Acessibilidade / Reportar erro

Khamapirad radiologic criteria as a predictor of pneumonia's bacterial etiology Please cite this article as: Bustamante DV. Khamapirad radiologic criteria as a predictor of pneumonia's bacterial etiology. J Pediatr (Rio J). 2018;94:689-90.

Dear Editor,

As the authors propose in their study, the chest X-ray has a significant role in the differentiation and identification of the bacterial etiology of pneumonia.11 Andrade DC, Borges IC, Vilas-Boas AL, Fontoura MS, Araújo-Neto CA, Andrade SC, et al. Infection by Streptococcus pneumoniae in children with or without radiologically confirmed pneumonia. J Pediatr (Rio J). 2018;94:23-30. The main findings of chest X-ray suggesting a pathology of bacterial origin are: lobar or segmental consolidation, pneumatocele and the presence of a pulmonary abscess. These findings are significantly associated with a typical bacterial infection.11 Andrade DC, Borges IC, Vilas-Boas AL, Fontoura MS, Araújo-Neto CA, Andrade SC, et al. Infection by Streptococcus pneumoniae in children with or without radiologically confirmed pneumonia. J Pediatr (Rio J). 2018;94:23-30.

Despite this, in most cases typical bacterial pneumonia - mainly in the early stages of the disease - is not accompanied by those classic radiographic patterns.22 Korppi M, Kiekara O, Heiskanen-Kosma T, Soimaakallio S. Comparison of radiological findings and microbial etiology of childhood pneumonia. Acta Paediatr. 1993;82:360-3. On the other hand, some viral infections are capable of showing similar radiological patterns; for example, a consolidation pattern can be observed in an adenovirus infection.22 Korppi M, Kiekara O, Heiskanen-Kosma T, Soimaakallio S. Comparison of radiological findings and microbial etiology of childhood pneumonia. Acta Paediatr. 1993;82:360-3. This scenario is a barrier to the etiological diagnosis based solely on the chest X-ray. Virkki et al., in a study of 215 children with Acquired Pneumonia in the Community (NAC), of which 62% had bacterial etiology and the rest were exclusively viral, found that the alveolar infiltrates had a sensitivity of 72% and a specificity of 51% to identify a bacterial etiology.33 Virkki TJ, Juven T, Rikalainen H, Svedström E, Mertsola J, Ruuskanen O. Differentiation of bacterial and viral pneumonia in children. Thorax. 2002;57:438-41. They also reported that the specificity increased up to 85% when the alveolar infiltrates were of the lobar type, mainly in children under 2 years of age. The interstitial infiltrates, on the other hand, failed to adequately differentiate between viral and bacterial pneumonia. The hyperaerial, atelectasis and small pleural effusion also had no significance for this differentiation.22 Korppi M, Kiekara O, Heiskanen-Kosma T, Soimaakallio S. Comparison of radiological findings and microbial etiology of childhood pneumonia. Acta Paediatr. 1993;82:360-3.

In contrast, Moreno et al. found in children with NAC a great correlation of the interpretation of chest radiographs in those read both by a pediatrician and by radiologists, which translated into excellent diagnostic accuracy. The radiological scale they used was the Khamapirad scale, which showed a sensitivity of 100% (95% CI: 90-100%), specificity of 98% (95% CI: 93-99%), a positive predictive value of 96% (95% CI: 85-99%), and a negative predictive value of 100% (95% CI: 96-100%) to predict bacterial pneumonia with a simple chest plaque X-ray.44 Moreno L, Bujedo E, Robledo H, Conci R, Mosca L, et al. Validez de la radiografía de tórax para diferenciar etiología bacteriana de viral en niños hospitalizados con neumonía. Arch Argent Pediatr. 2006;104:109-13. This study strongly reinforces the usefulness of an X-ray for the etiological diagnosis of bacterial pneumonia as well as its usefulness to rule it out when the result is negative.

