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

ObjectiveCommunity-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.MethodsThe 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.ResultsChildren 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.ConclusionsAmong 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.</p

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

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

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

Submitted by Ana Maria Fiscina Sampaio ([email protected]) on 2018-02-05T17:27:37Z No. of bitstreams: 1 Andrade DC Infection by Streptococcus....pdf: 430647 bytes, checksum: 12561d46eae1bfa6c0a7b41774319427 (MD5)Approved for entry into archive by Ana Maria Fiscina Sampaio ([email protected]) on 2018-02-05T17:55:09Z (GMT) No. of bitstreams: 1 Andrade DC Infection by Streptococcus....pdf: 430647 bytes, checksum: 12561d46eae1bfa6c0a7b41774319427 (MD5)Made available in DSpace on 2018-02-05T17:55:09Z (GMT). No. of bitstreams: 1 Andrade DC Infection by Streptococcus....pdf: 430647 bytes, checksum: 12561d46eae1bfa6c0a7b41774319427 (MD5) Previous issue date: 2018Sanofi Pasteur (Lyon, France)for supplying PcpA and PhtD; Prof. Elaine Tuomanen atSt. Judes Children’s Research Hospital (Memphis, UnitedStates) for supplying Ply, CbpA, PspA1; Profs. Susan Holling-shead, David Briles, and Pat Coan at University of Alabama(Birmingham, United States), for supplying PspA2; and Val-neva Austria GmbH (Vienna, Austria) for supplying SP1732-3,SP2216-1, NTHi Protein D, NTHi0371-1, NTHi0830, MCOmp CD, MC RH4 2506, MC RH4 1701, MC RH4 3729-1, andMC RH4 4730Universidade Federal da Bahia. Faculdade de Medicina. Programa de Pós-Graduação em Ciências da Saúde. Salvador, BA, BrasilUniversidade Federal da Bahia. Faculdade de Medicina. Programa de Pós-Graduação em Ciências da Saúde. Salvador, BA, BrasilUniversidade Federal da Bahia. Faculdade de Medicina. Programa de Pós-Graduação em Ciências da Saúde. Salvador, BA, BrasilUniversidade Federal da Bahia. Faculdade de Medicina. Departamento de Pediatria. Salvador, BA, BrasilUniversidade Federal da Bahia. Faculdade de Medicina. Departamento de Imagem Diagnóstico. Salvador, BA, BrasilUniversidade Federal da Bahia. Complexo Hospitalar Professor Edgard Santos. Salvador, BA, BrasilValneva Austria GmbH. Vienna, AustriaUniversidade Federal da Bahia. Faculdade de Medicina da Bahia. Departamento de Patologia. Salvador, BA, Brasil / Fundação Oswaldo Cruz. Centro de Pesquisas Gonçalo Moniz. Salvador, BA, BrasilTurku University and University Hospital. Department of Pediatrics. Turku, FinlandiNationalNational Institute for Health and Welfare. Helsinki, FinlandUniversidade Federal da Bahia. Faculdade de Medicina. Programa de Pós-Graduação em Ciências da Saúde. Salvador, BA, Brasil / Universidade Federal da Bahia. Faculdade de Medicina. Departamento de Pediatria. Salvador, BA, BrasilO objetivo deste estudo foi avaliar o papel do raio-X de tórax na identificação de casos de pneumonia adquirida na comunidade (PAC) causada por agentes bacterianos.Métodos: A frequência de infecção por Streptococcus pneumoniae, Haemophilus influenzae e Moraxella catarrhalis em crianças com PAC não hospitalizadas foi comparada com a presença de confirmação radiológica da pneumonia (n = 249 crianas com pneumonia radiologicamente confirmada e 366 crianças com raio X de tórax normal). Infecção por S. pneumoniae foi diagnos-ticada com base na resposta sorológica a pelo menos uma dentre oito proteínas pneumocócicas investigadas (aumento ≥2 vezes nos níveis de IgG em relação a Ply, CbpA, PspA1 e 2, PhtD, StkP-C e PcsB-N ou aumento≥1,5 vezes em relação aPcpA). Infecção por H. influenzae e M.catarrhalis foi definida por aumento≥2 vezes nos níveis de IgG específica a antígenos de cada agente. Resultados: Crianças com pneumonia radiologicamente confirmada apresentaram maior taxa de infecção pelo pneumococo. Além disso, a presença de infecção pneumocócica foi um fatorpreditor de pneumonia radiologicamente confirmada, aumentando sua chance de detecção em 2,8 vezes (IC 95%: 1,8-4,3). O valor preditivo negative do raio X normal para a infecção por S. pneumoniae foi 86,3% (IC95%: 82,4%-89,7%). Não houve diferença nas frequências de infecção por H. influenzae e M. catarrhalis entre crianças com PAC com ou sem confirmação radiológica.Conclusões: Crianç¸as com diagnóstico clínico de PAC submetidas a um raio X de tórax que apresentam confirmação radiológica tem maior taxa de infecção por S. pneumoniae, comparado às crianças com raio X normal.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 ofCAP 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 againstat least one of eight pneumococcal proteins (defined as an increase ≥2-fold in the IgG levelsagainst Ply, CbpA, PspA1 and PspA2, PhtD, StkP-C, and PcsB-N, or an increase ≥1.5-fold againstPcpA). Infection by H. influenzae and M. catarrhalis was defined as an increase ≥2-fold on thelevels of microbe-specific IgG

Comparison of oral amoxicillin given thrice or twice daily to children between 2 and 59 months old with non-severe pneumonia: a randomized controlled trial

