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Background

While recognizing the etiology of community-acquired pneumonia is necessary for formulating local antimicrobial guidelines, limited data is published about this etiology in Egyptian pediatric patients.

Objectives

To determine the frequency of bacterial and viral pathogens causing community-acquired pneumonia (CAP) among immunocompetent Egyptian infants and preschool children.

Methods

Ninety infants and preschool-age children admitted to our hospital with CAP were prospectively included in the study. Etiological agents were identified using conventional bacteriological identification methods and IgM antibodies detection against common atypical respiratory bacteria and viruses.

Results

An etiology was identified in 59 patients (65.5%). Bacterial pathogens were detected in 43 (47.8%) of the cases while viral pathogens were detected in 23 (25.5%). Coinfection with more than one etiologic agent was evident in seven patients (7.8%). The most common typical bacterial cause of pneumonia was Staphylococcus aureus (n = 12, 13.3%), followed by Streptococcus pneumoniae and Klebsiella pneumoniae (n = 7, 7.8%, each). The commonest atypical bacterium was Mycoplasma pneumoniae (n = 10, 11.1%), whereas the commonest viral etiology was influenza viruses (n = 11, 12.2%).

Conclusion

Although we could not determine the causative agent in some studied cases, this study provides preliminary data regarding the spectrum and frequency of microorganisms causing CAP in Egyptian infants and preschool children.

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  • 1.

    Zar HJ , Ferkol TW: The global burden of respiratory disease – impact on child health. Pediatr Pulmonol 49(5), 430434 (2014)

  • 2.

    Izadnegahdar R , Cohen AL, Klugman KP, Qazi SA: Childhood pneumonia in developing countries. Lancet Respir Med 1(7), 574584 (2013)

  • 3.

    World Health Organization: World Health Statistics 2014

  • 4.

    Cardinale F , Cappiello AR, Mastrototaro MF, Pignatelli M, Esposito S: Community-acquired pneumonia in children. Early Hum Dev 89 (Suppl 3), S4952 (2013)

    • Search Google Scholar
    • Export Citation
  • 5.

    Harris M , Clark J, Coote N, et al.: British Thoracic Society guidelines for the management of community acquired pneumonia in children: update 2011. Thorax 66 (Suppl 2), ii123 (2011)

    • Search Google Scholar
    • Export Citation
  • 6.

    Jones RN , Jacobs MR, Sader HS: Evolving trends in Streptococcus pneumoniae resistance: implications for therapy of community-acquired bacterial pneumonia. Int, J Antimicrob Agents 36(3), 197204 (2010)

    • Search Google Scholar
    • Export Citation
  • 7.

    World Health Organization: Pocketbook of Hospital Care for Children

  • 8.

    Cherian T , Mulholland EK, Carlin JB, et al.: Standardized interpretation of paediatric chest radiographs for the diagnosis of pneumonia in epidemiological studies. Bull World Health Organ 83(5), 353359 (2005)

    • Search Google Scholar
    • Export Citation
  • 9.

    Zar HJ , Tannenbaum E, Apolles P, Roux P, Hanslo D, Hussey G: Sputum induction for the diagnosis of pulmonary tuberculosis in infants and young children in an urban setting in South Africa. Arch Dis Child 82(4), 305308 (2000)

    • Search Google Scholar
    • Export Citation
  • 10.

    Equi AC , Pike SE, Davies J, Bush A: Use of cough swabs in a cystic fibrosis clinic. Arch Dis Child 85(5), 438439 (2001)

  • 11.

    Murray PR , Washington JA: Microscopic and baceriologic analysis of expectorated sputum. Mayo Clin Proc 50(6), 339344 (1975)

  • 12.

    Collee J : Mackie, & McCartney Practical Medical Microbiology. Churchill Livingstone, New York

  • 13.

    El-Sahrigy SAF , Abdel-Rahman AMO, Shady EAEA, Attia HR, Gomaa HE: Pneumoslide-M technique for rapid detection of atypical pathogens in critically ill children with lower respiratory tract infections. J Med Sci 6(5), 793799 (2006)

    • Search Google Scholar
    • Export Citation
  • 14.

