Aerobic bacteria, Chlamydia trachomatis, Pneumocystis carinii and Cytomegalovirus as agents of severe peneumonia in small infants

Ejzenberg, Bernardo; Melles, Heloisa; Melles, Carmo; Dias, Rosa; Baldacci, Evandro Roberto; Okay, Yassuhiko

doi:10.1590/S0036-46651996000100003

Abstracts

The authors studied 58 infants hospitalized for pneumonia in a semi-intensive care unit. Age ranged from 1 complete to 6 incomplete months. The infants were sent from another hospital in 20 cases and from home in a further 38. Pulmonary involvement, which was alveolar in 46 cases and interstitial in 12, was bilateral in 31 children. The investigation was carried out prospectively on the etiological agents associated with respiratory infection to look for evidence of aerobic bacteria (blood cultures), Chlamydia trachomatis and Cytomegalovirus (serology), and Pneumocystis carinii (direct microscopy of tracheal aspirated material). The following infectious agents were diagnosed in 21 children (36.2%): Aerobic bacteria (8), Chlamydia trachomatis (5), Pneumocystis carinii (3), Cytomegalovirus (3), Cytomegalovirus and Chlamydia trachomatis (1), Aerobic bacteria and Cytomegalovirus (1). Seven cases of infection by Chlamydia trachomatis and/or Cytomegalovirus were diagnosed out of the 12 cases with pulmonary interstitial involvement.

Pneumonia; Etiology; Infant

Os autores estudaram prospectivamente 58 lactentes internados por pneumonia em unidade semi-intensiva. A idade foi limitada entre 1 mês completo e 6 meses incompletos. A procedência das crianças foi de outro hospital em 20 casos e domiciliar em 38. O acometimento pulmonar era alveolar em 46 casos, intersticial em 12 e bilateral em 31 crianças. Foram pesquisados agentes etiológicos associados à infecção respiratória dos lactentes jovens: Bactérias aeróbias (Hemoculturas), Chlamydia trachomatis e Cytomegalovirus (sorologia), e Pneumocystis carinii (microscopia direta do aspirado traqueal). Foram diagnosticadas infecções em 21 crianças (36,2%): Bactérias aeróbias (8), Chlamydia trachomatis (5), Cytomegalovirus (3), Pneumocystis carinii (3), Cytomegalovirus e Chlamydia trachomatis (1), Bactéria aeróbia e Cytomegalovirus (1). Foram diagnosticadas 7 infecções por Chlamydia trachomatis e/ou Cytomegalovirus entre as 12 crianças com quadro intersticial

MICROBIOLOGY

Aerobic bacteria, Chlamydia trachomatis, Pneumocystis carinii and Cytomegalovirus as agents of severe peneumonia in small infants

Bactérias aeróbias, Chlamydia trachomatis, Pneumocystis carinii e Cytomegalovirus: agentes causadores de pneumonia grave em pequenos lactentes

Bernardo Ejzenberg^I; Heloisa Melles^II; Carmo Melles^II; Rosa Dias^II; Evandro Roberto Baldacci^III; Yassuhiko Okay^IV

^IPhD, MD. Children's Institute of the Pediatrics Department of the School of Medicine of the University of São Paulo

^IIAdolfo Lutz Institute Researcher. Adolfo Lutz Institute

^IIIPhD, MD, Emergency Care Director. Children's Institute of the Pediatrics Department of the School of Medicine of the University of São Paulo

^IVChairman of Pediatrics Department. Children's Institute of the Pediatrics Department of the School of Medicine of the University of São Paulo

^{Correspondence to} Correspondence to: Dr. Bernardo Ejzenberg Av. Prof. Lineu Prestes, 2565 Cidade Universitária - USP. 05508-900 São Paulo, SP, Brasil

