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. 2012 Mar;18(3):300-7.
doi: 10.1111/j.1469-0691.2011.03603.x. Epub 2011 Aug 18.

Viruses and Bacteria in Sputum Samples of Children With Community-Acquired Pneumonia

Free PMC article

Viruses and Bacteria in Sputum Samples of Children With Community-Acquired Pneumonia

M Honkinen et al. Clin Microbiol Infect. .
Free PMC article


Few comprehensive studies have searched for viruses and bacteria in children with community-acquired pneumonia (CAP). We identified 76 children hospitalized for pneumonia. Induced sputum samples were analysed for 18 viruses by antigen detection and PCR, and for six bacteria by culture and PCR. Viruses were found in 72% of samples, bacteria in 91%, and both in 66%. Rhinovirus (30%), human bocavirus (18%) and human metapneumovirus (14%) were the most commonly detected viruses. Two viruses were found in 22% of samples and three in 8%. The most common bacteria found were Streptococcus pneumoniae (50%), Haemophilus influenzae (38%), and Moraxella catarrhalis (28%). Rhinovirus-S. pneumoniae was the most commonly found combination of virus and bacterium (16%). All six children with treatment failure had both viruses and bacteria detected in the sputum. Otherwise, we found no special clinical characteristics in those with mixed viral-bacterial detections. With modern molecular diagnostic techniques, there are high rates of both viral and bacterial identification in childhood CAP. The clinical significance of mixed viral-bacterial infections remains unclear, although we found a potential association between them and treatment failure.


Figure 1
Figure 1
Proportions of microbiological findings in induced sputum in children with community‐acquired pneumonia. Proportions of viral, bacterial and mixed viral–bacterial detections are shown in the inside figure. Proportions of the most commonly found viruses (right side) and bacteria (left side) are shown in the outside figure, and the total percentage is over 100 because of co‐detections of multiple microorganisms. Total: 76 patients. *Mycoplasma pneumoniae was found in 20% of those 36 patients who were studied both serologically and by PCR.
Figure 2
Figure 2
A chest radiograph of a girl aged 3 years and 9 months with community‐acquired pneumonia. Six potential pathogens were detected in the sputum sample: Streptococcus pneumoniae, Moraxella catarrhalis, Haemophilus influenzae, enterovirus, human bocavirus, and rhinovirus. Parenchymal consolidation is seen in the right lung just below the hilus. The clinical picture on admission included fever of 39.8°C, fatigue, poor appetite, rhinitis, cough, right‐sided acute otitis media, right‐sided fine crackles on auscultation, a C‐reactive protein level of 108 mg/L, and a white blood cell count of 35.9 × 109/L. The patient was treated with intravenous penicillin G. After 1 day of treatment, the girl was afebrile and was discharged from hospital with a course of oral amoxycillin for 7 days.

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