Abstract
BackgroundLower respiratory infections constitute a major disease burden worldwide. Treatment is usually empiric and targeted towards typical bacterial pathogens. Understanding the prevalence of pathogens not covered by empirical treatment is important to improve diagnostic and treatment algorithms.MethodsA prospective observational study in peri-urban communities of Yangon, Myanmar was conducted between July 2018 and April 2019. Sputum specimens of 299 adults presenting with fever and productive cough were tested for Mycobacterium tuberculosis (microscopy and GeneXpert MTB/RIF [Mycobacterium tuberculosis/resistance to rifampicin]) and Burkholderia pseudomallei (Active Melioidosis Detect Lateral Flow Assay and culture). Nasopharyngeal swabs underwent respiratory virus (influenza A, B, respiratory syncytial virus) polymerase chain reaction testing.ResultsAmong 299 patients, 32% (95% confidence interval [CI] 26 to 37) were diagnosed with tuberculosis (TB), including 9 rifampicin-resistant cases. TB patients presented with a longer duration of fever (median 14 d) and productive cough (median 30 d) than non-TB patients (median fever duration 6 d, cough 7 d). One case of melioidosis pneumonia was detected by rapid test and confirmed by culture. Respiratory viruses were detected in 16% (95% CI 12 to 21) of patients.ConclusionsTB was very common in this population, suggesting that microscopy and GeneXpert MTB/RIF on all sputum samples should be routinely included in diagnostic algorithms for fever and cough. Melioidosis was uncommon in this population.
Highlights
Lower respiratory tract infections (LRTIs) were identified as the leading infectious cause of death worldwide and the fifth overall biggest killer in the 2015 Global Burden of Disease study.[1]
The primary aims of this study were to identify the proportion of cases of LRTI caused by B. pseudomallei during the wet season among adults attending outpatient clinics in Yangon and to evaluate the performance of a new rapid test, the Active Melioidosis Detect Lateral Flow Assay (AMD-LFA; InBios, Seattle, WA, USA) on sputum compared with culture
We considered what prevalence of melioidosis would be required to encourage the introduction of a diagnostic test as routine and we estimated that a sample size of 283 patients, assuming a target population prevalence of B. pseudomallei of 10%, would provide precision of 3.5% with 95% confidence
Summary
Lower respiratory tract infections (LRTIs) were identified as the leading infectious cause of death worldwide and the fifth overall biggest killer in the 2015 Global Burden of Disease study.[1] Conventional empirical therapy covering common communityacquired bacterial pathogens is widely used in healthcare settings for suspected bacterial LRTIs. Understanding the local prevalence of pathogens not susceptible to first-line empirical treatment is important for structuring population-specific syndromic treatment guidelines. Understanding the prevalence of pathogens not covered by empirical treatment is important to improve diagnostic and treatment algorithms
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