Abstract
BackgroundSevere malnutrition is a risk factor for pneumonia due to a wide range of pathogens but aetiological data are limited and the role of Mycobacterium tuberculosis is uncertain.MethodsWe prospectively investigated severely malnourished young children (<5 years) with radiological pneumonia admitted over a 15-month period. Investigations included blood culture, sputa for microscopy and mycobacterial culture. Xpert MTB/RIF assay was introduced during the study. Study children were followed for 12 weeks following their discharge from the hospital.Results405 eligible children were enrolled, with a median age of 10 months. Bacterial pathogens were isolated from blood culture in 18 (4.4%) children, of which 72% were Gram negatives. Tuberculosis was confirmed microbiologically in 7% (27/396) of children that provided sputum - 10 by culture, 21 by Xpert MTB/RIF assay, and 4 by both tests. The diagnostic yield from induced sputum was 6% compared to 3.5% from gastric aspirate. Sixty (16%) additional children had tuberculosis diagnosed clinically that was not microbiologically confirmed. Most confirmed tuberculosis cases did not have a positive contact history or positive tuberculin test. The sensitivity and specificity of Xpert MTB/RIF assay compared to culture was 67% (95% CI: 24–94) and 92% (95% CI: 87–95) respectively. Overall case-fatality rate was 17% and half of the deaths occurred in home following discharge from the hospital.Conclusion and SignificanceTB was common in severely malnourished Bangladeshi children with pneumonia. X-pert MTB/RIF assay provided higher case detection rate compared to sputum microscopy and culture. The high mortality among the study children underscores the need for further research aimed at improved case detection and management for better outcomes.
Highlights
Pneumonia is the leading cause of childhood mortality globally [1], and malnutrition is a recognized risk for pneumonia and death [2]
Mycobacterium tuberculosis is believed to be an important cause of pneumonia in severely malnourished children, but there are surprisingly few data [3,4,5]
We evaluated the frequencies of bacterial isolates from blood culture and of M.tuberculosis by culture and Xpert MTB/RIF from sputum
Summary
Pneumonia is the leading cause of childhood mortality globally [1], and malnutrition is a recognized risk for pneumonia and death [2]. Mycobacterium tuberculosis is believed to be an important cause of pneumonia in severely malnourished children, but there are surprisingly few data [3,4,5]. The actual contribution of TB to global child mortality is likely to be higher for two main reasons. Severe malnutrition is a risk factor for pneumonia due to a wide range of pathogens but aetiological data are limited and the role of Mycobacterium tuberculosis is uncertain
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