SUMMARY

The authors studied 58 infants hospitalized for pneumonia in a semi-intensive care unit. Age ranged from 1 complete to 6 incomplete months. The infants were sent from another hospital in 20 cases and from home in a further 38. Pulmonary involvement, which was alveolar in 46 cases and interstitial in 12, was bilateral in 31 children. The investigation was carried out prospectively on the etiological agents associated with respiratory infection to look for evidence of aerobic bacteria (blood cultures), Chlamydia trachomatis and Cytomegalovirus (serology), and Pneumocystis carinii (direct microscopy of tracheal aspirated material). The following infectious agents were diagnosed in 21 children (36.2%): Aerobic bacteria (8), Chlamydia trachomatis (5), Pneumocystis carinii (3), Cytomegalovirus (3), Cytomegalovirus and Chlamydia trachomatis (1), Aerobic bacteria and Cytomegalovirus (1). Seven cases of infection by Chlamydia trachomatis and/or Cytomegalovirus were diagnosed out of the 12 cases with pulmonary interstitial involvement.

Keywords: Pneumonia; Etiology; Infant.

RESUMO

Os autores estudaram prospectivamente 58 lactentes internados por pneumonia em unidade semi-intensiva. A idade foi limitada entre 1 mês completo e 6 meses incompletos. A procedência das crianças foi de outro hospital em 20 casos e domiciliar em 38. O acometimento pulmonar era alveolar em 46 casos, intersticial em 12 e bilateral em 31 crianças. Foram pesquisados agentes etiológicos associados à infecção respiratória dos lactentes jovens: Bactérias aeróbias (Hemoculturas), Chlamydia trachomatis e Cytomegalovirus (sorologia), e Pneumocystis carinii (microscopia direta do aspirado traqueal). Foram diagnosticadas infecções em 21 crianças (36,2%): Bactérias aeróbias (8), Chlamydia trachomatis (5), Cytomegalovirus (3), Pneumocystis carinii (3), Cytomegalovirus e Chlamydia trachomatis (1), Bactéria aeróbia e Cytomegalovirus (1). Foram diagnosticadas 7 infecções por Chlamydia trachomatis e/ou Cytomegalovirus entre as 12 crianças com quadro intersticial

Full text available only in PDF format.

Texto completo disponível apenas em PDF.

ACKNOWLEDGEMENTS

The authors thank Dr. Vera Lúcia Marão of the Immunology Laboratory of the School of Medicine of the University of São Paulo for carrying out serological tests for Cytomegalovirus.

Recebido para publicação em 11/09/1995.

Aceito para publicação em 19/12/1995.

Informed consent was obtained from the parents or guardians. The present investigation was carried out in accordance with the ethical norms approved for research by The Children's Institute of the Pediatrics Department of the School of Medicine of the University of São Paulo.

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10. CARDENAS, V.M.; KOOPMAN, J.S.; GARRIDO, F.J. et al. - Protective effect of antibodies on mortality risk from acute respiratory infections in Mexican children. Bull. Pan Amer. Hlth. Org., 26: 109-120, 1992.
11. DATTA, N.; KUMAR, V.; KUMAR, L. & SINGHIS, S. - Application of case management to the control of acute respiratory infections in low-birth-weight infants: a feasibility study. Bull. Wld. Hlth. Org., 65: 77-82, 1987.
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Correspondence to:

Dr. Bernardo Ejzenberg

Av. Prof. Lineu Prestes, 2565

Cidade Universitária - USP. 05508-900 São Paulo, SP, Brasil

Publication Dates

Publication in this collection
22 Sept 2006
Date of issue
Feb 1996

History

Accepted
19 Dec 1995
Received
11 Sept 1995

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. ADEGBOLA, R.A.; FALADE, A.G.; SAM, B.E. et al. - The etiology of pneumonia in malnouriched and well-nourished Gambian children. Pediat. infect. Dis. J., 13: 975-982, 1994.

[2] 2. ANDERSON, V.M. & TURNER, T. - Hystopathology of childhood pneumonia in developing countries. Rev. infect. Dis., 13 (suppl. 6): S470-S476, 1991.

