Aim: To find incidence of clinical pneumonia viz a viz radiologically confirmed pneumonia in children with severe acute malnutrition.

Materials and Methods: It was a hospital based prospective analytical study carried out over a period of 12 months from January 2013 to December 2013. 184children with SAM admitted to paediatrics ward were evaluated for pneumonia as per WHO criteria. Besides the routine investigations, each patient was subjected to X-ray chest, pulse-oximetry and Montoux test and the results were correlated.

Results: Out of 184 patients with SAM, 52 (28.26%) had features of clinical pneumonia but 7 (3.8%) out of them had a normal X-ray chest. Similarly, 15 (8.15%) cases had definite radiological features of pneumonia however, they did not fit into the clinical diagnostic criteria. Moreover, 6 of these 15 cases (40%) had hypoxia (Spo2< 90% at room air) on pulse-oximetry at the time of admission.

Conclusion: WHO recommended clinical criteria; if used alone is inadequate for diagnosis of pneumonia in children with SAM as occult pneumonia was seen in about 25% cases. Traditionally used X-ray chest should be made a basic cornerstone for diagnosis of pneumonia. Moreover, on pulse-oximetry, 40% of occult pneumonia cases showed hypoxia; thereby making it a useful adjunct in diagnosing pneumonia cases.

Keywords: Pneumonia, SAM, Occult pneumonia, Pulse-oximetry, Chest X-ray.

References

1.      Naheed A, Saha SK, Breiman RF, Khatun F, Brooks WA, El Arifeen S et al. Multihospital surveillance of pneumonia burden among children aged <5 years hospitalized for pneumonia in Bangladesh. Clin Infect Dis 2009;48 (Suppl 2):S82-9.

2.      Bryce J, Boschi-Pinto C, Shibuya K, Black RE. WHO estimates of the causes of death in children Lancet 2005;365:1147-52.

3.      Chisti MJ, Hossain MI, Malek MA, Faruque AS, Ahmed T, Salam MA. Characteristics of severely malnourished under-five children hospitalized with diarrhoea, and their policy implications. Acta Paediatr 2007;96:693-6.

4.      Chisti MJ, Huq S, Das SK, Malek MA, Ahmed T, Faruque AS et al. Predictors of severe illness in children under age five with concomitant infection with pneumo-nia and diarrhoea at a large hospital in Dhaka, Bangladesh. Southeast Asian J Trop Med Public Health 2008;39:719-27.

5.      Chisti MJ, Tebruegge M, La Vincente S, Graham SM, Duke T. Pneumonia in severely malnourished children in developing countries—mortality risk, aetiology and validity of WHO clinical signs: a systematic review. Trop Med Int Health 2009;14:1173-89.

6.      Suskind D, Murthy KK, Suskind RM. The malnourished child: an overview. In: Suskind RM, Lewinter-Suskind L, editors. The malnourished child. New York, NY: Vevey/Raven Press, 1990:1-22.

7.      Graham SM, English M, Hazir T, Enarson P, Duke Challenges to improving case management of childhood pneumonia at health facilities in resource-limited Settings. Bull World Health Organ 2008; 86:349-55.

8.      Falade AG, Tschappeler H, Greenwood BM, Mulholland EK. Use of simple clinical signs to predict pneumonia in young Gambian children: the influence of malnutrition. Bull World Health Organ 1995;73:299-304.

9.      Bachur R, Perry H & Harper MB. Occult pneumonias: empiric chest radiographs in febrile children with leucocytosis. Annals of Emergency Medicine 1999;33:166–173.

10.  Murphy CG, Van De Pol AC, Harper MB & Bachur RG. Clinical predictors of occult pneumonia in the febrile child Academic Emergency Medicine 2007;14: 243–249.

11.  Sarria E, Fischer GB, Lima JA, Menna Barreto SS, Flores JA & Sukiennik R. Interobserver agreement in the radiological diagnosis of lower respiratory tract infections in children. Journal of Pediatrics (Rio J) 2003;79:497–503.

12.  Bada C,Carreazo NY, Chalco JP & Huicho L Inter-observer agreement in interpreting chest X-rays on children with acute lower respiratory tract infections and concurrent wheezing. Sao Paulo Medical Journal  2007;125:150–154

13.  Pauls S, Kruger S, Richter K et al. Inter observer agreement in the assessment of pulmonary infiltrates on chest radiography in community-acquired pneumonia. Röfo-Fortschritte auf dem Gebieta der Röntge-nstrahlen and der Nuklearm-ediin 2007;179:1152–1158.

14.  Chisti MJ, Ahmed T, Faruque AS, Abdus Salam M Clinical and laboratory features of radiologic pneumonia in severely malnourished infants attending an urban diarrhoea treatment centre in Bangladesh. The Pediatric infectious disease journal 2010;29:174-7

15.  WHO Child Growth Standards and the Identification of Severe Acute Malnut-rition in Infants and Children. A joint statement by WHO and UNICEF, 2009. Accessed from http://www.wh-o.int/nutrition/publications/ severe malnutrition/9789241598163_eng.pdf

16.  Pneumonia: The forgotten killer of children. The United Nations Children’s Fund (UNICEF)/World Health Organiza-tion  (WHO), 2006

17.  Stephen M Graham Challenges to improving case management of childhood pneumonia at health facilities in resource-limited settings. Bulletin of the World Health Organization 2008;86:349–355.

18.  Rutman MS, Bachur R, Harper MB Radiographic pneumonia in young, highly febrile children with leucocytosis before and after universal conjugate pneumoc-occal vaccination. PediatrEmerg Care. 2009 Jan;25(1):1-7.

19.  Murphy CG, van de Pol AC, Harper MB, Bachur RG AcadEmerg Med Clinical predictors of occult pneumonia in the febrile child. 2007 Mar;14(3):243-9.

Mohd Raza

Address c/o 1191/00C2 Chaman Palace Al-Hamd Apartment near Nadeem Tarin Hall,

Sir Syed Nagar, Aligarh, Uttar Pradesh, India, 202001