Letter to the Editor
Khamapirad radiologic criteria as a predictor of pneumonia's bacterial etiology
Critérios radiológicos de Khampirad como variável preditora da etiologia da pneumonia bacteriana
Diego Victor Bustamante Heinsohn
Universidad Peruana de Ciencias Aplicadas, Lima, Peru
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Andrade, Cristiana Maria Nascimento-Carvalho" "autores" => array:2 [ 0 => array:2 [ "nombre" => "Dafne C." "apellidos" => "Andrade" ] 1 => array:2 [ "nombre" => "Cristiana Maria" "apellidos" => "Nascimento-Carvalho" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "pt" => array:9 [ "pii" => "S225555361830137X" "doi" => "10.1016/j.jpedp.2018.08.003" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "pt" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S225555361830137X?idApp=UINPBA000049" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S002175571830754X?idApp=UINPBA000049" "url" => "/00217557/0000009400000006/v1_201810280608/S002175571830754X/v1_201810280608/en/main.assets" ] ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Khamapirad radiologic criteria as a predictor of pneumonia's bacterial etiology" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "689" "paginaFinal" => "690" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "Diego Victor Bustamante Heinsohn" "autores" => array:1 [ 0 => array:3 [ "nombre" => "Diego Victor" "apellidos" => "Bustamante Heinsohn" "email" => array:1 [ 0 => "diegobush93@gmail.com" ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Universidad Peruana de Ciencias Aplicadas, Lima, Peru" "identificador" => "aff0005" ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Critérios radiológicos de Khampirad como variável preditora da etiologia da pneumonia bacteriana" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">As the authors propose in their study, the chest X-ray has a significant role in the differentiation and identification of the bacterial etiology of pneumonia.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> The main findings of chest X-ray suggesting a pathology of bacterial origin are: lobar or segmental consolidation, pneumatocele and the presence of a pulmonary abscess. These findings are significantly associated with a typical bacterial infection.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Despite this, in most cases typical bacterial pneumonia – mainly in the early stages of the disease – is not accompanied by those classic radiographic patterns.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> On the other hand, some viral infections are capable of showing similar radiological patterns; for example, a consolidation pattern can be observed in an adenovirus infection.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> This scenario is a barrier to the etiological diagnosis based solely on the chest X-ray. Virkki et al., in a study of 215 children with Acquired Pneumonia in the Community (NAC), of which 62% had bacterial etiology and the rest were exclusively viral, found that the alveolar infiltrates had a sensitivity of 72% and a specificity of 51% to identify a bacterial etiology.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a> They also reported that the specificity increased up to 85% when the alveolar infiltrates were of the lobar type, mainly in children under 2 years of age. The interstitial infiltrates, on the other hand, failed to adequately differentiate between viral and bacterial pneumonia. The hyperaerial, atelectasis and small pleural effusion also had no significance for this differentiation.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">In contrast, Moreno et al. found in children with NAC a great correlation of the interpretation of chest radiographs in those read both by a pediatrician and by radiologists, which translated into excellent diagnostic accuracy. The radiological scale they used was the Khamapirad scale, which showed a sensitivity of 100% (95% CI: 90–100%), specificity of 98% (95% CI: 93–99%), a positive predictive value of 96% (95% CI: 85–99%), and a negative predictive value of 100% (95% CI: 96–100%) to predict bacterial pneumonia with a simple chest plaque X-ray.