Differentiation of bacterial and viral pneumonia in children

Abstract

Background: A study was undertaken to investigate the differential diagnostic role of chest radiographic findings, total white blood cell count (WBC), erythrocyte sedimentation rate (ESR), and serum C reactive protein (CRP) in children with community acquired pneumonia of varying aetiology. Methods: The study population consisted of 254 consecutive children admitted to hospital with community acquired pneumonia diagnosed between 1993 and 1995. WBC, ESR, and CRP levels were determined on admission. Seventeen infective agents (10 viruses and seven bacteria) were searched for. Chest radiographs were retrospectively and separately reviewed by three paediatric radiologists. Results: A potential causative agent was found in 215 (85%) of the 254 cases. Bacterial infection was found in 71% of 137 children with alveolar infiltrates on the chest radiograph, while 72% of the 134 cases with a bacterial pneumonia had alveolar infiltrates. Half of the 77 children with solely interstitial infiltrates on the chest radiograph had evidence of bacterial infection. The proportion of patients with increased WBC or ESR did not differ between bacterial and viral pneumonias, but differences in the CRP levels of >40 mg/l, >80 mg/l, and >120 mg/l were significant although the sensitivity for detecting bacterial pneumonia was too low for use in clinical practice. Conclusions: Most children with alveolar pneumonia, especially those with lobar infiltrates, have laboratory evidence of a bacterial infection. Interstitial infiltrates are seen in both viral and bacterial pneumonias.

Pig Major Acute-Phase Protein and apolipoprotein A-I responses correlate with the clinical course of experimentally induced African Swine Fever and Aujeszky's disease

“…The CRP concentration was not highly modified during the first 5 days, but an increase in concentration was observed at day 6 p.i. In human medicine it is widely accepted that viral infections cause minor increases in CRP concentration compared to that of acute bacterial infections [41]. This could explain the low response of this protein in this viral infection.…”

“…bacteria, virus, and trauma). It has often been suggested that in humans, viral infections caused a weaker response compared to that of acute bacterial infections [41]. However, not much is known about APP response elicited by viruses in pigs [2,11,35,38].…”

How frequent is varicella-associated pneumonia in children?

“…5,6,7,8 Bacterial pneumonia was defined as: a) suggestive chest X-rays and one or more clinical, microbiological or laboratory findings; b) non-suggestive radiological pattern but both clinical, laboratory and microbiological findings suggestive of bacterial pneumonia. Viral non-varicella pneumonia was defined as: a) suggestive radiological finding and one or more clinical, microbiological or laboratory findings; b) non-suggestive radiological viral but both clinical, laboratory and microbiological findings suggestive of viral pneumonia.…”

Neumonía adquirida en la comunidad en niños: Aplicabilidad de las guías clínicas

“…El patrón viral presenta hiperinsuflación, infiltrados peribronquiales, atelectasias y adenopatías hiliares. Diversos estudios han intentado correlacionar estos patrones radiológicos y otros exámenes de laboratorios complementarios como la VHS, PCR y el recuento de leucocitos, con etiologías determinadas [10][11] , concluyendo que la etiología bacteriana es más frecuente en pacientes con infiltrados alveolares específicamente lobares en la Rx de tórax, que los infiltrados intersticiales se ven en neumonías virales y bacterianas y que los exáme- nes complementarios no aportan mucho al diagnóstico etiológico, a excepción de la PCR.…”