RESUMEN
OBJECTIVES: Few and small studies previously examined chest CT-scan characteristics of Coxiella burnetii (Cb) community-acquired pneumonia (CAP). Larger studies are needed to guide physicians towards diagnosis of Q fever in case of pneumonia. METHODS: We conducted a single-center retrospective observational study between 2013 and 2017. All patients with Cb or Streptococcus pneumoniae (Sp) CAP who had a chest CT-scan on admission at Cayenne Hospital (French Guiana) were included. Chest CT-scan were all analyzed by the same expert radiologist. RESULTS: We included 75 patients with Cb CAP and 36 with Sp CAP. Fifty-nine percent of all patients were men (n = 66) and median age was 52 [IQR = 38-62]. Chest CT-scans of Cb CAP patients revealed 67 alveolar condensations (89 %), 52 ground-glass opacities (69 %), 30 cases of lymphadenopathy(ies) (40 %) and 25 pleural effusions (33 %). Parenchyma lesions caused by Cb were predominantly unilateral (67 %). We found high numbers of alveolar condensations in both Cb and Sp CAP (89 % and 75 %; respectively), but the presence of ground-glass opacities was significantly associated with Cb CAP (69 % versus 30 %; p < 0.01). Cb CAP were associated with more lymphadenopathies (40 % vs 17 %; p = 0.01) while Sp CAP showed more bronchial thickening (19 % versus 3 %; p < 0.01) and (micro)nodule(s) ≤1 cm (25 % vs 3 %, p < 0.01). CONCLUSIONS: This large study shows that the most typical aspect of chest CT-scan in case of Cb CAP in French Guiana is a unilateral alveolar consolidation associated with ground glass opacities and lymphadenopathies. C. burnetti and S. pneumoniae both most often cause alveolar consolidations, but present some significantly different CT-scan patterns. This could help physicians through therapeutic choices.
Asunto(s)
Infecciones Comunitarias Adquiridas , Coxiella burnetii , Linfadenopatía , Neumonía , Fiebre Q , Masculino , Humanos , Persona de Mediana Edad , Femenino , Streptococcus pneumoniae , Fiebre Q/diagnóstico por imagen , Fiebre Q/epidemiología , Fiebre Q/etiología , Estudios Transversales , Guyana Francesa/epidemiología , Tomografía Computarizada por Rayos X/efectos adversos , Tomografía Computarizada por Rayos X/métodos , Estudios Retrospectivos , Linfadenopatía/diagnóstico por imagen , Infecciones Comunitarias Adquiridas/diagnóstico por imagenRESUMEN
OBJECTIVE: To evaluate the association between consolidation on chest radiograph and typical bacterial etiology of childhood community acquired pneumonia (CAP) in the Etiology of Pneumonia in the Community study. STUDY DESIGN: Hospitalized children <18 years of age with CAP enrolled in the Etiology of Pneumonia in the Community study at 3 children's hospitals between January 2010 and June 2012 were included. Testing of blood and respiratory specimens used multiple modalities to identify typical and atypical bacterial, or viral infection. Study radiologists classified chest radiographs (consolidation, other infiltrates [interstitial and/or alveolar], pleural effusion) using modified World Health Organization pneumonia criteria. Infiltrate patterns were compared according to etiology of CAP. RESULTS: Among 2212 children, there were 1302 (59%) with consolidation with or without other infiltrates, 910 (41%) with other infiltrates, and 296 (13%) with pleural effusion. In 1795 children, at least 1 pathogen was detected. Among these patients, consolidation (74%) was the most frequently observed pattern (74% in typical bacterial CAP, 58% in atypical bacterial CAP, and 54% in viral CAP). Positive and negative predictive values of consolidation for typical bacterial CAP were 12% (95% CI 10%-15%) and 96% (95% CI 95%-97%) respectively. In a multivariable model, typical bacterial CAP was associated with pleural effusion (OR 7.3, 95% CI 4.7-11.2) and white blood cell ≥15 000/mL (OR 3.2, 95% CI 2.2-4.9), and absence of wheeze (OR 0.5, 95% CI 0.3-0.8) or viral detection (OR 0.2, 95% CI 0.1-0.4). CONCLUSIONS: Consolidation predicted typical bacterial CAP poorly, but its absence made typical bacterial CAP unlikely. Pleural effusion was the best predictor of typical bacterial infection, but too uncommon to aid etiology prediction.
