Abstract
BackgroundAccurate data on childhood pneumonia aetiology are essential especially from regions where mortality is high, in order to inform case-management guidelines and the potential of prevention strategies such as bacterial conjugate vaccines. Yield from blood culture is low, but lung aspirate culture provides a higher diagnostic yield. We aimed to determine if diagnostic yield could be increased further by polymerase chain reaction (PCR) detection of bacteria (Streptococcus pneumoniae and Haemophilus influenzae b) and viruses in lung aspirate fluid.MethodsA total of 95 children with radiological focal, lobar or segmental consolidation had lung aspirate performed and sent for bacterial culture and for PCR for detection of bacteria, viruses and Pneumocystis jirovecii. In children with a pneumococcal aetiology, pneumococcal bacterial loads were calculated in blood and lung aspirate fluid.ResultsBlood culture identified a bacterial pathogen in only 8 patients (8%). With the addition of PCR on lung aspirate samples, causative pathogens (bacterial, viral, pneumocystis) were identified singly or as co-infections in 59 children (62%). The commonest bacterial organism was S.pneumoniae (41%), followed by H. influenzae b (6%), and the commonest virus identified was adenovirus (16%), followed by human bocavirus (HBoV) (4%), either as single or co-infection.ConclusionsIn a select group of African children, lung aspirate PCR significantly improves diagnostic yield. Our study confirms a major role of S.pneumoniae and viruses in the aetiology of childhood pneumonia in Africa.
Highlights
Pneumonia is the major cause of death in children throughout the developing world especially in children under the age of 5 years [1]
We report the use of polymerase chain reaction (PCR) for detection of Streptococcus pneumoniae, Haemophilus influenzae type b (Hib), Mycoplasma pneumoniae, Chlamydia pneumoniae, Pneumocystis jirovecii and nine respiratory viruses: Respiratory Syncytial Virus (RSV), Human metapneumovirus, Influenza A and B, Parainfuenza virus 1–4, Coronavirus (HKU-1, NL63, OC43), Rhinovirus, Adenovirus, and Human Bocavirus (HBoV) in lung aspiration specimens, and we compare diagnostic yield for bacteria between PCR applied to lung aspirate and bacteriological culture of blood and lung aspirate fluid
Cases presented throughout the year, but the peak of pneumonia cases occurred between August and November, the hot dry season
Summary
Pneumonia is the major cause of death in children throughout the developing world especially in children under the age of 5 years [1]. Data of the causes of pneumonia are required from regions where deaths due to pneumonia are common, in order to inform case-management guidelines and the potential of prevention strategies such as bacterial conjugate vaccines [3]. An inherent difficulty with pneumonia aetiology studies is the low yield from blood culture. Lung aspiration with culture provides a higher diagnostic yield and is more specific for causative pathogen than blood culture. Accurate data on childhood pneumonia aetiology are essential especially from regions where mortality is high, in order to inform case-management guidelines and the potential of prevention strategies such as bacterial conjugate vaccines. Yield from blood culture is low, but lung aspirate culture provides a higher diagnostic yield. We aimed to determine if diagnostic yield could be increased further by polymerase chain reaction (PCR) detection of bacteria (Streptococcus pneumoniae and Haemophilus influenzae b) and viruses in lung aspirate fluid
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