Infection by Streptococcus pneumoniae in children with or without radiologically confirmed pneumonia

• Main Authors: Dafne C. Andrade, Igor C. Borges, Ana Luísa Vilas-Boas, Maria S.H. Fontoura, César A. Araújo-Neto, Sandra C. Andrade, Rosa V. Brim, Andreas Meinke, Aldina Barral, Olli Ruuskanen, Helena Käyhty, Cristiana M. Nascimento-Carvalho
• Format: Article
• Language: English
• Published: Elsevier
• Series: Jornal de Pediatria
• Subjects: Infecção bacteriana; Etiologia; Infecção do trato respiratório inferior; Estudo radiológico; Testes sorológicos
• Online Access: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0021-75572018000100023&lng=en&tlng=en

Abstract Objective: Community-acquired pneumonia is an important cause of morbidity in childhood, but the detection of its causative agent remains a diagnostic challenge. The authors aimed to evaluate the role of the chest radiograph to identify cases of community-aquired pneumonia caused by typical bacteria. Methods: The frequency of infection by Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis was compared in non-hospitalized children with clinical diagnosis of community acquired pneumonia aged 2-59 months with or without radiological confirmation (n = 249 and 366, respectively). Infection by S. pneumoniae was diagnosed by the detection of a serological response against at least one of eight pneumococcal proteins (defined as an increase ≥2-fold in the IgG levels against Ply, CbpA, PspA1 and PspA2, PhtD, StkP-C, and PcsB-N, or an increase ≥1.5-fold against PcpA). Infection by H. influenzae and M. catarrhalis was defined as an increase ≥2-fold on the levels of microbe-specific IgG. Results: Children with radiologically confirmed pneumonia had higher rates of infection by S. pneumoniae. The presence of pneumococcal infection increased the odds of having radiologically confirmed pneumonia by 2.8 times (95% CI: 1.8-4.3). The negative predictive value of the normal chest radiograph for infection by S. pneumoniae was 86.3% (95% CI: 82.4-89.7%). There was no difference on the rates of infection by H. influenzae and M. catarrhalis between children with community-acquired pneumonia with and without radiological confirmation. Conclusions: Among children with clinical diagnosis of community-acquired pneumonia submitted to chest radiograph, those with radiologically confirmed pneumonia present a higher rate of infection by S. pneumoniae when compared with those with a normal chest radiograph.