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Worldwide, community-acquired pneumonia is a leading cause of infectious morbidity and mortality in children.1Studies that employ blood culture, serology, and polymerase chain reaction, as well as those that use pneumococcal conjugate vaccines as a probe to determine the proportion of disease due to Streptococcus pneumoniae, suggest that pneumococcus is the major pathogen in community-acquired pneumonia in children, frequently in the presence of concurrent viral respiratory infection. Several observations such as the presence of patchy perihilar infiltrates on x-ray suggests that most cases of bacterial pneumonia result from aspiration of nasopharyngeal organisms and provide the rationale that respiratory tract flora, nontypeable Haemophilus influenzae, Streptococcus pyogenes, Moraxella catahhralis, Staphylococcus aureus, and S pneumoniae are the major bacterial pathogens in pediatric pneumonia.

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Epidemiology

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Community-acquired pneumonia is most common in infants and toddlers. In children ages 6 months to 5 years, the incidence is 40/1000 patients/year with declining frequency with increasing age.2 Further analysis of the incidence of pneumonia in children < 5 years of age identifies a peak incidence of 52.3/1000 children/year at 2 to 5 years of age with slightly lower incidence rates in children < 24 months.3 Mortality due to community-acquired pneumonia is low—0.1/1000 patients/year in children aged < 15 years. Males are affected almost twice as commonly as females.4 Socioeconomic status and ethnicity affect pneumococcal pneumonia rates, with a greater risk of pneumonia in US children aged < 5 years of Asian, African American, or Hispanic ethnicity compared with those of Caucasian ethnicity.3 Seasonal variations show a greater frequency in the winter and spring months,2,6,7 and during peaks of respiratory syncytial virus (RSV), influenza A, and, in older children, Mycoplasma pneumoniae.2 Mortality due to community-acquired pneumonia, as reported from Finland, is low—0.1/1000 patients/year in children aged < 15 years. Gender differences are also observed, with males having a rate nearly double that of females (47.4 vs 23.6/1000 patients/year in Finland).4 Differences in incidence are also reported by socioeconomic status and ethnicity. Rates of pneumococcal pneumonia are higher in native Alaskan children than in nonnatives.5A greater risk of pneumonia in US children aged < 5 years of Asian, African American, or Hispanic ethnicity compared with those of Caucasian ethnicity has also been observed.3 The incidence of community-acquired pneumonia also varies by season; studies in the United States2,6 and Israel7 report greater frequency in the winter and spring months. Annual peaks of respiratory syncytial virus (RSV), influenza A, and, in older children, Mycoplasma pneumoniae, infection also are associated with higher pneumonia incidences.2Hospitalization for all cause community-acquired pneumonia is greatest in children less than 2 years of age and represents about 10% of all pneumonia cases in that age group.8

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Lower respiratory tract infections (RTIs) are both more frequent and associated with a greater mortality in developing countries. The incidence among children ages 0 to 5 years from 10 developing countries is estimated to range from 0.2 to 8.1 new episodes/100 child-weeks at risk.9 Mortality from pneumonia has become uncommon in developed countries,4,10,11 yet remains a major cause of death in developing countries.12 In 1990, respiratory infections were the third most common cause of death worldwide; 90 percent of deaths occurred in developing countries.12 Nearly 70% of deaths are in children less than 4 years old.

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Microbiological Etiology

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Community-Acquired Pneumonia

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A large spectrum of pathogens have the ...

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