Pneumonia

Gereige, Rani S.; Laufer, Pablo Marcelo

doi:10.1542/pir.34-10-438

Cited by 47 publications

(41 citation statements)

References 25 publications

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“…Therefore, parents may perceive pneumonia as a severe medical condition and then brought their children to seek medical care earlier. However, pneumonia also commonly affects children without SCID in Asia (40–42), and clinicians are not alerted to the possible diagnosis of SCID.…”

Section: Discussionmentioning

confidence: 99%

Family History of Early Infant Death Correlates with Earlier Age at Diagnosis But Not Shorter Time to Diagnosis for Severe Combined Immunodeficiency

et al. 2017

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BackgroundSevere combined immunodeficiency (SCID) is fatal unless treated with hematopoietic stem cell transplant. Delay in diagnosis is common without newborn screening. Family history of infant death due to infection or known SCID (FH) has been associated with earlier diagnosis.ObjectiveThe aim of this study was to identify the clinical features that affect age at diagnosis (AD) and time to the diagnosis of SCID.MethodsFrom 2005 to 2016, 147 SCID patients were referred to the Asian Primary Immunodeficiency Network. Patients with genetic diagnosis, age at presentation (AP), and AD were selected for study.ResultsA total of 88 different SCID gene mutations were identified in 94 patients, including 49 IL2RG mutations, 12 RAG1 mutations, 8 RAG2 mutations, 7 JAK3 mutations, 4 DCLRE1C mutations, 4 IL7R mutations, 2 RFXANK mutations, and 2 ADA mutations. A total of 29 mutations were previously unreported. Eighty-three of the 94 patients fulfilled the selection criteria. Their median AD was 4 months, and the time to diagnosis was 2 months. The commonest SCID was X-linked (n = 57). A total of 29 patients had a positive FH. Candidiasis (n = 27) and bacillus Calmette–Guérin (BCG) vaccine infection (n = 19) were the commonest infections. The median age for candidiasis and BCG infection documented were 3 months and 4 months, respectively. The median absolute lymphocyte count (ALC) was 1.05 × 109/L with over 88% patients below 3 × 109/L. Positive FH was associated with earlier AP by 1 month (p = 0.002) and diagnosis by 2 months (p = 0.008), but not shorter time to diagnosis (p = 0.494). Candidiasis was associated with later AD by 2 months (p = 0.008) and longer time to diagnosis by 0.55 months (p = 0.003). BCG infections were not associated with age or time to diagnosis.ConclusionFH was useful to aid earlier diagnosis but was overlooked by clinicians and not by parents. Similarly, typical clinical features of SCID were not recognized by clinicians to shorten the time to diagnosis. We suggest that lymphocyte subset should be performed for any infant with one or more of the following four clinical features: FH, candidiasis, BCG infections, and ALC below 3 × 109/L.

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Section: Discussionmentioning

confidence: 99%

Family History of Early Infant Death Correlates with Earlier Age at Diagnosis But Not Shorter Time to Diagnosis for Severe Combined Immunodeficiency

et al. 2017

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“…26,29 Similarly, the spectrum of disease found in children may differ from that seen in the adult population, necessitating different standards in both diagnosis and treatment. 3,27 To identify pneumonia by LUS, a consolidation needs to reach the pleura and be within an intercostal window. 28 In children, the former is offset by the relative small lung size, 26 as mentioned previously, and may explain the relative high sensitivity found in our results.…”

Section: Figurementioning

confidence: 99%

“…2 Pediatric pneumonia still remains a diagnostic challenge in resourcelimited settings. 3 Signs and symptoms of pneumonia vary depending on a child's age and the etiology of infection. [4][5][6][7] Moreover, presenting signs and symptoms have poor diagnostic specificity, which may further complicate the diagnosis.…”

mentioning

confidence: 99%

“…[8][9][10] Second, the lack of findings on CR does not rule out the diagnosis if there is a strong suspicion of pneumonia. 3 Finally, although a chest computed tomography (CT) scan has a higher level of diagnostic accuracy than CR, it is almost never used for the diagnosis of pneumonia because of higher ionizing radiation exposure, difficulty in patient cooperation, frequent need for sedation, and cost. 11 Other disadvantages of both techniques as a tool for the diagnosis of pneumonia, especially in resourcepoor settings, include availability and lack of portability.…”

