Viral pneumonia in children: present and future




viral community-acquired pneumonia, children, etiology, diagnosis, treatment


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.


Alimi Y, Lim WS, Lansbury L, Leonardi-Bee J, Nguyen-Van-Tam JS. (2017). Systematic review of respiratory viral pathogens identified in adults with community-acquired pneumonia in Europe. J Clin Virol. 95: 26-35.; PMid:28837859 PMCid:PMC7185624

Almeida A, Boattini M, Christaki E et al. (2021, Jun). Comparative virulence of seasonal viruses responsible for lower respiratory tract infections: a southern European multi-centre cohort study of hospital admissions. Infection. 49(3): 483-490.; PMid:33389699 PMCid:PMC7778853

Amanullah S. (2020). Viral Pneumonia Imaging (Medscape). URL:

Brittain-Long R, Nord S, Olofsson S, Westin J, Anderson LM, Lindh M. (2008). Multiplex real-time PCR for detection of respiratory tract infections. J Clin Virol. 41: 53-56.; PMid:18093871 PMCid:PMC7172039

Burk M, El-Kersh K, Saad M, Wiemken T, Ramirez J, Cavallazzi R. (2016). Viral infection in community-acquired pneumonia: a systematic review and meta-analysis. Eur Respir Rev. 25 (140): 178-188.; PMid:27246595 PMCid:PMC9487248

Chernyshova LI, Gilfanova AM, Bondarenko AV, Yakimovitch SA, Rabosh OV, Yanovskaya VV et al. (2014). Effect of early social activity in S. pneumoniae nasopharyngeal carriage and distribution of pneumococcus serotypes in children of the first five years of life. Sovremennaya pediatriya. 2(58): 58-63. URL doi 10.15574/SP.2014.58.58.

Dnipropetrovskyi oblasnyi CKPH. (2021). Vsesvitnii den borotby z pnevmoniieiu. 6-12 lystopada 2021 r. URL:

Duke T. (2019, Aug 31). What the PERCH study means for future pneumonia strategies. COMMENT. The Lancet. 394; 10200: 714-716.; PMid:31257128

Dunn L. (2005). Pneumonia: classification, diagnosis and nursing management. Nurs Stand. 19 (42): 50-54.; PMid:16013205

Febbo J, Revels J, Ketai L. (2022, May). Viral Pneumonias. Radiol Clin North Am. 60(3): 383-397.; PMid:35534126

Ferreira-Coimbra J, Sarda C, Rello J. (2020, Apr). Burden of Community-Acquired Pneumonia and Unmet Clinical Needs. Adv Ther. 37(4): 1302-1318. Epub 2020 Feb 18.; PMid:32072494 PMCid:PMC7140754

Franquet T. (2018, Sep). Imaging of Community-acquired Pneumonia. J Thorac Imaging. 33(5): 282-294.; PMid:30036297

Freeman AM, Leigh, Jr TR. (2022, Jul 4). Viral Pneumonia. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. PMID: 30020658.

Hudzenko PM, Rudniev IM. (1973). Detskye bolezny. Pod red. prof. P.N. Hudzenko i I.M. Rudneva. K.: «Vyshcha shkola»: 536.

Jain S, Self WH, Wunderink RG et al. (2015). Community-acquired pneumonia requiring hospitalization among U.S. adults. N Engl J Med. 373(5): 415-427.

Jain S, Williams DJ, Arnold SR. (2015). Community-acquired pneumonia requiring hospitalization among U.S. children. N Engl J Med. 372(9): 835-845.

Jalandoni-Cabahug V et al. (2021). Clinical Practice Guidelines in the Evaluation and Management of Pediatric Community-Acquired Pneumonia. Philippine Academy of Pediatric Pulmonologists, Inc. Pediatric Infectious Disease Society of the Philippines, Inc. URL:

Katz SE, Williams DJ. (2018, Mar). Pediatric Community-Acquired Pneumonia in the United States: Changing Epidemiology, Diagnostic and Therapeutic Challenges, and Areas for Future Research. Infect Dis Clin North Am. 32(1): 47-63. Epub 2017 Dec 18.; PMid:29269189 PMCid:PMC5801082

Koo HJ, Choi SH, Sung H, Choe J, Do KH. (2020, Jul-Aug). Radiographic and CT Features of Viral Pneumonia. Radiographics. 40(4): E8-E15. Epub 2020 Jun 5.; PMid:32501740 PMCid:PMC7336757

Lazner M, Chetty K, McEvoy S, Ruffles T et al. (2022). Paediatric Clinical Practice Guideline. The Alex Paediatric Clinical Practice Guideline - Community Acquired Pneumonia Page 1 of 4 Community Acquired Pneumonia (CAP) Approved by: UHS Antimicrobial Stewardship Group May 2022 & UHS Medicines Governance Committee June 2022 Publication date: June 2022. Version 3. URL:

Leung AKC, Wong AHC, Hon KL. (2018). Community-Acquired Pneumonia in Children. Recent Pat Inflamm Allergy Drug Discov. 12(2): 136-144.; PMid:29932038

Ministry of Health of Ukraine. (2022). Pneumonia in children. Evidence-based clinical practice. Order of Ministry of Health of Ukraine dated 02.08.2022 No. 1380. URL:

Ministry of Health of Ukraine. (2022). Standarty medychnoi dopomohy «Pozalikarniani pnevmonii u ditei». Nakaz MOZ Ukrainy vid 02.08.2022 No. 1380 (chact 2). URL:

Murdoch DR, Jennings LC, Bhat N, Anderson TP. (2010). Emerging advances in rapid diagnostics of respiratory infections. Infect Dis Clin North Am. 24: 791-807.; PMid:20674804 PMCid:PMC7134633

