Palabras clave
Diagnóstico Diferencial
Toma de decisiones clínicas
Neumonía
Neumonía bacteriana
Neumonía viral
Proteínas de fase aguda Radiografía torácica
Toma de decisiones clínicas
Neumonía
Neumonía bacteriana
Neumonía viral
Proteínas de fase aguda Radiografía torácica
Cómo citar
Mena Galviz, L. S., Carreño Almánzar, F. R., & Cala Vecino, L. L. (2020). Diagnóstico etiológico de la neumonía: un problema en la práctica clínica pediátrica. Médicas UIS, 33(1), 39–52. https://doi.org/10.18273/revmed.v33n1-2020005
Resumen
La neumonía en niños es causa frecuente de morbilidad y mortalidad, especialmente en países de bajos ingresos; es indispensable proporcionar una adecuada conducta terapéutica, idealmente orientada por etiología, pues la principal consecuencia de no establecer un diagnóstico etiológico preciso es el abuso de antibióticos. La evaluación clínica y radiológica son los pilares básicos para el diagnóstico de neumonía, y el conocimiento del comportamiento epidemiológico de los gérmenes y los biomarcadores ayudan a su aproximación etiológica. Se revisaron aspectos prácticos sobre el diagnóstico de la neumonía en niños, abordando criterios clínicos y epidemiológicos (edad y género), reactantes de fase aguda, hallazgos radiológicos y modelos de predicción etiológica utilizados como herramientas para la diferenciación de neumonía bacteriana de viral en menores de 18 años, en escenarios donde no se dispone rutinariamente de técnicas más precisas para diagnóstico rápido, como aquellas de tipo inmunológico o moleculares. MÉD.UIS.2020;33(1):39-52.
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30. Moreno L, Krishnan JA, Duran P, Ferrero F. Development and validation of a clinical prediction rule to distinguish bacterial from viral pneumonia in children. Pediatr Pulmonol. abril de 2006;41(4):331-7.
Cochrane Database Syst Rev. 26 de mayo de 2014;(5):CD009576.
2. le Roux DM, Zar HJ. Community-acquired pneumonia in children - a changing spectrum of disease. Pediatr Radiol. octubre de 2017;47(11):1392-8.
3. Gentile A, Bardach A, Ciapponi A, Garcia-Marti S, Aruj P, Glujovsky D, et al. Epidemiology of community-acquired pneumonia in children of Latin America and the Caribbean: a systematic review and meta-analysis. Int J Infect Dis. enero de 2012;16(1):e5-15.
4. Tasa de Mortalidad por Infección Respiratoria Aguda (IRA) en Menores de 5 años - Georeferenciado [Internet]. Así Vamos en Salud - indicadores en salud normatividad derechos. 2016 [citado 22 de octubre de 2018].
5. Harris M, Clark J, Coote N, Fletcher P, Harnden A, McKean M, et al. British Thoracic Society guidelines for the management of community acquired pneumonia in children: update 2011. Thorax. ctubre de 2011;66 Suppl 2:ii1-23.
6. Andrés Martín A, Moreno-Pérez D, Alfayate Miguélez S, Couceiro Gianzo JA, García García ML, Korta Murua J, et al. Etiología y diagnóstico de la neumonía adquirida en la comunidad y sus ormas complicadas. An Pediatr (Barc). 1 de marzo de 2012;76(3):162.e1-162.e18.
7. Ochoa C, Inglada L, Eiros JM, Solís G, Vallano A, Guerra L, et al. Appropriateness of antibiotic prescriptions in community-acquired acute pediatric respiratory infections in Spanish emergency
ooms. Pediatr Infect Dis J. agosto de 2001;20(8):751-8.
8. Esposito S, Blasi F, Allegra L, Principi N, Mowgli Study Group. Use of antimicrobial agents for community-acquired lower respiratory tract infections in hospitalised children. Eur J Clin Microbiol nfect Dis. septiembre de 2001;20(9):647-50.
9. Shah SN, Bachur RG, Simel DL, Neuman MI. Does This Child Have Pneumonia?: The Rational Clinical Examination Systematic Review. JAMA. 1 de agosto de 2017;318(5):462-71.
10. Calvo C, García-García ML, Blanco C, Pozo F, Flecha IC, Pérez-Breña P. Role of rhinovirus in hospitalized infants with respiratory tract infections in Spain. Pediatr Infect Dis J. octubre de
007;26(10):904-8.
11. Annamalay AA, Jroundi I, Bizzintino J, Khoo S-K, Zhang G, Lehmann D, et al. Rhinovirus C is associated with wheezing and rhinovirus A is associated with pneumonia in hospitalized children in
orocco. J Med Virol. abril de 2017;89(4):582-8.
