Evaluation of serum zinc levels in hospitalized children with bacterial pneumonia in Shahid Motahari Hospital

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Mohadeseh Balandeh
Ebrahim Sadeghi
Amir Nasimfar



Introduction: Pneumonia in children is the cause of approximately 30% of deaths in the world. The role of zinc as an important micronutrient in the treatment of pneumonia is still unclear. This substance has the properties of improving the function of the immune system, and its deficiency is associated with an increase in the risk of infectious diseases, as well as impaired growth and development. Therefore, the present study was designed and implemented with the aim of determining the serum level of zinc in children hospitalized with pneumonia in Shahid Motahari Hospital and comparing it with children without pneumonia.

Materials and Methods: A case-control study was conducted on 100 patients between the ages of 1 and 59 months between January 2022 and July 2022, 50 children admitted to Urmia Motahari Hospital in Iran with a diagnosis of pneumonia based on WHO criteria as a group The case and 50 other children were studied as a control group among the patients referred to the children's infectious superspecialty clinic. Zinc level was measured in two groups. The data was entered into SPSS software and subjected to statistical analysis.

Results: The average level of zinc in the case group was 67.35 ± 42.03 and in the control group it was 93.26 ± 41.80. According to the results of the independent t-test, the level of zinc in the control group was significantly higher (p=0.003). The results of the study showed that the level of zinc in hospitalization for more than 10 days was significantly lower than in hospitalization for less than 10 days (1-5 and 6-10 days). Also, the average serum zinc level was lower in patients with complications and this difference was statistically significant in empyema (P=0.02), pleural effusion (P=0.02) and ventilation (P=0.01). The average serum zinc level in patients with wheezing (P=0.02), stridor (P=0.04), cyanosis (P=0.001), sleep disorder (P=0.001) and lethargy (0.04) =P) was significantly less.

Conclusion: The average level of zinc in children with pneumonia was significantly lower than the control group.

Article Details

How to Cite
Balandeh, M., Sadeghi, E., & Nasimfar, A. (2024). Evaluation of serum zinc levels in hospitalized children with bacterial pneumonia in Shahid Motahari Hospital. Afghanistan Journal of Infectious Diseases, 2(2), 41–50. https://doi.org/10.60141/AJID/V.2.I.2/6
Research Article
Author Biography

Amir Nasimfar, Associate Professor of Pediatric Infectious Disease, Urmia University of Medical Sciences, Urmia, Iran

Associate Professor of Pediatric Infectious Disease, Urmia University of Medical Sciences, Urmia, Iran(0000-0002-0595-997X)


Lassi ZS, Moin A, Bhutta ZA. Zinc supplementation for the prevention of pneumonia in children aged 2 months to 59 months. Cochrane Database of Systematic Reviews. 2016(12).

UNICEF W, UNICEF W. Pneumonia: the forgotten killer of children. UNICEF/WHO. 2006;140.

Khan TA, Madni SA, Zaidi A. Acute respiratory infections in Pakistan: have we made any progress? Journal of the College of Physicians and Surgeons--pakistan: JCPSP. 2004;14(7):440-8.

Feigin RD, Demmler GJ, Cherry JD, Kaplan SL. Textbook of pediatric infectious diseases. Textbook of pediatric infectious diseases2004. p. 3626-.

Mulholland K. Global burden of acute respiratory infections in children: implications for interventions. Pediatric pulmonology. 2003;36(6):469-74.

Hambidge K. Zinc deficiency in man: its origins and effects. Philosophical Transactions of the Royal Society of London B, Biological Sciences. 1981;294(1071):129-44.

Brown KH. Effect of infections on plasma zinc concentration and implications for zinc status assessment in low-income countries. The American journal of clinical nutrition. 1998;68(2):425S-9S.

Prasad AS. Zinc: an overview. Nutrition (Burbank, Los Angeles County, Calif). 1995;11(1 Suppl):93-9.

Rink L. Zinc and the immune system. Proceedings of the Nutrition Society. 2000;59(4):541-52.

Maret W, Sandstead HH. Zinc requirements and the risks and benefits of zinc supplementation. Journal of trace elements in medicine and biology. 2006;20(1):3-18.

Brown KH, Peerson JM, Allen LH. Effect of zinc supplementation on children's growth: a meta-analysis of intervention trials. Bibliotheca Nutritio et Dieta. 1998;54:76-83.

Sandstead HH, Penland JG, Alcock NW, Dayal HH, Chen XC, Li JS, et al. Effects of repletion with zinc and other micronutrients on neuropsychologic performance and growth of Chinese children. The American journal of clinical nutrition. 1998;68(2):470S-5S.

Robert M, Kliegman M, Richard E, Behrman M, Hal B, Jenson M, et al. Nelson textbook of pediatrics 18th ed. Pennisylvania: WB Saunder company. 2007:756-60.

Cho Y-H, Lee S-J, Lee JY, Kim SW, Lee CB, Lee WY, et al. Antibacterial effect of intraprostatic zinc injection in a rat model of chronic bacterial prostatitis. International journal of antimicrobial agents. 2002;19(6):576-82.

Black RE, Morris SS, Bryce J. Where and why are 10 million children dying every year? The lancet. 2003;361(9376):2226-34.

Müller O, Becher H, van Zweeden AB, Ye Y, Diallo DA, Konate AT, et al. Effect of zinc supplementation on malaria and other causes of morbidity in west African children: randomised double blind placebo controlled trial. Bmj. 2001;322(7302):1567.

