Current challenges in lower respiratory infections in children.

PURPOSE OF REVIEW: Lower respiratory infections threaten the health of children worldwide. Streptococcus pneumoniae remains the most common bacterial cause of lower respiratory infection in children, whereas viral pathogens dominate as a more common cause of lower respiratory infection illness in infants and children overall. The diagnosis and clinical management of lower respiratory infections pose challenges to pediatric health providers as new technology is developed and new pathogens emerge in the spectrum of clinical disease.

RECENT FINDINGS: Human metapneumovirus is now recognized as a cause of lower respiratory infection disease in children, and coronavirus has been linked to epidemics of severe acute respiratory syndrome. Respiratory syncytial virus continues to be a major source of viral lower respiratory infection illness in children and can lead to childhood asthma. Treatment for respiratory syncytial virus bronchiolitis depends largely on the severity of disease and the course of clinical symptoms. The diagnosis of bacterial lower respiratory infection disease remains a clinical challenge, but new methods to detect S. pneumoniae, or Chlamydia pneumoniae and Mycoplasma pneumoniae may facilitate the clinical management of these illnesses. As immunization against S. pneumoniae becomes more widely used, the complications of bacterial lower respiratory infections will diminish markedly.

SUMMARY: Future progress in the clinical management of lower respiratory infection diseases will entail improved methods of early diagnosis, broader options for treatment, and better defined clinical parameters for triage and follow-up of children with lower respiratory infections.