Childhood pneumonia diagnostics: a narrative review.

BACKGROUND: Childhood pneumonia remains the leading infectious cause of death in children with highest mortality figures in sub-Saharan Africa and Southeast Asia. The primary etiologies are bacterial and viral; however, challenges in distinguishing bacterial and non-bacterial causes have culminated in antimicrobial overuse which has partly contributed to the rise in antimicrobial resistance, most notably among children in low- and middle-income countries.

AREAS COVERED: Existing literature was reviewed regarding modalities available, including emerging radiological and laboratory techniques, to diagnose childhood pneumonia. We evaluated their strengths and limitations, and their ability to distinguish between bacterial and viral etiologies.

EXPERT OPINION: The optimal modality to diagnose childhood pneumonia continues to be a challenge. This is a concern given its high disease burden and the importance of diagnostics for clinical care and antimicrobial stewardship, in the setting of rising antimicrobial resistance. Lung ultrasonography is a promising radiologic diagnostic modality. Combined serum biomarkers, micro-array-based whole-genome expression arrays and metabolomic analysis are also emerging biochemical modalities for childhood pneumonia diagnosis. More research and further validation are required to evaluate the diagnostic strengths of these new and emerging modalities as well as their ability to discriminate between the major etiologies of the disease.