Pediatric Pulmonology 45:1009–1013 (2010) Radiographic Findings Among Children Hospitalized With Severe Community-Acquired Pneumonia F. Ferrero, 1 * C.M. Nascimento-Carvalho, 2 M.-R. Cardoso, 3 P. Camargos, 4 M.-F.P. March, 5 E. Berezin, 6 R. Ruvinsky, 7 C. Sant’Anna, 5 J. Feris-Iglesias, 8 R. Maggi, 9 Y. Benguigui, 10 and the CARIBE group Summary. Background: Community-acquired pneumonia (CAP) is a leading cause of childhood death. There are few published reports of radiographic findings among children with severe CAP. Objective: To describe chest X-ray (CXR) findings and assess association between these radiographic findings and pneumococcal isolation in children with severe CAP. Methods: A prospective, multicenter, observational study was conducted in 12 centers in Argentina, Brazil, and the Dominican Republic. Children aged 3–59 months, hospitalized with severe pneumonia, were included. On admission, blood and pleural effusion cultures were performed. Streptococcus pneumoniae was identified according to standard procedures in the respective national reference laboratory. Chest X-rays were taken on admission and read before the culture results were reported. Results: Out of 2,536 enrolled patients, 283 (11.2%) had S. pneumoniae isolated, in 181 cases (7.1%) from blood. The follow radiographic patterns were observed: alveolar infiltrate (75.2%), pleural effusion (15.6%), and interstitial infiltrate (9.2%). Overall, pleural effusion was associated with pneumococcal isolation and pneumococcal bacteremia (P < 0.001). Infiltrates were unilateral (78.7%) or bilateral (21.3%), right-sided (76%) or left-sided (24%), in the lower lobe (53.6%) or the upper lobe (46.4%). Multivariate analysis including patients with affection of only one lobe showed that upper lobe affection and pleural effusion were associated with pneumo- coccal isolation (OR 1.8, 95% CI, 1.3–2.7; OR 11.0, 95% CI, 4.6–26.8, respectively) and with pneumococcal bacteremia (OR 1.7, 95% CI, 1.2–2.6; OR 3.1, 95% CI, 1.2–8.0, respectively). Conclusions: Three-quarters of the patients studied had alveolar infiltrates. Upper lobe compromising and pleural effusion were associated with pneumococcal invasive disease. Pediatr Pulmonol. 2010; 45:1009–1013. ß 2010 Wiley-Liss, Inc. Key words: bacteremia; chest X-ray; pleural effusion; respiratory tract infection; Streptococcus pneumoniae. Funding source: none reported. INTRODUCTION Community-acquired pneumonia (CAP) is a leading cause of childhood morbidity and mortality, causing up to 2 millions deaths each year worldwide among children younger than 5 years of age. 1 With a view to reducing these rates, the World Health Organization (WHO) has issued guidelines that recommend the use of simple clinical signs 1 Hospital de Nin ˜os Pedro de Elizalde, Buenos Aires, Argentina. 2 Department of Pediatrics, School of Medicine, Federal University of Bahia, Salvador, Brazil. 3 Faculty of Public Health, Sa ˜o Paulo University, Sa ˜o Paulo, Brazil. 4 Department of Pediatrics, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil. 5 Martaga ˜o Gesteira Pediatric Institute, Rio de Janeiro, Brazil. 6 Santa Casa de Sa ˜o Paulo Medical School, Sa ˜o Paulo, Brazil. 7 Hospital General Carlos Durand, Buenos Aires, Argentina. 8 Hospital Infantil Dr. Robert Reid Cabral, Santo Domingo, Dominican Republic. 9 Instituto de Medicina Integral Profesor Fernando Figueira, Pernambuco, Brazil. 10 Child and Adolescent Health Unit, Pan American Health Organization, Washington, District of Columbia. *Correspondence to: Dr. F. Ferrero, Amenabar 1935, Buenos Aires C1428CUV, Argentina. E-mail: fferrero@intramed.net Received 2 February 2010; Revised 29 April 2010; Accepted 30 April 2010. DOI 10.1002/ppul.21287 Published online 20 July 2010 in Wiley Online Library (wileyonlinelibrary.com). ß 2010 Wiley-Liss, Inc.