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confidence: 99%

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Lung Ultrasound for the Diagnosis of Pneumonia in Children: A Meta-analysis

et al. 2015

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BACKGROUND AND OBJECTIVE: Pneumonia is the leading cause of death of children. Diagnostic tools include chest radiography, but guidelines do not currently recommend the use of lung ultrasound (LUS) as a diagnostic method. We conducted a meta-analysis to summarize evidence on the diagnostic accuracy of LUS for childhood pneumonia. METHODS:We performed a systematic search in PubMed, Embase, the Cochrane Library, Scopus, Global Health, World Health Organization-Libraries, and Latin American and Caribbean Health Sciences Literature of studies comparing LUS diagnostic accuracy against a reference standard. We used a combination of controlled key words for age ,18 years, pneumonia, and ultrasound. We identified 1475 studies and selected 15 (1%) for further review. Eight studies (765 children) were retrieved for analysis, of which 6 (75%) were conducted in the general pediatric population and 2 (25%) in neonates. Eligible studies provided information to calculate sensitivity, specificity, and positive and negative likelihood ratios. Heterogeneity was assessed by using Q and I 2 statistics.RESULTS: Five studies (63%) reported using highly skilled sonographers. Overall methodologic quality was high, but heterogeneity was observed across studies. LUS had a sensitivity of 96% (95% confidence interval [CI]: 94%-97%) and specificity of 93% (95% CI: 90%-96%), and positive and negative likelihood ratios were 15.3 (95% CI: 6.6-35.3) and 0.06 (95% CI: 0.03-0.11), respectively. The area under the receiver operating characteristic curve was 0.98. Limitations included the following: most studies included in our analysis had a low number of patients, and the number of eligible studies was also small. Dr Pereda conceptualized and designed the study, reviewed all abstracts and selected articles to be included in the meta-analysis, was responsible for data collection, and drafted the initial manuscript; Dr Chavez conceptualized and designed the study, reviewed all abstracts and selected articles to be included in the meta-analysis, was responsible for data collection, led the analysis, and drafted the initial manuscript; Dr Hooper-Miele participated in analysis and interpretation of results, critically revised ultrasound methods used by selected studies, and reviewed and revised the manuscript; Drs Gilman, Steinhoff, Ellington, and Tielsch participated in the analysis and interpretation of results and reviewed and revised the manuscript; Ms Gross and Ms Price conducted the literature search and reviewed and revised the manuscript; Dr Checkley conceptualized and designed the study, contributed equally to the analysis, drafted the initial manuscript, and had ultimate oversight over the study conduct, analysis plan, and writing of the manuscript; and all authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.www.pediatrics.org/cgi

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“…Worldwide pneumonia accounts for 15% of the total number of deaths in children less than 5 years [7]. Early diagnosis of neonatal pneumonia still remains a diagnostic challenge [8]. Using X-ray as a “gold standard” for the diagnosis of pneumonia, however, it should be used cautiously in neonates because of the potential late adverse effects of ionized radiation [9, 10], and the lack of findings on chest radiographs does not rule out the diagnosis if there is a strong suspicion of pneumonia.…”

Section: Discussionmentioning

confidence: 99%

Lung Ultrasound in Early Diagnosis of Neonatal Ventilator Associated Pneumonia before Any Radiographic or Laboratory Changes

Ibrahim

Omran

Ibrahim

et al. 2016

Case Reports in Pediatrics

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Neonatal pneumonia is reported to be the primary cause of neonatal respiratory failure and one of the common causes of neonatal hospitalization and death in developing countries. Chest X-ray was considered the gold standard for diagnosis of neonatal pneumonia. Lung ultrasonography has been described as a valuable noninvasive tool for the diagnosis of many neonatal pulmonary diseases. We report a case of ventilation associated neonatal pneumonia with very early diagnosis using lung ultrasound before any significant radiographic changes in chest X-ray or laboratory findings suggestive of infection.

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Pneumonia

Cited by 47 publications

References 25 publications

Family History of Early Infant Death Correlates with Earlier Age at Diagnosis But Not Shorter Time to Diagnosis for Severe Combined Immunodeficiency

Family History of Early Infant Death Correlates with Earlier Age at Diagnosis But Not Shorter Time to Diagnosis for Severe Combined Immunodeficiency

Lung Ultrasound for the Diagnosis of Pneumonia in Children: A Meta-analysis

Lung Ultrasound in Early Diagnosis of Neonatal Ventilator Associated Pneumonia before Any Radiographic or Laboratory Changes

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