A literature review and survey of childhood pneumonia etiology studies: 2000-2010

Zunera Gilani, Yuenting D Kwong, Orin S Levine, Maria Deloria-Knoll, J Anthony G Scott, Katherine L O'Brien, Daniel R Feikin, Zunera Gilani, Yuenting D Kwong, Orin S Levine, Maria Deloria-Knoll, J Anthony G Scott, Katherine L O'Brien, Daniel R Feikin

Abstract

The Pneumonia Etiology Research for Child Health (PERCH) project is the largest multicountry etiology study of childhood pneumonia since the Board on Science and Technology in International Development studies of the 1980s. However, it is not the only recent or ongoing pneumonia etiology study, and even with seven sites, it cannot capture all epidemiologic settings in the developing world. Funding providers, researchers and policymakers rely on the best available evidence to strategically plan programs, new research directions and interventions. We aimed to describe the current landscape of recent pneumonia etiology studies in children under 5 years of age in the developed and developing world, as ascertained by a literature review of relevant studies with data since the year 2000 and a survey of researchers in the field of childhood pneumonia. We collected information on the study population, study design, case definitions, laboratory samples and methods and identified pathogens. A literature review identified 88 studies with child pneumonia etiology results. As of June 2010, our survey of researchers identified an additional 65 ongoing and recently completed child pneumonia etiology studies. This demonstrates the broad existing context into which the PERCH study must be placed. However, the landscape analysis also reveals a multiplicity of case definitions, levels of clinician involvement, facility types, specimen collection, and laboratory techniques. It reinforces the need for the standardization of methods and analyses for present and future pneumonia etiology studies in order to optimize their cumulative potential to accurately describe the microbial causes of childhood pneumonia.

References

    1. Black RE, Cousens S, Johnson HL, et al. Global, regional, and national causes of child mortality in 2008: a systematic analysis. Lancet. 2010;375:1969–87.
    1. Selwyn BJ. The epidemiology of acute respiratory tract infection in young children: comparison of findings from several developing countries. Coordinated Data Group of BOSTID Researchers. Rev Infect Dis. 1990;12(Suppl 8):S870–88.
    1. PneumoACTION. PneumoFOCUS. 2011. Available at: . Accessed 5 January 2012.
    1. Addo-Yobo E, Chisaka N, Hassan M, et al. Oral amoxicillin versus injectable penicillin for severe pneumonia in children aged 3 to 59 months: a randomised multicentre equivalency study. Lancet. 2004;364:1141–8.
    1. Agarwal J, Awasthi S, Rajput A, Tiwari M, Jain A. Atypical bacterial pathogens in community-acquired pneumonia in children: a hospital-based study. Trop Doct. 2009;39:109–11.
    1. Al-Ghizawi GJ, Al-Sulami AA, Al-Taher SS. Profile of community- and hospital-acquired pneumonia cases admitted to Basra General Hospital, Iraq. East Mediterr Health J. 2007;13:230–42.
    1. Al-Kaabi N, Solh Z, Pacheco S, Murray L, Gaboury I, Le Saux N. A Comparison of group A Streptococcus versus Streptococcus pneumoniae pneumonia. Pediatr Infect Dis J. 2006;25:1008–12.
    1. Andrade A, Oliveira R, Vieira M, et al. In: International Symposium on Pneumococci and Pneumococcal Diseases. Tel Aviv, Israel: ISPPD: 2010. Active surveillance of invasive pneumococcal disease (IPD) and chest radiograph-confirmed pneumonia (CXR+Pn) in infants and young children in Goiânia, Brazil.
    1. Anh DD, Kilgore PE, Slack MP, et al. Surveillance of pneumococcal-associated disease among hospitalized children in Khanh Hoa Province, Vietnam. Clin Infect Dis. 2009;48(Suppl 2):S57–64.
