Muro Florida, Reyburn Rita, Reyburn Hugh
Kilimanjaro Christian Medical Centre, Moshi, Tanzania.
Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia. Based at: New Vaccine Evaluation Project, Colonial War Memorial Hospital, Suva, Fiji.
Pneumonia (Nathan). 2015 May 29;6:6-17. doi: 10.15172/pneu.2015.6/488.
The replacement of "presumptive treatment for malaria" by "test before treat" strategies for the management of febrile illness is raising awareness of the importance of knowing more about the causes of illness in children who are suspected to have malaria but return a negative parasitological test. The most common cause of non-malarial febrile illness (NMFI) in African children is respiratory tract infection. Whilst the bacterial causes of NMFI are well known, the increasing use of sensitive techniques such as polymerase chain reaction (PCR) tests is revealing large numbers of viruses that are potential respiratory pathogens. However, many of these organisms are commonly present in the respiratory tract of healthy children so causality and risk factors for pneumonia remain poorly understood. Infection with a combination of viral and bacterial pathogens is increasingly recognised as important in the pathogenesis of pneumonia. Similarly, blood stream infections with organisms typically grown by aerobic culture are well known but a growing number of organisms that can be identified only by PCR, viral culture, or serology are now recognised to be common pathogens in African children. The high mortality of hospitalised children on the first or second day of admission suggests that, unless results are rapidly available, diagnostic tests to identify specific causes of illness will still be of limited use in guiding the potentially life saving decisions relating to initial treatment of children admitted to district hospitals in Africa with severe febrile illness and a negative test for malaria. Malaria control and the introduction of vaccines against type b and pneumococcal disease are contributing to improved child survival in Africa. However, increased parasitological testing for malaria is associated with increased use of antibiotics to which resistance is already high.
对于发热性疾病的管理，用“检测后治疗”策略取代“疟疾推定治疗”正在提高人们对于了解疑似患疟疾但寄生虫学检测呈阴性的儿童疾病病因重要性的认识。非洲儿童非疟疾发热性疾病（NMFI）最常见的病因是呼吸道感染。虽然NMFI的细菌病因众所周知，但聚合酶链反应（PCR）检测等敏感技术的日益广泛应用揭示出大量潜在的呼吸道病原体病毒。然而，这些微生物中有许多在健康儿童的呼吸道中普遍存在，因此肺炎的因果关系和危险因素仍知之甚少。病毒和细菌病原体联合感染在肺炎发病机制中的重要性日益得到认可。同样，通过需氧培养通常能培养出的微生物引起的血流感染也广为人知，但现在人们认识到，越来越多只能通过PCR、病毒培养或血清学鉴定的微生物是非洲儿童的常见病原体。住院儿童在入院第一天或第二天的高死亡率表明，除非能迅速得到检测结果，否则对于非洲地区医院收治的患有严重发热性疾病且疟疾检测呈阴性的儿童，用于确定疾病具体病因的诊断检测在指导可能挽救生命的初始治疗决策方面的作用仍然有限。疟疾控制以及针对b型流感嗜血杆菌和肺炎球菌疾病疫苗的引入正在促进非洲儿童生存率的提高。然而，疟疾寄生虫学检测的增加与抗生素使用的增加相关，而抗生素耐药性已经很高。
