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Lees EA, Williams TC, Marlow R, Fitzgerald F, Jones C, Lyall H, Bamford A, Pollock L, Smith A, Lamagni T, Kent A, Whittaker E. Epidemiology and Management of Pediatric Group A Streptococcal Pneumonia With Parapneumonic Effusion: An Observational Study. Pediatr Infect Dis J 2024:00006454-990000000-00906. [PMID: 38900036 DOI: 10.1097/inf.0000000000004418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Abstract
BACKGROUND During autumn/winter 2022, UK pediatricians reported an unseasonal increase in invasive group A streptococcal infections; a striking proportion presenting with pneumonia with parapneumonic effusion. METHODS Clinicians across the United Kingdom were requested to submit pseudonymized clinical data using a standardized report form for children (<16 years) admitted between September 30, 2022 and February 17, 2023, with microbiologically confirmed group A streptococcal pneumonia with parapneumonic effusion. RESULTS From 185 cases submitted, the median patient age was 4.4 years, and 163 (88.1%) were previously healthy. Respiratory viral coinfection was detected on admission for 101/153 (66.0%) children using extended respiratory pathogen polymerase chain reaction panel. Molecular testing was the primary method of detecting group A streptococcus on pleural fluid (86/171; 50.3% samples). Primary surgical management was undertaken in 171 (92.4%) children; 153/171 (89.4%) had pleural drain inserted (96 with fibrinolytic agent), 14/171 (8.2%) had video-assisted thoracoscopic surgery. Fever duration after admission was prolonged (median, 12 days; interquartile range, 9-16). Intravenous antibiotic courses varied in length (median, 14 days; interquartile range, 12-21), with many children receiving multiple broad-spectrum antibiotics, although evidence for additional bacterial infection was limited. CONCLUSIONS Most cases occurred with viral coinfection, a previously well-recognized risk with influenza and varicella zoster, highlighting the need to ensure routine vaccination coverage and progress on vaccines for other common viruses (eg, respiratory syncytial virus, human metapneumovirus) and for group A streptococcus. Molecular testing is valuable to detect viral coinfection and confirm invasive group A streptococcal diagnosis, expediting the incorporation of cases into national reporting systems. Range and duration of intravenous antibiotics administered demonstrated the need for research on the optimal duration of antimicrobials and improved stewardship.
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Affiliation(s)
- Emily A Lees
- From the Department of Paediatrics, University of Oxford, Children's Hospital Oxford, Oxford, United Kingdom
- Fitzwilliam College, University of Cambridge, Cambridge, United Kingdom
| | - Thomas C Williams
- Department of Child Life and Health, University of Edinburgh, Edinburgh, United Kingdom
| | - Robin Marlow
- Bristol Royal Hospital for Children, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
- Bristol Vaccine Centre, Schools of Population Health Sciences and of Cellular and Molecular Medicine, University of Bristol, Bristol, United Kingdom
| | - Felicity Fitzgerald
- Department of Paediatrics, Imperial College Healthcare NHS Trust, London, UK United Kingdom
- Section of Paediatric Infectious Disease, Department of Infectious Disease, Imperial College London, London, United Kingdom
| | - Christine Jones
- Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton, United Kingdom
- NIHR Southampton Clinical Research Facility and NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Hermione Lyall
- Department of Paediatrics, Imperial College Healthcare NHS Trust, London, UK United Kingdom
| | - Alasdair Bamford
- Department of Infectious Diseases, Great Ormond Street Hospital NHS Foundation Trust, London, United Kingdom
- Infection, Immunity, and Inflammation Department, UCL Great Ormond Street Institute of Child Health, London
| | - Louisa Pollock
- Department of Paediatric Infectious Diseases and Immunology, Royal Hospital for Children, Glasgow, United Kingdom
| | - Andrew Smith
- College of Medical, Veterinary and Life Sciences, Glasgow Dental School, University of Glasgow, Glasgow, United Kingdom
| | - Theresa Lamagni
- Healthcare-Associated Infection & Antimicrobial Resistance Division, UK Health Security Agency, London, United Kingdom
| | - Alison Kent
- Department of Paediatrics, Imperial College Healthcare NHS Trust, London, UK United Kingdom
| | - Elizabeth Whittaker
- Department of Paediatrics, Imperial College Healthcare NHS Trust, London, UK United Kingdom
- Section of Paediatric Infectious Disease, Department of Infectious Disease, Imperial College London, London, United Kingdom
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Buonsenso D, Tomà P, Scateni S, Curatola A, Morello R, Valentini P, Ferro V, D'Andrea ML, Pirozzi N, Musolino AM. Lung ultrasound findings in pediatric community-acquired pneumonia requiring surgical procedures: a two-center prospective study. Pediatr Radiol 2020; 50:1560-1569. [PMID: 32821992 DOI: 10.1007/s00247-020-04750-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 04/14/2020] [Accepted: 06/02/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Lung ultrasound (US) in the evaluation of suspected pediatric pneumonia is increasingly used and has a recognized role in evaluating pleural effusions, although there are no detailed studies specifically addressing its use in the pediatric population. OBJECTIVES To define lung US findings of severe pediatric community-acquired pneumonia that required surgical procedures during admission. MATERIALS AND METHODS Our prospective case-control study compared lung US findings in patients ages 1 month to 17 years admitted with community-acquired pneumonia that required surgical procedures from findings those who did not. Lung US was performed at admission and always before surgical procedures. Medical treatment, laboratory and microbiological findings, chest X-ray, computed tomography scan and surgical procedures are described. RESULTS One hundred twenty-one children with community-acquired pneumonia were included; of these, 23 underwent surgical intervention. Compared with the control group, children requiring a surgical procedure had a significantly higher rate of large consolidations (52.2%; 95% confidence interval [CI]: 30.6% to 73.2%), larger and complicated pleural effusions (100%; 95% CI: 85.2% to 100%), and both liquid and air bronchograms (73.9%; 95% CI: 51.6% to 89.8%). CONCLUSION Larger consolidations, larger and more complicated pleural effusions, and liquid and air bronchograms were associated with surgical treatment.
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Affiliation(s)
- Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
- Istituto di Microbiologia, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Paolo Tomà
- Department of Radiology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Simona Scateni
- Emergency Department, Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - Antonietta Curatola
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Rosa Morello
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Piero Valentini
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Department of Pediatrics, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168, Rome, Italy
| | - Valentina Ferro
- Emergency Department, Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | | | - Nicola Pirozzi
- Emergency Department, Ospedale Pediatrico Bambino Gesù, Rome, Italy
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