Intended for healthcare professionals

Clinical Review State of the Art Review

Advances in the diagnosis of pneumonia in children

BMJ 2017; 358 doi: (Published 26 July 2017) Cite this as: BMJ 2017;358:j2739
  1. Heather J Zar, professor and chair, Department of Paediatrics and Child Health1,
  2. Savvas Andronikou, professor1 2,
  3. Mark P Nicol, professor and head, Division of Medical Microbiology3 4
  1. 1Department of Paediatrics and Child Health, Red Cross Children’s Hospital and MRC Unit on Child and Adolescent Health, University of Cape Town, Cape Town 7700, South Africa
  2. 2Department of Radiology, University of Bristol and the Bristol Royal Hospital for Children, UK
  3. 3Division of Medical Microbiology, Department of Pathology, University of Cape Town
  4. 4National Health Laboratory Service of South Africa, Johannesburg, South Africa
  1. Correspondence to:
    H J Zar heather.zar{at}


Pneumonia remains a major cause of childhood mortality and morbidity globally. Accurate diagnosis and attribution of the causes of pneumonia are important for measuring the burden of disease, implementing appropriate preventive or treatment strategies, and developing more effective interventions. This review summarizes recent diagnostic advances in radiological techniques, specimen collection, and laboratory methods. Although chest ultrasound and chest magnetic resonance imaging are promising modalities for radiological diagnosis, their role in clinical management and their impact on outcomes need further study. Rapid, highly sensitive, multiplex laboratory tests performed on upper respiratory tract samples or induced sputum can detect nucleic acid from potential pathogens in most children with pneumonia. However, it may be difficult to attribute causality because it is often impossible to distinguish between organisms colonizing or infecting the upper respiratory tract and those causing pneumonia. Currently available host biomarkers lack accuracy for distinguishing bacterial or mixed bacterial-viral infections from viral infections. New biomarkers derived from host transcriptional profile analysis may be more accurate but require validation. Prospective studies with appropriate control populations, including studies of clinical impact, are needed to improve our understanding of the role of tests. Although progress has been made in radiological techniques and laboratory testing, current methods for diagnosing and attributing the causes of pneumonia are suboptimal.


  • Series explanation: State of the Art Reviews are commissioned on the basis of their relevance to academics and specialists in the US and internationally. For this reason they are written predominantly by US authors

  • Contributors: All three authors helped in the conception, design, drafting, final approval, and accountability of this article’s accuracy and integrity. HJZ serves as the overall guarantor.

  • Competing interests: All authors have read and understood BMJ policy on declaration of interests and declare the following interests: None.

  • Provenance and peer review: Commissioned; externally peer reviewed.

  • Patient involvement: No patients were involved in the creation of this article.

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