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a> This study strongly reinforces the usefulness of an X-ray for the etiological diagnosis of bacterial pneumonia as well as its usefulness to rule it out when the result is negative.</p><p id="par0020" class="elsevierStylePara elsevierViewall">In addition to this, Torres et al., also using the Khamapirad scale, found in their study of children hospitalized by NAC a sensitivity of 100% (95% CI: 83–100%), specificity of 94% (95% CI: 88–97%), a positive predictive value of 77% (95% CI: 58–90%), and a negative predictive value of 100% (95% CI: 96–100%) to predict bacterial pneumonia.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a> This corroborates the findings of all the aforementioned authors and shows us the capacity of bacterial etiological identification through the use of a chest X-ray and an adequate scale.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a> Ultimately, Guanoluisa and Geovanny obtained a kappa index of 0.87 which represents a very good accordance. In this study, they also used the Khamapirad scale to evaluate chest radiographs of children.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Based on the findings of the study by Andrade et al., and in addition to the reviewed literature, it can be concluded that the use of the Khamapirad scale on a chest radiograph to identify the bacterial etiology of pneumonia is quite accurate, both for the confirmation of the etiology and to dismiss it according to the radiologic score. The use of an evaluation score like that of Khamapirad allows a better sensitivity and specificity of the chest X-ray. In this way, it is recommended that these criteria be introduced to physicians in order to improve the etiological identification and therapeutic management of pediatric patients with a diagnosis of pneumonia, especially in areas where pediatricians are not found.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Funding</span><p id="par0030" class="elsevierStylePara elsevierViewall">This letter to the editor was funded by the author itself.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0045" class="elsevierStylePara elsevierViewall">The author declares no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Conflicts of interest" ] 2 => array:2 [ "identificador" => "xack373729" "titulo" => "Acknowledgement" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Bustamante DV. Khamapirad radiologic criteria as a predictor of pneumonia's bacterial etiology. J Pediatr (Rio J). 2018;94:689–90.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0035" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Infection by Streptococcus pneumoniae in children with or without radiologically confirmed pneumonia" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D.C. Andrade" 1 => "I.C. Borges" 2 => "A.L. Vilas-Boas" 3 => "M.S. Fontoura" 4 => "C.A. Araújo-Neto" 5 => "S.C. 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Ruuskanen" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Thorax" "fecha" => "2002" "volumen" => "57" "paginaInicial" => "438" "paginaFinal" => "441" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11978922" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0050" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Validez de la radiografía de tórax para diferenciar etiología bacteriana de viral en niños hospitalizados con neumonía" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "L. Moreno" 1 => "E. Bujedo" 2 => "H. Robledo" 3 => "R. Conci" 4 => "Inés Marqués" 5 => "L. Mosca" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Arch Argent Pediatr" "fecha" => "2006" "volumen" => "104" "paginaInicial" => "109" "paginaFinal" => "113" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0055" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Capacidad para predecir etiología con la radiografía de tórax en niños hospitalizados con neumonía" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "F. Torres" 