Table 2.
Prospective studies of specific pathogens from developed countries
| Reference [evidence level] | Age | Year and setting | Tests | Total episodes | Viral (n) | Bacteria, % (n) | Mycoplasma, % (n) | Chlamydia, % (n) | Mixed, % (n) | Total diagnosed, % (n) |
|---|---|---|---|---|---|---|---|---|---|---|
| Wolf [Ib] | <5 years | ED | NPA hMPV PCR; NPIA | 1296 | RSV 23.1 hMPV 8.3 Adeno 3.4 Infl A 2.9 PIV 2.9 | |||||
| Cilla [Ib] | 1–35 months | 2004–6, Spain, IP+OP | NPIA + PCR, BC, serology, Binax pleural fluid | 338 | 67 (18 viral co-infection) RSV 19.8 HboV 14.2 RV 13.6 HMPV 11.5 Corona 6.5 | Spn 2.1 (7) | 1.8 (6) | ∗ | NA | NA |
| Haman [II] | 0–19 years | 2005–6, Japan | NPA PCR | 1700 | 27.9 (2.1% multiple) RV 14.5 RSV 9.4 hMPV 7.2 HboV 2.9 | a | 14.8 (251) | 1.4 (24) | 15.2 | NAa |
| Don [II] | 0.3–16 years | 2001–2, Italy, IP+OP | Serology (viral and bacterial) | 101 | 42 (3 dual) RSV 17 PIV 12 Infl 9 hMPV 5 | 44 Spn18 HI 3 Mcat 1 | 26.7 (27)<2 years: 12–5 years: 8>5 years: 18p<0.0001 | 7.9 (8) | 20 | 65 (66) |
| Lin [II] | 3 months–18 years | 2001–2, Taiwan, IP | NPIA, NPVC; hMPV PCR; BC; urine Spn ag; serology MP+CP | 116 | 38.8 (45) RSV 28.9 Adeno 28.9 hMPV 13.3 Infl 13.3 | a | 37.9 (44) | 4.3 (5) | NA | NAa |
| Michelow [Ib] | 6 weeks–18 years | 1999–2000, USA, IP | NPIA, NPVC; Spn BPCR; BC; serology viral, Spn, MP, CP | 154 | 45 (65) RSV 13 Infl 22 PIV 13 Adeno 7 | 60 (93)Spn 44 (68) GAS 1 (2) SA 1 (2) | 14 (21) | 9 (14) | 23 | 79 (122) |
| Macherel[Ib] | 2 months–5 years | 2003–5, Switzerland: IP | NPIA + PCR; Spn BPCR; BC; serology viral, Spn, MP, CP; | 99 | 67 RV 20h MPV 13 RSV 13 Infl 14 Paraflu 13 Adeno 7 Corona 7 | 53 (52)Spn 46 (45)GAS 1 (1) | 11 | 7 | 33 (33) | 86 (85) |
| Drummond[II] | 0–16 years | 1996–8, UK, IP | NPIA; NPVC; serology viral, Spn, MP, CP; urine Spn ag; | 136 | 37 (50) RSV 25 Infl A 5 CMV 3 Adeno 1.4 | 12.5 (17) GAS 7 (9) Spn 4 (5) | 2 (3) | 11 (15) | 51 (70) | |
| Laundy[II] | 0–5 years | 2001–2, UK, IP+OP | NPIA+PCR;BC; specifically viral testing | 51 | 43 (22) RSV 18 (9) Infl A 16 (8) Adeno 6 (3) PIV 6 (3) | 12 (6) Spn 6 | 4 (2) | NA | NA | 49 (25) |
| Tsolia[Ib] | 5–14 years | 2004, Greece, IP | NPA PCR; serology MP, CP, Spn, HI, Mcat; | 75 | 65 (49) RV 45 (34) Adeno 12 (9) PIV 8 (6) Infl 7 (5) RSV 3 (2) hMPV 1 (1) | 40 (30)Spn 7 (5) | 35 (26) | 3 (2) | 28 (21) | 77 (58) |
| Macherel[Ib] | 2 months–5 years | 2003–5, Switzerland: IP | NPIA + PCR; Spn BPCR; BC; serology viral, Spn, MP, CP; | 99 | 67 RV 20h MPV 13 RSV 13 Infl 14 Paraflu 13 Adeno 7 Corona 7 | 53 (52)Spn 46 (45)GAS 1 (1) | 11 | 7 | 33 (33) | 86 (85) |
| Drummond[II] | 0–16 years | 1996–8, UK, IP | NPIA; NPVC; serology viral, Spn, MP, CP; urine Spn ag; | 136 | 37 (50) RSV 25 Infl A 5 CMV 3 Adeno 1.4 | 12.5 (17)GAS 7 (9) Spn 4 (5) | 2 (3) | 11 (15) | 51 (70) | |
| Laundy[II] | 0–5 years | 2001–2, UK, IP+OP | NPIA+PCR;BC; specifically viral testing | 51 | 43 (22) RSV 18 (9)Infl A 16 (8) Adeno 6 (3) PIV 6 (3) | 12 (6) Spn 6 | 4 (2) | NA | NA | 49 (25) |
| Tsolia[Ib] | 5–14 years | 2004, Greece, IP | NPA PCR; serology MP, CP, Spn, HI, Mcat; | 75 | 65 (49) RV 45 (34) Adeno 12 (9) PIV 8 (6) Infl 7 (5) RSV 3 (2) hMPV 1 (1) | 40 (30) Spn 7 (5) | 35 (26) | 3 (2) | 28 (21) | 77 (58) |
Reproduced with permission from the British Thoracic Society guidelines for the management of community acquired pneumonia in children: update 2011.Case definitions include clinical findings compatible with CAP together with radiological changes. In the columns the percentage indicates the percentage of all CAP cases in which that organism was detected. Where both viral and bacterial isolates were detected, it was classified as mixed and indicated in a separate column. In some studies it was not possible to determine whether infections were single or mixed (as indicated). Bacterial isolates are not included if isolated from a sputum or upper respiratory tract specimen in the absence of other evidence of significance for example, a rise in antibody concentrations.
No serological tests were performed for Chlamydia pneumonia.
∗ Adeno, adenovirus; ag, antigen; BC, blood culture; BPCR, blood PCR; Corona, coronavirus; CP, Chlamydia pneumoniae; ED, emergency department; GAS, group A streptococcus; HboV, human bocavirus; HI, Haemophilus influenzae; hMPV, human metapneumovirus; Infl, influenza A and B virus; IP, inpatients; Mcat, Moraxella catarrhalis; MP, mycoplasma; NA, not available; NPA PCR, nasopharyngeal PCR; NPIA, nasopharyngeal immunoassay; NPVC, nasopharyngeal viral culture; OP, outpatients; PIV, parainfluenza virus 1–3; PC, pharyngeal culture; RSV, respiratory syncytial virus; RV, rhinovirus; Spn, Streptococcus pneumoniae.
All bacterial cases identified by NPA PCR so difficult to distinguish carriage from pathogen.