    1. Arifeen SE, Saha SK, Rahman S, et al. Invasive pneumococcal disease among children in rural Bangladesh: results from a population-based surveillance. Clin Infect Dis. 2009;48(Suppl 2):S103–13.
    1. Asghar R, Banajeh S, Egas J, et al. Chloramphenicol versus ampicillin plus gentamicin for community acquired very severe pneumonia among children aged 2–59 months in low resource settings: multicentre randomised controlled trial (SPEAR study) BMJ. 2008;336:80–4.
    1. Azzari C, Moriondo M, Indolfi G, et al. Molecular detection methods and serotyping performed directly on clinical samples improve diagnostic sensitivity and reveal increased incidence of invasive disease by Streptococcus pneumoniae in Italian children. J Med Microbiol. 2008;57:1205–12.
    1. Baggett HC, Peruski LF, Olsen SJ, et al. Incidence of pneumococcal bacteremia requiring hospitalization in rural Thailand. Clin Infect Dis. 2009;48(Suppl 2):S65–74.
    1. Bamba M, Jozaki K, Sugaya N, et al. Prospective surveillance for atypical pathogens in children with community-acquired pneumonia in Japan. J Infect Chemother. 2006;12:36–41.
    1. Banajeh SM. Nutritional rickets and vitamin D deficiency–association with the outcomes of childhood very severe pneumonia: a prospective cohort study. Pediatr Pulmonol. 2009;44:1207–15.
    1. Baqui AH, Rahman M, Zaman K, et al. A population-based study of hospital admission incidence rate and bacterial aetiology of acute lower respiratory infections in children aged less than five years in Bangladesh. J Health Popul Nutr. 2007;25:179–88.
    1. Baqui AH, El Arifeen S, Saha SK, et al. Effectiveness of Haemophilus influenzae type B conjugate vaccine on prevention of pneumonia and meningitis in Bangladeshi children: a case-control study. Pediatr Infect Dis J. 2007;26:565–71.
    1. Batuwanthudawe R, Karunarathne K, Dassanayake M, et al. Surveillance of invasive pneumococcal disease in Colombo, Sri Lanka. Clin Infect Dis. 2009;48(Suppl 2):S136–40.
    1. Berkley JA, Munywoki P, Ngama M, et al. Viral etiology of severe pneumonia among Kenyan infants and children. JAMA. 2010;303:2051–7.
    1. Bharaj P, Sullender WM, Kabra SK, et al. Respiratory viral infections detected by multiplex PCR among pediatric patients with lower respiratory tract infections seen at an urban hospital in Delhi from 2005 to 2007. Virol J. 2009;6:89.
    1. Bii CC, Kose J, Taguchi H, et al. Pneumocystis jirovecii and microbiological findings in children with severe pneumonia in Nairobi, Kenya. Int J Tuberc Lung Dis. 2006;10:1286–91.
    1. Bravo L, Gonzales M, Lim A, et al. In: International Symposium on Pneumococci and Pneumococcal Diseases. Tel Aviv, Israel: ISPPD: 2010. Active hospital-based epidemiological surveillance to estimate the burden of invasive pneumococcal disease (Ipd) in children in Metro Manila, Philippines.
    1. Broughton S, Sylvester KP, Fox G, et al. Lung function in prematurely born infants after viral lower respiratory tract infections. Pediatr Infect Dis J. 2007;26:1019–24.
    1. Bruce N, Weber M, Arana B, et al. Pneumonia case-finding in the RESPIRE Guatemala indoor air pollution trial: standardizing methods for resource-poor settings. Bull World Health Organ. 2007;85:535–44.
    1. Capeding M, Brooks D, Gray S, et al. In: World Society for Pediatric Infectious Diseases. Buenos Aires, Argentina: WSPID: 2009. Active hospital-based epidemiological surveillance of invasive pneumococcal disease (IPD) in children in Muntinlupa, Philippines.
