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Correspondence

Indian Pediatr 2016;53: 749

Bacterial Pathogens Associated with Community-acquired Pneumonia

 

*Anirban Mandal and #Puneet Kaur Sahi

Departments of Pediatrics, *All India Institute of Medical Sciences and #Kalawati Saran Children’s Hospital; New Delhi, India.
Email: [email protected]

 

 


We read with much interest the recent article in Indian Pediatrics by Das, et al. [1], and have the following comments to offer:

1. The authors mention that "in cases of S. pneumoniae, K. pneumoniae and S. aureus, all cases detected by PCR analysis of the respiratory samples were also detected by culture." Authors have not provided the number or proportion of cases detected by PCR and culture. The bacterial load and antibiotic sensitivity of the culture positive cases would have contributed to the existing knowledge.

2. The use of oropharyngeal aspirate as the sample for isolation of bacterial pathogens associated with community acquired pneumonia (CAP) raises many questions. This is again highlighted by the isolation of organism like Acinetobacter and Citrobacter species from CAP cases. The value of isolating bacterial organisms that are frequently detected in the upper airways of children (eg, Streptococcus pneumoniae, Haemophilus influenzae, Staphylococcus aureus) are questionable. Nevertheless, had the authors provided the serotypes of the pneumococcal isolates, the presence of serotypes that are rarely found in the upper respiratory tract but are well recognized causes of invasive disease (eg, serotype 1), may have been highly predictive of pneumococcal pneumonia [2].

3. There is no mention whether the children had any pre-existing respiratory morbidity, as chronic respiratory diseases would significantly influence the bacterial flora.

4. The authors did not mention whether the children received antibiotics prior to sampling. Stralin, et al. [3] demonstrated that use of antibiotics decreased the yield of culture for S. pneumoniae significantly compared to PCR.

5. The conjugate H. influenzae vaccine is known to decrease the nasopharyngeal carriage of the organism [4], and many of these children might have received this vaccine as per latest National Immunization Schedule. As all the H. influenzae isolates were ‘non type b’, the data on H influenzae immunization status of the children would have been interesting.

6. Nasopharyngeal carriage of S. pneumoniae has been used as a surrogate marker for invasive disease in children with pneumonia [5]. The data on treatment received by the children and their outcome would have enlightened the readers about the clinical usefulness of the isolates in the absence of a positive blood culture.

References

1. Das A, Patgiri SJ, Saikia L, Dowerah P, Nath R. Bacterial pathogens associated with community-acquired pneumonia in children aged below five years. Indian Pediatr. 2016;53:225-7.

2. Hammitt LL, Murdoch DR, Scott JA, Driscoll A, Karron RA, Levine OS, et al. Specimen collection for the diagnosis of pediatric pneumonia. Clin Infect Dis. 2012;54:S132-9.

3. Stralin K, Tornqvist E, Kaltoft MS, Olcen P, Holmberg H. Etiologic diagnosis of adult pneumonia by culture and PCR applied to respiratory tract samples. J Clin Microbiol. 2006;44:643-5.

4. Barbour ML. Conjugate vaccines and the carriage of Haemophilus influenzae type b. Emerg Infect Dis. 1996;2:176-82.

5. Greenberg D, Givon-Lavi N, Newman N, Bar-Ziv J, Dagan R. Nasopharyngeal carriage of individual Streptococcus pneumoniae serotypes during pediatric pneumonia as a means to estimate serotype disease potential. Pediatr Infect Dis J. 2011;30:227-33.

 

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