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Febrile Children with Pneumonia Have Higher Nasopharyngeal Bacterial Load Than Other Children with Fever

Febrile episodes are common in children and the most frequent reason for attending emergency services. Although most infections have a benign and self-limiting course, severe and sometimes life-threatening infections occur. This prospective study describes a cohort of children presenting to a single...

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Autores principales: Bjornsdottir, Bryndis, Benitez Hernandez, Ubaldo, Haraldsson, Asgeir, Thors, Valtyr
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10143154/
https://www.ncbi.nlm.nih.gov/pubmed/37111403
http://dx.doi.org/10.3390/pathogens12040517
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author Bjornsdottir, Bryndis
Benitez Hernandez, Ubaldo
Haraldsson, Asgeir
Thors, Valtyr
author_facet Bjornsdottir, Bryndis
Benitez Hernandez, Ubaldo
Haraldsson, Asgeir
Thors, Valtyr
author_sort Bjornsdottir, Bryndis
collection PubMed
description Febrile episodes are common in children and the most frequent reason for attending emergency services. Although most infections have a benign and self-limiting course, severe and sometimes life-threatening infections occur. This prospective study describes a cohort of children presenting to a single-centre pediatric emergency department (ED) with suspected invasive bacterial infection, and explores the relationships between nasopharyngeal microbes and outcomes. All children attending the ED who had a blood culture taken were offered to participate over a two-year period. In addition to conventional medical care, a nasopharyngeal swab was obtained., which was analysed for respiratory viruses and three bacterial species using a quantitative PCR. Fisher’s exact test, Wilcoxon rank sum, and multivariable models were used for statistical analyses of the 196 children (75% younger than four years) who were enrolled and had sufficient data for analysis; 92 had severe infections according to the study protocol, while five had bloodstream infections. Radiologically confirmed pneumonia was the most common severe infection found in 44/92 patients. The presence of respiratory viruses and the carriage of Streptococcus pneumoniae and Haemophilus influenzae were associated with a higher risk of pneumonia. Higher density colonisation with these bacteria were independent risk factors for pneumonia, whereas Moraxella catarrhalis carriage was associated with lower risk. Our data support the hypothesis that higher nasopharyngeal density of pneumococci and H. influenzae could play a role in the development of bacterial pneumonia in children. A preceding viral infection of the respiratory tract may be a trigger and play a role in the progression to severe lower respiratory tract infection.
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spelling pubmed-101431542023-04-29 Febrile Children with Pneumonia Have Higher Nasopharyngeal Bacterial Load Than Other Children with Fever Bjornsdottir, Bryndis Benitez Hernandez, Ubaldo Haraldsson, Asgeir Thors, Valtyr Pathogens Article Febrile episodes are common in children and the most frequent reason for attending emergency services. Although most infections have a benign and self-limiting course, severe and sometimes life-threatening infections occur. This prospective study describes a cohort of children presenting to a single-centre pediatric emergency department (ED) with suspected invasive bacterial infection, and explores the relationships between nasopharyngeal microbes and outcomes. All children attending the ED who had a blood culture taken were offered to participate over a two-year period. In addition to conventional medical care, a nasopharyngeal swab was obtained., which was analysed for respiratory viruses and three bacterial species using a quantitative PCR. Fisher’s exact test, Wilcoxon rank sum, and multivariable models were used for statistical analyses of the 196 children (75% younger than four years) who were enrolled and had sufficient data for analysis; 92 had severe infections according to the study protocol, while five had bloodstream infections. Radiologically confirmed pneumonia was the most common severe infection found in 44/92 patients. The presence of respiratory viruses and the carriage of Streptococcus pneumoniae and Haemophilus influenzae were associated with a higher risk of pneumonia. Higher density colonisation with these bacteria were independent risk factors for pneumonia, whereas Moraxella catarrhalis carriage was associated with lower risk. Our data support the hypothesis that higher nasopharyngeal density of pneumococci and H. influenzae could play a role in the development of bacterial pneumonia in children. A preceding viral infection of the respiratory tract may be a trigger and play a role in the progression to severe lower respiratory tract infection. MDPI 2023-03-27 /pmc/articles/PMC10143154/ /pubmed/37111403 http://dx.doi.org/10.3390/pathogens12040517 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Bjornsdottir, Bryndis
Benitez Hernandez, Ubaldo
Haraldsson, Asgeir
Thors, Valtyr
Febrile Children with Pneumonia Have Higher Nasopharyngeal Bacterial Load Than Other Children with Fever
title Febrile Children with Pneumonia Have Higher Nasopharyngeal Bacterial Load Than Other Children with Fever
title_full Febrile Children with Pneumonia Have Higher Nasopharyngeal Bacterial Load Than Other Children with Fever
title_fullStr Febrile Children with Pneumonia Have Higher Nasopharyngeal Bacterial Load Than Other Children with Fever
title_full_unstemmed Febrile Children with Pneumonia Have Higher Nasopharyngeal Bacterial Load Than Other Children with Fever
title_short Febrile Children with Pneumonia Have Higher Nasopharyngeal Bacterial Load Than Other Children with Fever
title_sort febrile children with pneumonia have higher nasopharyngeal bacterial load than other children with fever
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10143154/
https://www.ncbi.nlm.nih.gov/pubmed/37111403
http://dx.doi.org/10.3390/pathogens12040517
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