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Infecciones Comunitarias Adquiridas , Derrame Pleural , Neumonía , Radiología , Humanos , Niño , Neumonía/diagnóstico por imagen , Neumonía/epidemiología , Neumonía/etiología , Radiografía , Derrame Pleural/diagnóstico por imagen , Derrame Pleural/etiología , Causalidad , Infecciones Comunitarias Adquiridas/diagnóstico por imagen , Infecciones Comunitarias Adquiridas/etiologíaRESUMEN
Resumen En la práctica clínica, la radiografía de tórax permite confirmar el diagnóstico y la extensión de la neumonía adquirida en la comunidad (NAC). Objetivos: Examinar las características radiográficas de la NAC según el agente causal y el grado de concordancia interobservador (CI) en la descripción de los hallazgos radiográficos. Métodos: Se evaluaron las radiografías de tórax de 300 pacientes adultos inmunocompetentes hospitalizados por NAC, tres residentes de radiología consignaron el patrón de los infiltrados pulmonares, su localización anatómica y extensión, la presencia de derrame pleural y otros hallazgos radiográficos. Se realizaron cultivos de esputo, hemocultivos, pruebas serológicas y técnicas de biología molecular de hisopado nasofaríngeo para identificar los principales patógenos respiratorios. Resultados: Las manifestaciones clínicas y los hallazgos de la radiografía de tórax fueron similares en las neumonías causadas por diferentes patógenos respiratorios: bacterias clásicas, virus respiratorios y microorganismos atípicos. En las neumonías bacterianas predominó el patrón de relleno alveolar de distribución lobar, en las neumonías vírales y atípicas predominó el patrón intersticial o mixto alvéolo-intersticial con opacidades en vidrio esmerilado. La CI fue satisfactoria (kappa > 0,6) para determinar el patrón principal de los infiltrados pulmonares, su localización anatómica y la presencia de derrame pleural, su localización y extensión. La CI fue moderada (kappa 0,4-0,6) para definir la extensión de la neumonía y detectar signos radiológicos asociados a congestión pulmonar. Conclusión: Los hallazgos de la radiografía de tórax no permitieron identificar con precisión el agente causal de la neumonía, siendo útil en la caracterización de los infiltrados pulmonares y para detectar complicaciones como el derrame paraneumónico.
In a clinical setting the chest radiograph is the reference standard in establishing the diagnosis of community-acquired pneumonia (CAP). Objectives: This study aimed to assess interobserver reliability (IR) of radiographic findings and the relationship to different respiratory pathogens in CAP. Methods: Chest radiographs of 300 immunocompetent adult patients hospitalized with pneumonia, obtained from a database, were reviewed by three residents of radiology without specific clinical information. Main pattern of pulmonary infiltrates, topographic localization, extent of pneumonia, presence of pleural fluid, thickened bronchial walls, lymphadenopathy and air bronchogram were scored. Sputum and blood cultures, serological tests and nasopharyngeal swab for respiratory virus detection by molecular diagnostic techniques were performed to identify the causative pathogen. Results: Clinical manifestations and chest X-ray findings were similar in pneumonias caused by different respiratory pathogens: classic bacteria, respiratory viruses and atypical microorganisms. The alveolar pattern of lobar distribution predominated in bacterial pneumonia; meanwhile, interstitial or mixed alveolar-interstitial pattern with ground glass opacities predominated in viral and atypical pneumonias. IR was fair to good (kappa > 0.6) for determining the main pattern of infiltrates, anatomical location and the presence of pleural effusion, their anatomical location and extension. IR was moderate (kappa 0.4-0.6) for determining the extent of pneumonia and signs of congestive heart failure. Conclusion: Simple features such as main pattern description, anatomical location, identifying the involved lobes and pleural fluid recognition showed fair to excellent interobserver reliability. Chest radiographs was of limited value in predicting the causative pathogen but were of beneficial use to characterize pulmonary infiltrates and to detect complications such as parapneumonic effusion.
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Humanos , Masculino , Femenino , Adolescente , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Adulto Joven , Infecciones Comunitarias Adquiridas/etiología , Infecciones Comunitarias Adquiridas/diagnóstico por imagen , Bacterias/aislamiento & purificación , Virus/aislamiento & purificación , Radiografía Torácica , Variaciones Dependientes del Observador , Estudios Prospectivos , Reproducibilidad de los Resultados , Infecciones Comunitarias Adquiridas/microbiología , Infecciones Comunitarias Adquiridas/virología , InmunocompetenciaRESUMEN
Abstract Objectives: To review, analyze, and present the available evidence on the usefulness of point-of-care pulmonary ultrasound in the diagnosis and monitoring of community-acquired pneumonia (CAP), aiming to facilitate its potential inclusion into pediatric clinical reference guidelines. Source of data: A non-systematic research was carried out in the MEDLINE (PubMed), LILACS, and SciELO databases, from January 1985 to September 2019. The articles that were considered the most relevant were selected. Synthesis of data: CAP is a relevant cause of morbidity and mortality in pediatrics and its clinical management remains a major challenge. The systematic use of chest X-ray for its diagnosis is controversial because it exposes the child to ionizing radiation and there are interobserver differences in its interpretation. Recently, the use of point-of-care pulmonary ultrasound by the pediatrician has been presented as an alternative for the diagnosis and monitoring of CAP. A great deal of evidence has disclosed its high sensitivity and diagnostic specificity, with the advantages of no ionizing radiation, relatively low cost, immediate results, portability, and the possibility of repetition according to the requirements of disease evolution. Moreover, its use can help rule out possible bacterial etiology and thus prevent inappropriate antibiotic treatments that favor bacterial resistance. Conclusions: Point-of-care ultrasonography represents an opportunity to improve the diagnosis and monitoring of CAP. However, as an operator-dependent technique, training is required for adequate image acquisition, correct interpretation, and integration with clinical data for correct decision-making.
