M.R. GATAULLIN¹, S.V. KHALIULLINA², V.A. ANOKHIN², G.S. SHAIKHIEVA¹, V.A. POZDNYAK², D.E. DOLOVSKOVA¹

 ¹Republican Clinical Hospital for Infectious Diseases named after Prof. A.F. Agafonov, Kazan

²Kazan State Medical University, Kazan

  Contact details:

Khaliullina S.V. — MD, Professor of the Department of Pediatric Infections

Address: 49 Butlerov St., 420012 Kazan, Russian Federation, tel.: +7 (843) 267-80-06, e-mail: svekhal@mail.ru

The search for clinical and laboratory markers specific for different pathogens of community-acquired pneumonia (CAP) has been going on for a long time. Researchers attempt to assess the diagnostic value of clinical tests for the early diagnosis of pneumonia and its etiological variants, but no combination of signs has shown a high level of reliability so far. In this situation, specific diagnostic methods become especially valuable, such as instrumental, laboratory, biochemical, microbiological, molecular genetic, etc. However, there are still many pitfalls; etiological studies have a number of limitations. For example, a microbial culture isolated from the blood of children with CAP can indicate a specific etiology of the disease, but has generally low sensitivity. Samples of expectorated sputum obtained directly from the respiratory system have a fairly high sensitivity, but can also be positive in asymptomatic carriers. Induced sputum demonstrates greater specificity, but it is technically difficult to collect, the technique requiring special equipment. Studies of aspirates of pulmonary or pleural fluid are classified as invasive procedures, which complicates their widespread use. Washings are easier to collect, but contamination with upper respiratory tract flora is also possible. Serological tests may have different sensitivity, etc. The authors attempted to assess the informativeness of various laboratory and instrumental diagnostic methods based on literature data.

Key words: community-acquired pneumonia, laboratory / instrumental diagnostics, differential diagnosis, children.

REFERENCES

1. Rueda Z.V., Aguilar Y., Maya M.A. et al. Etiology and the challenge of diagnostic testing of community-acquired pneumonia in children and adolescents. BMC Pediatr, 2022, vol. 22, p. 169. DOI: 10.1186/s12887-022-03235-z
2. Rudan I., O’Brien K.L., Nair H. et al. Epidemiology and etiology of childhood pneumonia in 2010: estimates of incidence, severe morbidity, mortality, underlying risk factors and causative pathogens for 192 countries. J. Glob. Health, 2013, vol. 3 (1), p. 010401. DOI: 10.7189/jogh.03.010401
3. Yun K.W. Community-acquired pneumonia in children: updated perspectives on its etiology, diagnosis, and treatment. Clin. Exp. Pediatr, 2024, vol. 67 (2), pp. 80–89. DOI: 10.3345/cep.2022.01452
4. Integrated management of childhood illness: conclusions. WHO division of child health and development. Bull. World Health Organ, 1997, vol. 75 (Suppl 1), pp. 119–128.
5. Davies H.D. Community-acquired pneumonia in children. Paediatr. Child Health., 2003, vol. 8 (10), pp. 616–619. DOI: 10.1093/pch/8.10.616
6. Palafox M., Guiscafré H., Reyes H. et al. Diagnostic value of tachypnoea in pneumonia defined radiologically. Arch. Dis. Child, 2000, vol. 82 (1), pp. 41–45. DOI: 10.1136/adc.82.1.41
7. Taylor J.A., Del Beccaro M., Done S. et al. Establishing clinically relevant standards for tachypnea in febrile children younger than 2 years. Arch. Pediatr. Adolesc. Med, 1995, vol. 149 (3), pp. 283–287. DOI: 10.1001/archpedi.1995.02170150063011
8. Rees C.A., Basnet S., Gentile A. et al. An analysis of clinical predictive values for radiographic pneumonia in children. BMJ Glob. Health, 2020, vol. 5 (8), p. e002708. DOI: 10.1136/bmjgh-2020-002708
9. Lynch T., Platt R., Gouin S. et al. Can we predict which children with clinically suspected pneumonia will have the presence of focal infiltrates on chest radiographs? Pediatrics, 2004, vol. 113 (3 Pt 1), p. e186–e189. DOI: 10.1542/peds.113.3.e186
10. Florin T.A., Ambroggio L., Brokamp C. et al. Reliability of examination findings in suspected community-acquired pneumonia. Pediatrics, 2017, vol. 140 (3), pp. e20170310. DOI: 10.1542/peds.2017-0310
11. Chan F.Y.Y., Lui C.T., Tse C.F. et al. Decision rule to predict pneumonia in children presented with acute febrile respiratory illness. Am. J. Emerg. Med, 2020, vol. 38 (12), pp. 2557–2563. DOI: 10.1016/j.ajem.2019.12.041
12. Goodman D., Crocker M.E., Pervaiz F. et al. Challenges in the diagnosis of paediatric pneumonia in intervention field trials: recommendations from a pneumonia field trial working group. Lancet Respir. Med, 2019, vol. 7 (12), pp. 1068–1083. DOI: 10.1016/S2213-2600(19)30249-8
13. Bradley J.S., Byington C.L., Shah S.S. et al. The management of community-acquired pneumonia in infants and children older than 3 months of age: clinical practice guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. Clin. Infec. Dis, 2011, vol. 53 (7), pp. e25–e76. DOI: 10.1093/cid/cir531
14. Smith D.K., Kuckel D.P., Recidoro A.M. Community-acquired pneumonia in children: rapid evidence review. Am. Fam. Physician, 2021, vol. 104 (6), pp. 618–625.
