Bahiana School of Medicine, Bahiana Foundation for Science Development, Salvador, Brazil.
Department of Pediatrics, Turku University, Turku, Finland.
Pediatr Pulmonol. 2019 Jul;54(7):1022-1028. doi: 10.1002/ppul.24339. Epub 2019 Apr 19.
To assess whether there was a difference in the frequency of symptoms and signs among children with community-acquired pneumonia (CAP) with viral or bacterial infection.
A prospective cross-sectional study was conducted in Salvador, Brazil. Children less than 5-years-old hospitalized with CAP were recruited. Viral or only bacterial infection was diagnosed by an investigation of 11 viruses and 8 bacteria. Bacterial infection was diagnosed by blood culture, detection of pneumococcal DNA in acute buffy coat, and serological tests. Viral infection was diagnosed by detection of respiratory virus in nasopharyngeal aspirate and serological tests. Viral infection comprised only viral or mixed viral-bacterial infection subgroups.
One hundred and eighty-eight patients had a probable etiology established as only viral (51.6%), mixed viral-bacterial (30.9%), and only bacterial infection (17.5%). Asthma was registered for 21.4%. Report of wheezing (47.4% vs 21.2%; P = 0.006), rhonchi (38.0% vs 15.2%; P = 0.01), and wheezing detected on physical examination (51.0% vs 9.1%; P < 0.001) were the differences found. Among children with asthma, detected wheezing was the only different finding when children with viral infection were compared with those with only bacterial infection (75.0% vs 0%; P = 0.008). By multivariable analysis, viral infection (AdjOR [95% CI]: 9.6; 95%CI: 2.7-34.0), asthma (AdjOR [95% CI]: 4.6; 95%CI: 1.9-11.0), and age (AdjOR [95% CI]: 0.95; 95%CI: 0.92-0.97) were independently associated with wheezing on physical examination. The positive predictive value of detected wheezing for viral infection was 96.3% (95% CI: 90.4-99.1%).
Wheezing detected on physical examination is an independent predictor of viral infection.
评估社区获得性肺炎（CAP）患儿中病毒或细菌感染的症状和体征频率是否存在差异。
在巴西萨尔瓦多进行了一项前瞻性的横断面研究。招募了因 CAP 住院的年龄小于 5 岁的儿童。通过对 11 种病毒和 8 种细菌的调查，诊断病毒或仅细菌感染。细菌感染通过血培养、急性血涂片检测肺炎球菌 DNA 和血清学试验来诊断。病毒感染通过检测鼻咽抽吸物中的呼吸道病毒和血清学试验来诊断。病毒感染包括单纯病毒或混合病毒-细菌感染亚组。
188 例患者确定了可能的病因，仅为病毒（51.6%）、混合病毒-细菌（30.9%）和单纯细菌感染（17.5%）。有 21.4%的患者登记有哮喘。报告喘息（47.4%比 21.2%；P=0.006）、喘鸣（38.0%比 15.2%；P=0.01）和体检时发现的喘息（51.0%比 9.1%；P<0.001）是发现的差异。在患有哮喘的儿童中，与单纯细菌感染相比，患有病毒感染的儿童仅发现有喘息（75.0%比 0%；P=0.008）。多变量分析显示，病毒感染（调整后的优势比[95%CI]：9.6；95%CI：2.7-34.0）、哮喘（调整后的优势比[95%CI]：4.6；95%CI：1.9-11.0）和年龄（调整后的优势比[95%CI]：0.95；95%CI：0.92-0.97）与体检时发现的喘息独立相关。体检时发现的喘息对病毒感染的阳性预测值为 96.3%（95%CI：90.4-99.1%）。
体检时发现的喘息是病毒感染的独立预测因子。
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