Clinical and laboratory observation

Induced sputum to diagnose Pneumocystis carinii pneumonia in immunosuppressed pediatric patients

This study aimed to evaluate the utility of induced sputum (IS) for the diagnosis of community-acquired pneumonia (CAP) in pediatric population.

This cross-sectional study included pediatric population aged between 1 month and 17 years who were hospitalized with a diagnosis of CAP in 13 hospitals in Colombia, in whom an IS sample was obtained. Gram staining, aerobic bacterial and mycobacterial culture tests, and polymerase chain reaction (PCR) for 6 atypical bacteria and 15 respiratory viruses were performed. We evaluated the quality of IS samples.

IS samples were collected in 516 of 525 children included in this study. The median age was 32 months, 38.6% were younger than 2 years, and 40.9% were between 2 and 5 years. Two patients had transient hypoxemia during the procedure. The quality of the IS obtained was good in 48.4% and intermediate in 24.5%. Identification of a respiratory pathogen was achieved with an IS sample (with Gram staining, culture test, and PCR) in 372 of 516 children with CAP.

Our study shows that IS is an adequate sample for the diagnosis of CAP in pediatric population that required hospitalization. The procedure was safe, well tolerated, and with better diagnostic yields compared with the rest of the samples obtained.

Respiratory disease is the commonest cause of illness in HIV-infected children, with a spectrum of disease that ranges from acute infection to chronic disease. With more widespread use of antiretroviral therapy early in infancy, the incidence of opportunistic infections and mortality has declined substantially. Effective preventive strategies and timely treatment of intercurrent infections can substantially reduce the burden of HIV-associated lung disease and the long-term sequelae.