The cause and clinical manifestations of pneumonia were studied in 98 pediatric outpatients. A viral diagnosis was established in 38 (39%) of the 98 patients, and a bacterial diagnosis in 19 (19%). Ten (53%) of the 19 patients with bacterial pneumonia had a concurrent viral infection. No clinical, laboratory, or radiographic findings that would reliably differentiate viral from bacterial infection were identified. This study suggests that bacterial pneumonia is more common in pediatric outpatients than previously reported, and that the clinical, laboratory, and radiographic findings in patients with bacterial infection may be indistinguishable from findings in patients with viral infection.

The chest roentgenogram is an accepted tool for the diagnosis of pneumonia. Little information is available, however, addressing the ability of physicians to distinguish bacterial from nonbacterial pneumonias by examination of the chest roentgenogram. Five different observers evaluated 36 chest films from patients with pneumonia who had a laboratory proven etiologic diagnosis. The sensitivity of roentgenogram diagnosis of bacterial pneumonia ranged from 42-58 percent. When clinical and laboratory data were provided to the observers the sensitivity ranged from 42-92 percent. This study indicates that chest film examination is too insensitive to be useful for the selection of patients who have bacterial pneumonia from those whose pneumonia is non-bacterial.

The increasing availability and use of marijuana in children, adolescents, and adults have been well documented in recent years. Adverse reactions have been described in adults who absorb the drug via inhalation or by oral and intravenous routes.1-5 To our knowledge, no cases of oral intoxication in very young children have been reported in the pediatric literature. We describe the adverse effects experienced by three children after an accidental oral ingestion of marijuana. CASE REPORTS Case 1 J.H., a 3-year-old previously healthy, white girl, was noted by her baby-sitter to be behaving abnormally a short time after lunch. Approximately two hours later, her mother observed the child to have an ataxic gait and a voracious appetite.

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