15. Ministerstvo zdravookhraneniya Rossiyskoy Federatsii. Klinicheskie rekomendatsii “Pnevmoniya (vnebol’nichnaya)”, 2022 [Ministry of Health of the Russian Federation. Clinical guidelines «Pneumonia (community-acquired)», 2022], available at: https://cr.minzdrav.gov.ru/schema/714_1 (accessed on: 02.09. 2024).
16. Tatochenko V.K. Community-acquired pneumonia in children — problems and solutions. Rossiyskiy vestnik perinatologii i pediatrii, 2021, vol. 66, no. 1, pp. 9–21 (in Russ.).
17. Rashad M.M., Ismail Y.M., Sobeih A.A. et al. Procalcitonin, C-reactive protein and white blood cells count in children with community acquired pneumonia. Benha Med. J, 2021, vol. 38 (1), pp. 125–136. DOI: 10.21608/bmfj.2021.142187
18. Ning J., Shao X., Ma Y. et al. Valuable hematological indicators for the diagnosis and severity assessment of Chinese children with community-acquired pneumonia: Prealbumin. Medicine (Baltimore), 2016, vol. 95 (47), p. e5452. DOI: 10.1097/MD.0000000000005452
19. Zheng H.H., Xiang Y., Wang Y. et al. Clinical value of blood related indexes in the diagnosis of bacterial infectious pneumonia in children. Transl. Pediatr, 2022, vol. 11 (1), pp. 114–119. DOI: 10.21037/tp-21-568
20. Güven D., Kışlal F.M. The diagnostic value of complete blood parameters in determining the severity of community-acquired pneumonia in children. J. Health Sci. Med, 2022, vol. 5 (6), pp. 1592–1599. DOI: 10.32322/jhsm.1171374
21. Kozyrev E.A., Babachenko I.V., Orlov A.V. et al. Platelet indices in community-acquired pneumonia in children with respiratory infections. Zhurnal infektologii, 2022, vol. 14, no. 1, pp. 60–68 (in Russ.). DOI: 10.22625/2072-6732-2022-14-1-60-68
22. Kozyrev E.A. Kliniko-etiologicheskaya kharakteristika vnebol’nichnoy pnevmonii u detey: avtoreferat dis. … kan. med. nauk [Clinical and etiological characteristics of community-acquired pneumonia in children. Synopsis of dis. PhD med. sciences]. Saint Petersburg, 2023. 22 p.
