Hospital records of 116 children under 5 years of age discharged from 11 hospitals in three regions in England with a diagnosis of lobar (pneumococcal) pneumonia were reviewed to estimate the proportion likely to be attributable to infection with Streptococcus pneumoniae. Of these, 100 (86%) had lobar/focal changes on chest X-ray consistent with pneumococcal infection, although only one (1%) had pneumococcus isolated from blood. However, a further 89 (89%) with a lobar/focal picture were considered to be likely or possibly due to pneumococcal infection on the basis of the white cell count, level of C-reactive protein, isolation of the S. pneumoniae from either sputum or nasopharingeal aspirate and failure to identify another responsible pathogen. Of 135 cases with a discharge diagnosis of bronchopneumonia or pneumonia (organism unspecified), two (1%) had S. pneumoniae isolated from blood and a further 95 (70%) had clinical or laboratory features consistent with pneumococcal infection or S. pneumoniae isolated from either sputum or nasopharyngeal aspirate. With the iminent availability of conjugate pneumococcal vaccines, there is a need for improved diagnostic methods for identifying the pathogens responsible for community-aquired pneumonia in young children.
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We would like to thank Medical Records Managers and Medical Records Department staff in the following 11 hospitals for their assistance: Central Middlesex Hospital, Chelsea and Westminster Healthcare NHS Trust, Gloucestershire Royal NHS Trust, Kingston Hospital NHS Trust, Northwick Park Hospital, Preston Acute Hospitals NHS Trust, The William Harvey Hospital Ash-ford, Queen Mary's University Hospital, Royal London Ilospital Whitechapel, Great Ormond Street Hospital for Children NIlS Trust and Queen Elizabeth Hospital Hackney. We also thank the following individuals for their help in setting up the study: Professor Geoffrey Pasvol (Northwick Park Hospital), Dr. James Nash (Ashford PILL), Dr. Peter Morgan-Capner (Preston PHL), Dr. Keith Cartwright (Gloucester PHL). Financial support for the study was provided by the Department of Health and by Lederle Praxis Biologicals.
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