Childhood pneumonia diagnostics: a narrative review

ABSTRACT

Background

Childhood pneumonia remains the leading infectious cause of death in children with highest mortality figures in sub-Saharan Africa and Southeast Asia. The primary etiologies are bacterial and viral; however, challenges in distinguishing bacterial and non-bacterial causes have culminated in antimicrobial overuse which has partly contributed to the rise in antimicrobial resistance, most notably among children in low- and middle-income countries.

Areas covered

Existing literature was reviewed regarding modalities available, including emerging radiological and laboratory techniques, to diagnose childhood pneumonia. We evaluated their strengths and limitations, and their ability to distinguish between bacterial and viral etiologies.

Expert opinion

The optimal modality to diagnose childhood pneumonia continues to be a challenge. This is a concern given its high disease burden and the importance of diagnostics for clinical care and antimicrobial stewardship, in the setting of rising antimicrobial resistance. Lung ultrasonography is a promising radiologic diagnostic modality. Combined serum biomarkers, micro-array-based whole-genome expression arrays and metabolomic analysis are also emerging biochemical modalities for childhood pneumonia diagnosis. More research and further validation are required to evaluate the diagnostic strengths of these new and emerging modalities as well as their ability to discriminate between the major etiologies of the disease.

KEYWORDS:

• Bacterial
• childhood
• diagnosis
• pneumonia
• review
• viral

Article highlights

• The optimal modality to diagnose childhood pneumonia and the ideal test to discriminate between the major aetiologic groups remains a conundrum.

• Radiological imaging like lung ultrasonography shows promise as a non-invasive sensitive bedside modality for the diagnosis of childhood pneumonia.

• Several microbiological tests have high sensitivity for detecting potential aetiologic agent, but their ability to attribute causality is limited, particularly when examining upper respiratory tract samples like nasopharyngeal and oropharyngeal specimens.

• The use of combined serum biomarkers, micro-array-based whole-genome expression arrays and metabolomic analysis are emerging biochemical modalities for childhood pneumonia diagnosis.

Declaration of interests

PI has received investigator-initiated research grant support from Bill & Melinda Gates Foundation.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Authors contributions

Conception and manuscript design: OO, PI. Collection of data: OO, AA, AO, MA, and PI. Manuscript writing: OO. Important revisions: OO, AA, AO, MA, and PI. All authors reviewed and approved the final version of the manuscript. All authors reviewed and approved the final version of the manuscript.

Availability of data and materials

The data is freely available in the literature.

Additional information

Funding

PI is supported by a Wellcome Trust Programme Grant (Grant number 091909/Z/10/Z) and the MLW Programme Core Award (Grant 206454) from the Wellcome Trust. However, no funding was received for this work.