This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow P3Rs: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when P3Rs are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via CrossRef
Right arrow Citing Articles via ISI Web of Science (67)
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Michelow, I. C.
Right arrow Articles by McCracken, G. H.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Michelow, I. C.
Right arrow Articles by McCracken, G. H., Jr
Related Collections
Right arrow Infectious Disease & Immunity
Right arrowRelated AAP Red Book topics:
Chlamydophila (formerly Chlamydia)...
Group A Streptococcal Infections
PEDIATRICS Vol. 113 No. 4 April 2004, pp. 701-707

Epidemiology and Clinical Characteristics of Community-Acquired Pneumonia in Hospitalized Children

Ian C. Michelow, MBBCh, DTM&H*, Kurt Olsen, BS*, Juanita Lozano, MD*, Nancy K. Rollins, MD{ddagger}, Lynn B. Duffy, MT (ASCP)§, Thedi Ziegler, PhD||, Jaana Kauppila, MD, Maija Leinonen, PhD# and George H. McCracken, Jr, MD*

* Division of Pediatric Infectious Diseases
{ddagger} Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas
§ Department of Microbiology, University of Alabama, Birmingham, Alabama
|| National Public Health Institute, Helsinki, Finland
# National Public Health Institute, Oulu, Finland
Department of Medical Microbiology, University of Oulu, Oulu, Finland

Objectives. The precise epidemiology of childhood pneumonia remains poorly defined. Accurate and prompt etiologic diagnosis is limited by inadequate clinical, radiologic, and laboratory diagnostic methods. The objective of this study was to determine as precisely as possible the epidemiology and morbidity of community-acquired pneumonia in hospitalized children.

Methods. Consecutive immunocompetent children hospitalized with radiographically confirmed lower respiratory infections (LRIs) were evaluated prospectively from January 1999 through March 2000. Positive blood or pleural fluid cultures or pneumolysin-based polymerase chain reaction assays, viral direct fluorescent antibody tests, or viral, mycoplasmal, or chlamydial serologic tests were considered indicative of infection by those organisms. Methods for diagnosis of pneumococcal pneumonia among study subjects were published by us previously. Selected clinical characteristics, indices of inflammation (white blood cell and differential counts and procalcitonin values), and clinical outcome measures (time to defervescence and duration of oxygen supplementation and hospitalization) were compared among groups of children.

Results. One hundred fifty-four hospitalized children with LRIs were enrolled. Median age was 33 months (range: 2 months to 17 years). A pathogen was identified in 79% of children. Typical respiratory bacteria were identified in 60% (of which 73% were Streptococcus pneumoniae), viruses in 45%, Mycoplasma pneumoniae in 14%, Chlamydia pneumoniae in 9%, and mixed bacterial/viral infections in 23%. Preschool-aged children had as many episodes of atypical bacterial LRIs as older children. Children with typical bacterial or mixed bacterial/viral infections had the greatest inflammation and disease severity. Multivariate logistic-regression analyses revealed that high temperature (≥38.4°C) within 72 hours after admission (odds ratio: 2.2; 95% confidence interval: 1.4–3.5) and the presence of pleural effusion (odds ratio: 6.6; 95% confidence interval: 2.1–21.2) were significantly associated with bacterial pneumonia.

Conclusions. This study used an expanded diagnostic armamentarium to define the broad spectrum of pathogens that cause pneumonia in hospitalized children. The data confirm the importance of S pneumoniae and the frequent occurrence of bacterial and viral coinfections in children with pneumonia. These findings will facilitate age-appropriate antibiotic selection and future evaluation of the clinical effectiveness of the pneumococcal conjugate vaccine as well as other candidate vaccines.

Key Words: community-acquired pneumonia • child • epidemiology • diagnosis • etiology • hospitalized

Abbreviations: LRI, lower respiratory infection • PCR, polymerase chain reaction • DFA, direct fluorescent antibody • RSV, respiratory syncytial virus • Ig, immunoglobulin • WBC, white blood cell

Received for publication Apr 17, 2003; Accepted Aug 14, 2003.




