1921
Volume 85, Issue 4
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645

Abstract

Abstract.

Malaria and severe pneumonia in hospitalized young children may show striking clinical similarities, making differential diagnosis challenging. We investigated ways to increase diagnostic accuracy in patients hospitalized with clinical symptoms compatible with malaria and severe pneumonia, in an area with high a prevalence of infection with human immunodeficiency virus. A total of 646 children admitted at the Manhiça District Hospital in Manhiça, Mozambique who met the World Health Organization clinical criteria for severe pneumonia and malaria were recruited for 12 months and thoroughly investigated to ascertain an accurate diagnosis. Although symptom overlap between malaria and severe pneumonia was frequent among hospitalized children, true disease overlap was uncommon. Clinical presentation and laboratory determinations were ineffective in reliably distinguishing between the two diseases. Infection with human immunodeficiency virus differentially influenced the epidemiology and clinical presentation of these two infectious diseases, further challenging their discrimination on clinical grounds, and having a greater impact on the current burden and prognosis of severe pneumonia.

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References

  1. Black RE, Cousens S, Johnson HL, Lawn JE, Rudan I, Bassani DG, Jha P, Campbell H, Walker CF, Cibulskis R, Eisele T, Liu L, Mathers C, , 2010. Global, regional, and national causes of child mortality in 2008: a systematic analysis. Lancet 375: 19691987.[Crossref] [Google Scholar]
  2. The United Nations Children's Fund (UNICEF)/World Health Organization, 2006. Pneumonia: The Forgotten Killer of Children. New York: United Nations. [Google Scholar]
  3. Williams BG, Gouws E, Boschi-Pinto C, Bryce J, Dye C, , 2002. Estimates of world-wide distribution of child deaths from acute respiratory infections. Lancet Infect Dis 2: 2532.[Crossref] [Google Scholar]
  4. World Health Organization, The World Malaria Report, 2009. Available at: http://www.who.int/malaria/world_malaria_report_2009/en/index.html. [Google Scholar]
  5. Gove S, , 1997. Integrated management of childhood illness by outpatient health workers: technical basis and overview. The WHO Working Group on Guidelines for Integrated Management of the Sick Child. Bull World Health Organ 75 (Suppl 1): 724. [Google Scholar]
  6. Arifeen SE, Hoque DM, Akter T, Rahman M, Hoque ME, Begum K, Chowdhury EK, Khan R, Blum LS, Ahmed S, Hossain MA, Siddik A, Begum N, Sadeq-ur Rahman Q, Haque TM, Billah SM, Islam M, Rumi RA, Law E, Al-Helal ZA, Baqui AH, Schellenberg J, Adam T, Moulton LH, Habicht JP, Scherpbier RW, Victora CG, Bryce J, Black RE, , 2009. Effect of the Integrated Management of Childhood Illness strategy on childhood mortality and nutrition in a rural area in Bangladesh: a cluster randomised trial. Lancet 374: 393403.[Crossref] [Google Scholar]
  7. English M, Berkley J, Mwangi I, Mohammed S, Ahmed M, Osier F, Muturi N, Ogutu B, Marsh K, Newton CR, , 2003. Hypothetical performance of syndrome-based management of acute paediatric admissions of children aged more than 60 days in a Kenyan district hospital. Bull World Health Organ 81: 166173. [Google Scholar]
  8. Nadjm B, Amos B, Mtove G, Ostermann J, Chonya S, Wangai H, Kimera J, Msuya W, Mtei F, Dekker D, Malahiyo R, Olomi R, Crump JA, Whitty CJ, Reyburn H, , 2010. WHO guidelines for antimicrobial treatment in children admitted to hospital in an area of intense Plasmodium falciparum transmission: prospective study. BMJ 340: c1350.[Crossref] [Google Scholar]