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Humanos , Niño , Neumonía/diagnóstico por imagen , Infecciones Comunitarias Adquiridas/diagnóstico por imagen , Estudios de Seguimiento , Ultrasonografía , Sistemas de Atención de Punto , PediatrasRESUMEN
OBJECTIVES: To review, analyze, and present the available evidence on the usefulness of point-of-care pulmonary ultrasound in the diagnosis and monitoring of community-acquired pneumonia (CAP), aiming to facilitate its potential inclusion into pediatric clinical reference guidelines. SOURCE OF DATA: A non-systematic research was carried out in the MEDLINE (PubMed), LILACS, and SciELO databases, from January 1985 to September 2019. The articles that were considered the most relevant were selected. SYNTHESIS OF DATA: CAP is a relevant cause of morbidity and mortality in pediatrics and its clinical management remains a major challenge. The systematic use of chest X-ray for its diagnosis is controversial because it exposes the child to ionizing radiation and there are interobserver differences in its interpretation. Recently, the use of point-of-care pulmonary ultrasound by the pediatrician has been presented as an alternative for the diagnosis and monitoring of CAP. A great deal of evidence has disclosed its high sensitivity and diagnostic specificity, with the advantages of no ionizing radiation, relatively low cost, immediate results, portability, and the possibility of repetition according to the requirements of disease evolution. Moreover, its use can help rule out possible bacterial etiology and thus prevent inappropriate antibiotic treatments that favor bacterial resistance. CONCLUSIONS: Point-of-care ultrasonography represents an opportunity to improve the diagnosis and monitoring of CAP. However, as an operator-dependent technique, training is required for adequate image acquisition, correct interpretation, and integration with clinical data for correct decision-making.
Asunto(s)
Infecciones Comunitarias Adquiridas , Neumonía , Niño , Infecciones Comunitarias Adquiridas/diagnóstico por imagen , Estudios de Seguimiento , Humanos , Pediatras , Neumonía/diagnóstico por imagen , Sistemas de Atención de Punto , UltrasonografíaRESUMEN
Chest imaging is often used as a complementary tool in the evaluation of coronavirus disease 2019 (COVID-19) patients, helping physicians to augment their clinical suspicion. Despite not being diagnostic for COVID-19, chest CT may help clinicians to isolate high suspicion patients with suggestive imaging findings. However, COVID-19 findings on CT are also common to other pulmonary infections and non-infectious diseases, and radiologists and point-of-care physicians should be aware of possible mimickers. This state-of-the-art review goal is to summarize and illustrate possible etiologies that may have a similar pattern on chest CT as COVID-19. The review encompasses both infectious etiologies, such as non-COVID viral pneumonia, Mycoplasma pneumoniae, Pneumocystis jiroveci, and pulmonary granulomatous infectious, and non-infectious disorders, such as pulmonary embolism, fat embolism, cryptogenic organizing pneumonia, non-specific interstitial pneumonia, desquamative interstitial pneumonia, and acute and chronic eosinophilic pneumonia.
