Pathogens identified in majority of childhood CAP hospitalizations

Sep 10 2012

By medwireNews Reporters

A comprehensive investigation of childhood community-acquired pneumonia (CAP) in Taiwan has identified at least one pathogen in 85% of previously healthy children.

Streptococcus pneumoniae, Mycoplasma pneumoniae, and viruses were equally identified as the responsible pathogens, with each found in approximately 40% of the Taiwanese pediatric cases.

However, frequent co-infection increased the difficulty of identifying the responsible organisms, report Yhu-Chering Huang (Chang Gung University, Kweishan, Taiwan) and colleagues in the Pediatric Infectious Disease Journal.

As a result, it may be difficult to choose the appropriate antibiotics for the management of pediatric CAP, according to the researchers.

Co-infection with two or more pathogens was identified in 41% of the children.

The present study included 209 children admitted to hospital with radiologically confirmed CAP. The age of patients ranged from 7 months to 16 years, with a median age of 4 years.

Widespread testing identified one etiologic agent in 85% of all CAP cases.

Of these, typical bacterial pathogens were identified in 88 children (42.1%), including S. pneumoniae in 86 cases and methicillin-resistant Staphylococcus aureus and Mycobacterium tuberculosis each in one patient.

The researchers also observed a high incidence of infection with of M.pneumoniae (37.0%) in the Taiwanese children with CAP, as well as a smaller number of infections with Chlamydia species (11.5%). There were also a significant number of viral and mixed viral-bacterial infections (41.1 and 33.0%, respectively).

In other areas of the world, the incidence of mycoplasmal infection ranges from 7 to 14%. In the present analysis, they attribute the higher incidence of M.pneumoniae infection to "geographic and ethnic factors."

"In agreement with previous surveys, M. pneumoniae, mainly involving school-aged children, with or without co-infection, accounted for approximately one-half of patients older than 5 years of age in the present study," write Huang et al.

In contrast, the incidence of infection with M. pneumoniae was just 31.5% in children aged 5 years and younger.

The researchers point out that most mycoplasmal infections tend to be mild and self-limiting but unfavorable outcomes can occasionally occur.

"Therapeutic agents actively against mycoplasma may still be needed for children, even those of preschool age, with moderate to severe CAP," they write.

Overall, the researchers note that age was an important factor affecting the etiology of CAP, with viral etiology without bacterial infection more likely to occur in younger children.

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