The value of clinical features in differentiating between viral, pneumococcal and atypical bacterial pneumonia in children.

OBJECTIVE: To evaluate the value of clinical features in differentiating between viral, pneumococcal and atypical bacterial pneumonia in children.

DESIGN: A retrospective analysis of clinical signs and symptoms, supplemented with chest radiograph and serum procalcitonin data, in 101 children with community-acquired pneumonia. Viral and bacterial aetiology was studied prospectively by antibody assays, and pneumococcal infection was found in 18, atypical bacterial infection in 28 and viral infection alone in 22 cases.

METHODS: Chest radiographs and serum procalcitonin were studied in all cases. Data on clinical signs and symptoms were retrospectively collected from the medical cards of the patients.

RESULTS: Among symptoms, cough was present in 89% and fever (>37.5 degrees C) in 88% of the cases. Among physical signs, crackles were present in 49% and decreased breath sounds in 58%. No significant associations were found between any of the clinical signs or symptoms and the aetiology of pneumonia. In multivariate analyses, age over 5 years and serum procalcitonin over 1.0 ng/mL were the only independent predictors of bacterial aetiology, but no finding was able to screen between pneumococcal and atypical bacterial aetiology of infection.

CONCLUSION: No clinical or radiological characteristic was helpful in the separation between viral, pneumococcal and atypical bacterial aetiology of community-acquired pneumonia (CAP) in children.