12. Lu M-P, Ma L-Y, Zheng Q, Dong L-L, Chen Z-M. Clinical characteristics of adenovirus associated lower respiratory tract infection in children. World J Pediatr. noviembre de 2013;9(4):346-9.
13. Guo W-L, Wang J, Zhu L-Y, Hao C-L. Differentiation between mycoplasma and viral community-acquired pneumonia in children with lobe or multi foci infiltration: a retrospective case study. BMJ
pen. 16 de enero de 2015;5(1):e006766.
14. Hsieh S-C, Kuo Y-T, Chern M-S, Chen C-Y, Chan WP, Yu C. Mycoplasma pneumonia: clinical and radiographic features in 39 children. Pediatr Int. junio de 2007;49(3):363-7.
15. Othman N, Isaacs D, Daley AJ, Kesson AM. Mycoplasma pneumoniae infection in a clinical setting. Pediatr Int. octubre de 2008;50(5):662-6.
16. Naydenova E, Tsanas A, Howie S, Casals-Pascual C, De Vos M. The power of data mining in diagnosis of childhood pneumonia. J R Soc Interface. 2016;13(120).
17. Irwin AD, Grant A, Williams R, Kolamunnage-Dona R, Drew RJ, Paulus S, et al. Predicting Risk of Serious Bacterial Infections in Febrile Children in the Emergency Department. Pediatrics. agosto de 2017;140(2).
18. Korppi M, Heiskanen-Kosma T, Leinonen M. White blood cells, C-reactive protein and erythrocyte sedimentation rate in pneumococcal pneumonia in children. European Respiratory Journal. 1 de
ayo de 1997;10(5):1125-9.
19. Toikka P, Irjala K, Juvén T, Virkki R, Mertsola J, Leinonen M, et al. Serum procalcitonin, C-reactive protein and interleukin-6 for distinguishing bacterial and viral pneumonia in children. The Pediatric Infectious Disease Journal. julio de 2000;19(7):598.
20. Moulin F, Raymond J, Lorrot M, Marc E, Coste J, Iniguez J, et al. Procalcitonin in children admitted to hospital with community acquired pneumonia. Arch Dis Child. abril de 2001;84(4):332-6. 21.
irkki R, Juven T, Rikalainen H, Svedström E, Mertsola J, Ruuskanen O. Differentiation of bacterial and viral pneumonia in children. Thorax. mayo de 2002;57(5):438-41.
22. Díez-Padrisa N, Bassat Q, Machevo S, Quintó L, Morais L, Nhampossa T, et al. Procalcitonin and C-reactive protein for invasive bacterial pneumonia diagnosis among children in Mozambique, a
alaria-endemic area. PLoS ONE. 14 de octubre de 2010;5(10):e13226.
23. Hoshina T, Nanishi E, Kanno S, Nishio H, Kusuhara K, Hara T. The utility of biomarkers in differentiating bacterial from non-bacterial lower respiratory tract infection in hospitalized children:
ifference of the diagnostic performance between acute pneumonia and bronchitis. J Infect Chemother. octubre de 2014;20(10):616-20.
24. Esposito S, Bianchini S, Gambino M, Madini B, Di Pietro G, Umbrello G, et al. Measurement of lipocalin-2 and syndecan-4 levels to differentiate bacterial from viral infection in children with
ommunity-acquired pneumonia. BMC Pulm Med. 20 de 2016;16(1):103.
25. Bellmann-Weiler R, Ausserwinkler M, Kurz K, Theurl I, Weiss G. Clinical potential of C-reactive protein and procalcitonin serum concentrations to guide differential diagnosis and clinical management of pneumococcal and Legionella pneumonia. J Clin Microbiol. mayo de 2010;48(5):1915-7.
26. Gauchan E, Adhikari S. C-reactive Protein Versus Neutrophil/ lymphocyte Ratio in Differentiating Bacterial and Non-bacterial Pneumonia in Children. J Nepal Health Res Counc. septiembre de
016;14(34):154-8.
27. Lala SG, Madhi SA, Pettifor JM. The discriminative value of C-reactive protein levels in distinguishing between communityacquired bacteraemic and respiratory virus-associated lower respiratory tract infections in HIV-1-infected and -uninfected children. Ann Trop Paediatr. septiembre de 2002;22(3):271-9.
28. Khamapirad T, Glezen WP. Clinical and radiographic assessment of acute lower respiratory tract disease in infants and children. Semin Respir Infect. junio de 1987;2(2):130-44.
29. Han BK, Son JA, Yoon HK, Lee SI. Epidemic adenoviral lower respiratory tract infection in pediatric patients: radiographic and clinical characteristics. AJR Am J Roentgenol. abril de 1998;170(4):1077-80.
30. Moreno L, Krishnan JA, Duran P, Ferrero F. Development and validation of a clinical prediction rule to distinguish bacterial from viral pneumonia in children. Pediatr Pulmonol. abril de 2006;41(4):331-7.
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