23. Jullien S., Richard-Greenblatt M., Casellas A. et al. Association of clinical signs, host biomarkers and etiology with radiological pneumonia in Bhutanese children. Glob. Pediatr. Health, 2022, vol. 9, p. 2333794X221078698. DOI: 10.1177/2333794X221078698
24. Hoshina T., Nanishi E., Kanno S. et al. The utility of biomarkers in differentiating bacterial from non-bacterial lower respiratory tract infection in hospitalized children: difference of the diagnostic performance between acute pneumonia and bronchitis. J. Infect. Chemother, 2014, vol. 20 (10), pp. 616–620. DOI: 10.1016/j.jiac.2014.06.003
25. Williams D.J., Hall M., Auger K.A. et al. Association of white blood cell count and c-reactive protein with outcomes in children hospitalized for community-acquired pneumonia. Pediatr. Infect. Dis. J, 2015, vol. 34 (7), pp. 792–793. DOI: 10.1097/INF.0000000000000724
26. Gunaratnam L.C., Robinson J.L., Hawkes M.T. Systematic review and meta-analysis of diagnostic biomarkers for pediatric pneumonia. J. Pediatric Infect. Dis. Soc, 2021, vol. 10 (9), pp. 891–900. DOI:10.1093/jpids/piab043
27. Ministerstvo zdravookhraneniya Rossiyskoy Federatsii. Klinicheskie rekomendatsii “Ostraya respiratornaya virusnaya infektsiya (ORVI)”, 2022 [Ministry of Health of the Russian Federation. Clinical guidelines «Acute respiratory viral infection (ARVI)», 2022], available at: https://cr.minzdrav.gov.ru/schema/25_2 (accessed on: 02.09. 2024).
28. Korppi M. Non-specific host response markers in the differentiation between pneumococcal and viral pneumonia: what is the most accurate combination? Pediatr Int, 2004, vol. 46 (5), pp. 545–550. DOI: 10.1111/j.1442-200x.2004.01947.x
29. Korppi M., Remes S., Heiskanen-Kosma T. Serum procalcitonin concentrations in bacterial pneumonia in children: a negative result in primary healthcare settings. Pediatr Pulmonol, 2003, vol. 35 (1), pp. 56–61. DOI: 10.1002/ppul.10201
30. Shah S.S., Florin T.A., Ambroggio L. Procalcitonin in childhood pneumonia. J. Pediatric Infect. Dis. Soc, 2018, vol. 7 (1), pp. 54–55. DOI: 10.1093/jpids/piw095
31. Ayaz N., Ilyas A., Iqbal A. et al. Evaluating the diagnostic accuracy of C-reactive protein in diagnosing pneumonia in children using blood culture as the gold standard: C-reactive protein in diagnosing pneumonia. Pakistan J. Health Sci, 2024, vol. 5 (8), pp. 93–97 DOI: 10.54393/pjhs.v5i08.1822
32. Stockmann C., Ampofo K., Killpack J. et al. Procalcitonin accurately identifies hospitalized children with low risk of bacterial community-acquired pneumonia. J. Pediatric Infect. Dis. Soc, 2018, vol. 7 (1), pp. 46–53. DOI: 10.1093/jpids/piw091
33. Toikka P., Irjala K., Juvén T. et al. Serum procalcitonin, C-reactive protein and interleukin-6 for distinguishing bacterial and viral pneumonia in children. Pediatr Infect. Dis. J, 2000, vol. 19 (7), pp. 598–602. DOI: 10.1097/00006454-200007000-00003
34. Kamat I.S., Ramachandran V., Eswaran H. et al. Procalcitonin to distinguish viral from bacterial pneumonia: a systematic review and meta-analysis. Clin. Infect. Dis, 2020, vol. 70 (3), pp. 538–542. DOI: 10.1093/cid/ciz545
35. Baranov A.A., Kozlov R.S., Namazova-Baranova L.S. et al. Modern approaches to the management of children with community-acquired pneumonia. Pediatricheskaya farmakologiya, 2023, vol. 20, no. 1, pp. 17–41 (in Russ.). DOI: 10.15690/pf.v20i1.2534
36. Flood R.G., Badik J., Aronoff S.C. The utility of serum C-reactive protein in differentiating bacterial from nonbacterial pneumonia in children: a meta-analysis of 1230 children. Pediatric Infect. Dis. J, 2008, vol. 27 (2), pp. 95–99.
