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. 1993;152(1):24–30. doi: 10.1007/BF02072512

Aetiology of community-acquired pneumonia in children treated in hospital

M Korppi 1,✉, T Heiskanen-Kosma 1, E Jalonen 2, P Saikku 3, M Leinonen 2, P Halonen 4, P H Mäkela 2
PMCID: PMC7087117  PMID: 8444202

Abstract

Viral and bacterial antigen and antibody assays were prospectively applied to study the microbial actiology of community-acquired pneumonia in 195 hospitalised children during a surveillance period of 12 months. A viral infection alone was indicated in 37 (19%), a bacterial infection alone in 30 (15%) and a mixed viral-bacterial infection in 32 (16%) patients. Thus, 46% of the 69 patients with viral infection and 52% of the 62 patients with bacterial infection had a mixed viral and bacterial aetiology. Respiratory syncytial virus (RSV) was identified in 52 patients andStreptococcus pneumoniae in 41 patients. The next common agents in order were non-classifiedHaemophilus influenzae (17 cases), adenoviruses (10 cases) andChlamydia species (8 cases). The diagnosis of an RSV infection was based on detecting viral antigen in nasopharyngeal secretions in 79% of the cases. Pneumococcal infections were in most cases identified by antibody assays; in 39% they were indicated by demonstrating pneumococcal antigen in acute phase serum. An alveolar infiltrate was present in 53 (27%) and an interstitial infiltrate in 108 (55%) of the 195 patients. The remaining 34 patients had probable pneumonia. C-reactive protein (CRP), erythrocyte sedimentation rate and total white blood cell count were elevated in 25%, 40% and 36% of the patients, respectively, CRP was more often elevated in patients with bacterial infection alone than in those with viral or mixed viral-bacterial infections. No other correlation was seen between the radiological or laboratory findings and serologically identified viral, bacterial or mixed viralbacterial infections. By using a comprehensive serological panel, the causative agent could be found in over 50% of patients with pneumonia. We conclude that RSV and pneumococcus are the two most common organisms causing pneumonia in children. Our results suggest that mixed viral-bacterial aetiology is common in lower respiratory tract infections affecting children.

Key words: Pneumonia, Respiratory syncytial virus, Pneumococcus, Enzyme immunoassay, Radioimmunoassay

Abbreviations

AOM

acute otitis media

CF

complement fixation

EIA

enzyme immunoassay

IF

immunofluorescence

NPS

nasopharyngeal secretion

PNC

pneumococcal

PV

parainfluenza

RSV

respiratory syncytial virus

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