[3] 3. BALE, J.L. - Creation of a research program to determine the etiology and epidemiology of acute respiratory tract infection among children in developing countries. Rev. infect. Dis., 12 (suppl. 8): S861-S866, 1990.

[4] 4. BEEM, M.O. & SAXON, E.M. - Respiratory tract colonization and a distinctive pneumonia syndrome in infants infected with Chlamydia trachomatis. New Engl. J. Med., 296: 306-310, 1977.

[5] 5. BERMAN, S.; SHANKS, M.B.; FEITEN, D. et al. - Acute respiratory infections during the first three months of life. Pediat. Emerg. Care, 6: 179-182, 1990.

[6] 6. BERMAN, S. - Epidemiology of acute respiratory infections in children of developing countries. Rev. infect. Dis., 13 (suppl. 6): S454-S462, 1991.

[7] 7. BOYLE, F.M.; GEORGHIU, P.R.; TILSE, M.H. & McCORMACK, J.G. - Branhamella (Moraxella) catarrhalis: pathogenic significance in respiratory infections. Med. J. Aust., 154: 592-596, 1991.

[8] 8. CAMPBELL, S.W.; MONTGOMERY, J.M.; POMAT, W. et al. Detection of Streptococcus pneumoniae and Haemophilus influenzae type b antigens in the serum and urine of patients with pneumonia in Papua, New Guinea: comparison of latex agglutination and counterimmunoelectrophoresis. Rev. infect. Dis., 12 (suppl. 8): S1001-S1005, 1990.

[9] 9. CARBALLAL, G.; MAHONY, J.B.; VIDELA, C.; CERQUEIRO, C. & CHERNESKI, M. - Chlamydial antibodies in children with lower respiratory disease. Pediatr. infect. Dis. J., 11: 68-71, 1992.

[10] 10. CARDENAS, V.M.; KOOPMAN, J.S.; GARRIDO, F.J. et al. - Protective effect of antibodies on mortality risk from acute respiratory infections in Mexican children. Bull. Pan Amer. Hlth. Org., 26: 109-120, 1992.

[11] 11. DATTA, N.; KUMAR, V.; KUMAR, L. & SINGHIS, S. - Application of case management to the control of acute respiratory infections in low-birth-weight infants: a feasibility study. Bull. Wld. Hlth. Org., 65: 77-82, 1987.

[12] 12. DERISH, M.T.; KULHAGIAN, J.A.; FRANKEL, L.R. & SMITH, D.W. - Value of bronchoalveolar lavage in diagnosing severe Respiratory Syncytial Virus infections in infants. J. Pediat, 119: 761-763, 1991.

[13] 13. EJZENBERG, B.; FERNANDES, V.O.; RODRIGUES NETO, A.J. et al. - Search for the bacterial etiology in 102 children in hospital due to a diagnosis of acute pneumonia. Pediat. (S. Paulo), 8: 99-106, 1986.

[14] 14. EJZENBERG, B.; FERNANDES, V.O.; RODRIGUES NETO, A.J. et al. - Infections by viruses, bacteria, and Mycoplasma pneumoniae in 42 children in hospital due to acute pneumonia. Pediat. (S. Paulo), 8: 141-147, 1986.

[15] 15. ESCOBAR, J.A.; DOVER, A.S.; DUEŃAS, A. et al. - Etiology of respiratory tract infections in children in Cali, Colombia. Pediatrics, 57: 123-130, 1976.

[16] 16. FAUVEAU, V.; STEWART, M.K.; CHAKRABORTY, J. & KHAN, S.A. - Impact on mortality of a community based programme to control acute lower respiratory tract infections. Bull. Wld. Hlth. Org., 70: 109-116, 1992.

[17] 17. FORGIE, I.M.; O'NEILL, K.P.; LEOYD-EVANS, N. et al. - Etiology of acute lower respiratory tract infections in Gambian children. Acute lower respiratory tract infections in infants presenting at the hospital. Pediat. infect. Dis. J., 10: 33-41, 1991.