  9. Simoes EA, Peterson S, Gamatie Y, Kisanga FS, Mukasa G, Nsungwa-Sabiiti J, Were MW, Weber MW, , 2003. Management of severely ill children at first-level health facilities in sub-Saharan Africa when referral is difficult. Bull World Health Organ 81: 522531. [Google Scholar]
  10. Kallander K, Nsungwa-Sabiiti J, Peterson S, , 2004. Symptom overlap for malaria and pneumonia–policy implications for home management strategies. Acta Trop 90: 211214.[Crossref] [Google Scholar]
  11. La Roche R, , 1854. Pneumonia: It's Supposed Connection, Pathological and Etiological, with Autumnal Fevers; Including an Inquiry into the Existence and Morbid Agency of Malaria. Philadelphia: Blanchard and Lee. [Google Scholar]
  12. O'Dempsey TJ, McArdle TF, Laurence BE, Lamont AC, Todd JE, Greenwood BM, , 1993. Overlap in the clinical features of pneumonia and malaria in African children. Trans R Soc Trop Med Hyg 87: 662665.[Crossref] [Google Scholar]
  13. Redd SC, Bloland PB, Kazembe PN, Patrick E, Tembenu R, Campbell CC, , 1992. Usefulness of clinical case-definitions in guiding therapy for African children with malaria or pneumonia. Lancet 340: 11401143.[Crossref] [Google Scholar]
  14. World Health Organization, 1992. The Overlap in the Clinical Presentation and Treatment of Malaria and Pneumonia in Children: Report of a Meeting. Geneva: World Health Organization, WHO/ARI/92.23.WHO/Mal/92.1065. [Google Scholar]
  15. English M, Punt J, Mwangi I, McHugh K, Marsh K, , 1996. Clinical overlap between malaria and severe pneumonia in Africa children in hospital. Trans R Soc Trop Med Hyg 90: 658662.[Crossref] [Google Scholar]
  16. Reyburn H, Mwakasungula E, Chonya S, Mtei F, Bygbjerg I, Poulsen A, Olomi R, , 2008. Clinical assessment and treatment in paediatric wards in the north-east of the United Republic of Tanzania. Bull World Health Organ 86: 132139.[Crossref] [Google Scholar]
  17. English M, Esamai F, Wasunna A, Were F, Ogutu B, Wamae A, Snow RW, Peshu N, , 2004. Assessment of inpatient paediatric care in first referral level hospitals in 13 districts in Kenya. Lancet 363: 19481953.[Crossref] [Google Scholar]
  18. Alonso PL, Saúte F, Aponte JJ, Gómez-Olivé FX, Nhacolo A, Thomson R, Macete E, Abacassamo F, Ventura PJ, Bosch X, Menéndez C, Dgedge M, , 2002. Population and Health in Developing Countries. Ottawa, Canada: International Development Research Centre (IDRC) and Manhiça, Mozambique. INDEPTH, 189195. [Google Scholar]
  19. Guinovart C, Bassat Q, Sigauque B, Aide P, Sacarlal J, Nhampossa T, Bardaji A, Nhacolo A, Macete E, Mandomando I, Aponte JJ, Menendez C, Alonso PL, , 2008. Malaria in rural Mozambique. Part I: children attending the outpatient clinic. Malar J 7: 36.[Crossref] [Google Scholar]
  20. Menendez C, Bardaji A, Sigauque B, Romagosa C, Sanz S, Serra-Casas E, Macete E, Berenguera A, David C, Dobano C, Naniche D, Mayor A, Ordi J, Mandomando I, Aponte JJ, Mabunda S, Alonso PL, , 2008. A randomized placebo-controlled trial of intermittent preventive treatment in pregnant women in the context of insecticide treated nets delivered through the antenatal clinic. PLoS ONE 3: e19346.[Crossref] [Google Scholar]
  21. Naniche D, Bardaji A, Lahuerta M, Berenguera A, Mandomando I, Sanz S, Aponte JJ, Sigauque B, Alonso PL, Menendez C, , 2009. Impact of maternal human immunodeficiency virus infection on birth outcomes and infant survival in rural Mozambique. Am J Trop Med Hyg 80: 870876. [Google Scholar]
  22. Bassat Q, Guinovart C, Sigauque B, Aide P, Sacarlal J, Nhampossa T, Bardaji A, Nhacolo A, Macete E, Mandomando I, Aponte JJ, Menendez C, Alonso PL, , 2008. Malaria in rural Mozambique. Part II: children admitted to hospital. Malar J 7: 37.[Crossref] [Google Scholar]
