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...

/content/journals/10.4269/ajtmh.2011.10-0640
2011-07-01
2017-11-25
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.
  2. Murray JF, , 2005. Pulmonary complications of HIV-infection among adults living in sub-Saharan Africa. Int J Tuberc Lung Dis 9: 826835.
  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]
  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]
  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.
  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.
  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.
  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.
  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.
  10. Gordon S, Graham S, , 2006. Epidemiology of respiratory disease in Malawi. Malawi Medical Journal 18: 134146.
  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]
  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]
  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]
  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]
  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]
  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.
  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]
  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]
  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]
  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]
  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]
  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]
  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]
  24. Malin AS, Gwanzura LK, Klein S, Robertson VJ, Musvaire P, Mason PR, , 1995. Pneumocystis carinii pneumonia in Zimbabwe. Lancet 346: 12581261.[Crossref]
  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]
  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]
  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.
  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.
  29. Harries AD, , 1997. Tuberculosis in Africa: clinical presentation and management. Pharmacol Ther 73: 150.[Crossref]
  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]
  31. Marcos MA, Esperatti M, Torres A, , 2009. Viral pneumonia. Curr Opin Infect Dis 22: 143147.[Crossref]
  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]
  33. van der Hoek L, , 2007. Human coronaviruses: what do they cause? Antivir Ther 12: 651658.
  34. Aboulafia DM, , 2000. The epidemiologic, pathologic and clinical features of AIDS-associated pulmonary Kaposi's sarcoma. Chest 117: 11281145.[Crossref]
  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]
  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]
  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]
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...

Supplementary Data

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