Etiological Diagnosis of Childhood Pneumonia by Use of Transthoracic Needle Aspiration and Modern Microbiological Methods

Abstract

Childhood pneumonia is usually treated without determining its etiology. The causative organism can be isolated from specimens of blood, empyema fluid, or lung aspirate, but this is rarely done. The potential of transthoracic needle aspiration for identification of causative agents was tested with use of modern microbiological methods. Aspiration was performed for 34 children who had radiological signs compatible with community-acquired pneumonia and had alveolar consolidation. In addition to bacterial and viral cultures and viral antigen detection, nucleic acid detection for common respiratory pathogens was performed on aspirate specimens. Aspiration disclosed the etiology in 20 (59%) of 34 cases overall and in 18 (69%) of 26 patients from whom a representative specimen was obtained. Aspiration's advantages are high microbiological yield and a relatively low risk of a clinically significant adverse event. Aspiration should be used if identification of the causative agent outweighs the modest risk of the procedure.

Pleural Fluid PCR Method for Detection of <i>Staphylococcus aureus, Streptococcus pneumoniae</i> and <i>Haemophilus influenzae</i> in Pediatric Parapneumonic Effusions

“…PCR detection of causative microorganisms in pleural fluid has been reported previously [17,18,19,20,21], indicating a high sensitivity in the detection of causative agents. The results of the present study show that PCR analysis could increase the diagnostic yield of conventional techniques from 7.1 to 35.7%, highlighting the limitations of standard culture as a diagnostic tool for the etiology in pleural effusions in children.…”

Etiology of Pneumonia in a Pediatric Population with High Pneumococcal Vaccine Coverage

“…1 Transthoracic lung aspiration with its ethical and practical issue when attempted determines the etiological agent in only two thirds of patients. 34 Induced sputum seems to increase bacterial yield and is implemented in a large multicenter CAP etiology study, 35 but retrieving representative material in pediatric patients is demanding and differentiating true bacterial pathogens from commensals makes it questionable as a standard procedure. 36 Because of this absence of a standard procedure, pneumococcal serological methods are insufficiently validated.…”

Rapid Detection of Streptococcus pyogenes in Pleural Fluid Samples from Pediatric Patients with Empyema

“…Successful management relies in part on early and rapid recognition of the etiology (3,8,12). Current microbiological diagnosis is usually based on direct Gram stain and routine bacterial culture even though the large majority of pediatric specimens are culture and Gram stain negative (3,8), likely related to antibiotic treatment before sample collection, limited organism load in specimens, and/or suboptimal transport and storage conditions.…”