In addition to this, Torres et al., also using the Khamapirad scale, found in their study of children hospitalized by NAC a sensitivity of 100% (95% CI: 83-100%), specificity of 94% (95% CI: 88-97%), a positive predictive value of 77% (95% CI: 58-90%), and a negative predictive value of 100% (95% CI: 96-100%) to predict bacterial pneumonia.55 Torres F, Chiolo MJ, González N, Durán P, Ossorio MF, Rial MJ, et al. Capacidad para predecir etiología con la radiografía de tórax en niños hospitalizados con neumonía. Arch Argent Pediatr. 2006;104:106-8. This corroborates the findings of all the aforementioned authors and shows us the capacity of bacterial etiological identification through the use of a chest X-ray and an adequate scale.55 Torres F, Chiolo MJ, González N, Durán P, Ossorio MF, Rial MJ, et al. Capacidad para predecir etiología con la radiografía de tórax en niños hospitalizados con neumonía. Arch Argent Pediatr. 2006;104:106-8. Ultimately, Guanoluisa and Geovanny obtained a kappa index of 0.87 which represents a very good accordance. In this study, they also used the Khamapirad scale to evaluate chest radiographs of children.66 Guanoluisa C, Geovanny K. Utilidad del score de neumonía bacteriana en el diagnóstico etiológico de los niños de 1 mes-5años con neumonía adquirida en la comunidad hospitalizados en el Hospital Alfredo Noboa Montenegro - período noviembre 2016 - abril 2017 [thesis]. Ambato, Equator: Universidad Regional Autónoma de los Andes "Uniandes"; 2017.

Based on the findings of the study by Andrade et al., and in addition to the reviewed literature, it can be concluded that the use of the Khamapirad scale on a chest radiograph to identify the bacterial etiology of pneumonia is quite accurate, both for the confirmation of the etiology and to dismiss it according to the radiologic score. The use of an evaluation score like that of Khamapirad allows a better sensitivity and specificity of the chest X-ray. In this way, it is recommended that these criteria be introduced to physicians in order to improve the etiological identification and therapeutic management of pediatric patients with a diagnosis of pneumonia, especially in areas where pediatricians are not found.

  • Please cite this article as: Bustamante DV. Khamapirad radiologic criteria as a predictor of pneumonia's bacterial etiology. J Pediatr (Rio J). 2018;94:689-90.
  • Funding
    This letter to the editor was funded by the author itself.

Acknowledgement

The author would like to thank Dr. Juan Francisco Sanchez (Lima, Perú) for all the help and advice given during the development of this letter.

References

  • 1
    Andrade DC, Borges IC, Vilas-Boas AL, Fontoura MS, Araújo-Neto CA, Andrade SC, et al. Infection by Streptococcus pneumoniae in children with or without radiologically confirmed pneumonia. J Pediatr (Rio J). 2018;94:23-30.
  • 2
    Korppi M, Kiekara O, Heiskanen-Kosma T, Soimaakallio S. Comparison of radiological findings and microbial etiology of childhood pneumonia. Acta Paediatr. 1993;82:360-3.
  • 3
    Virkki TJ, Juven T, Rikalainen H, Svedström E, Mertsola J, Ruuskanen O. Differentiation of bacterial and viral pneumonia in children. Thorax. 2002;57:438-41.
  • 4
    Moreno L, Bujedo E, Robledo H, Conci R, Mosca L, et al. Validez de la radiografía de tórax para diferenciar etiología bacteriana de viral en niños hospitalizados con neumonía. Arch Argent Pediatr. 2006;104:109-13.
  • 5
    Torres F, Chiolo MJ, González N, Durán P, Ossorio MF, Rial MJ, et al. Capacidad para predecir etiología con la radiografía de tórax en niños hospitalizados con neumonía. Arch Argent Pediatr. 2006;104:106-8.
  • 6
    Guanoluisa C, Geovanny K. Utilidad del score de neumonía bacteriana en el diagnóstico etiológico de los niños de 1 mes-5años con neumonía adquirida en la comunidad hospitalizados en el Hospital Alfredo Noboa Montenegro - período noviembre 2016 - abril 2017 [thesis]. Ambato, Equator: Universidad Regional Autónoma de los Andes "Uniandes"; 2017.

Publication Dates

  • Publication in this collection
    Nov-Dec 2018
Sociedade Brasileira de Pediatria Av. Carlos Gomes, 328 cj. 304, 90480-000 Porto Alegre RS Brazil, Tel.: +55 51 3328-9520 - Porto Alegre - RS - Brazil
E-mail: jped@jped.com.br