Iolascon G, Gimigliano R, Bianco M, De Sire A, Moretti A, Giusti A, et al. Are dietary supplements and nutraceuticals effective for musculoskeletal health and cognitive function? A scoping review. The journal of nutrition, health & aging. 2017;21(5):527-38.

McBurney MI, Hartunian-Sowa S, Matusheski NV. Implications of US nutrition facts label changes on micronutrient density of fortified foods and supplements. The Journal of Nutrition. 2017;147(6):1025-30.

Wakaskar RR, Bathena SPR, Tallapaka SB, Ambardekar VV, Gautam N, Thakare R, et al. Peripherally cross-linking the shell of core-shell polymer micelles decreases premature release of physically loaded combretastatin A4 in whole blood and increases its mean residence time and subsequent potency against primary murine breast tumors after IV administration. Pharmaceutical research. 2015;32(3):1028-44.

Meydani SN, Barnett JB, Dallal GE, Fine BC, Jacques PF, Leka LS, et al. Serum zinc and pneumonia in nursing home elderly. The American journal of clinical nutrition. 2007;86(4):1167-73.

Brooks WA, Yunus M, Santosham M, Wahed M, Nahar K, Yeasmin S, et al. Zinc for severe pneumonia in very young children: double-blind placebo-controlled trial. The Lancet. 2004;363(9422):1683-8.

Mahalanabis D, Lahiri M, Paul D, Gupta S, Gupta A, Wahed MA, et al. Randomized, double-blind, placebo-controlled clinical trial of the efficacy of treatment with zinc or vitamin A in infants and young children with severe acute lower respiratory infection. The American journal of clinical nutrition. 2004;79(3):430-6.

Ehsanipour F, Vahid Harandi N, Jalali K. The Survey of Serum Zinc Level in Children with Pneumonia. Razi Journal of Medical Sciences. 2009;16:21-5.

Rajasekaran J, Geminiganesan S, Jayapalan DK, Padmanaban R, Saminathan V. Serum Zinc Levels in Children 1-59 Months of Age with Pneumonia: A Single-Center Surveillance in India from 2014 to 2016. Archives of Pediatric Infectious Diseases. 2020;8(2).

Singh S, Chaudry SY, Phelps AL, Vallejo MC. A 5-year audit of accidental dural punctures, postdural puncture headaches, and failed regional anesthetics at a tertiary-care medical center. TheScientificWorldJournal. 2009;9:715-22.

Qasemzadeh MJ, Fathi M, Tashvighi M, Gharehbeglou M, Yadollah-Damavandi S, Parsa Y, et al. The effect of adjuvant zinc therapy on recovery from pneumonia in hospitalized children: a double-blind randomized controlled trial. Scientifica. 2014;2014.

Shah GS, Dutta AK, Shah D, Mishra OP. Role of zinc in severe pneumonia: a randomized double bind placebo controlled study. Italian journal of pediatrics. 2012;38(1):1-5.

Arıca S, Arıca V, Dag H, Kaya A, Hatipoglu S, Fenercioglu A, et al. Serum zinc levels in children of 0–24 months diagnosed with pneumonia admitted to our clinic. International journal of clinical and experimental medicine. 2011;4(3):227.

Soleimani GR, Abtahi S. Evaluation of serum Zinc status in hospitalized children aged 1-4 years with Pneumonia and gastroenteritis in Zahedan. Zahedan Journal of Research in Medical Sciences. 2005;7(4).

Leung DT, Chisti MJ, Pavia AT. Prevention and control of childhood pneumonia and diarrhea. Pediatric Clinics. 2016;63(1):67-79.

Rudan I, O’brien KL, Nair H, Liu L, Theodoratou E, Qazi S, et al. Epidemiology and etiology of childhood pneumonia in 2010: estimates of incidence, severe morbidity, mortality, underlying risk factors and causative pathogens for 192 countries. Journal of global health. 2013;3(1).

Krebs NF, Miller LV, Michael Hambidge K. Zinc deficiency in infants and children: a review of its complex and synergistic interactions. Paediatrics and international child health. 2014;34(4):279-88.

Strand TA, Adhikari RK, Chandyo RK, Sharma PR, Sommerfelt H. Predictors of plasma zinc concentrations in children with acute diarrhea. The American journal of clinical nutrition. 2004;79(3):451-6.

Shakur MS, Malek M, Bano N, Islam K. Zinc status in well nourished Bangladeshi children suffering from acute lower respiratory infection. Age (mo). 2004;32(6.52):30-6.64.

Kumar S, Awasthi S, Jain A, Srivastava R. Blood zinc levels in children hospitalized with severe pneumonia: a case control study. Indian pediatrics. 2004;41:486-91.

Umeta M, West CE, Haidar J, Deurenberg P, Hautvast JG. Zinc supplementation and stunted infants in Ethiopia: a randomised controlled trial. The lancet. 2000;355(9220):2021-6.

Ninh NX, Thissen J-P, Collette L, Gerard G, Khoi HH, Ketelslegers J-M. Zinc supplementation increases growth and circulating insulin-like growth factor I (IGF-I) in growth-retarded Vietnamese children. The American journal of clinical nutrition. 1996;63(4):514-9.

Gardner JM, Witter MM, Ramdath DD. Zinc supplementation: effects on the growth and morbidity of undernourished Jamaican children. European journal of clinical nutrition. 1998;52(1):34-9.