Murdoch DR, O'Brien KL, Scott AG. (2009). Breathing new life into pneumonia diagnostics. J Clin Microbiol. 47: 3405-3408.; PMid:19741073 PMCid:PMC2772647

Nair GB, Niederman MS. (2021, Jan). Updates on community acquired pneumonia management in the ICU. PharmacolTher. 217: 107663. Epub 2020 Aug 15.; PMid:32805298 PMCid:PMC7428725

Nguyen PTK, Tran HT, Fitzgerald DA, Tran TS, Graham SM, Marais BJ. (2019, Jul 11). Characterisation of children hospitalised with pneumonia in central Vietnam: a prospective study. Eur Respir J. 54(1): 1802256.; PMid:30956212

NIH. (2022). Therapeutic Management of Nonhospitalized Children With COVID-19. Last Updated: December 28, 2022. URL:

Nolan VG, Arnold SR, Bramley AM et al. (2018). Etiology and Impact of Coinfections in Children Hospitalized With Community-Acquired Pneumonia. J Infect Dis. 218: 179.; PMid:29228381 PMCid:PMC7108488

Opendatabot. (2020). Mortality structure. URL:

Pagliano P, Sellitto C, Conti V, Ascione T, Esposito S. (2021, Aug). Characteristics of viral pneumonia in the COVID-19 era: an update. Infection. 49(4): 607-616. Epub 2021 Mar 29.; PMid:33782861 PMCid:PMC8006879

Perlman S. (2020). Another decade, another coronavirus. N Engl J Med. 382: 760-762.; PMid:31978944 PMCid:PMC7121143

Richardson S, Hirsch JS, Narasimhan M, Crawford JM, McGinn T, Davidson KW et al. (2020, May 26). Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area. JAMA. 323(20): 2052-2059. Erratum in: JAMA. 2020 May 26; 323(20): 2098.; PMid:32320003 PMCid:PMC7177629

Rodriguez-Morales AJ, Bonilla-Aldana DK, Balbin-Ramon GJ, Rabaan AA et al. (2020). History is repeating itself: probable zoonotic spillover as the cause of the 2019 novel coronavirus epidemic. Infez Med. 28: 3-5.

Rose M. (2022). S2k-Leitlinie "Management der ambulant erworbenen Pneumonie bei Kindern und Jugendlichen (pädiatrische ambulant erworbene Pneumonie, pCAP)" Federführend herausgegeben von der Deutschen Gesellschaft für Pädiatrische Infektiologie (DGPI) und der Gesellschaft für Pädiatrische Pneumologie (GPP) Erstellungsdatum: 03/2017 Nächste Überprüfung geplant: 03/2022.

Rudan I, Boschi-Pinto C, Biloglav Z, Mulholland K, Campbell H. (2008). Epidemiology and etiology of childhood pneumonia. Bull World Health Organ. 86: 408-416.; PMid:18545744 PMCid:PMC2647437

Ruuskanen O, Lahti E, Jennings LC, Murdoch DR. (2011, Apr 9). Viral pneumonia. Lancet. 377(9773): 1264-1275. Epub 2011 Mar 22.; PMid:21435708

Shah SS, Bradley JS. (2018). Pediatric community-acquired pneumonia. In: Feigin and Cherry's Textbook of Pediatric Infectious Diseases. 8th ed. Cherry JD, Harrison G, Kaplan SL et al (Eds). Elsevier, Philadelphia: 208.

Shi T, McLean K, Campbell H, Nair H. (2015, Jun). 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. 5(1): 010408. PMID: 26445672; PMCID: PMC4593292.

Smith DK, Kuckel DP, Recidoro AM. (2021, Dec 1). Community-Acquired Pneumonia in Children: Rapid Evidence Review. Am Fam Physician. 104(6): 618-625. PMID: 34913645.

Tatar M, Shoorekchali JM, Faraji MR, Wilson FA. (2021, Jul 3). International COVID-19 vaccine inequality amid the pandemic: Perpetuating a global crisis? J Glob Health. 11: 03086.; PMid:34221356 PMCid:PMC8252691

Troeger C, Blacker B, Khalil IA et al. (2018). Estimates of the global, regional, and national morbidity, mortality, and aetiologies of lower respiratory infections in 195 countries, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Infect Dis. 18: 1191-1210.

Vidaur L, Totorika I, Montes M, Vicente D, Rello J, Cilla G. (2019). Human metapneumovirus as cause of severe community-acquired pneumonia in adults: insights from a ten-year molecular and epidemiological analysis. Ann Intensive Care. 9(1): 86.; PMid:31342206 PMCid:PMC6656825

Virkki R, Juven T, Rikalainen H, Svedström E, Mertsola J, Ruuskanen O. (2002, May). Differentiation of bacterial and viral pneumonia in children. Thorax. 57(5): 438-441.; PMid:11978922 PMCid:PMC1746322

Wang M, Cai F, Wu X et al. (2015). Incidence of viral infection detected by PCR and real-time PCR in childhood community-acquired pneumonia: a meta-analysis. Respirology. 20: 405-412.; PMid:25615588 PMCid:PMC7169115

Watkins RR. (2022, Jul). Using Precision Medicine for the Diagnosis and Treatment of Viral Pneumonia. Adv Ther. 39(7): 3061-3071. Epub 2022 May 21.; PMid:35596912 PMCid:PMC9123616

WHO. (2022). Pneumonia in children. 11 November 2022. URL:

WHO. (2014.) Revised WHO Classification and Treatment of Pneumonia in Children at Health Facilities: Evidence Summaries. Geneva: World Health Organization. URL:

World Health Rankings (2020). Ukraine: Influenza and Pneumonia. URL: