To the Editors-in-Chief of “Pediatric Infectious Disease Journal” Dear John D. Nelson, MD, Dear George H. McCracken, MD The article by K. Ampofo et al.(1) about pneumococcal diseases (PD) once again presents a valuable opportunity to critically evaluate the problem of “complicated pneumonia/empyema in children”. Quote from the article: “Despite decrease in PD among Utah children, complicated pneumonia/empyema has increased during the 7-valent pneumococcal conjugate vaccine era”… “The causes on increasing rates of empyema are unclear”… My question is: why unclear? Our understanding of the reasons of the AP complications development must be based, first of all, on well-known facts. And these facts state the following: First of all, AP is permanent nosology with non-permanent etiology. This disease does not have permanent and/or specific pathogen. The etiology of AP is distinguished by the variety of its microflora and the often change of its “leaders”. One of the examples to this is the famous “staphylococcal disaster”, which (few decades ago) was considered the main pathogen on the list of pathogens, but now-a-days is replaced by other pathogens. In the present, Staphylococcus is still amongst AP pathogens, but Pneumococcus is also not the unique one in the list. Today, according to World Health Organization(2), two microbes prevail in AP etiology – Streptococcus pneumonia and Haemophilus influenzae. Therefore, in times of etiological multiplicity of AP, we should not expect any positive results from specific vaccination! By trying to protect the patient’s organism from one non-specific microbe, we are “vacating” more room for its competitors, i.e. other microbes. As we know, there is no vacuum in living nature. It is unfortunate that the author of the articles did not include any results of microbiological empyema. Second, according to the data from WHO “…vast majority of cases of childhood pneumonia can be administered effectively within the home”. But “hospitalization is recommended …in very severe cases”. On the one hand, this demonstrates the common principles of division of patients into two groups: conditions and place of treatment of each patient depends on the seriousness of the initial stage of AP. Moreover, the first, more representative group is cured from AP without the necessity to establish its etiology. By doing so, we leave the question of the pathogen open. On the other hand, the necessity and the possibility of bacteriological examination (research) of the material directly from the inflammatory zone emerge just among the hospitalized patients in case of pleural complications development. The results, obtained in the course of the treatment (altogether with other tests, like laboratory, roentgenology etc) are one of additional characteristics of the nonspecific inflammation, but are valued after all as the main cause for the disease. To my opinion, this evident error is not reviewed or reevaluated, despite numerous publications about the role of different microorganisms in the lung nonspecific inflammation. And the fact that certain percent of bacteriological research and examination from the inflammatory zone do not discover microflora and the disease and its complications can progress despite the treatment, is also well-known. In my previous research of AP problem I leant on the thesis that the dynamics of the inflammatory process in lung depends on the organism’s reactivity and that the treatment (in case of rapid development of the disease) must be administered according to the AP pathogenesis. The achieved results confirmed the correctness of this particular approach. The attempts to solve the complicated form of AP by concentrating on the disease etiology are leading the researches in wrong direction. Every new publication convinces me that this error is widespread, and, unfortunately the article in the subject is not exclusion. With best regards, Igor Klepikov, MD Sources:
CC: pidjournal@yahoo.com Jan 21 2012 12:39:16 Re: MS PIDJ 212-45 Title: Evolution of the epidemiology of Pneumococcal Disease among Utah Children through the vaccine era Dear Dr. Klepikov: We have decided not to publish for letter-to-the-editor. The authors declined to prepare a response and, in fact, were uncertain what specific questions you were asking. We do not feel that you letter merits publication. We sincerely hope that this action will not discourage you from submitting articles to our journal in the future. Thank you. Yours truly, THE CHIEF EDITORS JDN/GHMc:asn |
Saturday, February 25, 2012
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