This article has been cited by other articles:


Home page
 Am J Trop Med HygHome page
B. Lassmann, M. Poetschke, B. Ninteretse, S. Issifou, S. Winkler, P. G. Kremsner, W. Graninger, and P. Apfalter
Community-acquired Pneumonia in Children in Lambarene, Gabon
Am J Trop Med Hyg, July 1, 2008; 79(1): 109 - 114.
[Abstract] [Full Text] [PDF]

Home page
 Pediatr. Rev.Home page
W. J. Durbin and C. Stille
Pneumonia
Pediatr. Rev., May 1, 2008; 29(5): 147 - 160.
[Full Text] [PDF]

Home page
 Arch. Dis. Child.Home page
M. R. A Cardoso, C. M Nascimento-Carvalho, F. Ferrero, E. N Berezin, R. Ruvinsky, P. A M Camargos, C. C Sant'Anna, M. C. C Brandileone, M. de Fatima P March, J. Feris-Iglesias, et al.
Penicillin-resistant pneumococcus and risk of treatment failure in pneumonia
Arch. Dis. Child., March 1, 2008; 93(3): 221 - 225.
[Abstract] [Full Text] [PDF]

Home page
 Infect. Immun.Home page
C. M. Salvatore, M. Fonseca-Aten, K. Katz-Gaynor, A. M. Gomez, and R. D. Hardy
Intranasal Interleukin-12 Therapy Inhibits Mycoplasma pneumoniae Clearance and Sustains Airway Obstruction in Murine Pneumonia
Infect. Immun., February 1, 2008; 76(2): 732 - 738.
[Abstract] [Full Text] [PDF]

Home page
 J. Clin. Microbiol.Home page
K. Gullsby, M. Storm, and K. Bondeson
Simultaneous Detection of Chlamydophila pneumoniae and Mycoplasma pneumoniae by Use of Molecular Beacons in a Duplex Real-Time PCR
J. Clin. Microbiol., February 1, 2008; 46(2): 727 - 731.
[Abstract] [Full Text] [PDF]

Home page
 Arch Pediatr Adolesc MedHome page
F. Zhou, M. H. Kyaw, A. Shefer, C. A. Winston, and J. P. Nuorti
Health Care Utilization for Pneumonia in Young Children After Routine Pneumococcal Conjugate Vaccine Use in the United States
Arch Pediatr Adolesc Med, December 1, 2007; 161(12): 1162 - 1168.
[Abstract] [Full Text] [PDF]

Home page
 Am. J. Clin. Nutr.Home page
C. L Coles, A. Bose, P. D Moses, L. Mathew, I. Agarwal, T. Mammen, and M. Santosham
Infectious etiology modifies the treatment effect of zinc in severe pneumonia
Am. J. Clinical Nutrition, August 1, 2007; 86(2): 397 - 403.
[Abstract] [Full Text] [PDF]

Home page
 ThoraxHome page
K Thorburn
Response to: Bacterial co-infection and the interpretation of immunological data from BAL fluid specimens in severe RSV bronchiolitis (Thorax 2006;61:1098)
Thorax, March 1, 2007; 62(3): 278 - 278.
[Full Text] [PDF]

Home page
 Am. J. Clin. Nutr.Home page
C. L Coles, M. Santosham, and A. Bose
Reply to S Howie et al
Am. J. Clinical Nutrition, January 1, 2007; 85(1): 243 - 243.
[Full Text] [PDF]

Home page
 Infect. Immun.Home page
C. M. Salvatore, M. Fonseca-Aten, K. Katz-Gaynor, A. M. Gomez, A. Mejias, C. Somers, S. Chavez-Bueno, G. H. McCracken, and R. D. Hardy
Respiratory Tract Infection with Mycoplasma pneumoniae in Interleukin-12 Knockout Mice Results in Improved Bacterial Clearance and Reduced Pulmonary Inflammation
Infect. Immun., January 1, 2007; 75(1): 236 - 242.
[Abstract] [Full Text] [PDF]

