الفهرس 
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Abstract
Community-acquired pneumonia (CAP) is one of the most common serious infections in children. Its incidence among children aged less than 5 years in developing countries reached 0.29% child per year, with a mortality rate of 1.3–2.6%.
Determining the cause of pneumonia in a child is often difficult, but the patient’s age can help narrow the list of likely etiology a significant number of CAP (8-40%) are mixed infections, in which many of the above mentioned pathogens may be involved (British Thoracic Society. 2002). Juven et al. found mixed viral-bacterial infections in 30%, mixed viral-viral infections in 13% and mixed bacterial-bacterial infections in 7% of cases (Juven et al., 2000).
Three severity scores in pediatric populations can be used in the assessment of CAP, the Respiratory Index of Severity Score (RISC), (Reed et al., 2012) the Pediatric Respiratory Severity Score (PRESS), (Miyaji et al., 2015) and the Predisposition, Insult, Response, Organ dysfunction modified (PIROm) (Araya et al., 2016)
Treatment decisions of CAP are based on the child’s age and clinical and epidemiologic factors. (McIntosh, 2002) Antibiotic therapy should be initiated promptly in children who are thought to have bacterial CAP. Because definitive information about the causative organism is usually unknown, the choice of antibiotic is empiric (McCracken, 2000)
Cytokines are important mediators in both lung defense and inflammation, several cytokines have been studied in relation to severity, aetiology and outcome of CAP. Although the number of cytokines identified in the immunopathogenesis of CAP has increased considerably over the years, studies remain focused on well-known cytokines of the innate immune response, including interleukin (IL)-6, IL-10, IL-8, IL-1β and tumour necrosis factor (TNF)-α. IL-17A and IL-22, which belong to the novel T-helper (Th) 17 subset, have also been implicated in CAP. Furthermore, interferon (IFN)-γ is an important cytokine in both innate and adaptive immunity to respiratory pathogens and IL-4 might be important in the immune response against Mycoplasma pneumonia. Further characterisation of local and systemic cytokine responses in CAP patients may increase our understanding of the host defence, with the goal of providing prognostic tools for clinicians or identifying potential therapeutic targets (Moret et al., 2011).
Cytokines such as IL-6 are important mediators in both lung defense and inflammation. They can have pro- or anti- therapeutic targets inflammatory effects depending on multiple interacting microbiologic, environmental, and genetic factors that influence host response to respiratory infections
The study aimed to assess the serum IL-6 in hospitalized children with community-acquired pneumonia and its relation to the severity of pneumonia.
This study included 88 children divided into two group the first group included 73children with CAP requiring hospitalization from Menoufia University Hospital and the second group included 15 healthy children.
For all children with CAP, the vital sign and oxygen saturation were monitored. The diagnostic work up included, bedsides routine investigation, chest x ray, blood gas analysis, complete blood count, blood culture. Serum IL-6 and CRP were measured for each patient within 24 hours of hospital admission.
For the control group, history, clinical examination, and routine laboratory investigations were performed besides serum IL-6 measurement.
IL-6 of patients is significantly higher than that of control and also IL-6 level was shown to increase significantly with pneumonia severity as determined by WHO and RISC, PRESS and PIROM score.
Further more IL-6 was significantly higher in the patient subgroups showing indicators of pneumonia severity such as SIRS, hypoxia, lobar consolidation, shock, and bacteremia. The highest IL-6 level was found among the two patients who died.
Also IL-6 has the highest sensitivity, and specificity for prediction of severe pneumonia compared with CRP, WBC, and platelet count
So it could be concluded that;
1- IL-6 is significantly higher among children with CAP compared with healthy controls.
2- IL-6 is significantly higher among children with severe pneumonia as determined by several classification systems, including WHO, PRESS, PIROm, and RISC.
3- IL-6 showed significant correlations with RISC, PRESS, and PIROm.
4- IL-6 is significantly elevated among children with lower SPo2, invasive mechanical ventilation, bacteremia, SIRS, PICU admission, shock, lobar consolidation, and prolonged PICU stay.
5- IL-6 is an excellent biomarker for prediction of CAP severity compared with CRP, WBC, and platelet count.