A three-step diagnosis of pediatric pneumonia at the emergency department using clinical predictors, C-reactive protein, and pneumococcal PCR

Alcoba, Gabriel; Keitel, Kristina; Maspoli, Veronica; Lacroix, Laurence; Manzano, Sergio; Gehri, Mario; Tabin, René; Gervaix, Alain; Galetto-Lacour, Annick

doi:10.1007/s00431-017-2913-0

Cited by 36 publications

(35 citation statements)

References 47 publications

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“…was even true for PCT and CRP of Mp-positive CAP in comparison to viral CAP (RSV) as a subgroup of Mp-negative CAP. Similar trends have been observed in previous CAP studies for CRP, WBC count, and ANC [23,[39][40][41][42][43], and recently for PCT with median levels from 0.05 to 0.19 μg/L in CAP considered to be caused by Mp [39][40][41]44]. A study with conflicting results suggesting higher PCT levels associated with Mp may be hampered by diagnostics [45].…”

Section: Discussionsupporting

confidence: 86%

“…A study with conflicting results suggesting higher PCT levels associated with Mp may be hampered by diagnostics [45]. A PCT cutoff of <0.25 μg/L reached the best discriminatory power in differentiating Mp-positive from Mp-negative children with CAP, which is supported by previous studies [39][40][41]44]. Only 1 Mp-positive patient had a PCT level of 0.55 μg/L and was above this cutoff.…”

Section: Discussionmentioning

confidence: 57%

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Improved Diagnostics Help to Identify Clinical Features and Biomarkers That Predict Mycoplasma pneumoniae Community-acquired Pneumonia in Children

Sauteur

Krautter

Ambroggio

et al. 2019

Clinical Infectious Diseases

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Background. There are no reliable signs or symptoms that differentiate Mycoplasma pneumoniae (Mp) infection in communityacquired pneumonia (CAP) from other etiologies. Additionally, current diagnostic tests do not reliably distinguish between Mp infection and carriage. We previously determined that the measurement of Mp-specific immunoglobulin M antibody-secreting cells (ASCs) by enzyme-linked immunospot assay allowed for differentiation between infection and carriage. Using this new diagnostic test, we aimed to identify clinical and laboratory features associated with Mp infection.Methods. This is a prospective cohort study of children, 3-18 years of age, with CAP from 2016 to 2017. Clinical features and biomarkers were compared between Mp-positive and -negative groups by Mann-Whitney U test or Fisher exact test, as appropriate. Area under the receiver operating characteristic curve (AUC) differences and optimal thresholds were determined by using the DeLong test and Youden J statistic, respectively.Results. Of 63 CAP patients, 29 were Mp-positive (46%). Mp positivity was statistically associated with older age (median, 8.6 vs 4.7 years), no underlying disease, family with respiratory symptoms, prior antibiotic treatment, prolonged prodromal respiratory symptoms and fever, and extrapulmonary (skin) manifestations. Lower levels of C-reactive protein, white blood cell count, absolute neutrophil count, and procalcitonin (PCT), specifically PCT <0.25 μg/L, were statistically associated with Mp infection. A combination of age >5 years (AUC = 0.77), prodromal fever and respiratory symptoms >6 days (AUC = 0.79), and PCT <0.25 μg/L (AUC = 0.81) improved diagnostic performance (AUC = 0.90) (P = .05).Conclusions. A combination of clinical features and biomarkers may aid physicians in identifying patients at high risk for Mp CAP.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 57%

Improved Diagnostics Help to Identify Clinical Features and Biomarkers That Predict Mycoplasma pneumoniae Community-acquired Pneumonia in Children

Sauteur

Krautter

Ambroggio

et al. 2019

Clinical Infectious Diseases

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show abstract

“…Curiously, PCT and CRP were studied in combination in 2 studies included in the present meta-analysis [19, 32], but the reported results were not sufficient to demonstrate a combined effect; rather, the authors only tested whether 1 parameter is a better marker than the other. In 1 study included here, performed in Italy, the authors identified a significant positive correlation between serum PCT levels and the main markers of inflammation such as CRP, percentage of neutrophils, and WBC [24].…”

Section: Discussionmentioning

confidence: 99%

Host Inflammatory Biomarkers of Disease Severity in Pediatric Community-Acquired Pneumonia: A Systematic Review and Meta-analysis

