Etiology and severity of community acquired pneumonia in children from Uruguay: a 4-year study

Hortal, Maria; Suarez, Adela; Deleon, Cristina; Estevan, Miguel; Mogdasy, Maria Cristina; Russi, José Carlos; Contera, Myriam; Meny, Miguel

doi:10.1590/S0036-46651994000300010

Abstracts

The 4-year study (1987-1990) covered the major clinical-epidemiological characteristics of pneumonia in children as diagnosed at the emergency service of the Children's Hospital, as well as etiologies, and factors involved in the most severe cases. Etiology was determined in 47.7% of the 541 pneumonia cases, involving 283 pathogens of which 38.6% were viruses and 12.6% bacteria. Viral and mixed etiologies were more frequent in children under 12 months of age. Bacteria predominated in ages between 6 and 23 months. Among the viruses, respiratory syncytial virus predominated (66%). The bacterial pneumonias accounted for 12.2% of the recognized etiologies. The most important bacterial agents were S. pneumoniae (64%) and H. influenzae (19%). H. influenzae and mixed infections had a relevant participation during the 1988 season, pointing to annual variations in the relative participation of pathogens and its possible implication in severity of diseases. Correlation of severity and increased percentage of etiological diagnosis was assessed: patients with respiratory rates over 70 rpm, or pleural effusion and/or extensive pulmonary parenchyma compromise yielded higher positive laboratory results. Various individual and family risk factors were recognized when comparing pneumonia children with healthy controls.

Pneumonia; Hemophilus influenzae; Streptococcus pneumoniae; Viral pneumonia

O estudo de quatro anos de duração (1987-1990) abarcou as principais características clínico-epidemiológicas de pneumonia em crianças, tal como foi diagnosticado no serviço de emergência do Hospital Infantil, e também as etiologias e fatores implicados nos casos mais severos. Determinou-se a etiologia em 47.7% dos 541 casos de pneumonia, que incluíam 283 patógenos, dos quais 38.6% eram virus e 12.6% bactérias. Observou-se etiologia viral e mista mais freqüentemente nas crianças de menos de 12 meses. A etiologia bacteriana prevaleceu nas idades entre 6 e 23 meses. Com relação aos virus, a predominância foi de RSV com prevalência de 66% do total de virus. Os mais importantes agentes bacterianos foram S. pneumoniae (64%) e H. influenzae (19%). O H. influenzae e as infecções mistas incidiram significativamente durante 1988 assinalando variações anuais na severidade das doenças. Observou-se correlação entre a gravidade dos casos e a alta porcentagem de diagnóstico etiológico: pacientes com ritmos respiratórios mais altos que 70rpm, derrame pleural ou com comprometimento extenso de parênquima pulmonar, apresentaram maior índice de positividade laboratorial. Reconheceu-se vários fatores de risco individuais e familiares ao comparar crianças com pneumonia com controles sadios.

EPIDEMIOLOGY

Etiology and severity of community acquired pneumonia in children from Uruguay: a 4-year study

Etiologia e severidade de pneumonia adquirida comunitariamente em crianças uruguaias: um estudo de 4 anos

Maria Hortal^I; Adela Suarez^II; Cristina Deleon^II; Miguel Estevan^II; Maria Cristina Mogdasy^III; José Carlos Russi^I; Myriam Contera^III; Miguel Meny^III

^ICentral Public Health Laboratory

^IIChildren's Hospital

^IIIARI Program, Div. Epidemiology, Ministry of P. Health

^{Address for correspondence} Address for correspondence: M. Hortal, M.D., M.P.H. Av. 8 de Octubre 2720 Montevideo 11.600, URUGUAY FAX: (598) 2 807014

SUMMARY

The 4-year study (1987-1990) covered the major clinical-epidemiological characteristics of pneumonia in children as diagnosed at the emergency service of the Children's Hospital, as well as etiologies, and factors involved in the most severe cases.

Etiology was determined in 47.7% of the 541 pneumonia cases, involving 283 pathogens of which 38.6% were viruses and 12.6% bacteria. Viral and mixed etiologies were more frequent in children under 12 months of age. Bacteria predominated in ages between 6 and 23 months. Among the viruses, respiratory syncytial virus predominated (66%). The bacterial pneumonias accounted for 12.2% of the recognized etiologies. The most important bacterial agents were S. pneumoniae (64%) and H. influenzae (19%). H. influenzae and mixed infections had a relevant participation during the 1988 season, pointing to annual variations in the relative participation of pathogens and its possible implication in severity of diseases. Correlation of severity and increased percentage of etiological diagnosis was assessed: patients with respiratory rates over 70 rpm, or pleural effusion and/or extensive pulmonary parenchyma compromise yielded higher positive laboratory results. Various individual and family risk factors were recognized when comparing pneumonia children with healthy controls.