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COVID-19/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Adulto , Anciano , Infecciones Comunitarias Adquiridas/diagnóstico por imagen , Diagnóstico Diferencial , Embolia Grasa/diagnóstico por imagen , Femenino , Enfermedad Granulomatosa Crónica/diagnóstico por imagen , Humanos , Enfermedades Pulmonares/diagnóstico por imagen , Enfermedades Pulmonares Intersticiales/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Neumonía por Mycoplasma/diagnóstico por imagen , Neumonía por Pneumocystis/diagnóstico por imagen , Neumonía Viral/diagnóstico por imagen , Embolia Pulmonar/diagnóstico por imagen , Eosinofilia Pulmonar/diagnóstico por imagen , Radiografía Torácica/métodos , Factores de TiempoRESUMEN
AIMS: The EURO-ENDO registry aimed to study the management and outcomes of patients with infective endocarditis (IE). METHODS AND RESULTS: Prospective cohort of 3116 adult patients (2470 from Europe, 646 from non-ESC countries), admitted to 156 hospitals in 40 countries between January 2016 and March 2018 with a diagnosis of IE based on ESC 2015 diagnostic criteria. Clinical, biological, microbiological, and imaging [echocardiography, computed tomography (CT) scan, 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT)] data were collected. Infective endocarditis was native (NVE) in 1764 (56.6%) patients, prosthetic (PVIE) in 939 (30.1%), and device-related (CDRIE) in 308 (9.9%). Infective endocarditis was community-acquired in 2046 (65.66%) patients. Microorganisms involved were staphylococci in 1085 (44.1%) patients, oral streptococci in 304 (12.3%), enterococci in 390 (15.8%), and Streptococcus gallolyticus in 162 (6.6%). 18F-fluorodeoxyglucose positron emission tomography/computed tomography was performed in 518 (16.6%) patients and presented with cardiac uptake (major criterion) in 222 (42.9%) patients, with a better sensitivity in PVIE (66.8%) than in NVE (28.0%) and CDRIE (16.3%). Embolic events occurred in 20.6% of patients, and were significantly associated with tricuspid or pulmonary IE, presence of a vegetation and Staphylococcus aureus IE. According to ESC guidelines, cardiac surgery was indicated in 2160 (69.3%) patients, but finally performed in only 1596 (73.9%) of them. In-hospital death occurred in 532 (17.1%) patients and was more frequent in PVIE. Independent predictors of mortality were Charlson index, creatinine > 2 mg/dL, congestive heart failure, vegetation length > 10 mm, cerebral complications, abscess, and failure to undertake surgery when indicated. CONCLUSION: Infective endocarditis is still a life-threatening disease with frequent lethal outcome despite profound changes in its clinical, microbiological, imaging, and therapeutic profiles.
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Embolia/microbiología , Endocarditis Bacteriana/diagnóstico por imagen , Endocarditis Bacteriana/terapia , Tomografía Computarizada por Tomografía de Emisión de Positrones/estadística & datos numéricos , Adulto , África del Norte/epidemiología , Anciano , Anciano de 80 o más Años , Asia/epidemiología , Infecciones Comunitarias Adquiridas/diagnóstico por imagen , Infecciones Comunitarias Adquiridas/epidemiología , Ecocardiografía/estadística & datos numéricos , Endocarditis Bacteriana/epidemiología , Endocarditis Bacteriana/microbiología , Enterococcus , Europa (Continente)/epidemiología , Femenino , Fluorodesoxiglucosa F18 , Prótesis Valvulares Cardíacas/efectos adversos , Mortalidad Hospitalaria , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Infecciones Relacionadas con Prótesis/diagnóstico por imagen , Infecciones Relacionadas con Prótesis/epidemiología , Radiofármacos , Sistema de Registros , América del Sur/epidemiología , Infecciones Estafilocócicas/complicaciones , Infecciones Estreptocócicas/complicaciones , Resultado del TratamientoRESUMEN
Community-acquired pneumonia (CAP) is the leading cause of death worldwide. Despite the vast diversity of respiratory microbiota, Streptococcus pneumoniae remains the most prevalent pathogen among etiologic agents. Despite the significant decrease in the mortality rates for lower respiratory tract infections in recent decades, CAP ranks third as a cause of death in Brazil. Since the latest Guidelines on CAP from the Sociedade Brasileira de Pneumologia e Tisiologia (SBPT, Brazilian Thoracic Association) were published (2009), there have been major advances in the application of imaging tests, in etiologic investigation, in risk stratification at admission and prognostic score stratification, in the use of biomarkers, and in the recommendations for antibiotic therapy (and its duration) and prevention through vaccination. To review these topics, the SBPT Committee on Respiratory Infections summoned 13 members with recognized experience in CAP in Brazil who identified issues relevant to clinical practice that require updates given the publication of new epidemiological and scientific evidence. Twelve topics concerning diagnostic, prognostic, therapeutic, and preventive issues were developed. The topics were divided among the authors, who conducted a nonsystematic review of the literature, but giving priority to major publications in the specific areas, including original articles, review articles, and systematic reviews. All authors had the opportunity to review and comment on all questions, producing a single final document that was approved by consensus.