    1. Carrol ED, Guiver M, Nkhoma S, et al. High pneumococcal DNA loads are associated with mortality in Malawian children with invasive pneumococcal disease. Pediatr Infect Dis J. 2007;26:416–22.
    1. 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. 2009;168:1429–36.
    1. Charkaluk ML, Kalach N, Mvogo H, et al. Assessment of a rapid urinary antigen detection by an immunochromatographic test for diagnosis of pneumococcal infection in children. Diagn Microbiol Infect Dis. 2006;55:89–94.
    1. Chintu C, Mudenda V, Lucas S, et al. Lung diseases at necropsy in African children dying from respiratory illnesses: a descriptive necropsy study. Lancet. 2002;360:985–90.
    1. Choi SH, Park EY, Jung HL, et al. Serum vascular endothelial growth factor in pediatric patients with community-acquired pneumonia and pleural effusion. J Korean Med Sci. 2006;21:608–13.
    1. Chong DC, Raboni SM, Abujamra KB, et al. Respiratory viruses in pediatric necropsies: an immunohistochemical study. Pediatr Dev Pathol. 2009;12:211–16.
    1. Chisti MJ, Ahmed T, Faruque AS, Abdus Salam M. Clinical and laboratory features of radiologic pneumonia in severely malnourished infants attending an urban diarrhea treatment center in Bangladesh. Pediatr Infect Dis J. 2010;29:174–7.
    1. Cilla G, Onate E, Perez-Yarza EG, Montes M, Vicente D, Perez-Trallero E. Viruses in community-acquired pneumonia in children aged less than 3 years old: high rate of viral coinfection. J Med Virol. 2008;80:1843–9.
    1. Coles CL, Bose A, Moses PD, et al. Infectious etiology modifies the treatment effect of zinc in severe pneumonia. Am J Clin Nutr. 2007;86:397–403.
    1. Cutts FT, Zaman SM, Enwere G, et al. Efficacy of nine-valent pneumococcal conjugate vaccine against pneumonia and invasive pneumococcal disease in The Gambia: randomised, double-blind, placebo-controlled trial. Lancet. 2005;365:1139–46.
    1. Dare RK, Fry AM, Chittaganpitch M, Sawanpanyalert P, Olsen SJ, Erdman DD. Human coronavirus infections in rural Thailand: a comprehensive study using real-time reverse-transcription polymerase chain reaction assays. J Infect Dis. 2007;196:1321–8.
    1. Deerojanawong J, Prapphal N, Suwanjutha S, et al. Prevalence and clinical features of mycoplasma pneumoniae in Thai children. J Med Assoc Thai. 2006;89:1641–7.
    1. Don M, Fasoli L, Paldanius M, et al. Aetiology of community-acquired pneumonia: serological results of a paediatric survey. Scand J Infect Dis. 2005;37:806–12.
    1. Eun BW, Kim NH, Choi EH, Lee HJ. Mycoplasma pneumoniae in Korean children: the epidemiology of pneumonia over an 18-year period. J Infect. 2008;56:326–31.
    1. Falade AG, Lagunju IA, Bakare RA, Odekanmi AA, Adegbola RA. Invasive pneumococcal disease in children aged <5 years admitted to 3 urban hospitals in Ibadan, Nigeria. Clin Infect Dis. 2009;48(Suppl 2):S190–6.
    1. Freitas M, Castelo A, Petty G, Gomes CE, Carvalho E. Viridans streptococci causing community acquired pneumonia. Arch Dis Child. 2006;91:779–80.
    1. Gerber JS, Coffin SE, Smathers SA, Zaoutis TE. Trends in the incidence of methicillin-resistant Staphylococcus aureus infection in childre’s hospitals in the United States. Clin Infect Dis. 2009;49:65–71.
    1. Hakansson S, Kallen K. Impact and risk factors for early-onset group B streptococcal morbidity: analysis of a national, population-based cohort in Sweden 1997–2001. BJOG. 2006;113:1452–8.
