DOI: http://dx.doi.org/10.18203/2349-3291.ijcp20163980

Clinical and bacterial profile of pneumonia in 2 months to 5 years age children: a prospective study done in a tertiary care hospital

Kamatham Madhusudhan, Bharathi Sreenivasaiah, Santhimayee Kalivela, Suresh Srinivasa Nadavapalli, Ramesh Babu T, Venkateswara Rao Jampana

Abstract


Background: Pneumonia is one of the leading causes of mortality among under-five children contributing to 15% of deaths all over the world. More than 95% of all new cases of pneumonia in children less than 5 years occur in developing countries due to increased prevalence of under nutrition, inadequate coverage of vaccination, lack of exclusive breast feeding, illiteracy etc.

Methods: A total 110 subjects with pneumonia aged 2 months to 5 years were included in the study. Pneumonia was diagnosed clinically and classified according to new guidelines of WHO. Nutrition history including breast feeding practices and immunization history was taken. Anthropometry recorded along with thorough clinical examination bacterial cultures of blood, sputum and nasopharyngeal aspirates were done. Chest X-ray was taken for all patients for confirmation.

Results: Out of 110 total subjects, Sixty three cases (57.27%) belonged to the revised WHO classification of ‘pneumonia’ and 47 (42.72%) cases had ‘severe pneumonia’. Ninety cases (81.81%) were less than 3 years of age. The percentage of severe pneumonia was higher in children less than 3 years of age with p value <0.05. No statistical correlation was found between gender and the severity of pneumonia. Out of total subjects, 64 cases were malnourished with weight for age <3rd percentile. 25 cases belonged to IAP Grade I PEM, 30 cases to Grade II, 7 cases to Grade III and 2 Children belonged to grade IV PEM. There is no correlation between the degree of malnutrition and severity of pneumonia. Severe pneumonia was observed in higher proportion in children who were not exclusively breast fed with p value <0.05. Out of 83 fully vaccinated children, 26 (31.32%) cases had severe pneumonia whereas out of 27 cases of not fully vaccinated group, 21 (77.7%) had severe pneumonia with significant P value <0.05. Twenty six (23.63%) blood samples and 34 (30.9%) sputum/ nasopharyngeal aspirates yielded positive bacterial growth. Common organisms were Staphylococcus aureus (18), Klebsiella (18), CONS (4), Acinetobacter (4) Citrobacter (3), Pseudomonas (1), MRSA (1) and Streptococcus pneumoniae (1).

Conclusions: Lack of exclusive breast feeding till 6 months of age, Failure of complete immunization coverage, Child malnutrition, Infancy and toddler age are the risk factors for ‘severe pneumonia’. Staphylococcus aureus (18), Klebsiella (18), CoNS (4), Acinetobacter (4), Citrobacter (3) are the common organisms isolated from cultures of blood and sputum/naso pharyngeal aspirates.


Keywords


Breast feeding, Infants, Malnutrition, Pneumonia, Vaccination

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References


Child mortality. WHO. Available from: http:// apps.who.int/gho/data/node.main.ChildMort?lang=en. Accessed on 12 June 2016.

Ramachandran P, Nedunchelian K, Vengatesan A, Suresh S. Risk factors for mortality in community acquired pneumonia among children aged 1-59 months admitted in a referral hospital. Indian Pediatr. 2012;49(11):889-95.

Revised WHO classification and treatment of pneumonia in children at health facilities: evidence summaries. Available from: http:// apps.who.int/I ris/bitstream/10665/137319/1/9789241507813_eng.pdf. Accessed on 12 July 2016.

Lahti E, Peltola V, Waris M, Virkki R, Jalava RK, Jalava J, et al. Induced sputum in the diagnosis of childhood community-acquired pneumonia. Thorax. 2009;64(3):252-7.

Divyarani DC, Patil GR, Ramesh K. Profile on risk factors of pneumonia among under-five age group at a tertiary care hospital. Int J Curr Microbiol App Sci. 2014;3(6):750-4.

