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Association Between Bacterial Infection and Radiologically Confirmed Pneumonia Among Children

Nascimento-Carvalho, Cristiana M. MD, PhD*; Araújo-Neto, César A. MD, PhD; Ruuskanen, Olli MD, PhD

The Pediatric Infectious Disease Journal: May 2015 - Volume 34 - Issue 5 - p 490–493
doi: 10.1097/INF.0000000000000622
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Background: The role of chest radiograph (CXR) among children with community-acquired pneumonia is controversial. We aimed to assess if there is association between a specific etiology and radiologically confirmed pneumonia.

Methods: This was a prospective cross-sectional study. Based on report of respiratory complaints and fever/difficulty breathing plus the detection of pulmonary infiltrate/pleural effusion on the CXR taken upon admission read by the pediatrician on duty, children <5-year-old hospitalized with community-acquired pneumonia were enrolled. On admission, clinical data and biological samples were collected to investigate 19 etiological agents (11 viruses and 8 bacteria). CXR taken upon admission was independently read by a pediatric radiologist blinded to clinical data.

Results: The study group comprised 209 cases with evaluated CXR and establishment of a probable etiology. Radiologically confirmed pneumonia, normal CXR and other radiographic diagnoses were described for 165 (79.0%), 36 (17.2%) and 8 (3.8%) patients, respectively. Viral infection was significantly more common among patients without radiologically confirmed pneumonia (68.2% vs. 47.9%; P = 0.02), particularly among those with normal CXR (66.7% vs. 47.9%; P = 0.04) when compared with patients with radiologically confirmed pneumonia. Bacterial infection was more frequent among cases with radiologically confirmed pneumonia (52.1% vs. 31.8%; P = 0.02). Likewise, pneumococcal infection was more frequently detected among children with radiologically confirmed pneumonia in regard to children with normal CXR (24.2% vs. 8.3%; P = 0.04). Sensitivity (95% confidence interval) of radiologically confirmed pneumonia for pneumococcal infection was 93% (80–98%), and negative predictive value (95% confidence interval) of normal CXR for pneumococcal infection was 92% (77–98%).

Conclusion: Bacterial infection, especially pneumococcal one, is associated with radiologically confirmed pneumonia.

Supplemental Digital Content is available in the text.

From the *Department of Pediatrics and Department of Image Diagnosis, Federal University of Bahia School of Medicine, Salvador, Brazil; and Department of Pediatrics, University of Turku, Turku, Finland.

Accepted for publication November 7, 2014.

This study was supported by the Bahia State Agency for Research Funding (FAPESB; grant number 52/2004) and the Brazilian Council for Scientific and Technological Development (CNPq; grant number 03551/2011–9) in Brazil and the Pediatric Research Foundation, in Finland.

C.M.N.-C. is an investigator at the Brazilian Council for Scientific and Technological Development (CNPq). The authors have no conflicts of interest to disclose.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (www.pidj.com).

Address for correspondence: Cristiana M. Nascimento-Carvalho, MD, PhD, Department of Pediatrics, Federal University of Bahia School of Medicine, Rua Prof. Aristides Novis, 105/1201B, Salvador, Bahia, CEP 40210-630, Brazil. E-mail: nascimentocarvalho@hotmail.com.

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