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Volume 39, Number 6, December 2006

Radiographic, clinical, and prognostic features of complicated and uncomplicated community-acquired lobar pneumonia in children


Chao-Jen Lin, Po-Yen Chen, Fang-Liang Huang, Tain Lee, Ching-Shiang Chi, Ching-Yuang Lin
Department of Pediatrics, Changhua Christian Children’s Hospital, Changhua; College of Health Sciences, Institute of Medical Research, Chang Jung Christian University, Changhua; and Departments of Pediatrics and 4Radiology, Taichung Veterans General Hospital, Taichung, Taiwan

Received: May 8, 2005    Revised: January 9, 2006    Accepted: April 9, 2006   

 

Corresponding author:

Po-Yen Chen, Department of Pediatrics, Taichung Veterans General Hospital, No. 160, Section 3, Chung-Kang Road, Taichung 407, Taiwan. E-mail: pychen@vghtc.gov.tw This e-mail address is being protected from spam bots, you need JavaScript enabled to view it

 



 

Background and purpose: 

The incidence of community-acquired lobar pneumonia in conjunction with either necrosis or empyema in children has rapidly increased in recent years. This study aimed to evaluate the radiographic, clinical, and predicted factors of complicated and uncomplicated lobar pneumonia in children.

 



 

Methods:

This retrospective study included 131 patients younger than 18 years of age with community-acquired lobar pneumonia treated between January 2002 and March 2005. Multiple logistic regression analysis was performed to demonstrate the risk factors of complicated lobar pneumonia.

 



 

Results:

The proportion of children with lobar pneumonia in children increased dramatically from 7% in 2002 to 19% in 2004. Analysis revealed the presence of elevated C-reactive protein level (>12 mg/dL) [odds ratio (OR), 3.51; 95% confidence interval (CI), 1.61-7.66], persistent fever for more than 1 week before admission (OR, 1.14; 95% CI, 1.04-1.26), and multilobar ( ≥ 2 lobes) confluent lung opacity on chest radiographs (OR, 2.83; 95% CI, 1.27-6.33) were independent predictors of the occurrence of complicated lobar pneumonia. A progressive increase in the number of penicillin-non-susceptible Streptococcus pneumoniae isolates was found during the study period. Prolonged fever was a common clinical feature of hospitalized children with lobar pneumonia. Failure of consolidative pneumonia to respond to appropriate antibiotic treatment within 4.4 days was associated with the development of necrosis or empyema.

 



 

Conclusion:

Complicated and uncomplicated lobar pneumonia are difficult to distinguish based on clinical symptoms at the time of admission. The presence of the above risk factors can help in the early diagnosis of complicated lobar pneumonia.

 



 

Key words:

Empyema, pneumonia, risk factors, Streptococcus pneumoniae


 



 

J Microbiol Immunol Infect 2006;39:489-495.