Keywords: Pneumonia; Hemophilus influenzae; Streptococcus pneumoniae; Viral pneumonia.

RESUMO

O estudo de quatro anos de duração (1987-1990) abarcou as principais características clínico-epidemiológicas de pneumonia em crianças, tal como foi diagnosticado no serviço de emergência do Hospital Infantil, e também as etiologias e fatores implicados nos casos mais severos.

Determinou-se a etiologia em 47.7% dos 541 casos de pneumonia, que incluíam 283 patógenos, dos quais 38.6% eram virus e 12.6% bactérias. Observou-se etiologia viral e mista mais freqüentemente nas crianças de menos de 12 meses. A etiologia bacteriana prevaleceu nas idades entre 6 e 23 meses. Com relação aos virus, a predominância foi de RSV com prevalência de 66% do total de virus.

Os mais importantes agentes bacterianos foram S. pneumoniae (64%) e H. influenzae (19%).

O H. influenzae e as infecções mistas incidiram significativamente durante 1988 assinalando variações anuais na severidade das doenças.

Observou-se correlação entre a gravidade dos casos e a alta porcentagem de diagnóstico etiológico: pacientes com ritmos respiratórios mais altos que 70rpm, derrame pleural ou com comprometimento extenso de parênquima pulmonar, apresentaram maior índice de positividade laboratorial.

Reconheceu-se vários fatores de risco individuais e familiares ao comparar crianças com pneumonia com controles sadios.

Full text available only in PDF format.

Texto completo disponível apenas em PDF.

ACKNOWLEDGEMENTS

We thank the U. S. National Academy of Sciences/National Research Council for financial support by means of a grant from the U. S. Agency for International Development, and to Swedish Agency for Reseach Cooperation with Developing Countries for their financial support during the 4^th year of the study. We also thank to Dr. J. Bale for her very comprehensive support and to Dr. P. Charache for her thoughtful suggestions about this manuscript.

Recebido para publicação em 06/07/1993.

Aceito para publicação em 10/03/1994.

