Prevalence of community-acquired pneumonia among Egyptian children from urban areas of the Delta region: a cross-sectional study
Authors: Zedan Magdy , Abousamra Nashwa , Osman Engy , Emad Eldin Rania M. 
Published: December 2024

Background
Community-acquired pneumonia (CAP) is one of the leading causes of morbidity and mortality among children under 5 years in developing countries. It is a common and severe lower respiratory tract infection, and it is recognized as “the forgotten killer of children.”

Aim
To detect the prevalence of CAP among Egyptian children from urban areas of the Delta region and to evaluate clinical phenotypes of CAP cases.

Patients and methods
This cross-sectional study was conducted for infants, children, and adolescents with CAP aged from 2 months up to 16 years admitted to the Mansoura University Children Hospital from 2016 to 2022. The cases were divided into two groups: either typical CAP or atypical CAP, and their clinical characteristics were evaluated.

Results
Out of the total admissions to Mansoura University Children Hospital, the prevalence of CAP cases in the Delta region was 1.96% among all admitted cases. However, the prevalence of CAP cases from urban Delta regions was 17.4% and the prevalence from rural Delta regions was 22.6%. Out of the children with CAP from urban Delta regions, the prevalence of children diagnosed as typical CAP was 71.6%. However, the prevalence of atypical CAP was 28.4%. In the current study, the commonest age for CAP was from 3 months up to 5 years (56.6%), with equal sex distribution, and children who were diagnosed with typical CAP had a significantly higher median age (2 years). There was a statistically significantly higher prevalence of fever, wet cough, recurrent infection, and rales in children with typical CAP compared with those with atypical CAP. The prevalence of complications, including respiratory failure and pleural effusion, were significantly higher among typical CAP patients compared with atypical CAP (P<0.001). However, none of the cases with atypical CAP had developed parapneumonic effusion as a complication. Children with atypical CAP had significant thrombocytosis and lymphocytosis compared with typical CAP. Regarding radiology children with typical CAP had a significantly higher prevalence of bilateral bronchopneumonia (46.9%) and parapneumonic effusion (13.5%), when compared with those with atypical CAP (P<0.001). Also, there was a significantly higher prevalence of interstitial pneumonia (50.0%) and collapse (10.5%) among children with atypical CAP compared with those with typical CAP. The distribution of antibiotic showed that the proportion of beta-lactamase inhibitors and macrolides were significantly higher among children with atypical CAP compared with those with typical CAP (P<0.001).

Conclusion
The prevalence of CAP cases in the Delta region was 1.96%, while the prevalence of CAP cases from urban Delta regions was 17.4% and from rural Delta regions was 22.6%. Out of children with CAP from urban Delta regions, the prevalence of children diagnosed as typical CAP was 71.6% whereas those diagnosed as atypical CAP was 28.4%. In our study, cough, fever, and respiratory distress (mainly tachypnea) are the main presenting signs of pediatric CAP. Typical CAP is more prevalent than atypical and causes severe forms of disease.