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Farida H, Triasih R, Lokida D, Mardian Y, Salim G, Wulan WN, Butar-butar DP, Sari RA, Budiman A, Hayuningsih C, Anam MS, Dipayana S, Mujahidah M, Setyati A, Aman AT, Naysilla AM, Lukman N, Diana A, Karyana M, Kline A, Neal A, Lane HC, Kosasih H, Lau CY. Epidemiologic, clinical, and serum markers may improve discrimination between bacterial and viral etiologies of childhood pneumonia. Front Med (Lausanne) 2023; 10:1140100. [PMID: 37275364 PMCID: PMC10233046 DOI: 10.3389/fmed.2023.1140100] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 04/25/2023] [Indexed: 06/07/2023] Open
Abstract
Background Discrimination of bacterial and viral etiologies of childhood community-acquired pneumonia (CAP) is often challenging. Unnecessary antibiotic administration exposes patients to undue risks and may engender antimicrobial resistance. This study aimed to develop a prediction model using epidemiological, clinical and laboratory data to differentiate between bacterial and viral CAP. Methods Data from 155 children with confirmed bacterial or mixed bacterial and viral infection (N = 124) and viral infection (N = 31) were derived from a comprehensive assessment of causative pathogens [Partnerships for Enhanced Engagement in Research-Pneumonia in Pediatrics (PEER-PePPeS)] conducted in Indonesia. Epidemiologic, clinical and biomarker profiles (hematology and inflammatory markers) were compared between groups. The area under the receiver operating characteristic curve (AUROC) for varying biomarker levels was used to characterize performance and determine cut-off values for discrimination of bacterial and mixed CAP versus viral CAP. Diagnostic predictors of bacterial and mixed CAP were assessed by multivariate logistic regression. Results Diarrhea was more frequently reported in bacterial and mixed CAP, while viral infections more frequently occurred during Indonesia's rainy season. White blood cell counts (WBC), absolute neutrophil counts (ANC), neutrophil-lymphocyte ratio (NLR), C-reactive protein (CRP), and procalcitonin (PCT) were significantly higher in bacterial and mixed cases. After adjusting for covariates, the following were the most important predictors of bacterial or mixed CAP: rainy season (aOR 0.26; 95% CI 0.08-0.90; p = 0.033), CRP ≥5.70 mg/L (aOR 4.71; 95% CI 1.18-18.74; p = 0.028), and presence of fever (aOR 5.26; 95% CI 1.07-25.91; p = 0.041). The model assessed had a low R-squared (Nagelkerke R2 = 0.490) but good calibration (p = 0.610 for Hosmer Lemeshow test). The combination of CRP and fever had moderate predictive value with sensitivity and specificity of 62.28 and 65.52%, respectively. Conclusion Combining clinical and laboratory profiles is potentially valuable for discriminating bacterial and mixed from viral pediatric CAP and may guide antibiotic use. Further studies with a larger sample size should be performed to validate this model.