37. Bhuiyan M.U., Blyth C.C., West R. et al. Combination of clinical symptoms and blood biomarkers can improve discrimination between bacterial or viral community-acquired pneumonia in children. BMC Pulm. Med, 2019, vol. 19 (1), pp. 71. DOI: 10.1186/s12890-019-0835-5
38. Dudognon D., Levy C., Chalumeau M. et al. Diagnostic accuracy of routinely available biomarkers to predict bacteremia in children with community-acquired pneumonia: a secondary analysis of the GPIP/ACTIV pneumonia study in France, 2009–2018. Front. Pediatrics, 2021, vol. 9, pp. 684628. DOI: 10.3389/fped.2021.684628
39. Esposito S., Tagliabue C., Picciolli I. et al. Procalcitonin measurements for guiding antibiotic treatment in pediatric pneumonia. Respir. Med, 2011, vol. 105 (12), pp. 1939–1945. DOI: 10.1016/j.rmed.2011.09.003
40. Florin T.A. Differentiating bacterial from viral etiologies in pediatric community-acquired pneumonia: the quest for the Holy Grail continues. J. Pediatric Infect. Dis. Soc, 2021, vol. 10 (12), pp. 1047–1050. DOI: 10.1093/jpids/piab034
41. Tanrıverdi H., Örnek T., Erboy F. et al. Comparison of diagnostic values of procalcitonin, C-reactive protein and blood neutrophil/lymphocyte ratio levels in predicting bacterial infection in hospitalized patients with acute exacerbations of COPD. Wien Klin Wochenschr, 2015, vol. 127 (19–20), pp. 756–763. DOI: 10.1007/s00508-014-0690-6
42. Moulin F., Raymond J., Lorrot M. et al. Procalcitonin in children admitted to hospital with community acquired pneumonia. Arch. Dis. Child, 2001, vol. 84 (4), pp. 332–336. DOI: 10.1136/adc.84.4.332
43. Wang H., Li D., Wang Y. et al. Clinical significance of serum S100 calcium-binding protein A12 concentrations in patients with community-acquired pneumonia. J. Int. Med. Res, 2023, vol. 51 (8), pp. 3000605231191021. DOI: 10.1177/03000605231191021
44. Golubeva M.V., Rakitina E.N., Minaev S.V. et al. Predictive role of bactericidal/permeability-increasing protein and S-reactive protein in a personalized approach to the treatment of children with acute pneumonia. Med. News of North Caucasus, 2021, vol. 16 (2), pp. 144–148. DOI: 10.14300/mnnc.2021.16032
45. Dudina K.R., Kutateladze M.M., Znoyko O.O. et al. Clinical significance of markers of acute inflammation in infectious pathology. Kazanskiy meditsinskiy zhurnal, 2014, vol. 95, no. 6, pp. 909–915 (in Russ.). DOI: 10.17816/KMJ2003
46. Wagner K.K.L., Corda D., Steinmayr A. et al. CRP/Neopterin ratio and neuropsychiatric symptoms in patients with different forms of pneumonia: results of a pilot study. Microorganisms, 2024, vol. 12 (6), p. 1099. DOI: 10.3390/microorganisms12061099
47. Garg M., Prabhakar N., Gulati A. et al. Spectrum of imaging findings in pulmonary infections. Part 1: Bacterial and viral. Pol. J. Radiol, 2019, vol. 84, pp. e205–e213. DOI: 10.5114/pjr.2019.85812
48. Swingler G.H. Radiologic differentiation between bacterial and viral lower respiratory infection in children: a systematic literature review. Clin. Pediatr. (Phila), 2000, vol. 39 (11), pp. 627–633. DOI: 10.1177/000992280003901101.2000
49. Robles A., Gil A., Pascual V. et al. Viral vs bacterial community-acquired pneumonia: Radiologic features. Eur. Resp. J, 2011, vol. 38 (55), pp. 2507.
