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2210. Nasopharyngeal Detection of Streptococcus pneumoniae and Clinical Disease Severity in Children with Community-Acquired Pneumonia (CAP)
BACKGROUND: Streptococcus pneumoniae is the most common pyogenic bacteria associated with CAP in children, but the proportion of cases might be underestimated because of the low sensitivity of current standard diagnostic methods. Nasopharyngeal (NP) carriage of pneumococcus commonly precedes the dev...
Autores principales: | , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Oxford University Press
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6810270/ http://dx.doi.org/10.1093/ofid/ofz360.1888 |
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author | Wook Yun, Ki Juergensen, Alexis Wallihan, Rebecca Desai, Ankita P Alter, Sherman J Ambroggio, Lilliam El-Assal, Osama Marzec, Sarah Florin, Todd A Florin, Todd A Keaton, Meghan Shah, Samir S Leber, Amy Mejias, Asuncion Ramilo, Octavio Ramilo, Octavio |
author_facet | Wook Yun, Ki Juergensen, Alexis Wallihan, Rebecca Desai, Ankita P Alter, Sherman J Ambroggio, Lilliam El-Assal, Osama Marzec, Sarah Florin, Todd A Florin, Todd A Keaton, Meghan Shah, Samir S Leber, Amy Mejias, Asuncion Ramilo, Octavio Ramilo, Octavio |
author_sort | Wook Yun, Ki |
collection | PubMed |
description | BACKGROUND: Streptococcus pneumoniae is the most common pyogenic bacteria associated with CAP in children, but the proportion of cases might be underestimated because of the low sensitivity of current standard diagnostic methods. Nasopharyngeal (NP) carriage of pneumococcus commonly precedes the development of pneumococcal pneumonia, and facilitates pneumococcus interactions with other respiratory pathogens and the host immune response. This study investigated the relationship between pneumococcal carriage and the severity of CAP in children. METHODS: We conducted a prospective, multicenter, observational study for CAP among previously healthy children aged 2 months through 18 years in six children’s hospitals in Ohio. Blood, pleural fluid, and NP swabs were collected for pathogen detection by culture and/or polymerase chain reaction (PCR). S. pneumoniae was quantified in NP swabs by real-time PCR. Patient management followed the standard of care in each study site. RESULTS: Among 441 children with radiologically confirmed CAP, 156 (35.4%) had no bacterial or viral pathogens identified as etiologic agents. NP pneumococcal carriage rate in this group was 34.6%. Children with CAP and pneumococcal carriage (53/156) were younger (5.9 vs. 9.6 years, P < 0.001) than those with no carriage (103/156). Median neutrophil counts and median procalcitonin concentrations were significantly higher in the pneumococcal carriage group (12,030 vs. 8,370 cells/mm(3) and 1.0 vs. 0.5 mg/dl, respectively; P < 0.05 for both) than in the non-carriage group. Children with documented pneumococcal carriage received respiratory support more frequently (50.0% vs. 28.2%, p = 0.012) and had a longer duration of hospitalization (3.5 ± 3.8 vs. 2.1 ± 2.0 days, P = 0.026) than those without pneumococcal carriage. Age was not associated with any of the variables used to assess clinical disease severity. CONCLUSION: Pneumococcal carriage was associated with higher inflammatory markers and greater clinical disease severity in children with CAP in whom no pathogens were identified by standard diagnostics. This suggests that NP carriage of pneumococcus in children with CAP may modulate the host immune response and possibly influence clinical disease severity. DISCLOSURES: Octavio Ramilo, MD, Bill & Melinda Gates Foundation: Research Grant; Janssen: Research Grant; Merck: Advisory Board; NIH: Research Grant; Ohio Children’s Hospital Association (OCHA): Research Grant; Pfizer: Advisory Board, Consultant, Lectures; Sanofi/Medimmune: Advisory Board. |
format | Online Article Text |
