Abreu SG, Fuentes FG, Domínguez CIM, Portuondo LR, Pérez OM, Toraño PG

Language: Spanish
References: 22
Page: 4-13
PDF size: 171.63 Kb.

ABSTRACT

Introduction: blood culturing in children with pneumococcal pneumonia children may show the germ if bacteremia exists and find out the susceptibility to antibiotics and the causative serotype. Such knowledge is fundamental to apply an optimal therapy with a view to evaluating the impact of a pneumococcal vaccine.
Objective: to describe the incidence of invasive pneumococcal disease in children younger than 5 years with severe pneumonia.
Methods: a cross-sectional and descriptive study was conducted in 117 children aged 2 months to younger than 5 years with community-acquired severe pneumonia, who had been admitted to "Centro Habana" pediatric hospital from August 2014 to November 2015, and two blood cultures were made before the start of treatment and the pleural fluid was studied in case of pleural effusion. Isolated pneumococci were then characterized at the reference laboratory of "Pedro Kouri" Institute of Tropical Medicine. They were grouped by age (< 1 year and ≥ 1 year) and onset of pleural effusion. Clinical and radiological data that allowed the diagnosis of severe pneumonia were then registered.
Results: children younger than 1 year (99-84.6 %) and males (59 %) predominated. Nine Streptococcus pneumoniae (7.7 %) were isolated, being more frequent in younger than one-year old children (3 out of 18, 16.7 %). There were 8 isolates in 33 children with pleural effusion (24.2 %), being more frequent in younger than one year-old infants (7 cases of effusion and 3 isolates [42.9 %]). Three serotypes 14, one 6A and one 19A, all susceptible to penicillin, ceftriaxome and vancomycin were reported whereas four isolates could not be characterized. No child died.
Conclusions: the presence of Streptococcus pneumoniae in the severe pneumonia of younger than 5 years-old children, which is complicated with pleural effusion, and the appropriateness of the Cuban pneumococcal vaccinal candidate according to the isolated serotypes were confirmed.

REFERENCES

1. Oliwa JN, Marais BJ. Vaccines to prevent pneumonia in children-a developing country perspective. Paediatric Respiratory Reviews [serie en Internet]. 2015 ago [citado 25 de Diciembre de 2015]. Disponible en: http://www.sciencedirect.com/science/article/pii/S1526054215000755

2. Rodríguez JM, Valerio AM, Vega D, Pacheco L, Castillo R, García JB, et al. Caracterización de la neumonía grave adquirida en la comunidad. Rev Cubana Pediatr [serie en Internet]. 2016 mar [citado 25 de Marzo de 2016];88(1). Disponible en: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S0034- 75312016000100007&lng=es&nrm=iso&tlng=es

3. Ash SY, Sheffield JVL. Pneumococcus. Med Clin N Am. 2013;97:647-66.

4. Berti E, Galli L, Martino M, Chiappini E. International guidelines on tackling community-acquired pneumonia show major discrepancies between developed and developing countries. Acta Pædiatrica. 2013;102(supp 465):4-16.

5. Spencer DA, Thomas MF. Necrotizing pneumonia in children. Paediatric Respiratory Reviews. 2014;15:240-5.

6. Zar HJ, Madhi SA, Aston SJ, Gordon SB. Pneumonia in low and middle income countries: progress and challenges. Thorax. 2013;68:1052-6.

7. de Martino M, Chiappini E. Pneumonia in children: more shadows than lights. Pædiatrica. 2013;102(supp 465):1-3.

8. Chiappini E, Venturini E, Galli L, Novelli V, Martino M. Diagnostic features of community-acquired pneumonia in children: what's new? Acta Pædiatrica. 2013;102(supp 465):17-24.

9. Dotres CP, Puga R, Ricardo Y, Broño CR, Paredes B, Echemendía V, et al. Safety and preliminary immunogenicity of Cuban pneumococcal conjugate vaccine candidate in healthy children: A randomized phase I clinical trial. Vaccine. 2014;32:5266-70.

10. Grupo Nacional de Pediatría. Grupo Nacional de Infectología. Comisión Nacional de Infecciones Respiratorias Agudas. Sociedad Cubana de Pediatría. Consenso nacional para el diagnóstico y tratamiento de la neumonía adquirida en la comunidad en Pediatría. Multimedia 2013.

11. Rodríguez Y, Mengana E, Fariñas A, García Y. Caracterización clínicoepidemiológica de pacientes con neumonía grave. Hospital Infantil Norte de Santiago de Cuba, 2012-2013. Panorama Cuba y Salud. 2015;10(3):25-31.

12. Michelow IC, Olsen K, Lozano J, Rollins NK, Duffy LB, Ziegler T, et al. Epidemiology and Clinical Characteristics of Community-Acquired Pneumonia in Hospitalized Children. Pediatrics. 2004;113(4):701-7.

13. François P, Desrumaux A, Cans C, Pin I, Pavese P, Labarère J. Prevalence and risk factors of suppurative complications in children with pneumonia. Acta Pædiatrica. 2010;99:861-6.

14. Vila Y, Valdés-Dapena MM, Medell M, Monzote A, Díaz L, Toraño G. Diagnóstico microbiológico de los líquidos pleurales procesados en el Hospital Pediátrico "Juan Manuel Márquez", 2009-2013. Panorama Cuba y Salud. 2015;10(2):10-6.

15. Ping-Sheng W, Li-Min H, I-Shou C, Chun-Yi L, Pei-Lan S, Fang-Yu T, et al. The epidemiology of hospitalized children with pneumococcal/lobar pneumonia and empyema from 1997 to 2004 in Taiwan. Eur J Pediatr. 2010;169:861-6.

16. Eastham KM, Freeman R, Kearns AM, Eltringham G, Clark J, Leeming J, et al. Clinical features, etiology and outcome of empyema in children in the north east of England. Thorax. 2004;59:522-5.

17. Iroh PY, Bernstein E, Ma X, Ferrieri P. Blood culture in evaluation of pediatric community-acquired pneumonia: A systematic review and meta-analysis. Hospital Pediatrics. 2015;5(6):324-36.

18. Delgado AL, Dorta AJ, López I. Derrame pleural paraneumónico en la infancia: utilidad del estudio microscópico del líquido y del ultrasonido. Revista de Ciencias Médicas La Habana. 2011;17(2):217-25.

19. Jain S, Williams DJ, Arnold SR, Ampofo K, Bramley AB, Reed C, et al. Community- Acquired Pneumonia Requiring Hospitalization among U.S. Children. N Engl J Med. 2015;372:835-45.

20. Fletcher M, Schmitt HJ, Syrochkina M, Sylvester G. Pneumococcal empyema and complicated pneumonias: global trends in incidence, prevalence, and serotype epidemiology. European Journal of Clinical Microbiology & Infectious Diseases. 2014;33(6):879-910.

21. Honkinen M, Lahti E, Svedström E, Jartti T, Virkki R, Peltola V, et al. Long-Term Recovery after Parapneumonic Empyema in Children. Pediatric Pulmonology. 2014;49:1020-7.

22. Renko M, Kukkola H-A, Kauma H, Tapiainen T, Kaijalainen T, Uhari M. Comparación de severidad y resultados de las infecciones neumocócicas invasivas en niños y adultos. Pediatr Infect Dis J. 2012;31:785-8.