50. Savenkova M.S., Savenkov M.P., Samitova E.R. et al. Mycoplasma infection: clinical forms, course features, diagnostic errors. Voprosy sovremennoy pediatrii, 2013, vol. 12, no. 6, pp. 108–114 (in Russ.). DOI: 10.15690/vsp.v12i6.884
51. Morikawa K., Okada F., Ando Y. et al. Meticillin-resistant Staphylococcus aureus and meticillin-susceptible S. aureus pneumonia: comparison of clinical and thin-section CT findings. Br. J. Radiol, 2012, vol. 85 (1014), pp. e168–e175. DOI: 10.1259/bjr/65538472
52. Dawson K.P., Long A., Kennedy J. et al. The chest radiograph in acute bronchiolitis. J. Paediatr. Child Health, 1990, vol. 26 (4), pp. 209–211. DOI: 10.1111/j.1440-1754.1990.tb02431.x
53. Koo H.J., Lim S., Choe J. et al. Radiographic and CT features of viral pneumonia. Radiographics, 2018, vol. 38 (3), pp. 719–739. DOI: 10.1148/rg.2018170048
54. Koo H.J., Choi S.H., Sung H. et al. Radio graphics update: radiographic and CT features of viral pneumonia. Radiographics, 2020, vol. 40 (4), pp. E8–E15. DOI: 10.1148/rg.2020200097
55. Wang Y., Dong C., Hu Y. et al. Temporal changes of CT findings in 90 patients with COVID-19 pneumonia: a longitudinal study. Radiology, 2020, vol. 296 (2), pp. E55–E64. DOI: 10.1148/radiol.2020200843
56. Bernheim A., Mei X., Huang M. et al. Chest CT findings in coronavirus disease-19 (COVID-19): relationship to duration of infection. Radiology, 2020, vol. 295 (3), pp. 200463. DOI: 10.1148/radiol.2020200463
57. Kloth C., Forler S., Gatidis S. et al. Comparison of chest-CT findings of Influenza virus-associated pneumonia in immunocompetent vs. immunocompromised patients. Eur. J. Radiol, 2015, vol. 84 (6), pp. 1177–1183. DOI: 10.1016/j.ejrad.2015.02.014
58. Mayer J.L., Lehners N., Egerer G. et al. CT-morphological characterization of respiratory syncytial virus (RSV) pneumonia in immune-compromised adults. Rofo, 2014, vol. 186 (7), pp. 686–692. DOI: 10.1055/s-0033-1356353
59. Tan D., Fu Y., Xu J. et al. Severe adenovirus community-acquired pneumonia in immunocompetent adults: chest radiographic and CT findings. J. Thorac. Dis, 2016, vol. 8 (5), pp. 848–854. DOI: 10.21037/jtd.2016.03.38
60. Virkki R., Juven T., Rikalainen H. et al. Differentiation of bacterial and viral pneumonia in children. Thorax, 2002, vol. 57 (5), pp. 438–441. DOI: 10.1136/thorax.57.5.438
61. Gu X., Pan L., Liang H. et al. Classification of bacterial and viral childhood pneumonia using deep learning in Chest Radiography. Proceedings of the 3rd International Conference on multimedia and image processing (ICMIP ’18), 2018, pp. 88–93. DOI: 10.1145/3195588.3195597
62. Ayan E., Karabulut B., Ünver H.M. Diagnosis of pediatric pneumonia with ensemble of deep convolutional neural networks in Chest X-ray images. Arab. J. Sci. Eng, 2022, vol. 7 (2), pp. 2123–2139. DOI: 10.1007/s13369-021-06127-z
63. Ibrahim A.U., Ozsoz M., Serte S. et al. Pneumonia classification using deep learning from chest X-ray images during COVID-19. Cognit. Comput. Published online, 2021, vol. 4, pp. 1–13. DOI: 10.1007/s12559-020-09787-5
64. Pochepnia S., Grabczak E.M., Johnson E. et al. Imaging in pulmonary infections of immunocompetent adult patients. Breathe, 2024, vol. 20, pp. 230186. DOI: 10.1183/20734735.0186-2023
65. Long L., Zhao H.T., Zhang Z.Y. et al. Lung ultrasound for the diagnosis of pneumonia in adults: A meta-analysis. Medicine (Baltimore), 2017, vol. 96 (3), pp. e5713. DOI: 10.1097/MD.0000000000005713
66. Chavez M.A., Shams N., Ellington L.E. et al. Lung ultrasound for the diagnosis of pneumonia in adults: a systematic review and meta-analysis. Respir. Res, 2014, vol. 15 (1), p. 50. DOI: 10.1186/1465-9921-15-50
67. Stoicescu E.R., Iacob R., Ilie A.C. et al. Differentiating viral from bacterial pneumonia in children: the diagnostic role of lung ultrasound-a prospective observational study. Diagnostics (Basel), 2024, vol. 14 (5), p. 480. DOI: 10.3390/diagnostics14050480
