Table 4

Prospective studies of specific pathogens from developed countries

Reference [evidence level]AgeYear and settingTestsTotal episodesViral (n)Bacteria, % (n)Mycoplasma, % (n)Chlamydia, % (n)Mixed, % (n)Total diagnosed, % (n)
Wolf23 [Ib]<5 yearsEDNPA hMPV PCR; NPIA1296RSV 23.1
hMPV 8.3
Adeno 3.4
Infl A 2.9
PIV 2.9
Cilla24 [Ib]1–35 months2004–6, Spain, IP+OPNPIA + PCR, BC, serology, Binax pleural fluid33867 (18 viral co-infection)
RSV 19.8
HboV 14.2
RV 13.6
HMPV 11.5
Corona 6.5
Spn 2.1 (7)1.8 (6)*NANA
Haman25 [II]0–19 years2005–6, JapanNPA PCR170027.9 (2.1% multiple)
RV 14.5
RSV 9.4
hMPV 7.2
HboV 2.9
14.8 (251)1.4 (24)15.2NA
Don26 [II]0.3–16 years2001–2, Italy, IP+OPSerology (viral and bacterial)10142 (3 dual)
RSV 17
PIV 12
Infl 9
hMPV 5
44
Spn18
HI 3
Mcat 1
26.7 (27)
<2 years: 1
2–5 years: 8
>5 years: 18
p<0.0001
7.9 (8)2065 (66)
Lin27 [II]3 months–18 years2001–2, Taiwan, IPNPIA, NPVC; hMPV PCR; BC; urine Spn ag; serology MP+CP11638.8 (45)
RSV 28.9
Adeno 28.9
hMPV 13.3
Infl 13.3
37.9 (44)4.3 (5)NANA
Michelow28 [Ib]6 weeks–18 years1999–2000, USA, IPNPIA, NPVC; Spn BPCR; BC; serology viral, Spn, MP, CP15445 (65)
RSV 13
Infl 22
PIV 13
Adeno 7
60 (93)
Spn 44 (68)
GAS 1 (2)
SA 1 (2)
14 (21)9 (14)2379 (122)
Macherel29 [Ib]2 months–5 years2003–5, Switzerland: IPNPIA + PCR; Spn BPCR; BC; serology viral, Spn, MP, CP;9967
RV 20h
MPV 13
RSV 13
Infl 14
Paraflu 13
Adeno 7
Corona 7
53 (52)
Spn 46 (45)
GAS 1 (1)
11733 (33)86 (85)
Drummond30[II]0–16 years1996–8, UK, IPNPIA; NPVC; serology viral, Spn, MP, CP; urine Spn ag;13637 (50)
RSV 25
Infl A 5
CMV 3
Adeno 1.4
12.5 (17)
GAS 7 (9)
Spn 4 (5)
2 (3)11 (15)51 (70)
Laundy31[II]0–5 years2001–2, UK, IP+OPNPIA+PCR;BC; specifically viral testing5143 (22)
RSV 18 (9)
Infl A 16 (8)
Adeno 6 (3)
PIV 6 (3)
12 (6)
Spn 6
4 (2)NANA49 (25)
Tsolia32[Ib]5–14 years2004, Greece, IPNPA PCR; serology MP, CP, Spn, HI, Mcat;7565 (49)
RV 45 (34)
Adeno 12 (9)
PIV 8 (6)
Infl 7 (5)
RSV 3 (2)
hMPV 1 (1)
40 (30)
Spn 7 (5)
35 (26)3 (2)28 (21)77 (58)
  • * No serological tests were performed for Chlamydia pneumoniae.

  • All bacterial cases identified by NPA PCR so difficult to distinguish carriage from pathogen.

  • Adeno, adenovirus; ag, antigen; BC, blood culture; BPCR, blood PCR; Corona, coronavirus; CP, Chlamydia pneumoniae; ED, emergency department; GAS, group A streptococcus; HboV, human bocavirus; HI, Haemophilus influenzae; hMPV, human metapneumovirus; Infl, influenza A and B virus; IP, inpatients; Mcat, Moraxella catarrhalis; MP, mycoplasma; NA, not available; NPA PCR, nasopharyngeal PCR; NPIA, nasopharyngeal immunoassay; NPVC, nasopharyngeal viral culture; OP, outpatients; PIV, parainfluenza virus 1–3; PC, pharyngeal culture; RSV, respiratory syncytial virus; RV, rhinovirus; Spn, Streptococcus pneumoniae.