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Neumonía Bacteriana/diagnóstico por imagen , Neumonía Viral , Antibacterianos/uso terapéutico , Brasil , Infecciones Comunitarias Adquiridas/diagnóstico por imagen , Infecciones Comunitarias Adquiridas/tratamiento farmacológico , Conferencias de Consenso como Asunto , Medicina Basada en la Evidencia , Humanos , Neumonía Bacteriana/tratamiento farmacológico , Neumonía Viral/diagnóstico por imagen , Neumonía Viral/tratamiento farmacológico , Sociedades MédicasRESUMEN
ABSTRACT Community-acquired pneumonia (CAP) is the leading cause of death worldwide. Despite the vast diversity of respiratory microbiota, Streptococcus pneumoniae remains the most prevalent pathogen among etiologic agents. Despite the significant decrease in the mortality rates for lower respiratory tract infections in recent decades, CAP ranks third as a cause of death in Brazil. Since the latest Guidelines on CAP from the Sociedade Brasileira de Pneumologia e Tisiologia (SBPT, Brazilian Thoracic Association) were published (2009), there have been major advances in the application of imaging tests, in etiologic investigation, in risk stratification at admission and prognostic score stratification, in the use of biomarkers, and in the recommendations for antibiotic therapy (and its duration) and prevention through vaccination. To review these topics, the SBPT Committee on Respiratory Infections summoned 13 members with recognized experience in CAP in Brazil who identified issues relevant to clinical practice that require updates given the publication of new epidemiological and scientific evidence. Twelve topics concerning diagnostic, prognostic, therapeutic, and preventive issues were developed. The topics were divided among the authors, who conducted a nonsystematic review of the literature, but giving priority to major publications in the specific areas, including original articles, review articles, and systematic reviews. All authors had the opportunity to review and comment on all questions, producing a single final document that was approved by consensus.
RESUMO A pneumonia adquirida na comunidade (PAC) constitui a principal causa de morte no mundo. Apesar da vasta microbiota respiratória, o Streptococcus pneumoniae permanece como a bactéria de maior prevalência dentre os agentes etiológicos. Apesar da redução significativa das taxas de mortalidade por infecções do trato respiratório inferior nas últimas décadas, a PAC ocupa o terceiro lugar como causa de mortalidade em nosso meio. Desde a última publicação das Diretrizes Brasileiras sobre PAC da Sociedade Brasileira de Pneumologia e Tisiologia (SBPT; 2009), houve importantes avanços na aplicação dos exames de imagem, na investigação etiológica, na estratificação de risco à admissão e de escores prognósticos evolutivos, no uso de biomarcadores e nas recomendações de antibioticoterapia (e sua duração) e da prevenção por vacinas. Para revisar esses tópicos, a Comissão de Infecções Respiratórias da SBPT reuniu 13 membros com reconhecida experiência em PAC no Brasil que identificaram aspectos relevantes à prática clínica que demandam atualizações frente às novas evidências epidemiológicas e científicas publicadas. Foram determinados doze tópicos envolvendo aspectos diagnósticos, prognósticos, terapêuticos e preventivos. Os tópicos foram divididos entre os autores, que realizaram uma revisão de forma não sistemática da literatura, porém priorizando as principais publicações nas áreas específicas, incluindo artigos originais, artigos de revisão e revisões sistemáticas. Todos os autores tiveram a oportunidade de revisar e opinar sobre todas as questões, criando um documento único final que foi aprovado por consenso.
Asunto(s)
Humanos , Neumonía Viral/diagnóstico por imagen , Neumonía Bacteriana/diagnóstico por imagen , Neumonía Viral/tratamiento farmacológico , Sociedades Médicas , Brasil , Conferencias de Consenso como Asunto , Infecciones Comunitarias Adquiridas/tratamiento farmacológico , Infecciones Comunitarias Adquiridas/diagnóstico por imagen , Neumonía Bacteriana/tratamiento farmacológico , Medicina Basada en la Evidencia , Antibacterianos/uso terapéuticoRESUMEN
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.
Resumo Objetivo: Avaliar o papel do raios 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 crianças com pneumonia radiologicamente confirmada e 366 crianças com raios X de tórax normal). Infecção por S. pneumoniae foi diagnosticada 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 vez 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 fator preditor de pneumonia radiologicamente confirmada, o que aumenta sua chance de detecção em 2,8 vezes (IC 95%: 1,8-4,3). O valor preditivo negativo do raios 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. Conclusão: Crianças com diagnóstico clínico de PAC submetidas a um raios X de tórax que apresentam confirmação radiológica têm maior taxa de infecção por S. pneumoniae comparadas com as crianças com raios X normal.
Asunto(s)
Humanos , Masculino , Femenino , Lactante , Preescolar , Radiografía Torácica , Neumonía Bacteriana/microbiología , Neumonía Bacteriana/diagnóstico por imagen , Infecciones por Moraxellaceae/diagnóstico por imagen , Infecciones por Haemophilus/diagnóstico por imagen , Inmunoglobulina G/inmunología , Inmunoglobulina G/sangre , Haemophilus influenzae/aislamiento & purificación , Haemophilus influenzae/inmunología , Moraxella catarrhalis/inmunología , Infecciones Comunitarias Adquiridas/microbiología , Infecciones Comunitarias Adquiridas/diagnóstico por imagen , Anticuerpos Antibacterianos/sangre , Antígenos Bacterianos/sangreRESUMEN
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.
