Etiology of infection and morphologic changes in the lungs of Filipino children who die of pneumonia.

Histopathologic studies and isolation of virus and bacteria in culture were carried out for 71 children less than 5 years of age with fatal pneumonia. A potential microbial etiology was identified for 61 children (86%): bacteria for 19 (27%), virus for 16 (23%), and virus plus bacteria for 26 (37%). Staphylococcus was the most prevalent pathogen, alone or in combination with other organisms, followed by Pseudomonas aeruginosa. Viral infection may predispose to bacterial infection in some children. A correlation of clinical course, results of cultures, and morphologic changes revealed cofactors that may have contributed to a fatal outcome. Lung abscess, pericarditis, myocarditis, endocarditis, and meningitis were associated with bacterial infection. Many patients in this study had severe bronchopneumonia, with a high prevalence of complications such as abscess (62%), atelectasis (40%), pericarditis (28%), and empyema (7%). Such complications added to multiple infections, measles, and malnutrition contributed to the fatal outcome in these children.