Published online February 1, 2005
PEDIATRICS
Vol. 115
No. 2
February 2005, pp.
517
(doi:10.1542/peds.2004-2055)
Epidemiology of Community-Acquired Pneumonia in Children
Tsutomu Yamazaki, MD, PhD
Kei Murayama, MD
Atsuko Ito, MD
Suzuko Uehara, MD, PhD
Nozomu Sasaki, MD, PhD
Department of Pediatrics
Saitama Medical School
Moroyama, Iruma, Saitama 350-0495, Japan
To the Editor.—
We read the recent article by Michelow et al,1 "Epidemiology and Clinical Characteristics of Community-Acquired Pneumonia in Hospitalized Children," with great interest. One hundred fifty-four children were enrolled in this study, and blood or pleural fluid cultures, pneumolysin-based polymerase chain reaction assays, and serologic tests were used to clarify the epidemiology. The study indicated that Streptococcus pneumoniae, Mycoplasma pneumoniae, Chlamydia pneumoniae, and respiratory viruses were the major pathogens involved in community-acquired pneumonia (CAP). Although these results are informative for pediatricians, it does not seem appropriate that Haemophilus influenzae was not found to be a causative pathogen of CAP in this study. In the guidelines2 published by the American Thoracic Society, H influenzae is recognized as an etiologic pathogen that causes CAP. There may be some discrepancy between adults and children over whether H influenzae is a respiratory pathogen of CAP. As it is stated by the authors in their discussion, however, such a discrepancy in the epidemiology might be the result of a lack of specific tests for H influenzae (and Moraxella catarrhalis). Because most respiratory infections of H influenzae are caused by nontypeable strains, analysis by serologic methods should be improved to include antigens made by local strains of H influenzae. We have been using a semiquantitative culture method of detection on washed sputum samples for a couple of decades and have found that H influenzae is one of the most frequent causative pathogens found in lower respiratory tract infections in children. This method is not difficult for pediatricians and is less invasive for children. Although expectorated sputum is difficult to obtain from younger children, it can be obtained successfully from children repeatedly by inducing cough. In this method, the sputum obtained is washed in sterile saline three times to reduce the effect of microorganisms from the upper respiratory tract that are usually present on the outside of the specimens. Using this method, Uehara3 emphasized the significant etiologic role of H influenzae in children with CAP, and our recent data also indicate that nearly 30% of lower respiratory infections in children are related to H influenzae (unpublished data). We would suggest that this semiquantitative culture analysis of washed sputum be compared with an improved serologic method for H influenzae in the future.
REFERENCES
- Michelow IC, Olsen K, Lozano J, et al. Epidemiology and clinical characteristics of community-acquired pneumonia in hospitalized children.
Pediatrics. 2004;113
:701
–707[Abstract/Free Full Text]
- Niederman MS, Bass JB Jr, Campbell GD, et al. Guidelines for the initial management of adults with community-acquired pneumonia: diagnosis, assessment of severity, and initial antimicrobial therapy. American Thoracic Society. Medical Section of the American Lung Association.
Am Rev Respir Dis. 1993;148
:1418
–1426[ISI][Medline]
- Uehara S. A method of bacteriological examination of washed sputum in infants and children.
Acta Paediatr Jpn. 1988;30
:253
–260[Medline]
PEDIATRICS (ISSN 1098-4275). ©2005 by the American Academy of Pediatrics
Related articles in Pediatrics:
- Epidemiology of Community-Acquired Pneumonia in Children: In Reply
- Ian C. Michelow and George H. McCracken, Jr
Pediatrics 2005 115: 517.
[Extract]
[Full Text]
