Recurrent Community-Acquired Pneumonia in Children
Recurrent community acquired pneumonia (rCAP) is not rare in children living in industrialised countries. The Isle of Wight birth cohort study of 1,336 children followed up for 10 years found a 7.4% prevalence of ≥2 lower respiratory tract infections (LRTIs) including CAP; a retrospective cohort study of German children aged 5–7 years found that 6.7–8.2% of the children had a positive history of CAP, 6.9–8.2% of whom had experienced rCAP; and data from Toronto's Hospital for Sick Children show that 238 of 2,900 children (8%) admitted because of CAP met the criteria for rCAP.
Identifying the factors that can favour the development of a new CAP episode is critical for the implementation of appropriate preventive, diagnostic and therapeutic measures. However, although it is relatively easy to evaluate and treat cases occurring in the same lung region, it is more difficult in the case of rCAP developing in different lung areas (DLAs). Recurring lung densities in the same regions are almost invariably due to intra- or extraluminal bronchial obstruction, or structural abnormalities of the airways or lung parenchyma, and the recommended airway endoscopy and/or diagnostic imaging (sometimes in association with laboratory tests for tuberculosis and fungal diseases) is almost always sufficient to make a diagnosis. On the contrary, rCAP affecting multiple lobes or different areas of the same lobe may be associated with a wide range of more or less severe clinical problems that could per se increase the risk of lung infection. As some of these can only be identified using specific laboratory and/or instrumental methods, diagnosing and treating patients with rCAP in DLAs can be particularly complicated and expensive, and is not always efficacious.
Various attempts have been made to define the most frequent causes of rCAP and establish the most rational diagnostic and therapeutic approach. Unfortunately, the findings are frequently conflicting, and it is not possible to state whether the cause of rCAP in DLAs is necessarily a serious underlying diseases requiring immediate diagnosis.
The aim of this case–control study was to analyse the demographic and clinical characteristics as well as the predisposing factors of children with rCAP in DLAs and compare them with those of children who had never experienced CAP in order to contribute to identifying the best approach to such patients.
Patients. We reviewed the medical records of all of the children aged <14 years who attended the Respiratory Disease Section of Pediatric Clinic 1, Department of Pathophysiology and Transplantation, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy, between January 2009 and December 2012 because of rCAP. The patients were included in the analysis if they had experienced ≥2 episodes of radiographically confirmed CAP in a single year (or ≥3 episodes in any time frame) with radiographic clearing of densities between occurrences. Only the children with rCAP in DLAs were enrolled, except for those with a diagnosis of cystic fibrosis identified in the first weeks of life who were excluded and followed up in accordance with specific diagnostic and therapeutic guidelines. The controls were age- and gender-matched children who had never experienced CAP, and for whom all of the data concerning their health problems since birth were available as they had been continuously followed at the same institution for the purpose of vaccinations and periodic evaluations of growth and psychological development.
The study was approved by the Ethics Committee of Fondazione IRCCS Ca' Granda. Ospedale Maggiore Policlinico, Milan, Italy, and written informed consent was obtained from the parents or legal guardian of all of the enrolled children.
Background
Recurrent community acquired pneumonia (rCAP) is not rare in children living in industrialised countries. The Isle of Wight birth cohort study of 1,336 children followed up for 10 years found a 7.4% prevalence of ≥2 lower respiratory tract infections (LRTIs) including CAP; a retrospective cohort study of German children aged 5–7 years found that 6.7–8.2% of the children had a positive history of CAP, 6.9–8.2% of whom had experienced rCAP; and data from Toronto's Hospital for Sick Children show that 238 of 2,900 children (8%) admitted because of CAP met the criteria for rCAP.
Identifying the factors that can favour the development of a new CAP episode is critical for the implementation of appropriate preventive, diagnostic and therapeutic measures. However, although it is relatively easy to evaluate and treat cases occurring in the same lung region, it is more difficult in the case of rCAP developing in different lung areas (DLAs). Recurring lung densities in the same regions are almost invariably due to intra- or extraluminal bronchial obstruction, or structural abnormalities of the airways or lung parenchyma, and the recommended airway endoscopy and/or diagnostic imaging (sometimes in association with laboratory tests for tuberculosis and fungal diseases) is almost always sufficient to make a diagnosis. On the contrary, rCAP affecting multiple lobes or different areas of the same lobe may be associated with a wide range of more or less severe clinical problems that could per se increase the risk of lung infection. As some of these can only be identified using specific laboratory and/or instrumental methods, diagnosing and treating patients with rCAP in DLAs can be particularly complicated and expensive, and is not always efficacious.
Various attempts have been made to define the most frequent causes of rCAP and establish the most rational diagnostic and therapeutic approach. Unfortunately, the findings are frequently conflicting, and it is not possible to state whether the cause of rCAP in DLAs is necessarily a serious underlying diseases requiring immediate diagnosis.
The aim of this case–control study was to analyse the demographic and clinical characteristics as well as the predisposing factors of children with rCAP in DLAs and compare them with those of children who had never experienced CAP in order to contribute to identifying the best approach to such patients.
Patients and Methods
Patients. We reviewed the medical records of all of the children aged <14 years who attended the Respiratory Disease Section of Pediatric Clinic 1, Department of Pathophysiology and Transplantation, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy, between January 2009 and December 2012 because of rCAP. The patients were included in the analysis if they had experienced ≥2 episodes of radiographically confirmed CAP in a single year (or ≥3 episodes in any time frame) with radiographic clearing of densities between occurrences. Only the children with rCAP in DLAs were enrolled, except for those with a diagnosis of cystic fibrosis identified in the first weeks of life who were excluded and followed up in accordance with specific diagnostic and therapeutic guidelines. The controls were age- and gender-matched children who had never experienced CAP, and for whom all of the data concerning their health problems since birth were available as they had been continuously followed at the same institution for the purpose of vaccinations and periodic evaluations of growth and psychological development.
The study was approved by the Ethics Committee of Fondazione IRCCS Ca' Granda. Ospedale Maggiore Policlinico, Milan, Italy, and written informed consent was obtained from the parents or legal guardian of all of the enrolled children.
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