الفهرس 
Community Acquired PneumoniaOnly 14 pages are availabe for public view
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Abstract
This study was carried out to evaluate the problem of community-acquired pneumonia in Egyptian infants and children below the age of 5 years trying to correlate clinical data, the results of complete blood count with differential, blood culture results and chest radiographic findings with microbiological causes and also trying to delineate the exact magnitude of pneumococcal infection in the problem of community-acquired bacterial pneumonia among that age group.
To fulfill our aim, a cross-sectional study was conducted on 150 infants and children with CAP admitted to Ain Shams University Pediatric Hospital in the period between 15th of January 2005 and 15th of July 2005. Inclusion criteria were set-up to diagnose community-acquired pneumonia on clinical basis in infants and children between 1 month and 5 years of age. Exclusion criteria included infants and children outside that range of age and those patients who had been hospitalized in the week prior to presentation.
All patients were subjected to full history taking and clinical examination, radiological assessment, CBC with differential leucocytic count and blood culture. Patients were followed up during their hospital stay, recording lines of management and clinical outcome.
This work revealed that:
• Infants (64%) were more affected than children (36%).
• Males (53.3%) were slightly more affected than females (46.7%).
• Most patients (69.3%) received antibiotics before presentation to our hospital and the most commonly used antibiotics were cephalosporins (27, 3%), penicillins (22%) and amikin (4.6%); mostly by the oral route (34.6%), 21.3% parentrally while 13.3% of patients received both oral and parentral antibiotics.
• Incidence of co-existing diseases was high (51.3%), the most common were congenital heart diseases (14%), primary malnutrition (9.3%), chromosomal disorders (8.6%) and neuromascular disorders (6.6%).
• All patients received obligatory vaccines according to schedule and no one received the Hib vaccine.
• All patients were febrile and tachypneic, according to our inclusion criteria, and the most commonly encountered symptoms and signs were cough (95, 3%), chest indrawing (90%) and inability to feed (82%).
• Most cases of pneumonia (86%) were x-ray documented with consolidation being the most common radiological finding (58%), followed by infiltrates (24.6%).
• CBC revealed only 37.3% leucocytosis (TLC > 11 x 103 /L) and 16.7% neutrophilia.
• Positive bacterial growth from blood culture among our patients was 23.3% with coagulase positive Staphylococcus being the most commonly isolated organism (12%).
• Neither Streptococcus pneumonia nor Haemophilus influenzae were isolated from blood culture inspite of being the most common causes of bacterial CAP in children.
• All patients received antibiotics at our hospital, mainly double regimen (62.7%) with the most commonly used antibiotics being third generation cephalosporins (94.6%), flumox (72.6%), augmentin or unasyn (25.3%) and amikin (22%).
• Most patients (77.3%) required oxygen therapy, 15.3% required ICU admission with only 10% intubated, while 2.7% required chest tube.
• Recovery rate was 84.7% while mortality rate was 10.6% being higher among infants (93.75% of patients who died were less than 1 year old) and patients with underlying diseases especially chromosomal disorders.
• Clinical outcome was neither affected by sex nor by previous antibiotic use.
• Clinical findings were nearly the same among patients who died and those who survived except for cyanosis which was much more common among the first group of patients (50%) compared to patients who recovered (11.81%).
• No relation was found between radiological findings, CBC results or blood culture positivity and clinical outcome of pneumonia.
• Patients who died received larger number of antibiotics and required oxygen, chest tubes, ICU admission and mechanical ventilation much more frequently than the patients who survived.
• Age, sex, previous antibiotic use and presence of
co-existing diseases did not affect blood culture positivity.
• No relation was found between blood culture positivity and clinical, radiological or CBC findings.
• A slight difference was detected between patients with positive blood cultures and those with negative cultures regarding number and type of antibiotics received at hospital. Meanwhile, oxygen, chest tubes, ICU admission and mechanical ventilation were needed equally among both groups of patients.
Finally, from the course of this study, we conclude that:
Community acquired pneumonia is a common cause of morbidity among Egyptian children less than 5 years of age especially in the first year of life.
Mortality rate of community acquired pneumonia is high among Egyptian children particularly infants under 1 year of age and those children with underlying diseases as Down syndrome.
Blood culture can not be considered individually as a dependable single tool in identifying the etiology of bacterial pneumonia and is not related to prognosis.
Chest radiographs and white blood cell counts together with absolute neutrophil counts can not be used to predict precisely the etiology or the prognosis of community acquired pneumonia in children.