    Chiang WC , Teoh OH, Chong CY, Goh A, Tang JPL, Chay OM: Epidemiology, clinical characteristics and antimicrobial resistance patterns of community-acquired pneumonia in 1702 hospitalized children in Singapore. Respirology 12(2), 254261 (2007)

    • Search Google Scholar
    • Export Citation
  • 15.

    Claesson BA , Trollfors B, Brolin I, et al.: Etiology of community-acquired pneumonia in children based on antibody responses to bacterial and viral antigens. Pediatr Infect Dis J 8(12), 856862 (1989)

    • Search Google Scholar
    • Export Citation
  • 16.

    Juvén T , Mertsola J, Waris M, et al.: Etiology of community-acquired pneumonia in 254 hospitalized children. Pediatr Infect Dis J 19(4), 293298 (2000)

    • Search Google Scholar
    • Export Citation
  • 17.

    Honkinen M , Lahti E, Österback R, Ruuskanen O, Waris M: Viruses and bacteria in sputum samples of children with community-acquired pneumonia. Clin Microbiol Infect 18(3), 300307 (2012)

    • Search Google Scholar
    • Export Citation
  • 18.

    Jain S , Self WH, Wunderink RG, et al.: Communityacquired pneumonia requiring hospitalization among U.S. adults. N Engl, J Med, 150714140110004 (2015)

    • Search Google Scholar
    • Export Citation
  • 19.

    Heiskanen-Kosma T , Korppi M, Jokinen C, et al.: Etiology of childhood pneumonia: serologic results of a prospective, population-based study. Pediatr Infect Dis J 17(11), 986991 (1998)

    • Search Google Scholar
    • Export Citation
  • 20.

    Don M , Fasoli L, Paldanius M, et al.: Aetiology of community-acquired pneumonia: serological results of a paediatric survey. Scand, J Infect Dis 37(11–12), 806812 (2005)

    • Search Google Scholar
    • Export Citation
  • 21.

    Myers AL , Hall M, Williams DJ, et al.: Prevalence of bac teremia in hospitalized pediatric patients with community-acquired pneumonia. Pediatr Infect Dis J 32(7), 736740 (2013)

    • Search Google Scholar
    • Export Citation
  • 22.

    Yen M , Hu B, Chen Y, et al.: A prospective etiologic study of community-acquired pneumonia in Taiwan. Methods 104(10), 724730 (2005)

  • 23.

    Heine D , Cochran C, Moore M, Titus MO, Andrews AL: The prevalence of bacteremia in pediatric patients with community-acquired pneumonia: guidelines to reduce the frequency of obtaining blood cultures. Hosp Pediatr 3(2), 9296 (2013)

    • Search Google Scholar
    • Export Citation
  • 24.

    Rashed HG, H H , ElShanawey O, Hassan L: Adult community acquired pneumonia in Assiut University Hospital. Assiut Med J 30(1) (2006)

  • 25.

    Chen K , Jia R, Li L, Yang C, Shi Y: The aetiology of community associated pneumonia in children in Nanjing, China and aetiological patterns associated with age and season. BMC Public Health 15(1), 16 (2015)

    • Search Google Scholar
    • Export Citation
  • 26.

    Gentile A , Bardach A, Ciapponi A, et al.: Epidemiology of community-acquired pneumonia in children of Latin America and the Caribbean: a systematic review and meta-analysis. Int, J Infect Dis 16(1), e515 (2012)

    • Search Google Scholar
    • Export Citation
  • 27.

    Atwa ZTH : Usefulness of gender and abnormal blood count for predicting pneumonia outcome in children. Egypt, J Chest Dis Tuberc 64(1), 169174 (2014)

    • Search Google Scholar
    • Export Citation
  • 28.

    Ezzat ESM , Fahmy K, Amer A, Abdel-aziz R: Hospital and community acquired methicillin resistant Staphylococcus aureus infections and their association with Panton–Valentine leukocidin gene 16(3), 481489 (2007)

    • Search Google Scholar
    • Export Citation
  • 29.

    Abdulghany HM , Khairy RM: The frequency of methicillin-resistant Staphylococcus aureus and coagulase gene polymorphism in Egypt. 2014 (2014)

    • Search Google Scholar
    • Export Citation
  • 30.