Fernandes

Arriaga

Costa

et al. 2019

Open Forum Infectious Diseases

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BackgroundCommunity-acquired pneumonia (CAP) is the leading cause of death in children. Identification of reliable biomarkers offers the potential to develop a severity quantitative score to assist in clinical decision-making and improve outcomes.MethodsA systematic review and meta-analysis was performed in PubMed and EMBASE on November 13, 2018, to examine the association between host inflammatory biomarkers and CAP severity in children. The inclusion criteria were case–control, cross-sectional, and cohort studies that examined candidate serum biomarkers. We extracted outcomes of interest, means, and standardized mean differences (SMDs) of plasma and serum levels of biomarkers together with information on disease severity. Meta-analysis was performed. This review was registered in the PROSPERO international registry (CRD42019123351).ResultsTwo hundred seventy-two abstracts were identified, and 17 studies were included. Among the biomarkers evaluated, levels of C-reactive protein (CRP; SMD, 0.63; 95% confidence interval [CI], 0.35 to 0.91), interleukin (IL)-6 (SMD, 0.46; 95% CI, 0.25 to 0.66), IL-8 (SMD, 0.72; 95% CI, 0.15 to 1.29), neutrophil count (SMD, 0.27; 95% CI, 0.07 to 0.47), and procalcitonin (SMD, 0.68; 95% CI, 0.20 to 1.15) were substantially increased in severe CAP. In contrast, IL-2 concentrations (SMD, –0.24; 95% CI, –0.45 to –0.03) were higher in nonsevere CAP. Study heterogeneity was reported to be high (I2 > 75%), except for IL-2, IL-5, IL-6, and IL-12p70, which were classified as moderate (I2 = 50%–74%). Only neutrophil and white blood cell counts were described by studies exhibiting a low level of heterogeneity.ConclusionsOur results suggest that host biomarkers, and especially CRP, IL-6, IL-8, and procalcitonin levels, have the potential to predict severe CAP in pediatric populations.

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“…In addition, researchers have proposed combining clinical signs and laboratory markers to assess an individual’s risk of contracting pneumonia. For example, high levels of CRP and procalcitonin accompanied by unilateral hyperventilation and grunting were associated with pneumonia ( 302 ). On the other hand, children with no clinical signs of pneumonia and low CRP results were at a lower risk for pneumonia.…”

Section: Diagnosis Age-dependent Response Prevention and Disease Pmentioning

confidence: 99%

“…The use of PCR for diagnosis is also being developed. A positive blood pneumococcal PCR can more accurately confirm the diagnosis of pneumonia ( 302 ). PCR has been used to detect pneumolysin in whole blood samples ( 303 ).…”

Section: Diagnosis Age-dependent Response Prevention and Disease Pmentioning

confidence: 99%

Streptococcus pneumoniae’s Virulence and Host Immunity: Aging, Diagnostics, and Prevention

2018

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Streptococcus pneumoniae is an infectious pathogen responsible for millions of deaths worldwide. Diseases caused by this bacterium are classified as pneumococcal diseases. This pathogen colonizes the nasopharynx of its host asymptomatically, but overtime can migrate to sterile tissues and organs and cause infections. Pneumonia is currently the most common pneumococcal disease. Pneumococcal pneumonia is a global health concern and vastly affects children under the age of five as well as the elderly and individuals with pre-existing health conditions. S. pneumoniae has a large selection of virulence factors that promote adherence, invasion of host tissues, and allows it to escape host immune defenses. A clear understanding of S. pneumoniae’s virulence factors, host immune responses, and examining the current techniques available for diagnosis, treatment, and disease prevention will allow for better regulation of the pathogen and its diseases. In terms of disease prevention, other considerations must include the effects of age on responses to vaccines and vaccine efficacy. Ongoing work aims to improve on current vaccination paradigms by including the use of serotype-independent vaccines, such as protein and whole cell vaccines. Extending our knowledge of the biology of, and associated host immune response to S. pneumoniae is paramount for our improvement of pneumococcal disease diagnosis, treatment, and improvement of patient outlook.

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A three-step diagnosis of pediatric pneumonia at the emergency department using clinical predictors, C-reactive protein, and pneumococcal PCR

Cited by 36 publications

References 47 publications

Improved Diagnostics Help to Identify Clinical Features and Biomarkers That Predict Mycoplasma pneumoniae Community-acquired Pneumonia in Children

Improved Diagnostics Help to Identify Clinical Features and Biomarkers That Predict Mycoplasma pneumoniae Community-acquired Pneumonia in Children

Host Inflammatory Biomarkers of Disease Severity in Pediatric Community-Acquired Pneumonia: A Systematic Review and Meta-analysis

Streptococcus pneumoniae’s Virulence and Host Immunity: Aging, Diagnostics, and Prevention

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