May 2, 2014

Should a breathless child with fever be treated withantibiotics in case they have pneumonia? This is the question emergency doctors ask themselves many times a day, and currently it takes over 24 hours to get a definitive answer.

Pneumonia remains the leading cause of death in children globally. Being able to tell whether a child has severe pneumonia caused by bacteria which must be treated quickly with antibiotics is critical.

A paper published in leading journal Clinical Infectious Diseases by Dr Climent Casals-Pascual, a researcher at the University of Oxford’s Wellcome Trust Centre for Human Genetics, has revealed that a protein “clue” detected in the blood can be used to diagnose pneumonia caused by bacteria in minutes. The rights to develop and manufacture the test are available through Isis Innovation, the University of Oxford’s technology commercialisation company.

Casals-Pascual said: “Making a quick and accurate diagnosis can have a major impact on the outcome for all children with pneumonia. Pneumonia can be caused by viruses or by bacteria. The critical question is to identify those pneumonia cases caused by bacteria, so that antibiotics can be given immediately.

“This test will be particularly important for children in remote areas or in the developing world where an x-ray or blood culture diagnosis is rarely available.”

The researchers found the protein biomarker by undertaking a painstaking and detailed comparison of blood samples from 390 children in Gambia with and without pneumonia.

“This biomarker can be developed into a test that is faster and more sensitive than blood cultures or x-rays,” said Casals-Pascual.

“We can also use this test to distinguish between those children who are breathless with malaria and those with pneumonia, and treat each child quickly and appropriately.”

Dr Casals-Pascual received funding from the Medical Research Council to work in collaboration with the MRC Unit, The Gambia, to identify these new biomarkers and with the KEMRI Wellcome Trust Unit in Kilifi, Kenya, to validate these findings.

Pneumonia facts:

  • Pneumonia is the single largest cause of death in children worldwide.
  • Pneumonia causes 1.1 million deaths every year in children younger than five (WHO data)/li>
  • Pneumonia accounts for 18% of all deaths of children under five years old worldwide/li>
  • Streptococcus pneumoniae is the most common cause of bacterial pneumonia in children/li>
  • Delayed diagnosis is an important risk factor for death in children with pneumonia/li>
  • In sub-Saharan Africa, malaria and septicaemia are also commonly associated with respiratory distress in children, making diagnosis difficult

Pneumonia diagnosis (current)

  • Bacterial culture-confirmation of pneumococcal infection takes at least 24 hours
  • Lack of microbiology facilities in developing countries – and in primary care or after-hours clinics in developed countries – limits rapid diagnosis
  • Rapid pneumonia tests using the biomarkers may replace time-consuming and labour-intensive methods, giving a diagnosis within hours

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