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公共卫生大会2018:在严重营养不良的儿童肺炎:病因、诊断、管理和未来——Mohammod Jobayer Chisti——国际腹泻病研究中心

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目的:管理问题的声明:肺炎严重营养不良的儿童在减少死亡这样的孩子是非常重要的。了解严重营养不良的儿童肺炎的病因是适当的管理的基本组成部分之一。肺炎的诊断患有严重营养不良的儿童也是有趣的。肺炎的病因和诊断山姆不是医学文献中描述。数据管理的肺炎这样的孩子也缺乏。方法和理论取向:我们已经做了系统回顾使用特定搜索条件在PUBMED评估的整体作用与肺炎山姆孩子严重营养不良的儿童。结果:共有215个分离株中,26%是克雷伯氏菌和金黄色葡萄球菌物种的25%;18%的肺炎球菌;8%的大肠杆菌和沙门氏菌的物种。孟加拉国最近的一项研究发现87/385结核分枝杆菌(23%),肺炎的细菌病原学山姆的孩子。 In SAM children, the sensitivity of fast breathing as a predictor of radio graphically proven pneumonia ranged from 14% to 76% and specificity from 66% to 100%. Surprisingly, metabolic acidosis found to have no impact on the diagnostic clinical features of pneumonia in SAM children having diarrhea. Studies revealed that as a first line therapy ampicillin and gentamicin are more effective against enteric Gram-negative bacilli than chloramphenicol in SAM children with pneumonia. Both the groups received in addition to diet, micronutrients, vitamins and minerals. Conclusions & Significance: Currently, available data suggests that the spectrum and frequency of causative agents of pneumonia in severely malnourished children differ from that observed in well-nourished children. Clinical signs are relatively poor predictors of pneumonia in severely malnourished children. However, injectable antibiotics in addition to diet, micronutrients, vitamins and minerals are the sine qua non. High prevalence of pulmonary tuberculosis in severely malnourished children having acute pneumonia underscores the importance of further research that may help to evaluate determinates of TB in such children. Methods: Systematic search of the existing literature using a variety of databases (Medline, EMBASE, the Web of Science, Scopus and CINAHL). Results: Mortality risk: Sixteen relevant studies were identified, which universally showed that children with pneumonia and moderate or severe malnutrition are at higher risk of death. For severe malnutrition, reported relative risks ranged from 2.9 to 121.2; odds ratios ranged from 2.5 to 15.1. For moderate malnutrition, relative risks ranged from 1.2 to 36.5. Aetiology: Eleven studies evaluated the aetiology of pneumonia in severely malnourished children. Commonly isolated bacterial pathogens were Klebsiella pneumoniae, Staphylococcus aureus, Streptococcus pneumoniae, Escherichia coli, and Haemophilus influenzae. The spectrum and frequency of organisms differed from those reported in children without severe malnutrition. There are very few data on the role of respiratory viruses and tuberculosis. Clinical signs: Four studies investigating the validity of clinical signs showed that WHO-recommended clinical signs were less sensitive as predictors of radiographic pneumonia in severely malnourished children. Conclusions: Pneumonia and malnutrition are two of the biggest killers in childhood. Guidelines for the care of children with pneumonia and malnutrition need to take into account this strong and often lethal association if they are to contribute to the UN Millennium Development Goal 4, aiming for substantial reductions in childhood mortality. Additional data regarding the optimal diagnostic approach to and management of pneumonia and malnutrition are required from regions where death from these two diseases is common.

Mohammod Jobayer Chisti阿布SM Sayeem K M Shahunja Tahmeed艾哈迈德

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