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Laboratory diagnosis of infection 

Laboratory diagnosis of infection
Chapter:
Laboratory diagnosis of infection
DOI:
10.1093/med/9780198729228.003.0021
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date: 26 June 2019

The respiratory tract is the commonest site of childhood infections, and acute respiratory infections make up 50% of all illnesses in children aged under 5 years. Most involve only the upper respiratory tract, but about 5% will involve the larynx and lower respiratory tract. Lower respiratory tract infection (LRTI) is commonest in the first year of life. The spectrum of organisms is wide and varies with age. In the newborn, pneumonia is usually due to organisms acquired from the mother’s genital tract before or during delivery. After the first month of life, the vast majority of respiratory infections are due to viruses (respiratory syncitial virus, parainfluenza, influenza, human metapneumovirus, coronavirus, bocavirus, adenovirus, rhinovirus), Chlamydophila pneumoniae, Mycoplasma pneumoniae, and Streptococcus pneumoniae. Bacterial superinfection during respiratory viral or mycoplasmal infections can occur. Usually the specific aetiology of an LRTI cannot be clinically determined. Developments in medical microbial diagnostic technology, such as nucleic acid technology and polymerase chain reaction, are increasing the proportion of respiratory infections that can be identified definitively. Treatment of LRTI is mainly supportive. Antibiotics should be prescribed in pneumonia because of the difficulty of differentiating bacterial from viral infections, particularly in very young or very sick children. The child’s age and likely pathogen can help to determine the initial choice of antibiotic. More research is required in the aetiology of LRTI and the reasons for its complications, a better definition of first- and second-line antibiotic therapies, the role of antiviral treatment, how to follow up patients with LRTI, and vaccination coverage.

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