    1. Hamano-Hasegawa K, Morozumi M, Nakayama E, et al. Comprehensive detection of causative pathogens using real-time PCR to diagnose pediatric community-acquired pneumonia. J Infect Chemother. 2008;14:424–32.
    1. Hon KL, Leung E, Tang J, et al. Premorbid factors and outcome associated with respiratory virus infections in a pediatric intensive care unit. Pediatr Pulmonol. 2008;43:275–80.
    1. Hsieh SC, Kuo YT, Chern MS, Chen CY, Chan WP, Yu C. Mycoplasma pneumonia: clinical and radiographic features in 39 children. Pediatr Int. 2007;49:363–7.
    1. Hsieh WY, Chiu NC, Chi H, Huang FY, Hung CC. Respiratory adenoviral infections in Taiwanese children: a hospital-based study. J Microbiol Immunol Infect. 2009;42:371–7.
    1. Huang HH, Zhang YY, Xiu QY, et al. Community-acquired pneumonia in Shanghai, China: microbial etiology and implications for empirical therapy in a prospective study of 389 patients. Eur J Clin Microbiol Infect Dis. 2006;25:369–74.
    1. Ingarfield SL, Celenza A, Jacobs IG, Riley TV. The bacteriology of pneumonia diagnosed in Western Australian emergency departments. Epidemiol Infect. 2007;135:1376–83.
    1. Jaspan HB, Huang LC, Cotton MF, Whitelaw A, Myer L. Bacterial disease and antimicrobial susceptibility patterns in HIV-infected, hospitalized children: a retrospective cohort study. PLoS One. 2008;3:e3260.
    1. Johnson AW, Osinusi K, Aderele WI, Gbadero DA, Olaleye OD, Adeyemi-Doro FA. Etiologic agents and outcome determinants of community-acquired pneumonia in urban children: a hospital-based study. J Natl Med Assoc. 2008;100:370–85.
    1. Kumar M, Biswal N, Bhuvaneswari V, Srinivasan S. Persistent pneumonia: underlying cause and outcome. Indian J Pediatr. 2009;76:1223–6.
    1. Kuypers J, Martin ET, Heugel J, Wright N, Morrow R, Englund JA. Clinical disease in children associated with newly described coronavirus subtypes. Pediatrics. 2007;119:e70–6.
    1. Lahti E, Peltola V, Waris M, et al. Induced sputum in the diagnosis of childhood community-acquired pneumonia. Thorax. 2009;64:252–7.
    1. Lehtinen P, Jartti T, Virkki R, et al. Bacterial coinfections in children with viral wheezing. Eur J Clin Microbiol Infect Dis. 2006;25:463–9.
    1. Lindblade KA, Arvelo W, Gray J, et al. A comparison of the epidemiology and clinical presentation of seasonal influenza A and 2009 pandemic influenza A (H1N1) in Guatemala. PLoS One. 2010;5:e15826.
    1. Liu FC, Chen PY, Huang F, Tsai CR, Lee CY, Wang LC. Rapid diagnosis of Mycoplasma pneumoniae infection in children by polymerase chain reaction. J Microbiol Immunol Infect. 2007;40:507–12.
    1. Lochindarat S, Suwanjutha S, Prapphal N, et al. Mycoplasma pneumoniae and Chlamydophila pneumoniae in children with community-acquired pneumonia in Thailand. Int J Tuberc Lung Dis. 2007;11:814–19.
    1. Lucero MG, Nohynek H, Williams G, et al. Efficacy of an 11-valent pneumococcal conjugate vaccine against radiologically confirmed pneumonia among children less than 2 years of age in the Philippines: a randomized, double-blind, placebo-controlled trial. Pediatr Infect Dis J. 2009;28:455–62.
    1. Madhi SA, Klugman KP. A role for Streptococcus pneumoniae in virus-associated pneumonia. Nat Med. 2004;10:811–13.
    1. Martinez MA, Millan F, Gonzalez C. Chlamydia trachomatis genotypes associated with pneumonia in Chilean infants. Scand J Infect Dis. 2009;41:313–16.
    1. Mathisen M, Strand TA, Sharma BN, et al. RNA viruses in community-acquired childhood pneumonia in semi-urban Nepal; a cross-sectional study. BMC Med. 2009;7:35.
    1. McNally LM, Jeena PM, Gajee K, et al. Effect of age, polymicrobial disease, and maternal HIV status on treatment response and cause of severe pneumonia in South African children: a prospective descriptive study. Lancet. 2007;369:1440–51.
    1. Moreno L, Krishnan JA, Duran P, Ferrero F. Development and validation of a clinical prediction rule to distinguish bacterial from viral pneumonia in children. Pediatr Pulmonol. 2006;41:331–7.
    1. Mudhune S, Wamae M. Report on invasive disease and meningitis due to Haemophilus influenzae and Streptococcus pneumonia from the network for surveillance of pneumococcal disease in the East African region. Clin Infect Dis. 2009;48(Suppl 2):S147–52.
    1. Naheed A, Saha SK, Breiman RF, et al. Multihospital surveillance of pneumonia burden among children aged <5 years hospitalized for pneumonia in Bangladesh. Clin Infect Dis. 2009;48(Suppl 2):S82–9.
    1. Nascimento-Carvalho CM, Ribeiro CT, Cardoso MR, et al. The role of respiratory viral infections among children hospitalized for community-acquired pneumonia in a developing country. Pediatr Infect Dis J. 2008;27:939–41.
    1. Ngeow YF, Suwanjutha S, Chantarojanasriri T, et al. An Asian study on the prevalence of atypical respiratory pathogens in community-acquired pneumonia. Int J Infect Dis. 2005;9:144–53.
    1. Paddock CD, Sanden GN, Cherry JD, et al. Pathology and pathogenesis of fatal Bordetella pertussis infection in infants. Clin Infect Dis. 2008;47:328–38.
    1. Perez A, Herranz M, Segura M, et al. Epidemiologic impact of blood culture practices and antibiotic consumption on pneumococcal bacteraemia in children. Eur J Clin Microbiol Infect Dis. 2008;27:717–24.
    1. Rahman M, Hossain S, Baqui AH, et al. Haemophilus influenzae type-b and non-b-type invasive diseases in urban children (<5 years) of Bangladesh: implications for therapy and vaccination. J Infect. 2008;56:191–6.
    1. Robertson SE, Roca A, Alonso P, et al. Respiratory syncytial virus infection: denominator-based studies in Indonesia, Mozambique, Nigeria and South Africa. Bull World Health Organ. 2004;82:914–22.
    1. Roca A, Sigauque B, Quinto L, et al. Invasive pneumococcal disease in children<5 years of age in rural Mozambique. Trop Med Int Health. 2006;11:1422–31.
    1. Rutman MS, Bachur R, Harper MB. Radiographic pneumonia in young, highly febrile children with leukocytosis before and after universal conjugate pneumococcal vaccination. Pediatr Emerg Care. 2009;25:1–7.
    1. Samransamruajkit R, Hiranrat T, Chieochansin T, et al. Prevalence, clinical presentations and complications among hospitalized children with influenza pneumonia. Jpn J Infect Dis. 2008;61:446–9.
    1. Sandora TJ, Desai R, Miko BA, Harper MB. Assessing quality indicators for pediatric community-acquired pneumonia. Am J Med Qual. 2009;24:419–27.
    1. Shah AS, Knoll MD, Sharma PR, et al. Invasive pneumococcal disease in Kanti children’s hospital, Nepal, as observed by the South Asian pneumococcal alliance network. Clin Infect Dis. 2009;48(Suppl 2):S123–8.