1 => "M.J. Chiolo" 2 => "N. González" 3 => "P. Durán" 4 => "M.F. Ossorio" 5 => "M.J. Rial" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Arch Argent Pediatr" "fecha" => "2006" "volumen" => "104" "paginaInicial" => "106" "paginaFinal" => "108" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0060" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Utilidad del score de neumonía bacteriana en el diagnóstico etiológico de los niños de 1 mes-5años con neumonía adquirida en la comunidad hospitalizados en el Hospital Alfredo Noboa Montenegro - período noviembre 2016 – abril 2017 [thesis]" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "C. Guanoluisa" 1 => "K. Geovanny" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "2017" "editorial" => "Universidad Regional Autónoma de los Andes “Uniandes”" "editorialLocalizacion" => "Ambato, Equator" ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack373729" "titulo" => "Acknowledgement" "texto" => "<p id="par0040" class="elsevierStylePara elsevierViewall">The author would like to thank Dr. Juan Francisco Sanchez (Lima, Perú) for all the help and advice given during the development of this letter.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/00217557/0000009400000006/v1_201810280608/S0021755718305151/v1_201810280608/en/main.assets" "Apartado" => array:4 [ "identificador" => "18984" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/00217557/0000009400000006/v1_201810280608/S0021755718305151/v1_201810280608/en/main.pdf?idApp=UINPBA000049&text.app=https://jped.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0021755718305151?idApp=UINPBA000049" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 5 | 3 | 8 |
| 2024 October | 33 | 12 | 45 |
| 2024 September | 32 | 27 | 59 |
| 2024 August | 49 | 32 | 81 |
| 2024 July | 55 | 32 | 87 |
| 2024 June | 52 | 14 | 66 |
| 2024 May | 44 | 7 | 51 |
| 2024 April | 73 | 19 | 92 |
| 2024 March | 47 | 22 | 69 |
| 2024 February | 26 | 29 | 55 |
| 2024 January | 29 | 26 | 55 |
| 2023 December | 25 | 18 | 43 |
| 2023 November | 29 | 36 | 65 |
| 2023 October | 33 | 33 | 66 |
| 2023 September | 27 | 37 | 64 |
| 2023 August | 25 | 15 | 40 |
| 2023 July | 36 | 13 | 49 |
| 2023 June | 21 | 11 | 32 |
| 2023 May | 24 | 15 | 39 |
| 2023 April | 16 | 11 | 27 |
| 2023 March | 29 | 16 | 45 |
| 2023 February | 19 | 20 | 39 |
| 2023 January | 21 | 17 | 38 |
| 2022 December | 34 | 27 | 61 |
| 2022 November | 29 | 27 | 56 |
| 2022 October | 30 | 30 | 60 |
| 2022 September | 34 | 35 | 69 |
| 2022 August | 28 | 30 | 58 |
| 2022 July | 29 | 28 | 57 |
| 2022 June | 24 | 26 | 50 |
| 2022 May | 23 | 27 | 50 |
| 2022 April | 26 | 35 | 61 |
| 2022 March | 30 | 40 | 70 |
| 2022 February | 30 | 22 | 52 |
| 2022 January | 14 | 19 | 33 |
| 2021 December | 27 | 19 | 46 |
| 2021 November | 17 | 12 | 29 |
| 2021 October | 17 | 23 | 40 |
| 2021 September | 13 | 4 | 17 |
| 2021 August | 6 | 11 | 17 |
| 2021 July | 5 | 5 | 10 |
| 2021 June | 10 | 8 | 18 |
| 2021 May | 14 | 16 | 30 |
| 2021 April | 10 | 9 | 19 |
| 2021 March | 15 | 13 | 28 |
| 2021 February | 6 | 9 | 15 |
| 2021 January | 8 | 7 | 15 |
| 2020 December | 10 | 8 | 18 |
| 2020 November | 12 | 11 | 23 |
| 2020 October | 9 | 9 | 18 |
| 2020 September | 15 | 12 | 27 |
| 2020 August | 9 | 3 | 12 |
| 2020 July | 6 | 8 | 14 |
| 2020 June | 7 | 5 | 12 |
| 2020 May | 15 | 6 | 21 |
| 2020 April | 8 | 16 | 24 |
| 2020 March | 8 | 15 | 23 |
| 2020 February | 17 | 12 | 29 |
| 2020 January | 25 | 16 | 41 |
| 2019 December | 11 | 5 | 16 |
| 2019 November | 13 | 3 | 16 |
| 2019 October | 21 | 13 | 34 |
| 2019 September | 22 | 17 | 39 |
| 2019 August | 15 | 11 | 26 |
| 2019 July | 17 | 11 | 28 |
| 2019 June | 20 | 11 | 31 |
| 2019 May | 15 | 12 | 27 |
| 2019 April | 17 | 16 | 33 |
| 2019 March | 17 | 8 | 25 |
| 2019 February | 10 | 6 | 16 |
| 2019 January | 28 | 12 | 40 |
| 2018 December | 24 | 13 | 37 |
| 2018 November | 28 | 7 | 35 |
| 2018 October | 19 | 12 | 31 |
| 2018 September | 8 | 0 | 8 |
| 2018 August | 13 | 6 | 19 |
| 2018 July | 6 | 5 | 11 |
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