Asunto(s)
Infecciones por Haemophilus/diagnóstico por imagen , Infecciones por Moraxellaceae/diagnóstico por imagen , Neumonía Bacteriana/diagnóstico por imagen , Neumonía Bacteriana/microbiología , Radiografía Torácica , Anticuerpos Antibacterianos/sangre , Antígenos Bacterianos/sangre , Preescolar , Infecciones Comunitarias Adquiridas/diagnóstico por imagen , Infecciones Comunitarias Adquiridas/microbiología , Femenino , Haemophilus influenzae/inmunología , Haemophilus influenzae/aislamiento & purificación , Humanos , Inmunoglobulina G/sangre , Inmunoglobulina G/inmunología , Lactante , Masculino , Moraxella catarrhalis/inmunología , Moraxella catarrhalis/aislamiento & purificación , Neumonía Neumocócica/diagnóstico por imagen , Estudios Prospectivos , Sensibilidad y Especificidad , Streptococcus pneumoniae/inmunología , Streptococcus pneumoniae/aislamiento & purificaciónRESUMEN
BACKGROUND: The use of chest radiograph (CXR) for the diagnosis of childhood community-acquired pneumonia (CAP) is controversial. We assessed if children with CAP diagnosed on clinical grounds, with or without radiologically-confirmed pneumonia on admission, evolved differently. METHODS: Children aged ≥ 2 months, hospitalized with CAP diagnosed on clinical grounds, treated with 200,000 IU/Kg/day of aqueous penicillin G for ≥ 48 h and with CXR taken upon admission, without pleural effusion, were included in this retrospective cohort. One researcher, blinded to the radiological diagnosis, collected data on demographics, clinical history and physical examination on admission, daily hospital course during the first 2 days of treatment, and outcome, all from medical charts. Radiological confirmation of pneumonia was based on presence of pulmonary infiltrate detected by a paediatric radiologist who was also blinded to clinical data. Variables were initially compared by bivariate analysis. Multi-variable logistic regression analysis assessed independent association between radiologically-confirmed pneumonia and factors which significantly differed during hospital course in the bivariate analysis. The multi-variable analysis was performed in a model adjusted for age and for the same factor present upon admission. RESULTS: 109 (38.5%) children had radiologically-confirmed pneumonia, 143 (50.5%) had normal CXR and 31 (11.0%) had atelectasis or peribronchial thickening. Children without radiologically-confirmed pneumonia were younger than those with radiologically-confirmed pneumonia (median [IQR]: 14 [7-28 months versus 21 [12-44] months; P = 0.001). None died. The subgroup with radiologically-confirmed pneumonia presented fever on D1 (33.7 vs. 19.1; P = 0.015) and on D2 (31.6% vs. 16.2%; P = 0.004) more frequently. The subgroup without radiologically-confirmed pneumonia had chest indrawing on D1 (22.4% vs. 11.9%; P = 0.027) more often detected. By multi-variable analysis, Fever on D2 (OR [95% CI]: 2.16 [1.15-4.06]) was directly and independently associated with radiologically-confirmed pneumonia upon admission. CONCLUSION: The compared subgroups evolved differently.
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Infecciones Comunitarias Adquiridas/diagnóstico por imagen , Tiempo de Internación/tendencias , Admisión del Paciente/tendencias , Neumonía/diagnóstico por imagen , Radiografía Torácica/métodos , Brasil/epidemiología , Niño , Preescolar , Infecciones Comunitarias Adquiridas/epidemiología , Infecciones Comunitarias Adquiridas/terapia , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Lactante , Masculino , Neumonía/epidemiología , Neumonía/terapia , Estudios RetrospectivosRESUMEN
BACKGROUND: The role of chest radiograph (CXR) among children with community-acquired pneumonia is controversial. We aimed to assess if there is association between a specific etiology and radiologically confirmed pneumonia. METHODS: This was a prospective cross-sectional study. Based on report of respiratory complaints and fever/difficulty breathing plus the detection of pulmonary infiltrate/pleural effusion on the CXR taken upon admission read by the pediatrician on duty, children <5-year-old hospitalized with community-acquired pneumonia were enrolled. On admission, clinical data and biological samples were collected to investigate 19 etiological agents (11 viruses and 8 bacteria). CXR taken upon admission was independently read by a pediatric radiologist blinded to clinical data. RESULTS: The study group comprised 209 cases with evaluated CXR and establishment of a probable etiology. Radiologically confirmed pneumonia, normal CXR and other radiographic diagnoses were described for 165 (79.0%), 36 (17.2%) and 8 (3.8%) patients, respectively. Viral infection was significantly more common among patients without radiologically confirmed pneumonia (68.2% vs. 47.9%; P = 0.02), particularly among those with normal CXR (66.7% vs. 47.9%; P = 0.04) when compared with patients with radiologically confirmed pneumonia. Bacterial infection was more frequent among cases with radiologically confirmed pneumonia (52.1% vs. 31.8%; P = 0.02). Likewise, pneumococcal infection was more frequently detected among children with radiologically confirmed pneumonia in regard to children with normal CXR (24.2% vs. 8.3%; P = 0.04). Sensitivity (95% confidence interval) of radiologically confirmed pneumonia for pneumococcal infection was 93% (80-98%), and negative predictive value (95% confidence interval) of normal CXR for pneumococcal infection was 92% (77-98%). CONCLUSION: Bacterial infection, especially pneumococcal one, is associated with radiologically confirmed pneumonia.