68. Fritz C.Q., Edwards K.M., Self W.H. et al. Prevalence, risk factors, and outcomes of bacteremic pneumonia in children. Pediatrics, 2019, vol. 144 (1), p. e20183090. DOI: 10.1542/peds.2018-3090
69. Iroh Tam P.Y., Bernstein E., Ma X. et al. Blood culture in evaluation of pediatric community-acquired pneumonia: a systematic review and meta-analysis. Hosp. Pediatr, 2015, vol. 5 (6), pp. 324–336. DOI: 10.1542/hpeds.2014-0138
70. Neuman M.I., Hall M., Lipsett S.C. et al. Utility of blood culture among children hospitalized with community-acquired pneumonia. Pediatrics, 2017, vol. 140 (3), pp. e20171013. DOI: 10.1542/peds.2017-1013
71. Galeano F., Estigarribia L., Sanabria G. et al. Duration of fever in pediatric patients hospitalized with Community Acquired Pneumonia in a reference center for infectious diseases. Open J. Tropical Med, 2020, vol. 4 (1), pp. 023–027. DOI: 10.17352/ojtm.000016
72. Resti M., Moriondo M., Cortimiglia M. et al. Community-acquired bacteremic pneumococcal pneumonia in children: diagnosis and serotyping by real-time polymerase chain reaction using blood samples. Clin. Infect. Dis, 2010, vol. 51 (9), pp. 1042–1049. DOI: 10.1086/656579
73. Miners L., Huntington S., Lee N. et al. An economic evaluation of two PCR-based respiratory panel assays for patients admitted to hospital with community-acquired pneumonia (CAP) in the UK, France and Spain. BMC Pulm Med, 2023, vol. 23 (220), pp. 1–10. DOI: 10.1186/s12890-023-02516-2
74. Templeton K.E., Scheltinga S.A., van den Eeden W.C. et al. Improved diagnosis of the etiology of community-acquired pneumonia with real-time polymerase chain reaction. Clin. Infect. Dis, 2005, vol. 41 (3), pp. 345–351. DOI: 10.1086/431588
75. Eber E., Midulla F. ERS handbook of paediatric respiratory medicine. Sheffield: European Respiratory Society, 2013. 719 p.
76. Shen F., Sergi C. Sputum Analysis [Internet]. Treasure Island (FL): StatPearls Publishing, 2024, available at: https://www.ncbi.nlm.nih.gov/books/NBK563195/
77. Murdoch D.R., Morpeth S.C., Hammitt L.L. et al. Microscopic analysis and quality assessment of induced sputum from children with pneumonia in the PERCH study. Clin. Infect. Dis, 2017, vol. 64, pp. 271–279. DOI: 10.1093/cid/cix083
78. Markussen D.L., Ebbesen M., Serigstad S. et al. The diagnostic utility of microscopic quality assessment of sputum samples in the era of rapid syndromic PCR testing. Microbiol. Spectr, 2023, vol. 11 (5), p. e0300223. DOI: 10.1128/spectrum.03002-23
79. Musher D.M., Montoya R., Wanahita A. Diagnostic value of microscopic examination of Gram-stained sputum and sputum cultures in patients with bacteremic pneumococcal pneumonia. Clin. Infect. Dis, 2004, vol. 39 (2), pp. 165–169. DOI: 10.1086/421497
80. García-Vázquez E., Marcos M.A., Mensa J. et al. Assessment of the usefulness of sputum culture for diagnosis of community-acquired pneumonia using the PORT predictive scoring system. Arch. Intern. Med, 2004, vol. 164 (16), pp. 1807–1811. DOI: 10.1001/archinte.164.16.1807
81. Yang S., Lin S., Khalil A. et al. Quantitative PCR assay using sputum samples for rapid diagnosis of pneumococcal pneumonia in adult emergency department patients. J. Clin. Microbiol, 2005, vol. 43 (7), pp. 3221–3226. DOI: 10.1128/JCM.43.7.3221-3226.2005
82. Shi T., McLean K., Campbell H. et al. Aetiological role of common respiratory viruses in acute lower respiratory infections in children under five years: A systematic review and meta-analysis. J. Glob. Health, 2015, vol. 5 (1), p. 010408. DOI: 10.7189/jogh.05.010408
83. File T.M. Jr. New diagnostic tests for pneumonia: what is their role in clinical practice? Clin. Chest. Med, 2011, vol. 32 (3), pp. 417–430. DOI: 10.1016/j.ccm.2011.05.011