    Enany S , Yaoita E, Yoshida Y, Enany M, Yamamoto T: Molecular characterization of Panton–Valentine leukocidin-positive community-acquired methicillin-resistant Staphylococcus aureus isolates in Egypt. Microbiol Res 165(2), 152162 (2010)

    • Search Google Scholar
    • Export Citation
  • 31.

    Kallen AJ , Brunkard J, Moore Z, et al.: Staphylococcus aureus community-acquired pneumonia during the 2006 to 2007 influenza season. Ann Emerg Med 53(3), 358365 (2009)

    • Search Google Scholar
    • Export Citation
  • 32.

    Carrillo-Marquez MA , Hulten KG, Hammerman W, Lamberth L, Mason EO, Kaplan SL: Staphylococcus aureus pneumonia in children in the era of community-acquired methicillin-resistance at Texas Children’s Hospital. Pediatr Infect Dis J 30(7), 545550 (2011)

    • Search Google Scholar
    • Export Citation
  • 33.

    Hageman JC , Uyeki TM, Francis JS, et al.: Severe community-acquired pneumonia due to Staphylococcus aureus, 2003-04 influenza season. Emerg Infect Dis 12(6), 894899 (2006)

    • Search Google Scholar
    • Export Citation
  • 34.

    Rice TW , Rubinson L, Uyeki TM, et al.: Critical illness from 2009 pandemic influenza A virus and bacterial coinfection in the United States. Crit Care Med 40(5), 14871498 (2012)

    • Search Google Scholar
    • Export Citation
  • 35.

    Tsolia MN , Psarras S, Bossios A, et al.: Etiology of community-acquired pneumonia in hospitalized school-age children: evidence for high prevalence of viral infections. Clin Infect Dis 39 (April 2003), 681686 (2004)

    • Search Google Scholar
    • Export Citation
  • 36.

    Layani-Milon MP , Gras I, Valette M, et al.: Incidence of upper respiratory tract Mycoplasma pneumoniae infections among outpatients in Rhône-Alpes, France, during five successive winter periods. J Clin Microbiol 37(6), 17211726 (1999)

    • Search Google Scholar
    • Export Citation
  • 37.

    Medjo B , Atanaskovic-Markovic M, Radic S, Nikolic D, Lukac M, Djukic S: Mycoplasma pneumoniae as a causative agent of community-acquired pneumonia in children: clinical features and laboratory diagnosis. Ital, J Pediatr 40(1), 104 (2014)

    • Search Google Scholar
    • Export Citation
  • 38.

    Yeldandi AV , Colby TV: Pathologic features of lung biopsy specimens from influenza pneumonia cases. Hum Pathol 25(1), 4753 (1994)

  • 39.

    Samransamruajkit R , Hiranrat T, Chieochansin T, et al.: Prevalence, clinical presentations and complications among hospitalized children with influenza pneumonia. Jpn, J Infect Dis 61(6), 446449 (2008)

    • Search Google Scholar
    • Export Citation
  • 40.

    Cevey-Macherel M , Galetto-Lacour A, Gervaix A, et al.: Etiology of community-acquired pneumonia in hospitalized children based on WHO clinical guidelines. Eur, J Pediatr 168(12), 14291436 (2009)

    • Search Google Scholar
    • Export Citation
  • 41.

    Hatchette TF , Gupta R, Marrie TJ: Pseudomonas aeruginosa community-acquired pneumonia in previously healthy adults: case report and review of the literature. Clin Infect Dis 31(6), 13491356 (2000)

    • Search Google Scholar
    • Export Citation
  • 42.

    Michelow IC , Olsen K, Lozano J, et al.: Epidemiology and clinical characteristics of community-acquired pneumonia in hospitalized children. Pediatrics 113(4), 701707 (2004)

    • Search Google Scholar
    • Export Citation
  • 43.

    Elemraid MA , Rushton SP, Thomas MF, Spencer DA, Gennery AR, Clark JE: Utility of inflammatory markers in predicting the aetiology of pneumonia in children. Diagn Microbiol Infect Dis 79(4), 458462 (2014)

    • Search Google Scholar
    • Export Citation

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