title: Radiographic findings among children hospitalized with severe community-acquired pneumonia.
abstract: BACKGROUND
  Community-acquired pneumonia (CAP) is a leading cause of childhood death. There are few published reports of radiographic findings among children with severe CAP.
  
  
  OBJECTIVE
  To describe chest X-ray (CXR) findings and assess association between these radiographic findings and pneumococcal isolation in children with severe CAP.
  
  
  METHODS
  A prospective, multicenter, observational study was conducted in 12 centers in Argentina, Brazil, and the Dominican Republic. Children aged 3-59 months, hospitalized with severe pneumonia, were included. On admission, blood and pleural effusion cultures were performed. Streptococcus pneumoniae was identified according to standard procedures in the respective national reference laboratory. Chest X-rays were taken on admission and read before the culture results were reported.
  
  
  RESULTS
  Out of 2,536 enrolled patients, 283 (11.2%) had S. pneumoniae isolated, in 181 cases (7.1%) from blood. The follow radiographic patterns were observed: alveolar infiltrate (75.2%), pleural effusion (15.6%), and interstitial infiltrate (9.2%). Overall, pleural effusion was associated with pneumococcal isolation and pneumococcal bacteremia (P < 0.001). Infiltrates were unilateral (78.7%) or bilateral (21.3%), right-sided (76%) or left-sided (24%), in the lower lobe (53.6%) or the upper lobe (46.4%). Multivariate analysis including patients with affection of only one lobe showed that upper lobe affection and pleural effusion were associated with pneumococcal isolation (OR 1.8, 95% CI, 1.3-2.7; OR 11.0, 95% CI, 4.6-26.8, respectively) and with pneumococcal bacteremia (OR 1.7, 95% CI, 1.2-2.6; OR 3.1, 95% CI, 1.2-8.0, respectively).
  
  
  CONCLUSIONS
  Three-quarters of the patients studied had alveolar infiltrates. Upper lobe compromising and pleural effusion were associated with pneumococcal invasive disease.
authors.affiliation: Hospital de Niños Pedro de Elizalde, Buenos Aires, Argentina. fferrero@intramed.net
authors.forename: F
authors.initials: F
authors.lastname: Ferrero
authors.forename: C M
authors.initials: CM
authors.lastname: Nascimento-Carvalho
authors.forename: M-R
authors.initials: MR
authors.lastname: Cardoso
authors.forename: P
authors.initials: P
authors.lastname: Camargos
authors.forename: M-F P
authors.initials: MF
authors.lastname: March
authors.forename: E
authors.initials: E
authors.lastname: Berezin
authors.forename: R
authors.initials: R
authors.lastname: Ruvinsky
authors.forename: C
authors.initials: C
authors.lastname: Sant'Anna
authors.forename: J
authors.initials: J
authors.lastname: Feris-Iglesias
authors.forename: R
authors.initials: R
authors.lastname: Maggi
authors.forename: Y
authors.initials: Y
authors.lastname: Benguigui
mesh_terms: D002675:Child, Preschool; D017714:Community-Acquired Infections / Q000000981:diagnostic imaging* / Q000382:microbiology*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D011014:Pneumonia / Q000000981:diagnostic imaging* / Q000382:microbiology*; D011859:Radiography; D012720:Severity of Illness Index; D013296:Streptococcus pneumoniae / Q000302:isolation & purification