1921
Volume 85, Issue 1
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645

Abstract

Abstract.

The microbiologic etiology of severe pneumonia in hospitalized patients is rarely known in sub-Saharan Africa. Through a comprehensive diagnostic work-up, we aimed to identify the causative agent in severely ill patients with a clinical picture of pneumonia admitted to a high-dependency unit. A final diagnosis was made and categorized as confirmed or probable by using predefined criteria. Fifty-one patients were recruited (45% females), with a mean age of 35 years (range = 17–88 years), of whom 11(22%) died. Forty-eight (94%) of the patients were seropositive for human immunodeficiency virus; 14 (29%) of these patients were receiving antiretroviral treatment. Final diagnoses were bacterial pneumonia (29%), pneumonia (27%), pulmonary tuberculosis (22%), and pulmonary Kaposi's sarcoma (16%); 39 (77%) of these cases were confirmed cases. Fifteen (29%) patients had multiple isolates. At least 3 of 11 viral-positive polymerase chain reaction (PCR) results of bronchoalveolar lavage fluid were attributed clinical relevance. No atypical bacterial organisms were found.

Loading

Article metrics loading...

The graphs shown below represent data from March 2017
/content/journals/10.4269/ajtmh.2011.10-0640
2011-07-01
2018-12-12
Loading full text...

Full text loading...

/deliver/fulltext/14761645/85/1/105.html?itemId=/content/journals/10.4269/ajtmh.2011.10-0640&mimeType=html&fmt=ahah

