1921
Volume 97, Issue 1
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645

Abstract

Abstract.

Pneumonia is the leading cause of death in children. The objectives were to evaluate the microbiological agents linked with hypoxemia in hospitalized children with pneumonia from developing countries, to identify predictors of hypoxemia, and to characterize factors associated with in-hospital mortality. A multicenter, observational study was conducted in five hospitals, from India (Lucknow, Vadu), Madagascar (Antananarivo), Mali (Bamako), and Paraguay (San Lorenzo). Children aged 2–60 months with radiologically confirmed pneumonia were enrolled prospectively. Respiratory and whole blood specimens were collected, identifying viruses and bacteria by real-time multiplex polymerase chain reaction (PCR). Microbiological agents linked with hypoxemia at admission (oxygen saturation < 90%) were analyzed by multivariate logistic regression, and factors associated with 14-day in-hospital mortality were assessed by bivariate Cox regression. Overall, 405 pneumonia cases (3,338 hospitalization days) were analyzed; 13 patients died within 14 days of hospitalization. Hypoxemia prevalence was 17.3%. Detection of human metapneumovirus (hMPV) and respiratory syncytial virus (RSV) in respiratory samples was independently associated with increased risk of hypoxemia (adjusted odds ratio [aOR] = 2.4, 95% confidence interval [95% CI] = 1.0–5.8 and aOR = 2.5, 95% CI = 1.1–5.3, respectively). Lower chest indrawing and cyanosis were predictive of hypoxemia (positive likelihood ratios = 2.3 and 2.4, respectively). Predictors of death were detection by blood PCR (crude hazard ratio [cHR] = 4.6, 95% CI = 1.5–14.0), procalcitonin ≥ 50 ng/mL (cHR = 22.4, 95% CI = 7.3–68.5) and hypoxemia (cHR = 4.8, 95% CI = 1.6–14.4). These findings were consistent on bivariate analysis. hMPV and RSV in respiratory samples were linked with hypoxemia, and in blood was associated with increased risk of death among hospitalized children with pneumonia in developing countries.

[open-access] This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Loading

Article metrics loading...

/content/journals/10.4269/ajtmh.16-0733
2017-07-12
2017-09-21
Loading full text...

Full text loading...

/deliver/fulltext/14761645/97/1/tpmd160733.html?itemId=/content/journals/10.4269/ajtmh.16-0733&mimeType=html&fmt=ahah