    1. Shah AS, Nisarga R, Ravi Kumar KL, Hubler R, Herrera G, Kilgore PE. Establishment of population-based surveillance for invasive pneumococcal disease in Bangalore, India. Indian J Med Sci. 2009;63:498–507.
    1. Singleton RJ, Bulkow LR, Miernyk K, et al. Viral respiratory infections in hospitalized and community control children in Alaska. J Med Virol. 2010;82:1282–90.
    1. Sung RY, Chan PK, Tsen T, et al. Identification of viral and atypical bacterial pathogens in children hospitalized with acute respiratory infections in Hong Kong by multiplex PCR assays. J Med Virol. 2009;81:153–9.
    1. Tajima T, Nakayama E, Kondo Y, et al. Etiology and clinical study of community-acquired pneumonia in 157 hospitalized children. J Infect Chemother. 2006;12:372–9.
    1. Tregnaghi M, Ceballos A, Ruttimann R, et al. Active epidemiologic surveillance of pneumonia and invasive pneumococcal disease in ambulatory and hospitalized infants in Cordoba, Argentina. Pediatr Infect Dis J. 2006;25:370–2.
    1. Tumgor G, Celik U, Alabaz D, et al. Aetiological agents, interleukin-6, interleukin-8 and CRP concentrations in children with community- and hospital-acquired pneumonia. Ann Trop Paediatr. 2006;26:285–91.
    1. van Woensel JB, Bos AP, Lutter R, Rossen JW, Schuurman R. Absence of human metapneumovirus co-infection in cases of severe respiratory syncytial virus infection. Pediatr Pulmonol. 2006;41:872–4.
    1. Walter ND, Taylor TH, Shay DK, et al. Influenza circulation and the burden of invasive pneumococcal pneumonia during a non-pandemic period in the United States. Clin Infect Dis. 2010;50:175–83.
    1. Watanabe K, Anh DD, Huong Ple T, et al. Drug-resistant pneumococci in children with acute lower respiratory infections in Vietnam. Pediatr Int. 2008;50:514–18.
    1. Williams EJ, Thorson S, Maskey M, et al. Hospital-based surveillance of invasive pneumococcal disease among young children in urban Nepal. Clin Infect Dis. 2009;48(Suppl 2):S114–22.
    1. Williams JV, Edwards KM, Weinberg GA, et al. Population-based incidence of human metapneumovirus infection among hospitalized children. J Infect Dis. 2010;201:1890–8.
    1. Wolf DG, Greenberg D, Shemer-Avni Y, Givon-Lavi N, Bar-Ziv J, Dagan R. Association of human metapneumovirus with radiologically diagnosed community-acquired alveolar pneumonia in young children. J Pediatr. 2010;156:115–20.
    1. Xatzipsalti M, Kyrana S, Tsolia M, et al. Rhinovirus viremia in children with respiratory infections. Am J Respir Crit Care Med. 2005;172:1037–40.
    1. Zhang HY, Li ZM, Zhang GL, Diao TT, Cao CX, Sun HQ. Respiratory viruses in hospitalized children with acute lower respiratory tract infections in Harbin, China. Jpn J Infect Dis. 2009;62:458–60.
    1. World Health Organization. Conclusions from the WHO multicenter study of serious infections in young infants. The WHO Young Infants Study Group. Pediatr Infect Dis J. 1999;18(Suppl 10):S32–4.
    1. Turner G, Wonodi C, Levine O, Scott JA, Murdoch D. Methodological and practical challenges in post-mortem studies of pneumonia etiology. Clin Infect Dis. 2012 In Press.
    1. Centersfor Disease Control and Prevention. Division of bacterial diseases bulletin. 2010. Winter 2010. Available at: . Accessed 27 July 2011.
    1. Ruuskanen O, Lahti E, Jennings LC, Murdoch DR. Viral pneumonia. Lancet. 2011;377:1264–75.

Source: PubMed

3
Prenumerera