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.

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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] [Google Scholar]
  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] [Google Scholar]
  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. [Google Scholar]
  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] [Google Scholar]
  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] [Google Scholar]
  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] [Google Scholar]
  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. [Google Scholar]
  8. Ibraheem RM, Johnson WB, Abdulkarim AA, , 2014. Hypoxaemia in hospitalised under-five Nigerian children with pneumonia. West Afr J Med 33: 3743. [Google Scholar]
  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] [Google Scholar]
  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] [Google Scholar]
  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] [Google Scholar]
  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] [Google Scholar]
  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. [Google Scholar]
  14. Ayieko P, English M, , 2007. Case management of childhood pneumonia in developing countries. Pediatr Infect Dis J 26: 432440.[Crossref] [Google Scholar]
  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. [Google Scholar]
  16. Grimes DA, Schulz KF, , 2005. Refining clinical diagnosis with likelihood ratios. Lancet 365: 15001505.[Crossref] [Google Scholar]
  17. Lozano JM, , 2001. Epidemiology of hypoxaemia in children with acute lower respiratory infection. Int J Tuberc Lung Dis 5: 496504. [Google Scholar]
  18. Ruuskanen O, Lahti E, Jennings LC, Murdoch DR, , 2011. Viral pneumonia. Lancet 377: 12641275.[Crossref] [Google Scholar]
  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] [Google Scholar]
  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] [Google Scholar]
  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] [Google Scholar]
  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. [Google Scholar]
  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] [Google Scholar]
  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. [Google Scholar]
  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] [Google Scholar]
  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] [Google Scholar]
  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] [Google Scholar]
  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] [Google Scholar]
  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] [Google Scholar]
  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] [Google Scholar]
  31. Bogaert D, de Groot R, Hermans PW, , 2004. Streptococcus pneumoniae colonisation: the key to pneumococcal disease. Lancet Infect Dis 4: 144154.[Crossref] [Google Scholar]
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  • Received : 09 Sep 2016
  • Accepted : 30 Jan 2017
  • Published online : 01 May 2017

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