References

  1. Liu L, Oza S, Hogan D, Perin J, Rudan I, Lawn JE, Cousens S, Mathers C, Black RE, , 2015. Global, regional, and national causes of child mortality in 2000–13, with projections to inform post-2015 priorities: an updated systematic analysis. Lancet 385: 430440.[Crossref]
  2. Subhi R, Adamson M, Campbell H, Weber M, Smith K, Duke T, Hypoxaemia in Developing Countries Study Group, 2009. The prevalence of hypoxaemia among ill children in developing countries: a systematic review. Lancet Infect Dis 9: 219227.[Crossref]
  3. Rojas-Reyes MX, Granados Rugeles C, Charry-Anzola LP, , 2014. Oxygen therapy for lower respiratory tract infections in children between 3 months and 15 years of age. Cochrane Database Syst Rev 12: CD005975.
  4. Floyd J, Wu L, Hay Burgess D, Izadnegahdar R, Mukanga D, Ghani AC, , 2015. Evaluating the impact of pulse oximetry on childhood pneumonia mortality in resource-poor settings. Nature 528: S53S59.[Crossref]
  5. Ginsburg AS, Cleve WCV, Thompson MIW, English M, , 2012. Oxygen and pulse oximetry in childhood pneumonia: a survey of healthcare providers in resource-limited settings. J Trop Pediatr 58: 389393.[Crossref]
  6. Duke T, Blaschke AJ, Sialis S, Bonkowsky JL, , 2002. Hypoxaemia in acute respiratory and non-respiratory illnesses in neonates and children in a developing country. Arch Dis Child 86: 108112.[Crossref]
  7. Duke T, Mgone J, Frank D, , 2001. Hypoxaemia in children with severe pneumonia in Papua New Guinea. Int J Tuberc Lung Dis 5: 511519.
  8. Ibraheem RM, Johnson WB, Abdulkarim AA, , 2014. Hypoxaemia in hospitalised under-five Nigerian children with pneumonia. West Afr J Med 33: 3743.
  9. Rudan I, Chan KY, Zhang JSF, Theodoratou E, Feng XL, Salomon JA, Lawn JE, Cousens S, Black RE, Guo Y, Campbell H, WHO/UNICEF's Child Health Epidemiology Reference Group (CHERG), 2010. Causes of deaths in children younger than 5 years in China in 2008. Lancet 375: 10831089.[Crossref]
  10. Chisti MJ, Salam MA, Ashraf H, Faruque ASG, Bardhan PK, Hossain MI, Shahid ASMSB, Shahunja KM, Das SK, Imran G, Ahmed T, , 2013. Clinical risk factors of death from pneumonia in children with severe acute malnutrition in an urban critical care ward of Bangladesh. PLoS One 8: e73728.[Crossref]
  11. Komurian-Pradel F, Grundmann N, Siqueira MM, Chou M, Diallo S, Mbacham W, Paboriboune P, Russomando G, Nymadawa P, Sarkis DK, Samison LH, Wang J, Pape JW, Paranhos-Baccalà G, Vernet G, , 2013. Enhancing research capacities in infectious diseases: The GABRIEL network, a joint approach to major local health issues in developing countries. Clin Epidemiol Glob Health 1: 4043.[Crossref]
  12. Picot VS, Bénet T, Messaoudi M, Telles J-N, Chou M, Eap T, Wang J, Shen K, Pape J-W, Rouzier V, Awasthi S, Pandey N, Bavdekar A, Sanghvi S, Robinson A, Contamin B, Hoffmann J, Sylla M, Diallo S, Nymadawa P, Dash-Yandag B, Russomando G, Basualdo W, Siqueira MM, Barreto P, Komurian-Pradel F, Vernet G, Endtz H, Vanhems P, Paranhos-Baccalà G, Network on Behalf of the Pneumonia G, 2014. Multicenter case–control study protocol of pneumonia etiology in children: Global Approach to Biological Research, Infectious diseases and Epidemics in Low-income countries (GABRIEL network). BMC Infect Dis 14: 635.[Crossref]
  13. Cherian T, Mulholland EK, Carlin JB, Ostensen H, Amin R, de Campo M, Greenberg D, Lagos R, Lucero M, Madhi SA, O'Brien KL, Obaro S, Steinhoff MC, , 2005. Standardized interpretation of paediatric chest radiographs for the diagnosis of pneumonia in epidemiological studies. Bull World Health Organ 83: 353359.
  14. Ayieko P, English M, , 2007. Case management of childhood pneumonia in developing countries. Pediatr Infect Dis J 26: 432440.[Crossref]
  15. WHO, 2013. Guidelines for the management of common childhood illnesses. Pocket Book of Hospital Care for Children, 2nd edition. Geneva, Switzerland: WHO. Available at: http://www.who.int/maternal_child_adolescent/documents/child_hospital_care/en/. Accessed August 31, 2015.