Yellanthoor RB, Shah VKB. Prevalence of malnutrition among under-five year old children with acute lower respiratory tract infection hospitalized at udupi district hospital. Research Gate. 2013;2(4):203-6.

Victora CG, Kirkwood BR, Ashworth A, Black RE, Rogers S, Sazawal S, et al. Potential interventions for the prevention of childhood pneumonia in developing countries: improving nutrition. Am J Clin Nutr. 1999;70(3):309-20.

WHO. Epidemiology and etiology of childhood pneumonia. Available at http:// www.who.int/ bulletin/volumes/86/5/07-048769/en/. Accessed on 20 August 2016.

Mathew JL, Patwari AK, Gupta P, Shah D, Gera T, Gogia S, et al. Acute respiratory infection and pneumonia in India: a systematic review of literature for advocacy and action: UNICEF-PHFI series on newborn and child health, India. Indian Pediatr. 2011;48(3):191-218.

Lamberti LM, Grkovic ZI, Walker CL, Theodoratou E, Nair H, Campbell H, et al. Breastfeeding for reducing the risk of pneumonia morbidity and mortality in children under two: a systematic literature review and meta-analysis. BMC Public Health. 2013;13(3):1-8.

Arpitha G, Rehman MA, Ashwitha G. Effect of severity of malnutrition on pneumonia in children aged 2M-5Y at a tertiary care center in Khammam, Andhra Pradesh: a clinical study. Sch J App Med Sci. 2014;2(6):3199-203.

Bharti B, Kaur L, Bharti S. Role of chest X-ray in predicting outcome of acute severe pneumonia. Indian Pediatr. 2008;45(11):893-8.

Karambelkar GR, Agarkhedkar SR, Karwa DS, Singhania S, Mane SV. Disease pattern and bacteriology of childhood pneumonia in Western India. Int J Pharm Biomed Sci. 2012;3:177-80.

Oberoi A, Aggarwal A. Bacteriological profile, serology and antibiotic sensitivity pattern of micro-organisms from community acquired pneumonia. 2006;8(2):79-82.

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(3):225-7.

Kelly D, Coutts AG. Early nutrition and the development of immune function in the neonate. Proc Nutr Soc. 2000;59(2):177-85.

Ogawa J, Sasahara A, Yoshida T, Sira MM, Futatani T, Kanegane H, et al. Role of transforming growth factor-beta in breast milk for initiation of IgA production in newborn infants. Early Hum Dev. 2004;77(1):67-75.

Chantry CJ, Howard CR, Auinger P. Full breastfeeding duration and associated decrease in respiratory tract infection in US children. Pediatrics. 2006;117(2):425-32.

Gustavo C, Eider O, Eduardo GP, Agustin N, Emilio PT. Incidence of hospitalization due to pneumonia in children aged less than 5 years. Open Infectious Dis J. 2009;3:27-30.

Magree HC, Russell FM, Saaga R, Greenwood P, Tikoduadua L, Pryor J, et al. Chest X-ray-confirmed pneumonia in children in Fiji. Bull World Health Organ. 2005;83(6):427-33.

Hammitt LL, Kazungu S, Morpeth SC, Gibson DG, Mvera B, Brent AJ, et al. A preliminary study of pneumonia etiology among hospitalized children in Kenya. Clin Infect Dis. 2012;54(2):190-9.

Karambelkar GR, Agarkhedkar SR, Karwa DS, Singhania S, Mane SV. Disease pattern and bacteriology of childhood pneumonia in Western India. Int J Pharm Biomed Sci. 2012;3:177-80.

Kabra SK, Lodha R, Broor S, Chaudhary R, Ghosh M, Maitreyi RS. Etiology of acute lower respiratory tract infection. Indian J Pediatr. 2003;70(1):33-6.

Salih KEMA, Ibrahim OAW. Radiological findings in severe pneumonia in children 1-59 months in a children’s hospital, Khartoum, Sudan. Pediatr Therap. 2012;2(3):1-3.