References

  1. Scott JA, Hall AJ, Muyodi C, Lowe B, Ross M, Chohan B, Mandaliya K, Getambu E, Gleeson E, Gleeson F, Drobniewski F, Marsh K, , 2000. Aetiology, outcome and risk factors for mortality among adults with acute pneumonia in Kenya. Lancet 355: 11251130. [Google Scholar]
  2. Murray JF, , 2005. Pulmonary complications of HIV-infection among adults living in sub-Saharan Africa. Int J Tuberc Lung Dis 9: 826835. [Google Scholar]
  3. Shelburne SA, Visnegarwala F, Darcourt J, Graviss EA, Giordano TP, White AC, Jr Hamill RJ, , 2005. Incidence and risk factors for immune reconstitution inflammatory syndrome during highly active antiretroviral therapy. AIDS 19: 399406.[Crossref] [Google Scholar]
  4. Bonnet MM, Pinoges LL, Varaine FF, Oberhauser BB, O'Brien DD, Kebede YY, Hewison CC, Zachariah RR, Ferradini LL, , 2006. Tuberculosis after HAART initiation in HIV-positive patients from five countries with a high tuberculosis burden. AIDS 20: 12751279.[Crossref] [Google Scholar]
  5. Worodria W, Okot-Nwang M, Yoo SD, Aisu T, , 2003. Causes of lower respiratory infection in HIV-infected Ugandan adults who are sputum AFB smear-negative. Int J Tuberc Lung Dis 7: 117123. [Google Scholar]
  6. Kibiki GS, Berckers P, Mulder T, Arens T, Mueller A, Boeree MJ, Shao JF, Van Der Ven AJ, Diefendahl H, Dolmans WM, , 2007. Aetiology and presentation of HIV/AIDS associated pulmonary infections in patients presenting for bronchoscopy at a referral hospital in Northern Tanzania. East Afr Med J 84: 420428. [Google Scholar]
  7. Chakaya JM, Bii C, Ng'ang'a L, Amukoye E, Ouko T, Muita L, Gathua S, Gitau J, Odongo I, Kabanga JM, Nagai K, Suzumura S, Sugiura Y, , 2003. Pneumocystis carinii pneumonia in HIV/AIDS at an urban district hospital in Kenya. East Afr Med 80: 3035. [Google Scholar]
  8. Lockman S, Hone N, Kenyon TA, Mwasekaga M, Villauthapillai M, Creek T, Zell E, Kirby A, Thaker WL, Talkington D, Moura IN, Binkin NJ, Clay L, Tappero JW, , 2003. Etiology of pulmonary infections in predominantly HIV-infected adults with suspected tuberculosis, Botswana. Int J Tuberc Lung Dis 7: 714723. [Google Scholar]
  9. Crampin AC, Glynn JR, Fine PEM, , 2009. What has Karonga taught us? Tuberculosis studied over three decades. Int J Tuberc Lung Dis 13: 153164. [Google Scholar]
  10. Gordon S, Graham S, , 2006. Epidemiology of respiratory disease in Malawi. Malawi Medical Journal 18: 134146. [Google Scholar]
  11. Gordon SB, Chaponda M, Walsh AL, Whitty CJM, Gordon M, Machili CE, Gilks CF, Boeree MJ, Kampondeni S, Read RC, Molyneux ME, , 2002. Pneumococcal disease in HIV-infected Malawian adults: acute mortality and long-term survival. AIDS 16: 14091417.[Crossref] [Google Scholar]
  12. Graham SM, Mtitimila EI, Kamanga HS, Walsh AL, Hart CA, Molyneux ME, , 2000. Clinical presentation and outcome of Pneumocystis carinii pneumonia in Malawian children. Lancet 355: 369373.[Crossref] [Google Scholar]
  13. van Oosterhout JJ, Laufer ML, Thesing PC, Perez MA, Graham SM, Chimbiya N, Thesing PC, Alvarez-Martinez MJ, Wilson PE, Zijlstra EE, Taylor TE, Plowe CV, Meshnick SR, , 2007. Pneumocystis pneumonia in HIV-positive adults, Malawi. Emerg Infect Dis 13: 325328.[Crossref] [Google Scholar]
  14. Hargreaves NJ, Kadzakumanja O, Phiri S, Lee CH, Tang X, Salaniponi FM, Harries AD, Squire SB, , 2001. Pneumocystis carinii pneumonia in patients being registered for smear-negative pulmonary tuberculosis in Malawi. Trans R Soc Trop Med Hyg 95: 402408.[Crossref] [Google Scholar]
  15. Lewis DK, Callaghan M, Phiri K, Chipwete J, Kublin JG, Borgstein E, Zijlstra EE, , 2003. Prevalence and indicators of HIV and AIDS among adults admitted to medical and surgical wards in Blantyre, Malawi. Trans R Soc Med Hyg 97: 9196.[Crossref] [Google Scholar]
  16. Honeybourne D, Babb J, Bowie P, Brewin A, Fraise A, Garrard C, Harvey J, Lewis R, Neumann C, Wathen CG, Williams T, The British Thoracic Society Guidelines Committee., 2001. British Thoracic Society guidelines on diagnostic flexible brochoscopy. Thorax 56: i1i21. [Google Scholar]
  17. Bosis S, Esposito S, Niesters HG, Zuccotti GV, Marseglia G, Lanari M, Zuin G, Pelucchi C, Osterhaus AD, Principi N, , 2008. Role of respiratory pathogens in infants hospitalized for a first episode of wheezing and their impact on recurrences. Clin Microbiol Infect 14: 677684.[Crossref] [Google Scholar]
  18. Linssen CF, Jacob JA, Beckers P, Templeton KE, Bakkers J, Kuijper EJ, Melchers WJ, Drent M, Vink C, , 2006. Inter-laboratory comparison of three different real-time PCR assays for the detection of Pneumocystis jirovecii in bronchoalveolar lavage fluid samples. J Med Microbiol 55: 12291235.[Crossref] [Google Scholar]
