pulmoПульмонологияPULMONOLOGIYA0869-01892541-9617Scientific and Practical Journal “PULMONOLOGIYA” LLC10.18093/0869-0189-2014-0-5-78-82pulmo-472Research ArticleОБЗОРЫREVIEWЭтиологическая диагностика внебольничной пневмонии у детейEtiologic diagnosis of communityacquired pneumonia in childrenПротасоваИ. Н.ProtasovaI. N.

к. м. н., доцент кафедры микробиологии ГБОУ ВПО "КрасГМУ" им. проф. В.Ф.ВойноЯсенецкого Минздрава России; тел.: (960) 7531414

ovsyanka802@gmail.comПерьяноваО. В.PeryanovaO. V.

к. б. н., доцент, зав. кафедрой микробиологии ГБОУ ВПО "КрасГМУ" им. проф. В.Ф.ВойноЯсенецкого Минздрава России; тел.: (391) 2201361

perianova@mail.ruИльенковаН. А.IlyenkovaN. A.

д. м. н., профессор, зав. кафедрой детских болезней с курсом ПО ГБОУ ВПО "КрасГМУ" им. проф. В.Ф.ВойноЯсенецкого Минздрава России; тел.: (391) 2640961

ilenkova1@mail.ruГБОУ ВПО "Красноярский государственный медицинский университет им. проф. В.Ф.Войно-Ясенецкого" Минздрава России: 660022, Красноярск, ул. Партизана Железняка, 1РоссияState Institute V.F.Voyno+Yasenetskiy Krasnoyarsk State Medical University, the Healthcare Ministry of Russia; Krasnoyarsk, RussiaRussian Federation201428102014057882Copyright © Протасова И.Н., Перьянова О.В., Ильенкова Н.А., 20142014Протасова И.Н., Перьянова О.В., Ильенкова Н.А.Protasova I.N., Peryanova O.V., Ilyenkova N.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.pulmonology.ru/pulm/article/view/472

Представлен обзор современных методов этиологической диагностики внебольничной пневмонии у детей по результатам проведенных в последние годы исследований. Приведены данные о чувствительности и специфичности различных методов диагностики. Проанализированы достоинства и недостатки традиционных методов микробиологической диагностики. Представлены возможности применения молекулярных методов исследования как наиболее информативных, быстрых и простых в применении.

The paper represents a systematic review of current etiological diagnostic methods in childhood communityacquired pneumonia based on studies and guidelines of recent years. The authors compare sensitivity and specificity of different diagnostic methods, advantages and limitations of different routine microbiological diagnostic approaches. According to most opinions molecular methods are very valuable, quick and easy to use but should be combined with culturing and other routine tests for better interpretation of results.