  16. Grimes DA, Schulz KF, , 2005. Refining clinical diagnosis with likelihood ratios. Lancet 365: 15001505.[Crossref]
  17. Lozano JM, , 2001. Epidemiology of hypoxaemia in children with acute lower respiratory infection. Int J Tuberc Lung Dis 5: 496504.
  18. Ruuskanen O, Lahti E, Jennings LC, Murdoch DR, , 2011. Viral pneumonia. Lancet 377: 12641275.[Crossref]
  19. Virkki R, Juven T, Rikalainen H, Svedström E, Mertsola J, Ruuskanen O, , 2002. Differentiation of bacterial and viral pneumonia in children. Thorax 57: 438441.[Crossref]
  20. Nair H, Nokes DJ, Gessner BD, Dherani M, Madhi SA, Singleton RJ, O'Brien KL, Roca A, Wright PF, Bruce N, Chandran A, Theodoratou E, Sutanto A, Sedyaningsih ER, Ngama M, Munywoki PK, Kartasasmita C, Simões EAF, Rudan I, Weber MW, Campbell H, , 2010. Global burden of acute lower respiratory infections due to respiratory syncytial virus in young children: a systematic review and meta-analysis. Lancet 375: 15451555.[Crossref]
  21. Berkley JA, Munywoki P, Ngama M, Kazungu S, Abwao J, Bett A, Lassauniére R, Kresfelder T, Cane PA, Venter M, Scott JA, Nokes DJ, , 2010. Viral etiology of severe pneumonia among Kenyan infants and children. JAMA 303: 20512057.[Crossref]
  22. Kelly MS, Smieja M, Luinstra K, Wirth KE, Goldfarb DM, Steenhoff AP, Arscott-Mills T, Cunningham CK, Boiditswe S, Sethomo W, Shah SS, Finalle R, Feemster KA, , 2015. Association of respiratory viruses with outcomes of severe childhood pneumonia in Botswana. PLoS One 10: e0126593.
  23. Panda S, Mohakud NK, Pena L, Kumar S, , 2014. Human metapneumovirus: review of an important respiratory pathogen. Int J Infect Dis 25: 4552.[Crossref]
  24. Duke T, Mgone J, Frank D, , 2001. Hypoxaemia in children with severe pneumonia in Papua New Guinea. Int J Tuberc Lung Dis 5: 511519.
  25. Walker CLF, Rudan I, Liu L, Nair H, Theodoratou E, Bhutta ZA, O'Brien KL, Campbell H, Black RE, , 2013. Global burden of childhood pneumonia and diarrhoea. Lancet 381: 14051416.[Crossref]
  26. Bogaert D, van Belkum A, Sluijter M, Luijendijk A, de Groot R, Rümke HC, Verbrugh HA, Hermans PWM, , 2004. Colonisation by Streptococcus pneumoniae and Staphylococcus aureus in healthy children. Lancet 363: 18711872.[Crossref]
  27. Nascimento-Carvalho CM, Cardoso M-RA, Barral A, Araújo-Neto CA, Guerin S, Saukkoriipi A, Paldanius M, Vainionpää R, Lebon P, Leinonen M, Ruuskanen O, Gendrel D, , 2010. Procalcitonin is useful in identifying bacteraemia among children with pneumonia. Scand J Infect Dis 42: 644649.[Crossref]
  28. Olaciregui I, Hernández U, Muñoz JA, Emparanza JI, Landa JJ, , 2009. Markers that predict serious bacterial infection in infants under 3 months of age presenting with fever of unknown origin. Arch Dis Child 94: 501505.[Crossref]
  29. Moulin F, Raymond J, Lorrot M, Marc E, Coste J, Iniguez J-L, Kalifa G, Bohuon C, Gendrel D, , 2001. Procalcitonin in children admitted to hospital with community acquired pneumonia. Arch Dis Child 84: 332336.[Crossref]
  30. Carrol ED, Mankhambo LA, Jeffers G, Parker D, Guiver M, Newland P, Banda DL; IPD Study Group, 2009. The diagnostic and prognostic accuracy of five markers of serious bacterial infection in Malawian children with signs of severe infection. PLoS One 4: e6621.[Crossref]
  31. Bogaert D, de Groot R, Hermans PW, , 2004. Streptococcus pneumoniae colonisation: the key to pneumococcal disease. Lancet Infect Dis 4: 144154.[Crossref]
http://instance.metastore.ingenta.com/content/journals/10.4269/ajtmh.16-0733
Loading
/content/journals/10.4269/ajtmh.16-0733
Loading

Data & Media loading...

Supplementary Data

Supplemental Figure and Table

  • Received : 09 Sep 2016
  • Accepted : 30 Jan 2017

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error