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Affiliation(s)
- Helmia Farida
- Rumah Sakit Umum Pusat Dr. Kariadi Hospital/Diponegoro University, Semarang, Indonesia
| | - Rina Triasih
- Rumah Sakit Umum Pusat Dr. Sardjito Hospital/Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Dewi Lokida
- Tangerang District General Hospital, Tangerang, Indonesia
| | - Yan Mardian
- Indonesia Research Partnership on Infectious Disease, Jakarta, Indonesia
| | - Gustiani Salim
- Indonesia Research Partnership on Infectious Disease, Jakarta, Indonesia
| | - Wahyu Nawang Wulan
- Indonesia Research Partnership on Infectious Disease, Jakarta, Indonesia
| | | | - Rizki Amalia Sari
- Indonesia Research Partnership on Infectious Disease, Jakarta, Indonesia
| | - Arif Budiman
- Tangerang District General Hospital, Tangerang, Indonesia
| | | | - Moh Syarofil Anam
- Rumah Sakit Umum Pusat Dr. Kariadi Hospital/Diponegoro University, Semarang, Indonesia
| | - Setya Dipayana
- Rumah Sakit Umum Pusat Dr. Kariadi Hospital/Diponegoro University, Semarang, Indonesia
| | - Mujahidah Mujahidah
- Rumah Sakit Umum Pusat Dr. Sardjito Hospital/Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Amalia Setyati
- Rumah Sakit Umum Pusat Dr. Sardjito Hospital/Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Abu Tholib Aman
- Rumah Sakit Umum Pusat Dr. Sardjito Hospital/Universitas Gadjah Mada, Yogyakarta, Indonesia
| | | | - Nurhayati Lukman
- Indonesia Research Partnership on Infectious Disease, Jakarta, Indonesia
| | - Aly Diana
- Indonesia Research Partnership on Infectious Disease, Jakarta, Indonesia
| | - Muhammad Karyana
- National Institute of Health Research and Development, Ministry of Health Republic of Indonesia, Jakarta, Indonesia
| | - Ahnika Kline
- National Institute of Allergy and Infectious Diseases, Bethesda, MD, United States
| | - Aaron Neal
- National Institute of Allergy and Infectious Diseases, Bethesda, MD, United States
| | - H. Clifford Lane
- National Institute of Allergy and Infectious Diseases, Bethesda, MD, United States
| | - Herman Kosasih
- Indonesia Research Partnership on Infectious Disease, Jakarta, Indonesia
| | - Chuen-Yen Lau
- National Cancer Institute, Bethesda, MD, United States
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Li L, Wang H, Liu A, Chen J, Yang Y, Wang W. Age-Dependent Clinical Characteristics of Acute Lower Respiratory Infections in Young Hospitalized Children with Respiratory Syncytial Virus Infection. Infect Drug Resist 2022; 15:5971-5979. [PMID: 36262595 PMCID: PMC9576216 DOI: 10.2147/idr.s380681] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 10/05/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Human respiratory syncytial virus (HRSV) is the most common cause of acute lower respiratory infection (LRTI) in children. The main clinical manifestations are fever, cough, wheezing, and intercostal retractions. Its age-dependent clinical characteristics remain to be defined. Objective We investigated whether HRSV caused any age-related differences in clinical manifestations of LRTI. Methods We enrolled 130 hospitalized children with LRTI caused by HRSV. These were stratified into four age groups. The main signs and symptoms and rates thereof were compared across the four age groups. Results The incidence of pneumonia was the same in all four age groups. Patients in the 1-6 months old group experienced fever and the highest body temperature ≥ 38.5°C less frequently than patients in other age groups.The frequency of fever increased with age among the patients under 24 months old. Children over 12 months old experienced less wheezing, tachypnoea, hypoxia, and intercostal retractions than children in the 1-6 months old group. Conclusion HRSV caused age-related differences in clinical manifestations of LRTI. Reduced fever responses among patients 6 months old and younger during RSV infection does not implicate less severity, wheezing, tachypnoea, hypoxia, and intercostal retractions are the main clinical manifestations, Fever responses were enhanced with advancing age among children under 24 months old.
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Affiliation(s)
- Li Li
- Department of Respiratory Diseases, Shenzhen Children’s Hospital, Shenzhen, People’s Republic of China
| | - Heping Wang
- Department of Respiratory Diseases, Shenzhen Children’s Hospital, Shenzhen, People’s Republic of China
| | - Ailiang Liu
- Department of Respiratory Diseases, Shenzhen Children’s Hospital, Shenzhen, People’s Republic of China
| | - Jiehua Chen
- Department of Respiratory Diseases, Shenzhen Children’s Hospital, Shenzhen, People’s Republic of China
| | - Yonghong Yang
- Department of Respiratory Diseases, Shenzhen Children’s Hospital, Shenzhen, People’s Republic of China,Microbiology Laboratory, Beijing Pediatric Research Institute, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, People’s Republic of China,Correspondence: Yonghong Yang, Microbiology Laboratory, Beijing Pediatric Research Institute, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, People’s Republic of China, Email
| | - Wenjian Wang
- Department of Respiratory Diseases, Shenzhen Children’s Hospital, Shenzhen, People’s Republic of China,Wenjian Wang, Department of Respiratory Diseases, Shenzhen Children’s Hospital, No. 7019 Yitian Road, Futian District, Shenzhen, Guangdong, People’s Republic of China, Email
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