внебольничная пневмониядетиэтиологиябактериологический методмолекулярногенетические методы.communityacquired pneumoniachildrenetiologyculturemolecular methodsReferencesGlobal action Plan for Prevention and Control of Pneumonia (GaPP). WHO / UNICEF; 2009.Global action Plan for Prevention and Control of Pneumonia (GaPP). WHO / UNICEF; 2009.http://www.who.int/mediacentre/factsheets/fs331/ru/http://www.who.int/mediacentre/factsheets/fs331/ru/Baranov A.A. Pediatrics: National guidelines. Moscow: GEO TARMedia; 2009; vol. 2 (in Russian).Baranov A.A. Pediatrics: National guidelines. Moscow: GEO TARMedia; 2009; vol. 2 (in Russian).Ending Preventable Child Deaths from Pneumonia and Diarrhoea by 2025. The integrated Global Action Plan for Pneumonia and Diarrhoea (GAPPD). WHO / UNICEF; 2013.Ending Preventable Child Deaths from Pneumonia and Diarrhoea by 2025. The integrated Global Action Plan for Pneumonia and Diarrhoea (GAPPD). WHO / UNICEF; 2013.Artyukhov I.P., Galaktionova M.Yu., Rakhimova A.L. General features of health status in adolescents of Krasnoyarsk. Sibirskoe meditsinskoe obozrenie. 2012; 6: 47–52 (in Russian).Artyukhov I.P., Galaktionova M.Yu., Rakhimova A.L. General features of health status in adolescents of Krasnoyarsk. Sibirskoe meditsinskoe obozrenie. 2012; 6: 47–52 (in Russian).Il'enkova N.A. Management of medical care for children with pneumonia in Russian Federation. Rosssiyskiy vestnik perina tologii i pediatrii. 2005; 3: 4–8 (in Russian).Il'enkova N.A. Management of medical care for children with pneumonia in Russian Federation. Rosssiyskiy vestnik perina tologii i pediatrii. 2005; 3: 4–8 (in Russian).Ostapchuk M., Roberts D.M., Haddy R. Community acquired pneumonia in infants and children. Am. Fam. Physician. 2004; 70 (5): 899–908.Ostapchuk M., Roberts D.M., Haddy R. Community acquired pneumonia in infants and children. Am. Fam. Physician. 2004; 70 (5): 899–908.WeilOlivier C., van der Linden M., de Schutter I. et al. Prevention of pneumococcal diseases in the postseven valent vaccine era: A European perspective. BMC Infect. Dis. 2012;12: 207.WeilOlivier C., van der Linden M., de Schutter I. et al. Prevention of pneumococcal diseases in the postseven valent vaccine era: A European perspective. BMC Infect. Dis. 2012;12: 207.Carrol E.D., Mankhambo L.A., Guiver M. et al. PCR improves diagnostic yield from lung aspiration in Malawian children with radiologically confirmed pneumonia. PLoS One. 2011; 6 (6): e21042.Carrol E.D., Mankhambo L.A., Guiver M. et al. PCR improves diagnostic yield from lung aspiration in Malawian children with radiologically confirmed pneumonia. PLoS One. 2011; 6 (6): e21042.Bhat N., O'Brien K.L., Karron R.A. et al. Use and evaluation of molecular diagnostics for pneumonia etiology studies. Clin. Infect. Dis. 2012; 54 (Suppl. 2): 153–158.Bhat N., O'Brien K.L., Karron R.A. et al. Use and evaluation of molecular diagnostics for pneumonia etiology studies. Clin. Infect. Dis. 2012; 54 (Suppl. 2): 153–158.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. Global Hlth. 2013; 3 (1): e010401.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. Global Hlth. 2013; 3 (1): e010401.Grant L.R., Hammit L.L., Murdoch D.R. et al. Procedures for collection of induced sputum specimens from children. Clin. Infect. Dis. 2012; 54 (Suppl. 2): 140–145.Grant L.R., Hammit L.L., Murdoch D.R. et al. Procedures for collection of induced sputum specimens from children. Clin. Infect. Dis. 2012; 54 (Suppl. 2): 140–145.Vong S., Guillard B., Borand L. et al. Acute lower respiratory infections in ≥ 5 yearold hospitalized patients in Cambodia, a lowincome tropical country: clinical characteristics and pathogenic etiology. BMC Infect. Dis. 2013; 13: 97.Vong S., Guillard B., Borand L. et al. Acute lower respiratory infections in ≥ 5 yearold hospitalized patients in Cambodia, a lowincome tropical country: clinical characteristics and pathogenic etiology. BMC Infect. Dis. 2013; 13: 97.Bradley J.S., Byington C.L., Shah S.S. et al. The management of communityacquired 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. Infect. Dis. 2011; 53: e25.Bradley J.S., Byington C.L., Shah S.S. et al. The management of communityacquired 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. Infect. Dis. 2011; 53: e25.Loens K., Van Heirstraeten L., MalhotraKumar S. et al. Optimal sampling sites and methods for detection of pathogens possibly causing communityacquired lower respi ratory tract infections. J. Clin. Microbiol. 2009; 47 (1): 21–31.Loens K., Van Heirstraeten L., MalhotraKumar S. et al. Optimal sampling sites and methods for detection of pathogens possibly causing communityacquired lower respi ratory tract infections. J. Clin. Microbiol. 