84. Mardian Y., Menur Naysilla A., Lokida D. et al. Approach to identifying causative pathogens of community-acquired pneumonia in children using culture, molecular, and serology tests. Front. Pediatr, 2021, vol. 9, p. 629318. DOI: 10.3389/fped.2021.629318
85. Baggett H.C., Watson N.L., Deloria Knoll M. et al. Density of upper respiratory colonization with Streptococcus pneumoniae and its role in the diagnosis of pneumococcal pneumonia among children aged <5 years in the PERCH study. Clin. Infect. Dis, 2017, vol. 64 (3), pp. 317–327. DOI: 10.1093/cid/cix100
86. Park D.E., Baggett H.C., Howie S.R.C. et al. Colonization density of the upper respiratory tract as a predictor of pneumonia-Haemophilus influenzae, Moraxella catarrhalis, Staphylococcus aureus, and Pneumocystis jirovecii. Clin. Infect. Dis, 2017, vol. 64 (3), pp. 328–336. DOI: 10.1093/cid/cix104
87. Nathan A.M., Teh C.S.J., Jabar K.A. et al. Bacterial pneumonia and its associated factors in children from a developing country: A prospective cohort study. PLoS ONE, 2020, vol. 15, p. e0228056. DOI: 10.1371/journal.pone.0228056
88. Markussen D.L., Serigstad S., Ritz C. et al. Diagnostic stewardship in community-acquired pneumonia with syndromic molecular testing: a randomized clinical trial. JAMA Netw Open, 2024, vol. 7 (3), p. e240830. DOI: 10.1001/jamanetworkopen.2024.0830
89. Wang L., Lu S., Guo Y. et al. Comparative study of diagnostic efficacy of sputum and bronchoalveolar lavage fluid specimens in community-acquired pneumonia children treated with fiberoptic bronchoscopy. BMC Infect. Dis, 2023, vol. 23 (565), pp. 1–8. DOI: 10.1186/s12879-023-08522-3
90. Falguera M., López A., Nogués A. et al. Evaluation of the polymerase chain reaction method for detection of Streptococcus pneumoniae DNA in pleural fluid samples. Chest, 2002, vol. 122 (6), pp. 2212–2216. DOI: 10.1378/chest.122.6.2212
91. Don M., Fasoli L., Paldanius M. et al. Aetiology of community-acquired pneumonia: serological results of a paediatric survey. Scand. J. Infect. Dis, 2005, vol. 37 (11–12), pp. 806–812. DOI: 10.1080/00365540500262435
92. Kashyap B., Kumar S., Sethi G.R. et al. Comparison of PCR, culture & serological tests for the diagnosis of Mycoplasma pneumoniae in community-acquired lower respiratory tract infections in children. Indian J. Med. Res, 2008, vol. 128 (2), pp. 134–139.
93. Li Q.L., Dong H.T., Sun H.M. et al. The diagnostic value of serological tests and real-time polymerase chain reaction in children with acute Mycoplasma pneumoniae infection. Ann. Transl. Med, 2020, vol. 8 (6), pp. 386. DOI: 10.21037/atm.2020.03.121
94. Murdoch D.R., O’Brien K.L., Driscoll A.J. et al. Laboratory methods for determining pneumonia etiology in children. Clin. Infect. Dis, 2012, vol. 54 (2), pp. 146–152. DOI: 10.1093/cid/cir1073
95. Smith M.D., Derrington P., Evans R. et al. Rapid diagnosis of bacteremic pneumococcal infections in adults by using the Binax NOW Streptococcus pneumoniae urinary antigen test: a prospective, controlled clinical evaluation. J. Clin. Microbiol, 2003, vol. 41 (7), pp. 2810–2813. DOI: 10.1128/JCM.41.7.2810-2813.2003
96. Gutiérrez F., Masiá M., Rodríguez J.C. et al. Evaluation of the immunochromatographic Binax NOW assay for detection of Streptococcus pneumoniae urinary antigen in a prospective study of community-acquired pneumonia in Spain. Clin. Infect. Dis, 2003, vol. 36 (3), pp. 286–292. DOI: 10.1086/345852
97. Farnaes L., Wilke J., Ryan Loker K. et al. Community-acquired pneumonia in children: cell-free plasma sequencing for diagnosis and management. Diagn. Microbiol. Infect. Dis, 2019, vol. 94 (2), pp. 188–191. DOI: 10.1016/j.diagmicrobio.2018.12.016
98. Wallihan R.G., Suárez N.M., Cohen D.M. et al. Molecular distance to health transcriptional score and disease severity in children hospitalized with community-acquired pneumonia. Front. Cell Infect. Microbiol, 2018, vol. 8, p. 382. DOI: 10.3389/fcimb.2018.00382