Viral pneumonia in children: present and future

Abstract

Purpose - to attract attention and provide information about modern approaches to the diagnosis of viral pneumonia, which in the future will make it possible to make a more confident diagnosis of viral pneumonia and not to prescribe antibiotics to all patients.

Pneumonia is the leading cause of morbidity and mortality among young children outside the neonatal period worldwide. Not always a detected microorganism or virus in the nasopharynx is proof that it is the causative agent of this particular pneumonia, since healthy carriers of both bacteria and viruses are found quite often. For example, during the examination of healthy children under the age of 5 years in Ukraine, pneumococcal carriers, which are recognized as the leading cause of community-acquired pneumonias (CAP), were found in 21.3% when bacterially examining swabs from the nasopharynx, and when using the PCR method - in 53.8%. However, on in practice, the diagnosis of viral pneumonias was almost never made, and when a diagnosis of pneumonia is made, the first thought about a bacterial infection traditionally arises. Following the emergence of severe acute respiratory syndrome (SARS), avian influenza A (H5N1) and pandemic influenza A (H1N1) viruses in 2009, the important role of respiratory viruses as causes of severe pneumonia has received special attention. Recently, the availability of multiplex PCR-based tests, which allow for the simultaneous identification of a large number of viruses, contributes to an increase in the number of diagnoses of viral pneumonia, increasing awareness of viruses as causative agents of respiratory lung diseases. Clinically, it is not easy to distinguish between viral and bacterial pneumonia. New protocols for the treatment of CAP in children are already being created, which include a set of clinical and laboratory signs that allow us to think about the viral etiology of pneumonia. However, today there is a dissonance: everyone recognizes the predominance of viral etiology of CAP, but at the same time, the main treatment for the most part remains antibiotics. With the expansion of universal vaccination against Hib and pneumococcus, an increase in the share of viral pneumonias among CAP is predicted, which will stimulate the development of drugs against respiratory viruses. We can hope that in the near future not all children will be prescribed antibiotics, which will contribute to reducing the development of resistance of microorganisms to antibacterial drugs.

No conflict of interests was declared by the authors.