Published online February 1, 2005
PEDIATRICS Vol. 115 No. 2 February 2005, pp. 517 (doi:10.1542/peds.2004-2480)
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Haemophilus influenzae Infections

Epidemiology of Community-Acquired Pneumonia in Children: In Reply

Ian C. Michelow, MBBCh, DTM&H
Department of Pediatrics
Massachusetts General Hospital
Boston, MA 02114

George H. McCracken, Jr, MD
Department of Pediatrics
University of Texas Southwestern Medical Center
Dallas, TX 75390

In Reply.—

The incidence of Haemophilus influenzae infection was not specifically studied in our recent publication.1 Although non-type b and nontypeable H influenzae have been confirmed as causes of pneumonia in children, the frequency of infection in the United States is poorly defined. Since the introduction of the conjugated polysaccharide H influenzae type b vaccine in 1990, the incidence of invasive disease by that pathogen has declined dramatically. A limited number of publications have demonstrated lower frequencies of non-type b and nontypeable H influenzae pneumonia in children compared with adults and in developed countries compared with developing countries.2 These strains have also been isolated from patients with underlying respiratory disorders including acute exacerbations of chronic bronchitis, bronchiectasis, and cystic fibrosis.3

H influenzae commonly colonizes the upper respiratory tract of children. These commensal organisms can gain access to the lungs by contiguous spread or aspiration but are less likely to invade the blood stream than H influenzae type b. Therefore, to confirm infection with non-type b or nontypeable H influenzae, culture of percutaneous lung aspirates are necessary.4,5 Because these invasive procedures are rarely undertaken in children, the incidence of pneumonia caused by these strains presumably is underestimated.

Other diagnostic approaches have not been adequately validated in children. Specifically, acute and convalescent serology may indicate acute infection with H influenzae, but serologic assays may also reflect a nonspecific anamnestic response to a previous infection or a response to colonizing organisms during a viral infection.6,7 Sputum collection in young children is unreliable, and semiquantitative cultures of sputum samples to diagnose causes of pneumonia in children have not been adequately validated by other investigators. Because H influenzae frequently colonizes the nasopharynx of children, there is a substantial risk of overestimating H influenzae pneumonia based on nasopharyngeal cultures.5

REFERENCES

  1. 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]
  2. Heath PT, Booy R, Azzopardi HJ, et al. Non-type b Haemophilus influenzae disease: clinical and epidemiologic characteristics in the Haemophilus influenzae type b vaccine era. Pediatr Infect Dis J. 2001;20 :300 –305[CrossRef][ISI][Medline]
  3. Klein JO. Role of nontypeable Haemophilus influenzae in pediatric respiratory tract infections. Pediatr Infect Dis J. 1997;16 :S5 –S8[CrossRef][Medline]
  4. Liston TE, Foshee WS. Invasive disease due to nontypable Haemophilus influenzae in children. South Med J. 1982;75 :753 –754[Medline]
  5. Shann F. Haemophilus influenzae pneumonia: type b or non-type b? Lancet. 1999;354 :1488 –1490[CrossRef][ISI][Medline]
  6. Korppi M, Katila ML, Jaaskelainen J, Leinonen M. Role of non-capsulated Haemophilus influenzae as a respiratory pathogen in children. Acta Paediatr. 1992;81 :989 –992[Medline]
  7. Bradley JS. Management of community-acquired pediatric pneumonia in an era of increasing antibiotic resistance and conjugate vaccines. Pediatr Infect Dis J. 2002;21 :592 –598; discussion 613–614[CrossRef][Medline]
PEDIATRICS (ISSN 1098-4275). ©2005 by the American Academy of Pediatrics

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Tsutomu Yamazaki, Kei Murayama, Atsuko Ito, Suzuko Uehara, and Nozomu Sasaki
Pediatrics 2005 115: 517. [Extract] [Full Text]  




This Article
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Right arrow Infectious Disease & Immunity
Right arrowRelated AAP Red Book topics:
Haemophilus influenzae Infections