2009; 47 (1): 21–31.Lakhani D., Muley P. The association of positive chest radiograph and laboratory parameters with community acquired pneumonia in children. J. Clin. Diagn. Res. 2013; 7 (8):1629–1631.Lakhani D., Muley P. The association of positive chest radiograph and laboratory parameters with community acquired pneumonia in children. J. Clin. Diagn. Res. 2013; 7 (8):1629–1631.MendozaParedes A., Bastos J., Leber M. et al. Utility of blood culture in uncomplicated pneumonia in children. Clin. Med. Insigts Pediatr. 2013; 7: 1–5.MendozaParedes A., Bastos J., Leber M. et al. Utility of blood culture in uncomplicated pneumonia in children. Clin. Med. Insigts Pediatr. 2013; 7: 1–5.Gutierrez F., Masia M., Rodriguez J.C. et al. Evaluation of the immunochromatographic Binax NOW assay for detection of Streptococcus pneumoniae urinary antigen in a prospective study of communityacquired pneumonia in Spain. Clin. Infect. Dis. 2003; 36 (3): 286–292.Gutierrez F., Masia M., Rodriguez J.C. et al. Evaluation of the immunochromatographic Binax NOW assay for detection of Streptococcus pneumoniae urinary antigen in a prospective study of communityacquired pneumonia in Spain. Clin. Infect. Dis. 2003; 36 (3): 286–292.Werno A.M., Murdoch D.R. Medical microbiology: laboratory diagnosis of invasive pneumococcal disease. Clin. Infect. Dis. 2008; 46 (6): 926–932.Werno A.M., Murdoch D.R. Medical microbiology: laboratory diagnosis of invasive pneumococcal disease. Clin. Infect. Dis. 2008; 46 (6): 926–932.Blaschke A.J. Interpreting assays for the detection of Streptococcus pneumoniae. Clin. Infect. Dis. 2011; 52 (Suppl. 4):331–337.Blaschke A.J. Interpreting assays for the detection of Streptococcus pneumoniae. Clin. Infect. Dis. 2011; 52 (Suppl. 4):331–337.Navarro D., GarciaMaset L., Gimeno C. et al. Performance of the Binax NOW Streptococcus pneumoniae urinary antigen assay for diagnosis of pneumonia in children with underlying pulmonary diseases in the absence of acute pneumococcal infection. J. Clin. Microbiol. 2004; 42 (10): 4853–4855.Navarro D., GarciaMaset L., Gimeno C. et al. Performance of the Binax NOW Streptococcus pneumoniae urinary antigen assay for diagnosis of pneumonia in children with underlying pulmonary diseases in the absence of acute pneumococcal infection. J. Clin. Microbiol. 2004; 42 (10): 4853–4855.Baggett H.C., Rhodes J., Dejsirilert S. et al. Pneumococcal antigen testing of blood culture broth to enhance the detection of Streptococcus pneumoniae bacteremia. Eur. J. Clin. Microbiol. Infect. Dis. 2012; 31 (5): 753–756.Baggett H.C., Rhodes J., Dejsirilert S. et al. Pneumococcal antigen testing of blood culture broth to enhance the detection of Streptococcus pneumoniae bacteremia. Eur. J. Clin. Microbiol. Infect. Dis. 2012; 31 (5): 753–756.GalettoLacour A., Alcoba G., PosfayBarbe K.M. et al. Elevated inflammatory markers combined with positive pneumococcal urinary antigen are a good predictor of pneumococ cal communityacquired pneumonia in children. Pediatr. Infect. Dis. J. 2013; 32 (11): 1175–1179.GalettoLacour A., Alcoba G., PosfayBarbe K.M. et al. Elevated inflammatory markers combined with positive pneumococcal urinary antigen are a good predictor of pneumococ cal communityacquired pneumonia in children. Pediatr. Infect. Dis. J. 2013; 32 (11): 1175–1179.Selva L., Benmessaoud R., Lanaspa M. et al. Detection of Streptococcus pneumoniae and Haemophilus influenzae type bby realtime PCR from dried blood spot samples among children with pneumonia: a useful approach for developing countries. PLoS One. 2013; 8 (10): e76970.Selva L., Benmessaoud R., Lanaspa M. et al. Detection of Streptococcus pneumoniae and Haemophilus influenzae type bby realtime PCR from dried blood spot samples among children with pneumonia: a useful approach for developing countries. PLoS One. 2013; 8 (10): e76970.Cvitkovic S.V., Beovic B., Pokorn M. et al. Improvement of pneumococcal pneumonia diagnostics by the use of rtPCR on plasma and respiratory samples. Scand. J. Infect. Dis. 2013;45 (10): 731–737.Cvitkovic S.V., Beovic B., Pokorn M. et al. Improvement of pneumococcal pneumonia diagnostics by the use of rtPCR on plasma and respiratory samples. Scand. J. Infect. Dis. 2013;45 (10): 731–737.Abdeldaim G., Herrmann B., Mölling P. et al. Usefulness of realtime PCR for lytA, ply, and Spn9802 on plasma samples for the diagnosis of pneumococcal pneumonia. Clin. Microbiol. Infect. 2010; 16 (8): 1135–1141.Abdeldaim G., Herrmann B., Mölling P. et al. Usefulness of realtime PCR for lytA, ply, and Spn9802 on plasma samples for the diagnosis of pneumococcal pneumonia. Clin. Microbiol. Infect. 