id | pubmed-6810270 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-68102702019-10-28 2210. Nasopharyngeal Detection of Streptococcus pneumoniae and Clinical Disease Severity in Children with Community-Acquired Pneumonia (CAP) Wook Yun, Ki Juergensen, Alexis Wallihan, Rebecca Desai, Ankita P Alter, Sherman J Ambroggio, Lilliam El-Assal, Osama Marzec, Sarah Florin, Todd A Florin, Todd A Keaton, Meghan Shah, Samir S Leber, Amy Mejias, Asuncion Ramilo, Octavio Ramilo, Octavio Open Forum Infect Dis Abstracts BACKGROUND: Streptococcus pneumoniae is the most common pyogenic bacteria associated with CAP in children, but the proportion of cases might be underestimated because of the low sensitivity of current standard diagnostic methods. Nasopharyngeal (NP) carriage of pneumococcus commonly precedes the development of pneumococcal pneumonia, and facilitates pneumococcus interactions with other respiratory pathogens and the host immune response. This study investigated the relationship between pneumococcal carriage and the severity of CAP in children. METHODS: We conducted a prospective, multicenter, observational study for CAP among previously healthy children aged 2 months through 18 years in six children’s hospitals in Ohio. Blood, pleural fluid, and NP swabs were collected for pathogen detection by culture and/or polymerase chain reaction (PCR). S. pneumoniae was quantified in NP swabs by real-time PCR. Patient management followed the standard of care in each study site. RESULTS: Among 441 children with radiologically confirmed CAP, 156 (35.4%) had no bacterial or viral pathogens identified as etiologic agents. NP pneumococcal carriage rate in this group was 34.6%. Children with CAP and pneumococcal carriage (53/156) were younger (5.9 vs. 9.6 years, P < 0.001) than those with no carriage (103/156). Median neutrophil counts and median procalcitonin concentrations were significantly higher in the pneumococcal carriage group (12,030 vs. 8,370 cells/mm(3) and 1.0 vs. 0.5 mg/dl, respectively; P < 0.05 for both) than in the non-carriage group. Children with documented pneumococcal carriage received respiratory support more frequently (50.0% vs. 28.2%, p = 0.012) and had a longer duration of hospitalization (3.5 ± 3.8 vs. 2.1 ± 2.0 days, P = 0.026) than those without pneumococcal carriage. Age was not associated with any of the variables used to assess clinical disease severity. CONCLUSION: Pneumococcal carriage was associated with higher inflammatory markers and greater clinical disease severity in children with CAP in whom no pathogens were identified by standard diagnostics. This suggests that NP carriage of pneumococcus in children with CAP may modulate the host immune response and possibly influence clinical disease severity. DISCLOSURES: Octavio Ramilo, MD, Bill & Melinda Gates Foundation: Research Grant; Janssen: Research Grant; Merck: Advisory Board; NIH: Research Grant; Ohio Children’s Hospital Association (OCHA): Research Grant; Pfizer: Advisory Board, Consultant, Lectures; Sanofi/Medimmune: Advisory Board. Oxford University Press 2019-10-23 /pmc/articles/PMC6810270/ http://dx.doi.org/10.1093/ofid/ofz360.1888 Text en © The Author(s) 2019. Published by Oxford University Press on behalf of Infectious Diseases Society of America. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com |
spellingShingle | Abstracts Wook Yun, Ki Juergensen, Alexis Wallihan, Rebecca Desai, Ankita P Alter, Sherman J Ambroggio, Lilliam El-Assal, Osama Marzec, Sarah Florin, Todd A Florin, Todd A Keaton, Meghan Shah, Samir S Leber, Amy Mejias, Asuncion Ramilo, Octavio Ramilo, Octavio 2210. Nasopharyngeal Detection of Streptococcus pneumoniae and Clinical Disease Severity in Children with Community-Acquired Pneumonia (CAP) |
title | 2210. Nasopharyngeal Detection of Streptococcus pneumoniae and Clinical Disease Severity in Children with Community-Acquired Pneumonia (CAP) |
title_full | 2210. Nasopharyngeal Detection of Streptococcus pneumoniae and Clinical Disease Severity in Children with Community-Acquired Pneumonia (CAP) |
title_fullStr | 2210. Nasopharyngeal Detection of Streptococcus pneumoniae and Clinical Disease Severity in Children with Community-Acquired Pneumonia (CAP) |
title_full_unstemmed | 2210. Nasopharyngeal Detection of Streptococcus pneumoniae and Clinical Disease Severity in Children with Community-Acquired Pneumonia (CAP) |
title_short | 2210. Nasopharyngeal Detection of Streptococcus pneumoniae and Clinical Disease Severity in Children with Community-Acquired Pneumonia (CAP) |
title_sort | 2210. nasopharyngeal detection of streptococcus pneumoniae and clinical disease severity in children with community-acquired pneumonia (cap) |
topic | Abstracts |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6810270/ http://dx.doi.org/10.1093/ofid/ofz360.1888 |
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