. Moreover, up to one-third of CAP cases seem to be mixed viral-bacterial or dual bacterial infections. Recent serologic studies have confirmed that S. pneumoniae is an important causative agent of CAP at all ages. M. pneumoniae is common from the age of 5 years onwards, and C. pneumoniae is common from the age of 10 years onwards. In addition to age, the etiology and treatment of CAP are dependent on the severity of the disease. Pneumococcal infections are predominant in children treated in hospital, and mycoplasmal infections are predominant in children treated at home.In ambulatory patients with CAP, amoxicillin (or penicillin V [phenoxymethylpenicillin]) is the drug of choice from the age of 4 months to 4 years, and at all ages if S. pneumoniae is the presumptive causative organism. Macrolides, preferably clarithromycin or azithromycin, are the first-line drugs from the age of 5 years onwards. In hospitalized patients who need parenteral therapy for CAP, cefuroxime (or penicillin G [benzylpenicillin]) is the drug of choice. Macrolides should be administered concomitantly if M. pneumoniae or C. pneumoniae infection is suspected. Radiologic findings and C-reactive protein (CRP) levels offer limited help for the selection of antibacterials; alveolar infiltrations and high CRP levels indicate pneumococcal pneumonia, but the lack of these findings does not rule out bacterial CAP. Most guidelines recommend antibacterials for 7-10 days (except azithromycin, which has a recommended treatment duration of 5 days). If no improvement takes place within 2 days, therapy must be reviewed.
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Affiliation(s)
- Matti Korppi
- Department of Paediatrics, Kuopio University and University Hospital, Kuopio, Finland.
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Korppi M, Heiskanen-Kosma T, Kleemola M. Incidence of community-acquired pneumonia in children caused by Mycoplasma pneumoniae: Serological results of a prospective, population-based study in primary health care. Respirology 2004; 9:109-14. [PMID: 14982611 DOI: 10.1111/j.1440-1843.2003.00522.x] [Citation(s) in RCA: 103] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The objective of the present study was to assess the incidence of community-acquired pneumonia (CAP) in children caused by Mycoplasma pneumoniae. METHODOLOGY During 12 months in 1981-1982, all CAP cases in a defined child population were registered. M. pneumoniae aetiology, initially measured by complement fixation (CF) test, was in 1999 supplemented by measurement of IgG and IgM antibodies using enzyme immunoassays (EIA). RESULTS M. pneumoniae was detected in 61 (30%) of 201 paediatric CAP cases, being the most common aetiological agent in those 5 years of age or over. At that age, M. pneumoniae was responsible for over 50% of cases, and over 90% of mycoplasmal cases were treated as outpatients. The EIA detected 17 new cases over and above the 44 detected by CF, while CF alone revealed 10 cases. The incidence of M. pneumoniae CAP increased with age, being over 10/1000 children at the age of 10 years or more. Co-infections with Streptococcus pneumoniae and Chlamydia pneumoniae were present in over 30% and 15%, respectively, of mycoplasmal CAP cases. CONCLUSION M. pneumoniae is a common cause of paediatric CAP in primary health care, and co-infections with S. pneumoniae are common. Both S. pneumoniae and M. pneumoniae should be taken into account when starting antibiotics for children with CAP.
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Affiliation(s)
- Matti Korppi
- Department of Pediatrics, Kuopio University and University Hospital, Kuopio, Finland.
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Principi N, Esposito S. Paediatric community-acquired pneumonia: current concept in pharmacological control. Expert Opin Pharmacother 2003; 4:761-77. [PMID: 12739999 DOI: 10.1517/14656566.4.5.761] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Community-acquired pneumonia (CAP) is one of the most frequent infections in childhood but it is not easy to establish a rational therapeutic approach for a number of reasons, including difficulties in identifying the aetiology, the fact that the most frequent bacterial pathogens become resistant to commonly used antibiotics and the lack of certain information concerning the possible preventive role of conjugate vaccines. This leads paediatricians to treat almost all cases of CAP with antibiotics, often using a combination of different antimicrobial classes. In order to avoid unnecessary antibiotic use and limit the spread of antibiotic resistance, consensus guidelines for the management of CAP in childhood should be developed and used by practitioners in their offices and hospitals.
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Affiliation(s)
- Nicola Principi
- Paediatric Department I, University of Milan, Via Commenda 9, 20122 Milano, Italy.
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Esposito S, Bosis S, Cavagna R, Faelli N, Begliatti E, Marchisio P, Blasi F, Bianchi C, Principi N. Characteristics of Streptococcus pneumoniae and atypical bacterial infections in children 2-5 years of age with community-acquired pneumonia. Clin Infect Dis 2002; 35:1345-52. [PMID: 12439797 DOI: 10.1086/344191] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2002] [Accepted: 07/20/2002] [Indexed: 12/24/2022] Open
Abstract
The characteristics of community-acquired pneumonia associated with Streptococcus pneumoniae infection were compared with those associated with atypical bacterial infection and with mixed S. pneumoniae-atypical bacterial infection in 196 children aged 2-5 years. S. pneumoniae infections were diagnosed in 48 patients (24.5%); atypical bacterial infections, in 46 (23.5%); and mixed infections, in 16 (8.2%). Although white blood cell counts and C-reactive protein levels were higher in patients with pneumococcal infections, no other clinical, laboratory, or radiographic characteristic was significantly correlated with the different etiologic diagnoses. There was no significant difference in the efficacy of the different treatment regimens followed by children with S. pneumoniae infection, whereas clinical failure occurred significantly more frequently among children with atypical bacterial or mixed infection who were not treated with a macrolide. This study shows the major role of both S. pneumoniae and atypical bacteria in the development of community-acquired pneumonia in young children, the limited role of clinical, laboratory, and radiological features in predicting etiology, and the importance of the use of adequate antimicrobial agents for treatment.