2010; 16 (8): 1135–1141.Peters R.P.H., de Boer R.F., Schuurman T. et al. Streptococcus pneumoniae DNA Load in Blood as a Marker of Infection in Patients with CommunityAcquired Pneumonia. J. Clin. Microbiol. 2009; 47 (10): 3308–3312.Peters R.P.H., de Boer R.F., Schuurman T. et al. Streptococcus pneumoniae DNA Load in Blood as a Marker of Infection in Patients with CommunityAcquired Pneumonia. J. Clin. Microbiol. 2009; 47 (10): 3308–3312.Berkley J.A., Munywoki P., Ngama M. et al. Viral etiology of severe pneumonia among Kenyan young infants and children. J.A.M.A. 2010; 303 (20): 2051–2057.Berkley J.A., Munywoki P., Ngama M. et al. Viral etiology of severe pneumonia among Kenyan young infants and children. J.A.M.A. 2010; 303 (20): 2051–2057.Ali A., Khowaja A.R., Bashir M.Z. et al. Role of Human metapneumovirus, Influenza A virus and Respiratory Syncytial virus in causing WHOdefined severe pneumonia in children in a developing country. PLoS One. 2013; 8 (9): e74756.Ali A., Khowaja A.R., Bashir M.Z. et al. Role of Human metapneumovirus, Influenza A virus and Respiratory Syncytial virus in causing WHOdefined severe pneumonia in children in a developing country. PLoS One. 2013; 8 (9): e74756.CeveyMacherel M., GalettoLacour A., Gervaix A. et al. Etiology of communityacquired pneumonia in hospitalized children based on WHO clinical guidelines. Eur. J. Pediatr. 2009; 168 (12): 1429–1436.CeveyMacherel M., GalettoLacour A., Gervaix A. et al. Etiology of communityacquired pneumonia in hospitalized children based on WHO clinical guidelines. Eur. J. Pediatr. 2009; 168 (12): 1429–1436.Michelow I.C., Olsen K., Lozano J. et al. Diagnostic utility and clinical significance of naso and oropharyngeal samples used in a PCR assay to diagnose Mycoplasma neumoniae infection in children with communityacquired pneumonia. J. Clin. Microbiol. 2004; 42 (7): 3339–3341.Michelow I.C., Olsen K., Lozano J. et al. Diagnostic utility and clinical significance of naso and oropharyngeal samples used in a PCR assay to diagnose Mycoplasma neumoniae infection in children with communityacquired pneumonia. J. Clin. Microbiol. 2004; 42 (7): 3339–3341.Michelow I.C., Lozano J., Olsen K. et al. Diagnosis of Streptococcus pneumoniae Lower Respiratory Infection in Hospitalized Children by Culture, Polymerase Chain Reaction, Serological Testing, and Urinary Antigen Detection. Clin. Infect. Dis. 2002; 34 (1): e1–e11.Michelow I.C., Lozano J., Olsen K. et al. Diagnosis of Streptococcus pneumoniae Lower Respiratory Infection in Hospitalized Children by Culture, Polymerase Chain Reaction, Serological Testing, and Urinary Antigen Detection. Clin. Infect. Dis. 2002; 34 (1): e1–e11.Stralin K., Korsgaard J., Olcen P. et al. Evaluation of a multiplex PCR for bacterial pathogens applied to bronchoalveolar lavage. Eur. Respir. J. 2006; 28 (3); 568–575.Stralin K., Korsgaard J., Olcen P. et al. Evaluation of a multiplex PCR for bacterial pathogens applied to bronchoalveolar lavage. Eur. Respir. J. 2006; 28 (3); 568–575.Falsey A.R., Formica M.A., Walsh E.E. Diagnosis of Respiratory Syncytial Virus infection: comparison of reverse transcriptionPCR to viral culture and serology in adults with respiratory illness. J. Clin. Microbiol. 2002; 40 (3): 817–820.Falsey A.R., Formica M.A., Walsh E.E. Diagnosis of Respiratory Syncytial Virus infection: comparison of reverse transcriptionPCR to viral culture and serology in adults with respiratory illness. J. Clin. Microbiol. 2002; 40 (3): 817–820.Garrido V.V., Sancho J.F., Blasco L.H. et al. Diagnosis and treatment of pleural effusion. Arch. Bronconeumol. 2006; 42 (7): 349–372.Garrido V.V., Sancho J.F., Blasco L.H. et al. Diagnosis and treatment of pleural effusion. Arch. Bronconeumol. 2006; 42 (7): 349–372.Song J.Y., Eun B.W., Nahm M.H. Diagnosis of pneumococcal pneumonia: current pitfalls and the way forward. Infect. Chemother. 2013; 45 (4): 351–366.Song J.Y., Eun B.W., Nahm M.H. Diagnosis of pneumococcal pneumonia: current pitfalls and the way forward. Infect. Chemother. 2013; 45 (4): 351–366.Yamazaki T., Narita M., Sasaki N. et al. Comparison of PCR for sputum samples obtained by induced cough and serological tests for diagnosis of Mycoplasma pneumoniae infection in children. Clin. Vaccine Immunol. 2006; 13 (6): 708–710.Yamazaki T., Narita M., Sasaki N. et al. Comparison of PCR for sputum samples obtained by induced cough and serological tests for diagnosis of Mycoplasma pneumoniae infection in children. Clin. Vaccine Immunol. 2006; 13 (6): 708–710.

The authors declare that there are no conflicts of interest present.