Submitted by Ana Maria Fiscina Sampaio ([email protected]) on 2014-06-30T17:58:15Z No. of bitstreams: 1 Vilas-Boas AL Comparison of oral....pdf: 192137 bytes, checksum: c8cc369ee368a9bdb6e9eedde3f9fbab (MD5)Made available in DSpace on 2014-06-30T17:58:15Z (GMT). No. of bitstreams: 1 Vilas-Boas AL Comparison of oral....pdf: 192137 bytes, checksum: c8cc369ee368a9bdb6e9eedde3f9fbab (MD5) Previous issue date: 2014Federal University of Bahia. School of Medicine. Department of Paediatrics. Salvador, BA, BrasilFederal University of Bahia. School of Medicine. Department of Paediatrics. Salvador, BA, BrasilFederal University of Bahia. School of Medicine. Department of Paediatrics. Salvador, BA, BrasilUniversity Federal of Bahia School of Medicine. Department of Image Diagnosis. Salvador, BA, BrasilFederal University of Bahia Hospital. Image Diagnosis Unit. Salvador, BA, BrasilUniversity Federal of Bahia School of Medicine. Department of Image Diagnosis. Salvador, BA, BrasilFederal University of Bahia Hospital. Pharmacy Unit. Salvador, BA, BrasilFederal University of Bahia School of Medicine. Pathology Department. Salvador, BA, Brasil / Fundação Oswaldo Cruz. Centro de Pesquisa Gonçalo Moniz. Salvador, BA, BrasilUniversity of São Paulo School of Public Health. Department of Epidemiology. São Paulo, SP, BrasilUniversity of São Paulo School of Public Health. Department of Epidemiology. São Paulo, SP, BrasilFederal University of Bahia. School of Medicine. Department of Paediatrics. Salvador, BA, BrasilObjectives: Oral amoxicillin (50 mg/kg/day) thrice daily is the first-line therapy for non-severe childhood pneumonia. Compliance could be enhanced if two daily doses are employed. We assessed the equivalence of oral amoxicillin (50 mg/kg/day) thrice or twice daily in those patients. Patients and methods: This randomized (1: 1), controlled, triple-blinded investigation conducted at one centre in Brazil included children aged 2–59 months with non-severe pneumonia diagnosed by trained paediatricians based on respiratory complaints and radiographic pulmonary infiltrate/consolidation. Participantswere randomly assigned to receive one bottle (Amoxicillin 1) at 6 am, 2 pm and 10 pm and the other bottle (Amoxicillin 2) at 8 am and 8 pm: one bottle contained amoxicillin and the other placebo and vice versa. Only the pharmacist knew patients’ allocation. Follow-up assessments were done at 2, 5 and 14 days after enrolment. Chest radiographs were read by three independent radiologists. Primary outcome was treatment failure (development of danger signs, persistence of fever, tachypnoea, development of serious adverse reactions, death and withdrawal from the trial) at 48 h. ClinicalTrials.gov: identifier NCT01200706. Results: Four hundred and twelve and 408 participants received amoxicillin thrice or twice daily, respectively. Treatment failure was detected in 94 (22.8%) and 94 (23.0%) patients in intention-to-treat analysis (risk difference 0.2%; 95% CI: 25.5%–6.0%) and in 80 (20.1%) and 85 (21.3%) patients in per-protocol analysis (risk difference 1.2%; 95% CI: 24.4%–6.8%). Pneumonia was radiologically confirmed by concordant reading in 277 (33.8%) cases, among whom treatment failure was registered in 25/133 (18.8%) and 27/144 (18.8%) participants from the thrice and twice daily doses subgroups, respectively (risk difference 20.05%; 95% CI: 29.3%– 9.2%). Conclusions: Oral amoxicillin (50 mg/kg/day) twice daily is as efficacious as thrice daily

Comparison of oral amoxicillin given thrice or twice daily to children between 2 and 59 months old with non-severe pneumonia: a randomized controlled trial

Objectives: Oral amoxicillin (50 mg/kg/day) thrice daily is the first-line therapy for non-severe childhood pneumonia. Compliance could be enhanced if two daily doses are employed. We assessed the equivalence of oral amoxicillin (50 mg/kg/day) thrice or twice daily in those patients. Patients and methods: This randomized (1: 1), controlled, triple-blinded investigation conducted at one centre in Brazil included children aged 2–59 months with non-severe pneumonia diagnosed by trained paediatricians based on respiratory complaints and radiographic pulmonary infiltrate/consolidation. Participantswere randomly assigned to receive one bottle (Amoxicillin 1) at 6 am, 2 pm and 10 pm and the other bottle (Amoxicillin 2) at 8 am and 8 pm: one bottle contained amoxicillin and the other placebo and vice versa. Only the pharmacist knew patients’ allocation. Follow-up assessments were done at 2, 5 and 14 days after enrolment. Chest radiographs were read by three independent radiologists. Primary outcome was treatment failure (development of danger signs, persistence of fever, tachypnoea, development of serious adverse reactions, death and withdrawal from the trial) at 48 h. ClinicalTrials.gov: identifier NCT01200706. Results: Four hundred and twelve and 408 participants received amoxicillin thrice or twice daily, respectively. Treatment failure was detected in 94 (22.8%) and 94 (23.0%) patients in intention-to-treat analysis (risk difference 0.2%; 95% CI: 25.5%–6.0%) and in 80 (20.1%) and 85 (21.3%) patients in per-protocol analysis (risk difference 1.2%; 95% CI: 24.4%–6.8%). Pneumonia was radiologically confirmed by concordant reading in 277 (33.8%) cases, among whom treatment failure was registered in 25/133 (18.8%) and 27/144 (18.8%) participants from the thrice and twice daily doses subgroups, respectively (risk difference 20.05%; 95% CI: 29.3%– 9.2%). Conclusions: Oral amoxicillin (50 mg/kg/day) twice daily is as efficacious as thrice daily