| Abstract: |
INTRODUCCIÓN: la NAC no complicada en el niño es una infección muy frecuente, cuya epidemiología se encuentra pobremente definida y cuyo diagnóstico microbiológico sigue siendo difícil, dificultando la elección del tratamiento antibiótico, especialmente cuando no puede distinguirse clínicamente entre neumonía típica y atípica. OBJETIVOS: describir la presentación clínico-epidemiológica de la NAC no complicada en el niño y buscar rasgos clínico-epidemiológicos predictivos de infección por M. pneumoniae. MÉTODOS: estudio prospectivo, descriptivo, de seguimiento de una cohorte, desde el 1 de Enero de 2000 hasta el 31 de Diciembre de 2001. Se incluyeron niños de edad. |
| Abstract: |
INTRODUCTION: Community-acquired childhood pneumonia (CAP) is a common infection but its precise epidemiology remains poorly defined and its treatment is complicated by the difficulty in microbiological diagnosis and the increasing incidence of antibiotic resistance among respiratory pathogens. OBJECTIVES: The purpose of this study is to present the main epidemiologic features of patients with CAP and to compare the clinical, biological, and radiologic features of presentation in atypical pneumonia and in other community-acquired pneumonia, to try to help in early diagnosis of atypical pneumonia. METHODS: Consecutive immunocompetent children with radiographically confirmed lower respiratory infection were enrolled and evaluated in the emergency department of a 400-bed university children's hospital, prospectively from January 2000 through December 2001. Clinical, radiologic and microbiological evaluations were performed at study entry, at 10-15 days, and at 4 weeks post-therapy. Mycoplasmal, chlamydial, Legionella and Coxiella serologic tests were performed on paired samples in order to identifye the infection by those organisms. Univariate and multivariate analyses were performed to compare epidemiologic and demographic data and clinical, analytical, and radiologic features of presentation in the patients with atypical pneumonia and the patients with CAP by other bacterial etiology. RESULTS: 166 patients with CAP were studied, 54,2% male, mean age 48 months. The mean duration between onset of symptoms and diagnosis was 3 days, and the mean treatment duration was 8 days. 83,1% of the patients were treated with amoxicillin-clavulanate. Seven days after the start of therapy clinical symptoms were absent in 98,2% of patients and two weeks after radiologic infiltrates were only present in 24,3% of patients. Etiologic atypical agents were identified in 42 (25,3%) of 166 patients. Infection was attributed to M. pneumoniae in 85,7% (36 of 42), C. pneumoniae in 9,5% (4 of 42), and coinfections in 4,8% (2 of 42). 74,7% patients were diagnosed of CAP by other bacterial etiology . Clinical findings and chest radiographs did not distinguish patients with a defined atypical etiology from those without a known cause for pneumonia. There were no differences in the clinical responses of patients to the antimicrobial regimen. Multivariate logistic-regression analyses revealed that age. |
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