الفهرس 
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Abstract
Community-acquired pneumonia(CAP) is defined as a clinical diagnosis of pneumonia caused by a community acquired infection in a previously healthy child, It is a major cause of death among all age groups.
In Egypt, it was estimated that 10% of children deaths below the age of 5 years is likely caused by pneumonia.
In the majority of cases ,community-acquired pneumonia (CAP) presents as an acute illness with cough, purulent sputum and fever. A patient may rapidly deteriorate from respiratory failure and/or sepsis in the first 3 days following admission. This may be not be recognized in younger patients due to their ability to compensate for respiratory failure.
For assessment of pneumonia severity several scores can be used as British thoracic society guidelines , American Thoracic Society consensus guidelines, PRESS scoring system and PRIOM score.
It is important to note that no clinical or radiological sign either alone or in combination, is sensitive and specific enough to differentiate between viral, atypical or typical bacterial etiology of pneumonia.
Similar signs and symptoms caused by viral and bacterial agents result in the failure of radiological findings to differentiate the agents and difficulties in the routine practice of invasive interventions , such as hemoculture, broncho alveolar lavage (BAL), and lung needle biopsy. Complications resulting from these interventions encouraged clinicians to research diagnostic and prognostic biochemical indicators for severity and etiology in community-acquired pneumonia.
Furthermore, the unnecessary use of antibiotics due to failure to perform invasive interventions based on viral and bacterial pneumonia differentiation leads to financial burdens. Consequently, differentiation is another issue that emphasizes the importance of these bioindicators.
Surfactant protein D (SP-D) is a hydrophilic protein synthesized and secreted by alveolar epithelial type 2 and Clara cells as an acute phase reactant in lung SP-D plays an important role in host defense by recognizing the carbohydrate structures in bacteria and viruse. It is secreted in inflammatory lung diseases, such as lung infection and pneumonitis. Surfactant protein D (SP-D) levels also increase due to the deterioration of alveolar cells.
Surfactant protein D (SP-D) is a promising biomarker that might help to determine the health status of patients with lung diseases, particularly with respect to progression of dyspnea and decreasing pulmonary functions. It contributes in pulmonary surfactant homeostasis and plays a critical role in pulmonary innate
Our aim in this study was to investigate whether serum Surfactant protein D( SP-D) level can be used in determining clinical severity in cases with community acquired pneumonia and differentiating bacterial and viral pneumonia.
To achieve this target, we studied a series of 90 subjects( 75 of them diagnosed community acquired pneumonia and met the inclusion criteria while the other 15 were apparently healthy infants and children of the same age and sex . This study was prospective case control, done at the pediatric department of Menoufia university Hospital including its wards and pediatric intensive care with cooperation of medical biochemistry of Menoufia university .All children incorporated in the study were subjected to: careful history taking, thorough clinical examination including(Anthropometric measures, general examination and systemic examination), assessment of pneumonia severity according to different scores and classifications and investigations ,laboratory , ( Surfactant protein D(SPD) level admission by ELISA technique and radiological evaluation.
There was significant increase in serum Surfactant protein level among cases than control, but there were no statistically significant difference between bacterial and viral regarding surfactant.
Mean value of surfactant was significantly higher among severe pneumonia than pneumonia.
Diagnostic validity of surfactant protein D in detecting severity of pneumonia among studied cases Cut off point was37513 Sensitivity was84% ,Specificity was27% PPV was45% and NPV was71% Accuracy was 51%.
The study concluded that, serum Surfactant protein D levels in children are applicable biomarkers that can help to determine severity in community-acquired pneumonia cases applying to pediatric emergency services. But serum Surfactant protein D levels ability in differentiating bacterial and viral pneumonia are limited as there were no statistically significant difference between bacterial and viral regarding surfactant protein D.
Recommendation ,large, well- designed prospective multi-center study should confirm the ability of surfactant protein D (SP-D) to predict severity of pneumonia instead of several clinical severity scores. The potential role of surfactant protein D (SP-D) in detection of pneumonia etiology should be further investigated.