1. BAKEMKAMP, S.J.; MUNSON, R.S. & GRANOFF, D.M. - Subtyping isolates of H. influenzae type b by outer membrane protein profiles. J. infect. Dis., 143: 668-676, 1981.
²
BOSTID RESEARCH GRANTS PROGRAM - Manual on procedures for diagnosis of respiratory viral pathogens. Washington DC. Borad on Science and Technology for International Development, National Research Council, 1986.
³
BOSTID RESEARCH GRANTS PROGRAM - Manual on procedures for diagnosis of respiratory bacterial pathogens, Washington DC, Board on Science and Technology for International Development, National Research Council, 1986.
4. CARBALLAL, G.; SIMINOVICH, M.; MURTAGH, B. et al. - Etiologic clinical and pathologic analysis of 31 fatal cases of acute respiratory tract infection in Argentinian children under 5 years of age. Rev. infect. Dis., 12 (suppl. 8): S1074-S1080, 1990.
5. CRISTINA, J.; MOYA, A.; ARBIZA, J.R. et al. - Evolution of the G and P genes of human respiratory syncytial virus (subgroup A) studied by the RNase A mismatch cleavage method. Virology, 184: 210-218, 1991.
⁶
MINISTERIO DE SALUD PUBLICA, DIVISIÓN DE ESTADISTCA. Uruguay, 1990.
7. DONOWITZ, G.R. & MANDELL, G.L. - Acute pneumonia. In: MANDELL, R.G.; GORDON, J.E. & BENNET, J.E. ed. Principles and practices of infectious diseases. 2. ed., New York, John Wiley & Sons, 1985. p. 394-404.
8. GRAY, G.M.;CONSERVE, G.M. & DILLON, H.C. - Serotypes of S. pneumoniae causing disease. J. infect. Dis., 140: 979-983, 1979.
9. HANSEN, E.J. - Non capsular surface antigens and their association with virulence of H. influenzae type b. In: AYOUB, E.M.; BRANCHE, W.C.; CASSEL, G.H. & HENRY, T.J., ed. Microbial determinants of virulence and host response. Washington D. C, ASM, 1990. p. 45-54.
10. HORTAL, M.; FERRARI, A.M.; RUSSI, J.C. & ESTEVAN, M. - Infecciones respiratorias agudas intratoracicas en nińos hospitalizados, Uruguay 1984-86. Bol. méd. Hosp. infant. (Méx.), 47: 624-629, 1990.
11. HORTAL, M.; BENITEZ, A.; CONTERA, M. et al. - A community-based study of acute respiratory tract infections in children in Uruguay. Rev. infect. Dis. 12 (suppl. 8): S966-S973, 1990.
12. HORTAL, M.; RUSSI, J.C.; ARBIZA, J.R. et al. - Identification of viruses in a study of acute respiratory tract infections in children from Uruguay. Rev. infect. Dis., 12(suppl. 8): S995-S997, 1990.
13. HORTAL, M.; MOGDASY, M.C.; RUSSI, J.C.; DELEON, C. & SUAREZ, A. - Microbial agents associated with pneumonia in children from Uruguay. Rev. infect. Dis., 12 (suppl. 8): S915-S922, 1990.
14. KILBOURNE, E.D. - The epidemiology of influenza. In: KILBOURNE, E.D., ed. Influenza. New York, Plenum Medical Book, 1987. p. 255-289.
15. KAJON, A.; MURTAGH, P.; GARCIA, S.F. et al. - A new genome type of adenovirus 3 associated with severe lower respiratory infection in children. J. med. Virol., 30: 73-76, 1990.
16. MARRIE, T.J.; DURANT, H. & YATES, L. - Community-acquired pneumonia requiring hospitalization: 5-year prospective study. Rev. infect. Dis., 11: 586-599, 1989.
17. MUNSON, R.S.; KABEER, M.H.; LENOIR, A.A. & GRANOFF, D.M. - Epidemiology and prospects for prevention of disease due to H. influenzae in developing countries. Rev. infect. Dis., 11 (suppl. 3): S588-S597, 1989.
18. MUSSER, J.M.; KROLL, J.S.; GRANOFF, D.M. et al. - Global genetic structure and molecular epidemiology of encapsulated H. influenzae. Rev. infect. Dis., 12: 75-111, 1990.
¹⁹
ORGANIZACIÓN PANAMERICANA DE LA SALUD - Tratamiento del niño con infección respiratoria aguda. 1987. (Serie Paltex, No. 15).
20. RUSSI, J.C.; DELFRARO, A.; ARBIZA, J.R. et al. - Antigenic characterization of respiratory syncytial virus associated with acute respiratory infections in Uruguayan children from 1985 to 1987. J. clin. Microbiol., 27: 1464-1466, 1989
21. SELWYN, B.J. - The epidemiology of acute respiratory tract infection in young children: comparison of findings from several developing countries. Rev. infect. Dis., 12 (suppl. 8): S870-S888, 1990.
22. TURNER, R.B.; LANDE, A.E.; CHASE, P.; HILTON, N. & WEINBERG, D. - Pneumonia in pediatric outpatients: cause and clinical manifestations. J. Pediatr., 111: 194-200, 1987.
23. WEISER, J.N.; LINDBERG, A.A.; MANNING, E.J.; HANSEN, E.J. & MOXON, E.B. - Identification of a chromosomal locus for expression of lipopolysaccharide epitopes in H. influenzae. Infect. Immun., 57: 3045-3052, 1989.
24. WEISSENBACHER, M.; CARBALLAL, G.; AVILA, M. et al. - Etiological and clinical evaluation of acute lower respiratory tract infections in young Argentinian children: an overview. Rev. infect. Dis., 12(suppl. 8): S889-S898, 1990.

Address for correspondence:

M. Hortal, M.D., M.P.H.

Av. 8 de Octubre 2720

Montevideo 11.600, URUGUAY

FAX: (598) 2 807014

Publication Dates

Publication in this collection
20 Sept 2006
Date of issue
June 1994

History

Accepted
10 Mar 1994
Received
06 July 1993

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

[1] 1. BAKEMKAMP, S.J.; MUNSON, R.S. & GRANOFF, D.M. - Subtyping isolates of H. influenzae type b by outer membrane protein profiles. J. infect. Dis., 143: 668-676, 1981.

[2] ²
BOSTID RESEARCH GRANTS PROGRAM - Manual on procedures for diagnosis of respiratory viral pathogens. Washington DC. Borad on Science and Technology for International Development, National Research Council, 1986.

[3] ³
BOSTID RESEARCH GRANTS PROGRAM - Manual on procedures for diagnosis of respiratory bacterial pathogens, Washington DC, Board on Science and Technology for International Development, National Research Council, 1986.

[4] 4. CARBALLAL, G.; SIMINOVICH, M.; MURTAGH, B. et al. - Etiologic clinical and pathologic analysis of 31 fatal cases of acute respiratory tract infection in Argentinian children under 5 years of age. Rev. infect. Dis., 12 (suppl. 8): S1074-S1080, 1990.

[5] 5. CRISTINA, J.; MOYA, A.; ARBIZA, J.R. et al. - Evolution of the G and P genes of human respiratory syncytial virus (subgroup A) studied by the RNase A mismatch cleavage method. Virology, 184: 210-218, 1991.

