Abstract
BackgroundAcute pneumonia remains a leading cause of death among children below 5 years of age in the Democratic Republic of the Congo (DR Congo), despite introduction of the 13-valent pneumococcal conjugate vaccine (PCV13) in 2013. Potential pathogens in the nasopharynx of hospitalised children with pneumonia have not been studied previously in DR Congo. Here we compare clinical characteristics, risk factors and nasopharyngeal occurrence of bacteria and viruses between children with severe and non-severe pneumonia.MethodsBetween June 2015 and June 2017, 116 children aged from 2 to 59 months hospitalised due to radiologically confirmed pneumonia at Panzi referral university hospital, Bukavu, Eastern DR Congo were included in the study and sampled from nasopharynx. A multiplex real-time PCR assay for detection of 15 different viruses and 5 bacterial species was performed and another multiplex PCR assay was used for pneumococcal serotype/serogroup determination.ResultsDuring the study period 85 (73%) of the children with radiologically confirmed pneumonia met the WHO classification criteria of severe pneumonia and 31 (27%) had non-severe pneumonia. The fatality rate was 9.5%. Almost all (87%) children were treated with antibiotics before they were hospitalised, in most cases with amoxicillin (58%) or trimethoprim-sulfamethoxazole (20%). The frequency of potential pathogens in the nasopharynx of the children was high, and any viral or bacterial nucleic acids present at high levels, irrespective of species or type, were significantly associated with severe pneumonia as compared with non-severe cases (52% versus 29%, p = 0.032). White blood cell count > 20,000/μL and C-Reactive Protein > 75 mg/dL were associated with severe pneumonia at admission. Fatal outcome was in the multivariable analysis associated with having a congenital disease as an underlying condition. One or more pneumococcal serotypes/serogroups could be identified in 61 patients, and out of all identified serotypes 31/83 (37%) were non-PCV13 serotypes.ConclusionsThe occurrence of any bacteria or any viruses at high levels was associated with severe pneumonia at admission. Children with congenital disorders might need a higher attention when having symptoms of acute respiratory infection, as developed pneumonia could lead to fatal outcome.
Highlights
Acute pneumonia remains a leading cause of death among children below 5 years of age in the Democratic Republic of the Congo (DR Congo), despite introduction of the 13-valent pneumococcal conjugate vac‐ cine (PCV13) in 2013
Characteristics of the included children Two years after the introduction of 13-Valent pneumococcal conjugate vaccine (PCV13) in the infant immunization program in the Eastern DR Congo, 125/2322 (5.4%) of all children admitted to Panzi Hospital, DR Congo were diagnosed with radiologically confirmed pneumonia
We have recently showed a high level of resistance against trimethoprim-sulfamethoxazole in pneumococci colonizing children in the general population in this area of DR Congo [17] and similar results were shown for healthy children in northern Tanzania [37]
Summary
Acute pneumonia remains a leading cause of death among children below 5 years of age in the Democratic Republic of the Congo (DR Congo), despite introduction of the 13-valent pneumococcal conjugate vac‐ cine (PCV13) in 2013. Acute pneumonia remains a leading cause of childhood morbidity and mortality worldwide [1] the estimated number of pneumonia episodes in young children decreased from 180 million in 2000 to 140 million in 2015 [2]. Pneumonia caused deaths in 0.9 million children below five years worldwide in 2015 [3] and is a leading cause of death in young children in the Democratic Republic of the Congo (DR Congo) [2]. The incidence of clinical childhood pneumonia decreased in the DR Congo from over 400 cases per 1000 children and year in 2000 to less than 300 in 2015 [2]. Abuse of antibiotics is abundant due to self-medication or consulting a non-appropriate health care provider, as well as over-prescription by clinicians [7, 8]
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