Asunto(s)
Infecciones Bacterianas/diagnóstico por imagen , Infecciones Bacterianas/epidemiología , Neumonía/diagnóstico por imagen , Neumonía/epidemiología , Infecciones Bacterianas/complicaciones , Infecciones Bacterianas/microbiología , Brasil/epidemiología , Preescolar , Infecciones Comunitarias Adquiridas/diagnóstico por imagen , Infecciones Comunitarias Adquiridas/epidemiología , Infecciones Comunitarias Adquiridas/microbiología , Estudios Transversales , Femenino , Humanos , Lactante , Masculino , Neumonía/complicaciones , Neumonía/etiología , Estudios Prospectivos , RadiografíaAsunto(s)
Absceso/diagnóstico por imagen , Infecciones Comunitarias Adquiridas/diagnóstico por imagen , Staphylococcus aureus Resistente a Meticilina/aislamiento & purificación , Miositis/diagnóstico por imagen , Infecciones Estafilocócicas/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Absceso/tratamiento farmacológico , Absceso/microbiología , Absceso/cirugía , Antibacterianos/uso terapéutico , Terapia Combinada , Infecciones Comunitarias Adquiridas/tratamiento farmacológico , Infecciones Comunitarias Adquiridas/microbiología , Infecciones Comunitarias Adquiridas/cirugía , Desbridamiento , Drenaje , Quimioterapia Combinada , Femenino , Humanos , Inmunocompetencia , Persona de Mediana Edad , Miositis/tratamiento farmacológico , Miositis/microbiología , Miositis/cirugía , Osteomielitis/tratamiento farmacológico , Osteomielitis/microbiología , Osteomielitis/cirugía , Periostio/microbiología , Periostio/cirugía , Absceso del Psoas/diagnóstico por imagen , Absceso del Psoas/tratamiento farmacológico , Absceso del Psoas/microbiología , Absceso del Psoas/cirugía , Recurrencia , Sacroileítis/tratamiento farmacológico , Sacroileítis/microbiología , Sacroileítis/cirugía , Infecciones Estafilocócicas/tratamiento farmacológico , Infecciones Estafilocócicas/microbiología , Infecciones Estafilocócicas/cirugía , MusloAsunto(s)
Absceso/diagnóstico por imagen , Infecciones Comunitarias Adquiridas/diagnóstico por imagen , Infecciones Estafilocócicas/diagnóstico por imagen , Miositis/diagnóstico por imagen , Staphylococcus aureus Resistente a Meticilina/aislamiento & purificación , Tomografía Computarizada por Rayos X , Absceso del Psoas/cirugía , Absceso del Psoas/diagnóstico por imagen , Absceso del Psoas/microbiología , Absceso del Psoas/tratamiento farmacológico , Absceso/cirugía , Absceso/microbiología , Absceso/tratamiento farmacológico , Antibacterianos/uso terapéutico , Muslo , Desbridamiento , Drenaje , Femenino , Humanos , Inmunocompetencia , Infecciones Comunitarias Adquiridas/cirugía , Infecciones Comunitarias Adquiridas/microbiología , Infecciones Comunitarias Adquiridas/tratamiento farmacológico , Infecciones Estafilocócicas/cirugía , Infecciones Estafilocócicas/microbiología , Infecciones Estafilocócicas/tratamiento farmacológico , Miositis/cirugía , Miositis/microbiología , Miositis/tratamiento farmacológico , Osteomielitis/cirugía , Osteomielitis/microbiología , Osteomielitis/tratamiento farmacológico , Periostio/cirugía , Periostio/microbiología , Persona de Mediana Edad , Quimioterapia Combinada , Recurrencia , Sacroileítis/cirugía , Sacroileítis/microbiología , Sacroileítis/tratamiento farmacológico , Terapia CombinadaAsunto(s)
Absceso/diagnóstico por imagen , Infecciones Comunitarias Adquiridas/diagnóstico por imagen , Staphylococcus aureus Resistente a Meticilina/aislamiento & purificación , Miositis/diagnóstico por imagen , Infecciones Estafilocócicas/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Absceso/tratamiento farmacológico , Absceso/microbiología , Absceso/cirugía , Antibacterianos/uso terapéutico , Terapia Combinada , Infecciones Comunitarias Adquiridas/tratamiento farmacológico , Infecciones Comunitarias Adquiridas/microbiología , Infecciones Comunitarias Adquiridas/cirugía , Desbridamiento , Drenaje , Quimioterapia Combinada , Femenino , Humanos , Inmunocompetencia , Persona de Mediana Edad , Miositis/tratamiento farmacológico , Miositis/microbiología , Miositis/cirugía , Osteomielitis/tratamiento farmacológico , Osteomielitis/microbiología , Osteomielitis/cirugía , Periostio/microbiología , Periostio/cirugía , Absceso del Psoas/tratamiento farmacológico , Absceso del Psoas/microbiología , Absceso del Psoas/diagnóstico por imagen , Absceso del Psoas/cirugía , Recurrencia , Sacroileítis/tratamiento farmacológico , Sacroileítis/microbiología , Sacroileítis/cirugía , Infecciones Estafilocócicas/tratamiento farmacológico , Infecciones Estafilocócicas/microbiología , Infecciones Estafilocócicas/cirugía , MusloRESUMEN
