Abstract
Background: Community-acquired pneumonia (CAP), a leading cause of mortality, mainly affects children in developing countries. The harsh circumstances experienced by refugees include various factors associated with respiratory pathogen transmission, and clinical progression of CAP. Consequently, the etiology of CAP in humanitarian crisis situations may differ to that of settled populations, which would impact appropriate case management. Therefore, the Pneumonia Etiology Among Refugees and the Lebanese population (PEARL) study was initiated with the objective of identifying the causal pathogenic microorganisms in the respiratory tract of children and adults from both the refugee and host country population presenting with signs of CAP during a humanitarian crisis. Methods: PEARL, a prospective, multicentric, case-control study, will be conducted at four primary healthcare facilities in Tripoli and the Bekaa valley over 15 months (including two high-transmission seasons/winters). Sociodemographic and medical data, and biological samples will be collected from at least 600 CAP cases and 600 controls. Nasopharyngeal swabs, sputum, urine and blood samples will be analyzed at five clinical pathology laboratories in Lebanon to identify the bacterial and viral etiological agents of CAP. Transcriptomic profiling of host leukocytes will be performed. Conclusions: PEARL is an original observational study that will provide important new information on the etiology of pneumonia among refugees, which may improve case management, help design antimicrobial stewardship interventions, and reduce morbidity and mortality due to CAP in a humanitarian crisis.
Highlights
Lower respiratory tract infections (LRTI) are the second leading cause of mortality worldwide, accounting for an estimated 2.8 million deaths annually, and mainly affect children in developing countries[1]
Current interventions for Community-acquired pneumonia (CAP) are primarily based on etiological studies conducted in the early 1980s2–4, which indicated bacteria are responsible for almost half of all cases of CAP5,6; Streptococcus pneumoniae, Haemophilus influenzae and Staphylococcus aureus were the most commonly identified bacteria
In children < 5-years-old, bacteria were responsible for severe forms of CAP: S. pneumoniae and H. influenzae accounted for approximately 60% of cases of severe and fatal pneumonia[7,8] and S. pneumoniae alone accounted for 11% of mortalities overall in children < 5-years-old[9]
Summary
Conclusions: PEARL is an original observational study that will provide important new information on the etiology of pneumonia among refugees, which may improve case management, help design antimicrobial stewardship interventions, and reduce morbidity and mortality due to CAP in a humanitarian crisis. Changes included the addition of the complete methodology of a triplex PCR that had not been disclosed in a previous scientific article. This prompted us to add M Stéphane Pouzol, who designed and developed that technique, as an author of the second version of the manuscript. ‘Erasmus Medical Center, Rotterdam, The Netherlands’ has been added as affiliation for co-author Hubert Endtz
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