Open Access

Viral and bacterial pathogens identification in children hospitalised for severe pneumonia and parapneumonic empyema

  • Jean-Noel Telles14,
  • Nathalie Richard24,
  • Yves Gillet24,
  • Susanne Hartwig14,
  • Stéphane Pouzol14,
  • Sandra Dollet14,
  • Melina Messaoudi14,
  • Elodie Paredes14,
  • Christine Ploton34,
  • Gerard Lina34,
  • Guy Vernet14,
  • Daniel Floret34,
  • Etienne Javouhey34 and
  • Gláucia Paranhos-Baccalà14Email author

Received: 22 August 2012

Accepted: 31 October 2012

Published: 9 November 2012


Pneumonia is caused by respiratory bacteria and/or viruses. Little is known if co-infections are an aggravating factor in hospitalised children with severe pneumonia. We studied the impact of respiratory pathogens on the severity of pneumonia. Between 2007 and 2009, 52 children hospitalised with a well-documented diagnosis of community-acquired pneumonia (CAP), with or without parapneumonic empyema (PPE), were enrolled in the study. The patients were classified into 2 groups: CAP + PPE (n = 28) and CAP (n = 24). The identification of respiratory viruses and bacteria in nasopharyngeal aspirates and pleural effusion samples were performed using conventional bacterial techniques and molecular assays. Using real-time multiplex PCR and antigen detection, Streptococcus pneumoniae was the main agent identified in 76% of the cases by molecular tests and BinaxNOW® in pleural fluid. A total of 8% of pleural fluid samples remained undiagnosed. In nasopharyngeal aspirates, rhinovirus, parainfluenza viruses, human metapneumovirus, and respiratory syncytial virus were detected in both CAP and CAP + PPE populations; however, the percentage of viral co-detection was significantly higher in nasopharyngeal aspirates from CAP + PPE patients (35%) compared with CAP patients (5%). In conclusion, viral co-detection was observed mainly in patients with more severe pneumonia. Molecular biology assays improved the pathogens detection in pneumonia and confirmed the S. pneumoniae detection by BinaxNOW® in pleural effusion samples. Interestingly, the main S. pneumoniae serotypes found in PPE are not the ones targeted by the heptavalent pneumococcal conjugate vaccine.


Respiratory pathogensaetiologyReal-time multiplex PCRS. pneumoniae serotyping