COMPARISON OF RADIOLOGICAL FINDINGS AND MICROBIAL ETIOLOGY OF CHILDHOOD PNEUMONIA

Sixty-one children were treated in hospital from 1981 to 1982 because of both radiologically and microbiologically verified viral or bacteri al pneumonia. The chest radiographs were interpreted by two radiologis ts, not familiar with the clinical data, on two occasions three years apart, and only those patients with a definite alveolar (n = 27) or in terstitial (n = 34) pneumonia at both evaluations were included in the present analysis. In addition, all patients had viral (n = 20), mixed viral-bacterial (n = 21) or bacterial (n = 20) infections diagnosed b y viral or bacterial antibody or antigen assays. Viral infection alone was seen in 7 (26%), mixed viral-bacterial infection in 8 (30%) and b acterial infection alone in 12 (44%) of the 27 patients with alveolar pneumonia. The respective figures were 13 (38%), 13 (38%) and 8 (24%) for the 34 patients with interstitial pneumonia. C-reactive protein co ncentration was greater than 40 mg/l (a screening limit for viral and bacterial infections) in 15 (56%) of the patients with alveolar and in 11 (32%) of the patients with interstitial pneumonia. Thus 74% of the patients with alveolar and 62% with interstitial pneumonia had bacter ial infection, either alone or as a mixed viral-bacterial infection. O ur results suggest that the presence of an alveolar infiltrate in a ch est radiograph is a specific but insensitive indicator of bacterial pn eumonia. We conclude that patients with alveolar pneumonia should be t reated with antibiotics. In patients with interstitial pneumonia, howe ver, both viral and bacterial aetiology are possible. In those, the de cision concerning antibiotic treatment should be based on clinical and laboratory findings.