  19. Flori P, Bellete B, Durand F, Raberin H, Cazorla C, Hafid J, Lucht F, Tran Manh Sung R, , 2004. Comparison between real-time PCR, conventional PCR and different staining techniques for diagnosing Pneumocystis jirovecii pneumonia from bronchoalveolar specimens. J Med Microbiol 53: 603607.[Crossref] [Google Scholar]
  20. Maynaud C, Parrot A, Cadranel J, , 2002. Pyogenic bacterial lower respiratory tract infection in human immunodeficiency virus-infected patients. Eur Respir J 20: 28S39S.[Crossref] [Google Scholar]
  21. Lim WS, Baudouin SV, George RC, Hill AT, Jamieson C, Le Jeune I, Macfarlane JT, Read RC, Roberts HJ, Levy ML, Wani M, Woodhead MA, , 2009. British Thoracic Society guidelines for the management of community acquired pneumonia in adults: update 2009. Thorax 64: iii1iii55.[Crossref] [Google Scholar]
  22. Anglaret X, Chene G, Attia A, Toure S, Lafont S, Combe P, Manlan K, N'Dri-Yoman T, Salamon R, , 1999. Early chemoprophylaxis with trimethoprim-sulphamethoxazole for HIV-1-infected adults in Abidjan, Côte d'Ivoire: a randomized trial. Cotrimo-CI Study Group. Lancet 353: 14631468.[Crossref] [Google Scholar]
  23. Aderaye G, Bruchfeld J, Aseffa G, Nigussie Y, Melaku K, Woldeamanuel Y, Asrat D, Worku A, Gaegziabher H, Lebaad M, Lindquist L, , 2007. Pneumocystis jirovecii pneumonia and other pulmonary infections in TB smear negative HIV positive patients with atypical chest X-ray in Ethiopia. Scand J Infect Dis 39: 10451053.[Crossref] [Google Scholar]
  24. Malin AS, Gwanzura LK, Klein S, Robertson VJ, Musvaire P, Mason PR, , 1995. Pneumocystis carinii pneumonia in Zimbabwe. Lancet 346: 12581261.[Crossref] [Google Scholar]
  25. Fisk DT, Meshnick S, Kazanjian PH, , 2003. Pneumocystis carinii pneumonia in patients in the developing world who have acquired immunodeficiency syndrome. CID 36: 7078.[Crossref] [Google Scholar]
  26. Morris A, Lundgren JD, Masur H, Walzer PD, Hanson DL, Frederick T, Huang L, Beard CB, Kaplan JE, , 2004. Current epidemiology of Pneumocystis pneumonia. Emerg Infect Dis 10: 17131720.[Crossref] [Google Scholar]
  27. Colebunders R, Bastian I, , 2000. A review of the diagnosis and treatment of smear-negative pulmonary tuberculosis. Int J Tuberc Lung Dis 4: 97107. [Google Scholar]
  28. Hartung TK, Maulu A, Nash J, Fredlund VG, , 2002. Suspected pulmonary tuberculosis in rural South Africa. Sputum induction as a simple diagnostic tool? S Afr Med J 92: 455458. [Google Scholar]
  29. Harries AD, , 1997. Tuberculosis in Africa: clinical presentation and management. Pharmacol Ther 73: 150.[Crossref] [Google Scholar]
  30. Jennings LC, Anderson TP, Beynon KA, Chua A, Laing RTR, Wemo AM, Young SA, Chambers ST, Murdoch DR, , 2008. Incidence and characteristics of viral community-acquired pneumonia in adults. Thorax 63: 4248.[Crossref] [Google Scholar]
  31. Marcos MA, Esperatti M, Torres A, , 2009. Viral pneumonia. Curr Opin Infect Dis 22: 143147.[Crossref] [Google Scholar]
  32. Longtin J, Bastien M, Gilca R, Leblanc E, de Serres G, Bergeron MG, Boivin G, , 2008. Human bocavirus infection in hospitalized children and adults. Emerg Infect Dis 14: 217221.[Crossref] [Google Scholar]
  33. van der Hoek L, , 2007. Human coronaviruses: what do they cause? Antivir Ther 12: 651658. [Google Scholar]
  34. Aboulafia DM, , 2000. The epidemiologic, pathologic and clinical features of AIDS-associated pulmonary Kaposi's sarcoma. Chest 117: 11281145.[Crossref] [Google Scholar]
  35. Miller RF, Tomlinson MC, Cottrill CP, Donals JJ, Spittle MF, Semple SJ, , 1992. Bronchopulmonary Kaposi's sarcoma in patients with AIDS. Thorax 47: 721725.[Crossref] [Google Scholar]
  36. Muller M, Wandel S, Colebunders R, Attia S, Furrer H, Eggert M, , 2010. Immune reconstitution inflammatory syndrome in patients starting antiretroviral therapy for HIV infection: a systematic review and meta-analysis. Lancet Infect Dis 10: 251261.[Crossref] [Google Scholar]
  37. Lim WS, van der Eerden MM, Laing R, Boersma WG, Karalus N, Town GI, Lewis SA, MacFarlane JT, , 2003. Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax 58: 377382.[Crossref] [Google Scholar]
http://instance.metastore.ingenta.com/content/journals/10.4269/ajtmh.2011.10-0640
Loading
/content/journals/10.4269/ajtmh.2011.10-0640
Loading

Data & Media loading...

Erratum

  • Received : 11 Nov 2010
  • Accepted : 14 Feb 2011

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