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Affiliation(s)
- Susanna Esposito
- Pediatric Department I, Istituto Ricerca e Cura a Carattere Scientifico Maggiore Hospital, University of Milan, 20122 Milan, Italy
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15
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Abstract
Seven paediatric studies on community-acquired pneumonia with serological methods for both viruses and bacteria have been published, allowing the evaluation of concomitant multiple etiological findings. In these studies, dual viral infection has been present in 0-14%, dual bacterial infection likewise in 0-14%, and mixed viral-bacterial infection in 3-30% of the pneumonia cases. The results confirm former clinical observations that respiratory viruses often pave the way for airway-colonising bacteria. The measured frequency of multiple infections has been dependent on the available test panel, mainly on the tests used for pneumococcal aetiology. Mixed viral-bacterial infections have been especially common in young children under 2 years of age, reflecting the high frequency of respiratory syncytial virus infections and their tendency to induce bacterial co-infections. No microbe-specific viral-bacterial associations have been demonstrated. The clinical implications of mixed viral-bacterial infections, compared with viral infections alone or bacterial infections alone, have so far remained unresolved. Current guidelines recommend antibiotic therapy for all community-acquired pneumonia cases in children.
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Affiliation(s)
- Matti Korppi
- Department of Paediatrics, Kuopio University Hospital, Finland.
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Nikkari S, Lopez FA, Lepp PW, Cieslak PR, Ladd-Wilson S, Passaro D, Danila R, Relman DA. Broad-range bacterial detection and the analysis of unexplained death and critical illness. Emerg Infect Dis 2002; 8:188-94. [PMID: 11897072 PMCID: PMC2732447 DOI: 10.3201/eid0802.010150] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Broad-range rDNA polymerase chain reaction (PCR) provides an alternative, cultivation-independent approach for identifying pathogens. In 1995, the Centers for Disease Control and Prevention initiated population-based surveillance for unexplained life-threatening infections (Unexplained Death and Critical Illness Project [UNEX]). To address the causes of UNEX cases, we examined 59 specimens from 46 cases by using broad-range bacterial 16S rDNA PCR and phylogenetic analysis of amplified sequences. Specimens from eight cases yielded sequences from Neisseria meningitidis (cerebrospinal fluid from two patients with meningitis), Streptococcus pneumoniae (cerebrospinal fluid from one patient with meningitis2 and pleural fluid from two patients with pneumonia), or Stenotrophomonas maltophilia (bone marrow aspirate from one patient with pneumonia). Streptococcus pneumoniae rDNA sequence microheterogeneity was found in one pleural fluid specimen, suggesting the presence of multiple strains. In conclusion, known bacterial pathogens cause some critical illnesses and deaths that fail to be explained with traditional diagnostic methods.
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Affiliation(s)
- Simo Nikkari
- Stanford University School of Medicine, California, USA
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Martínez Roig A, Busquets Monge R, López Segura N, Herrero Pérez S, Esteban Torné E. Coinfección por virus de Epstein-Barr y Mycoplasma pneumoniae en dos niñas con neumonía comunitaria. An Pediatr (Barc) 2002. [DOI: 10.1016/s1695-4033(02)77771-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Principi N, Esposito S. Emerging role of Mycoplasma pneumoniae and Chlamydia pneumoniae in paediatric respiratory-tract infections. THE LANCET. INFECTIOUS DISEASES 2001; 1:334-44. [PMID: 11871806 DOI: 10.1016/s1473-3099(01)00147-5] [Citation(s) in RCA: 118] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Increased use of specialised diagnostic techniques over the past 10 years has allowed considerable new information to be obtained concerning Mycoplasma pneumoniae and Chlamydia pneumoniae infections. In children, these pathogens seem to have a more important role in causing respiratory-tract infections than previously thought; they have been associated with wheezing, and they are also frequent in children aged under 5 years. Contrary to original belief, no clinical, laboratory, or radiological findings seem to be unique to M. pneumoniae or C. pneumoniae; furthermore, there is no rapid and cost-effective diagnostic test capable of identifying these pathogens. Appropriate antimicrobial treatment of the infections they cause is needed to reduce the recurrent episodes of wheezing and other respiratory symptoms, to decrease morbidity, and to avoid the spread of the pathogens. However, a number of therapeutic issues remain unsolved.
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Affiliation(s)
- N Principi
- Department of Paediatrics, Azienda Ospedaliera Istituti Clinici di Perfezionamento, Milan, Italy.
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