[18] 18. FUNKHOUSER, A.; STEINHOFF, M.C. & WARD, J. - Haemophilus influenzae disease and immunization in developing countries. Rev. infect. Dis., 13 (suppl. 6): S542-S545, 1991.

[19] 19. GHAFOON, A.; NORMANI, N.K.; ISHAK, Z. et al. - Diagnosis of acute lower respiratory tract infections in children in Rawalpindi and Islamabad, Pakistan. Rev. infect. Dis., 12 (suppl. 8): S907-S914, 1990.

[20] 20. GONZAGA, N.C.; NAVARRO, E.E.; LUCERO, M.G. et al. - Etiology of infection and morphologic changes in the lungs of Filipino children who die of pneumonia. Rev. infect. Dis., 12 (suppl. 8): S1055-S1064, 1990.

[21] 21. GOSEY, L.L.; HOWARD, R.M.; WITEBSKY, F.G. et al. - Advantages of a modified toluidine blue o stain and bronchoalveolar lavage to the diagnosis of Pneumocystis carinii pneumonia. J. clin. Microbiol., 22: 803-807, 1985.

[22] 22. GRAYSTON, J.T. - Chlamydia pneumoniae infections in children. Pediat. infect. Dis. J., 13: 675-685, 1994.

[23] 23. GRISI, S.J.F.E.; EJZENBERG, B.; RODRIGUES NETO, A.J. et al. - Bacteremia due to Salmonella typhimurium: the lung. Pediat. (S. Paulo), 5: 313-316, 1983.

[24] 24. GRISI, S.J.F.E.; KIMURA, H.M.; BELIZZIA NETO, L. et al. - Pneumonia due to Klebsiella pneumoniae. Pediat. (S. Paulo), 5: 376-378, 1983.

[25] 25. HERRMANN, B.; SALIH, M.A.M.; YOUSIF, B.E. et al. - Chlamydial etiology of acute lower respiratory tract infections in children in the Sudan. Acta paediat. (Uppsala), 83: 169-172, 1994.

[26] 26. HODINKA, R.L. & FRIEDMAN, H.M. - Human Cytomegalovirus. In: BALOWS, A.; HAUSLER, W.J.J.; HERMAN, K.L.; ISENBERG, H.O. & SHADOMY, H.J., ed. 5.ed. Manual of clinical microbiology. Washington, American Society for Microbiology, 1991. p. 829-837.

[27] 27. IKEOGU, M.O. - Acute pneumonia in Zimbabwe: bacteria isolates by lung aspiration. Arch. Dis. Child., 63: 1266-1267, 1988.

[28] 28. JOHN, T.J.; CHEDRIAN, T.; STEINHOFF, M.C. et al. - Etiology of acute respiratory infections in children in tropical Southern India. Rev. infect. Dis., 13 (suppl. 6): S463-S469, 1991.

[29] 29. KAHN, F.W. & JONES, J.M. - Diagnosing bacterial respiratory infection by bronchoalveolar lavage. J. infect. Dis., 155: 862-869, 1987.

[30] 30. KLEIN, M. - Multicenter trial of cefpodoxime proxetil vs amoxicillin-clavulanate in acute lower respiratory tract infections in childhood. Pediat. infect. Dis. J., 14: S19-S22, 1995.

[31] 31. KONEMAN, E.W.; ALLEN, S.D.; DOWELL Jr, U.R. & SOMMERS, H.M., ed. - Color atlas and textbook of diagnostic microbiology. 2. ed. Philadelphia, J. B. Lippincott, 1983. p. 18-20.

[32] 32. KORPY, M.; LEINONEN, M.; MAKELA, P.H. & CAUNIOLO, K. - Mixed infection is common in children with respiratory adenovirus infection. Acta Paediat. scand., 80: 413-417, 1991.

[33] 33. LEIGH, M.W.; CARSON, J.L. & DENNY, F.W. - Pathogenesis of respiratory infections due to Influenzae Virus: implications for developing countries. Rev. infect. Dis., 13 (suppl. 6): S501-S508, 1991.

[34] ³⁴
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