Home page
 PediatricsHome page
B. W. Trautner, C. G. Macias, and A. C. Caviness
Febrile Confusion: Do the Hyperpyrexia Study Conclusions Fit?: In Reply.
Pediatrics, December 1, 2006; 118(6): 2606 - 2607.
[Full Text] [PDF]

Home page
 Arch. Dis. Child.Home page
M Freitas, A Castelo, G Petty, C E Gomes, and E Carvalho
Viridans streptococci causing community acquired pneumonia
Arch. Dis. Child., September 1, 2006; 91(9): 779 - 780.
[Abstract] [Full Text] [PDF]

Home page
 Clin. Microbiol. Rev.Home page
J. A. McCullers
Insights into the Interaction between Influenza Virus and Pneumococcus
Clin. Microbiol. Rev., July 1, 2006; 19(3): 571 - 582.
[Abstract] [Full Text] [PDF]

Home page
 PediatricsHome page
B. W. Trautner, A. C. Caviness, G. R. Gerlacher, G. Demmler, and C. G. Macias
Prospective Evaluation of the Risk of Serious Bacterial Infection in Children Who Present to the Emergency Department With Hyperpyrexia (Temperature of 106{degrees}F or Higher)
Pediatrics, July 1, 2006; 118(1): 34 - 40.
[Abstract] [Full Text] [PDF]

Home page
 ThoraxHome page
K Thorburn, S Harigopal, V Reddy, N Taylor, and H K F van Saene
High incidence of pulmonary bacterial co-infection in children with severe respiratory syncytial virus (RSV) bronchiolitis
Thorax, July 1, 2006; 61(7): 611 - 615.
[Abstract] [Full Text] [PDF]

Home page
 Infect. Immun.Home page
V. T. Peltola, K. L. Boyd, J. L. McAuley, J. E. Rehg, and J. A. McCullers
Bacterial Sinusitis and Otitis Media following Influenza Virus Infection in Ferrets.
Infect. Immun., May 1, 2006; 74(5): 2562 - 2567.
[Abstract] [Full Text] [PDF]

Home page
 PediatricsHome page
T. Yamazaki, K. Murayama, A. Ito, S. Uehara, and N. Sasaki
Epidemiology of Community-Acquired Pneumonia in Children
Pediatrics, February 1, 2005; 115(2): 517 - 517.
[Full Text] [PDF]

Home page
 PediatricsHome page
I. C. Michelow and G. H. McCracken Jr
Epidemiology of Community-Acquired Pneumonia in Children: In Reply
Pediatrics, February 1, 2005; 115(2): 517 - 517.
[Full Text] [PDF]

Home page
 PediatricsHome page
C. J. Stille, S. E. Andrade, S. S. Huang, J. Nordin, M. A. Raebel, A. S. Go, K. A. Chan, and J. A. Finkelstein
Increased Use of Second-Generation Macrolide Antibiotics for Children in Nine Health Plans in the United States
Pediatrics, November 1, 2004; 114(5): 1206 - 1211.
[Abstract] [Full Text] [PDF]

Home page
 AAP Grand RoundsHome page
B. M. Pate and M. A. Jackson
Etiology of Community-Acquired Pneumonia in Hospitalized Pediatric Patients
AAP Grand Rounds, September 1, 2004; 12(3): 28 - 29.
[Full Text] [PDF]

Home page
 J. Clin. Microbiol.Home page
I. C. Michelow, K. Olsen, J. Lozano, L. B. Duffy, G. H. McCracken, and R. D. Hardy
Diagnostic Utility and Clinical Significance of Naso- and Oropharyngeal Samples Used in a PCR Assay To Diagnose Mycoplasma pneumoniae Infection in Children with Community-Acquired Pneumonia
J. Clin. Microbiol., July 1, 2004; 42(7): 3339 - 3341.
[Abstract] [Full Text] [PDF]

Home page
 JWatch Infect. DiseasesHome page
Can We Improve Etiologic Diagnosis of Pediatric Pneumonia?
Journal Watch Infectious Diseases, April 26, 2004; 2004(426): 3 - 3.
[Full Text]