Thymomas are neoplasms of the anterior mediastinum and generally occur between the fourth and sixth decades of life. In children, they are rare, with few reported cases. We describe a 9-year-old boy with invasive thymoma treated successfully by surgery alone. The patient was previously healthy and under treatment for a community-acquired pneumonia. A chest radiograph showed an opacity at the left lung base, and thoracic computed tomographic scan showed a mass with thick walls and liquid content situated in the lingula with no cleavage plane with the mediastinum. The patient underwent a left anterolateral thoracotomy, which showed a mass extending from the anterior mediastinum, infiltrating the left upper lobe of lung, phrenic nerve, and pericardium. A left upper lobectomy and resection of the mediastinal mass and lymph nodes were carried out. The pathologic analysis showed it to be a type B3 fusiform-cell thymoma, infiltrating the left upper lobe and 1 peribronchial lymph node. A multidisciplined tumor group decided to observe the patient and followed with thoracic computed tomographic scans every 3 months. After 2 years of follow-up, the patient has no evidence of recurrent disease.
Asunto(s)
Pulmón/patología , Pericardio/patología , Nervio Frénico/patología , Timoma/patología , Neoplasias del Timo/patología , Niño , Infecciones Comunitarias Adquiridas/complicaciones , Infecciones Comunitarias Adquiridas/diagnóstico por imagen , Humanos , Hallazgos Incidentales , Escisión del Ganglio Linfático , Metástasis Linfática , Masculino , Invasividad Neoplásica , Neumonectomía , Neumonía/complicaciones , Neumonía/diagnóstico por imagen , Toracotomía , Timectomía , Timoma/complicaciones , Timoma/diagnóstico por imagen , Timoma/cirugía , Neoplasias del Timo/complicaciones , Neoplasias del Timo/diagnóstico por imagen , Neoplasias del Timo/cirugía , Tomografía Computarizada por Rayos XRESUMEN
OBJECTIVE: To assess the association of demographic and clinical aspects with radiographically diagnosed pneumonia. DESIGN: By active surveillance, the admitted pneumonia cases by the pediatrician on duty were identified in a 2 year period. Demographic, clinical and radiographic data were registered into standardized forms. SETTING: A public university pediatric hospital in Salvador, Northeast Brazil. PATIENTS: Children <5 years-old. MAIN OUTCOME MEASURES: Radiographically diagnosed pneumonia based on detection of pulmonary infiltrate/ consolidation. RESULTS: 301 cases had the chest X-ray evaluated by a pediatric radiologist blinded to clinical information, among whom pulmonary infiltrate and consolidation were described in 161 (54%) and 119 (40%), respectively. Chest X-ray was read normal for 140 cases. Overall, the median age was 17 months (mean 20±14, range 12 days-59 months). Pulmonary infiltrate was less frequently described among patients aged under 1 year (41.3% vs 59.9%, P=0.002, OR [95% CI] = 0.47 [0.29-0.76]) and hyperinflation was significantly more frequent in this age group (27.9% vs 4.1%, P<0.001, OR [95% CI] = 9.14 [4.0-20.9]). By multiple logistic regression, fever on admission was independently associated with pulmonary infiltrate (OR [95% CI] = 1.68 [1.03-2.73]) or consolidation (1.79 [1.10-2.92]), wheezing was independently associated with absence of pulmonary infiltrate (0.53 [0.33-0.86]) or of consolidation (0.53 [0.33-0.87]). The positive likelihood ratio of fever on examination for pulmonary infiltrate and consolidation was 1.49 (95% CI:1.11-1.98) and 1.49 (95% CI: 1.14-1.94), respectively. CONCLUSION: Presence of fever enhanced 2.5 times the chance of children hospitalized with lower respiratory tract disease to have radiographically diagnosed pneumonia.