[6] ⁶
MINISTERIO DE SALUD PUBLICA, DIVISIÓN DE ESTADISTCA. Uruguay, 1990.

[7] 7. DONOWITZ, G.R. & MANDELL, G.L. - Acute pneumonia. In: MANDELL, R.G.; GORDON, J.E. & BENNET, J.E. ed. Principles and practices of infectious diseases. 2. ed., New York, John Wiley & Sons, 1985. p. 394-404.

[8] 8. GRAY, G.M.;CONSERVE, G.M. & DILLON, H.C. - Serotypes of S. pneumoniae causing disease. J. infect. Dis., 140: 979-983, 1979.

[9] 9. HANSEN, E.J. - Non capsular surface antigens and their association with virulence of H. influenzae type b. In: AYOUB, E.M.; BRANCHE, W.C.; CASSEL, G.H. & HENRY, T.J., ed. Microbial determinants of virulence and host response. Washington D. C, ASM, 1990. p. 45-54.

[10] 10. HORTAL, M.; FERRARI, A.M.; RUSSI, J.C. & ESTEVAN, M. - Infecciones respiratorias agudas intratoracicas en nińos hospitalizados, Uruguay 1984-86. Bol. méd. Hosp. infant. (Méx.), 47: 624-629, 1990.

[11] 11. HORTAL, M.; BENITEZ, A.; CONTERA, M. et al. - A community-based study of acute respiratory tract infections in children in Uruguay. Rev. infect. Dis. 12 (suppl. 8): S966-S973, 1990.

[12] 12. HORTAL, M.; RUSSI, J.C.; ARBIZA, J.R. et al. - Identification of viruses in a study of acute respiratory tract infections in children from Uruguay. Rev. infect. Dis., 12(suppl. 8): S995-S997, 1990.

[13] 13. HORTAL, M.; MOGDASY, M.C.; RUSSI, J.C.; DELEON, C. & SUAREZ, A. - Microbial agents associated with pneumonia in children from Uruguay. Rev. infect. Dis., 12 (suppl. 8): S915-S922, 1990.

[14] 14. KILBOURNE, E.D. - The epidemiology of influenza. In: KILBOURNE, E.D., ed. Influenza. New York, Plenum Medical Book, 1987. p. 255-289.

[15] 15. KAJON, A.; MURTAGH, P.; GARCIA, S.F. et al. - A new genome type of adenovirus 3 associated with severe lower respiratory infection in children. J. med. Virol., 30: 73-76, 1990.

[16] 16. MARRIE, T.J.; DURANT, H. & YATES, L. - Community-acquired pneumonia requiring hospitalization: 5-year prospective study. Rev. infect. Dis., 11: 586-599, 1989.

[17] 17. MUNSON, R.S.; KABEER, M.H.; LENOIR, A.A. & GRANOFF, D.M. - Epidemiology and prospects for prevention of disease due to H. influenzae in developing countries. Rev. infect. Dis., 11 (suppl. 3): S588-S597, 1989.

[18] 18. MUSSER, J.M.; KROLL, J.S.; GRANOFF, D.M. et al. - Global genetic structure and molecular epidemiology of encapsulated H. influenzae. Rev. infect. Dis., 12: 75-111, 1990.

[19] ¹⁹
ORGANIZACIÓN PANAMERICANA DE LA SALUD - Tratamiento del niño con infección respiratoria aguda. 1987. (Serie Paltex, No. 15).

[20] 20. RUSSI, J.C.; DELFRARO, A.; ARBIZA, J.R. et al. - Antigenic characterization of respiratory syncytial virus associated with acute respiratory infections in Uruguayan children from 1985 to 1987. J. clin. Microbiol., 27: 1464-1466, 1989

[21] 21. SELWYN, B.J. - The epidemiology of acute respiratory tract infection in young children: comparison of findings from several developing countries. Rev. infect. Dis., 12 (suppl. 8): S870-S888, 1990.

[22] 22. TURNER, R.B.; LANDE, A.E.; CHASE, P.; HILTON, N. & WEINBERG, D. - Pneumonia in pediatric outpatients: cause and clinical manifestations. J. Pediatr., 111: 194-200, 1987.

[23] 23. WEISER, J.N.; LINDBERG, A.A.; MANNING, E.J.; HANSEN, E.J. & MOXON, E.B. - Identification of a chromosomal locus for expression of lipopolysaccharide epitopes in H. influenzae. Infect. Immun., 57: 3045-3052, 1989.

[24] 24. WEISSENBACHER, M.; CARBALLAL, G.; AVILA, M. et al. - Etiological and clinical evaluation of acute lower respiratory tract infections in young Argentinian children: an overview. Rev. infect. Dis., 12(suppl. 8): S889-S898, 1990.

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