Abstract
BackgroundIn Latin America, community-acquired pneumonia remains a major cause of morbidity and mortality among children. Few studies have examined the etiology of pneumonia in Ecuador.MethodsThis observational study was part of a randomized, double blind, placebo-controlled clinical trial conducted among children aged 2–59 months with severe pneumonia in Quito, Ecuador. Nasopharyngeal and blood samples were tested for bacterial and viral etiology by polymerase chain reaction. Risk factors for specific respiratory pathogens were also evaluated.ResultsAmong 406 children tested, 159 (39.2%) had respiratory syncytial virus (RSV), 71 (17.5%) had human metapneumovirus (hMPV), and 62 (15.3%) had adenovirus. Streptococcus pneumoniae was identified in 37 (9.2%) samples and Mycoplasma pneumoniae in three (0.74%) samples. The yearly circulation pattern of RSV (P = 0.0003) overlapped with S. pneumoniae, (P = 0.03) with most cases occurring in the rainy season. In multivariable analysis, risk factors for RSV included younger age (adjusted odds ratio [aOR] = 1.9, P = 0.01) and being underweight (aOR = 1.8, P = 0.04). Maternal education (aOR = 0.82, P = 0.003), pulse oximetry (aOR = 0.93, P = 0.005), and rales (aOR = 0.25, P = 0.007) were associated with influenza A. Younger age (aOR = 3.5, P = 0.007) and elevated baseline respiratory rate were associated with HPIV-3 infection (aOR = 0.94, P = 0.03).ConclusionThese results indicate the importance of RSV and influenza, and potentially modifiable risk factors including undernutrition and future use of a RSV vaccine, when an effective vaccine becomes available.Trial registrationClinicalTrials.gov NCT 00513929
Highlights
Pneumonia is the leading infectious cause of mortality among children below 5 years of age, and is responsible for nearly one million deaths annually in this population [1,2,3]
The yearly circulation pattern of respiratory syncytial virus (RSV) (P = 0.0003) overlapped with S. pneumoniae, (P = 0.03) with most cases occurring in the rainy season
Younger age and elevated baseline respiratory rate were associated with HPIV-3 infection
Summary
Pneumonia is the leading infectious cause of mortality among children below 5 years of age, and is responsible for nearly one million deaths annually in this population [1,2,3]. The World Health Organization (WHO) estimates that the vast majority (over 95%) of the estimated 156 million pneumonia episodes occurring each year among young children takes place in developing countries [4]. In Latin America and the Caribbean, community-acquired pneumonia continues to be a prominent cause of high morbidity and mortality among children. An estimated 327,000 cases and 12,000–28,000 deaths due to pneumonia occur annually in children in this region [8,9]. In Latin America, community-acquired pneumonia remains a major cause of morbidity and mortality among children. Few studies have examined the etiology of pneumonia in Ecuador
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