  23. Sigauque B, Roca A, Bassat Q, Morais L, Quinto L, Berenguera A, Machevo S, Bardaji A, Corachan M, Ribo J, Menendez C, Schuchat A, Flannery B, Soriano-Gabarro M, Alonso PL, , 2009. Severe pneumonia in Mozambican young children: clinical and radiological characteristics and risk factors. J Trop Pediatr 55: 379387.[Crossref] [Google Scholar]
  24. Sacarlal J, Nhacolo AQ, Sigauque B, Nhalungo DA, Abacassamo F, Sacoor CN, Aide P, Machevo S, Nhampossa T, Macete EV, Bassat Q, David C, Bardaji A, Letang E, Saute F, Aponte JJ, Thompson R, Alonso PL, , 2009. A 10 year study of the cause of death in children under 15 years in Manhica, Mozambique. BMC Public Health 9: 67.[Crossref] [Google Scholar]
  25. World Health Organization, 2005. Pocket Book for Hospital Care of Children: Guidelines for the Management of Common Illness with Limited Resources. Geneva: World Health Organization. [Google Scholar]
  26. Bassat Q, Guinovart C, Sigauque B, Mandomando I, Aide P, Sacarlal J, Nhampossa T, Bardaji A, Morais L, Machevo S, Letang E, Macete E, Aponte JJ, Roca A, Menendez C, Alonso PL, , 2009. Severe malaria and concomitant bacteraemia in children admitted to a rural Mozambican hospital. Trop Med Int Health 14: 10111019.[Crossref] [Google Scholar]
  27. Sigauque B, Roca A, Mandomando I, Morais L, Quinto L, Sacarlal J, Macete E, Nhamposa T, Machevo S, Aide P, Bassat Q, Bardaji A, Nhalungo D, Soriano-Gabarro M, Flannery B, Menendez C, Levine MM, Alonso PL, , 2009. Community-acquired bacteremia among children admitted to a rural hospital in Mozambique. Pediatr Infect Dis J 28: 108113.[Crossref] [Google Scholar]
  28. Roca A, Sigauque B, Quinto L, Mandomando I, Valles X, Espasa M, Abacassamo F, Sacarlal J, Macete E, Nhacolo A, Levine M, Alonso P, , 2006. Invasive pneumococcal disease in children < 5 years of age in rural Mozambique. Trop Med Int Health 11: 14221431.[Crossref] [Google Scholar]
  29. Valles X, Flannery B, Roca A, Mandomando I, Sigauque B, Sanz S, Schuchat A, Levine M, Soriano-Gabarro M, Alonso P, , 2006. Serotype distribution and antibiotic susceptibility of invasive and nasopharyngeal isolates of Streptococcus pneumoniae among children in rural Mozambique. Trop Med Int Health 11: 358366.[Crossref] [Google Scholar]
  30. O'Callaghan-Gordo C, Bassat Q, Morais L, Diez-Padrisa N, Machevo S, Nhampossa T, Nhalungo D, Sanz S, Quinto L, Alonso PL, Roca A, , 2011. Etiology and epidemiology of viral pneumonia among hospitalized children in rural Mozambique: a malaria endemic area with high prevalence of human immunodeficiency virus. Pediatr Infect Dis J 30: 3944.[Crossref] [Google Scholar]
  31. 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]
  32. Roca A, Sigauque B, Quinto L, Morais L, Berenguera A, Corachan M, Ribo JL, Naniche D, Bassat E, Sacoor C, Nhalungo D, Macete E, Schuchat A, Soriano-Gabarro M, Flannery B, Alonso PL, , 2010. Estimating the vaccine-preventable burden of hospitalized pneumonia among young Mozambican children. Vaccine 28: 48514857.[Crossref] [Google Scholar]
  33. Berkley JA, Maitland K, Mwangi I, Ngetsa C, Mwarumba S, Lowe BS, Newton CR, Marsh K, Scott JA, English M, , 2005. Use of clinical syndromes to target antibiotic prescribing in seriously ill children in malaria endemic area: observational study. BMJ 330: 995.[Crossref] [Google Scholar]
  34. McNally LM, Jeena PM, Gajee K, Thula SA, Sturm AW, Cassol S, Tomkins AM, Coovadia HM, Goldblatt D, , 2007. Effect of age, polymicrobial disease, and maternal HIV status on treatment response and cause of severe pneumonia in South African children: a prospective descriptive study. Lancet 369: 14401451.[Crossref] [Google Scholar]
  35. Muller B, Harbarth S, Stolz D, Bingisser R, Mueller C, Leuppi J, Nusbaumer C, Tamm M, Christ-Crain M, , 2007. Diagnostic and prognostic accuracy of clinical and laboratory parameters in community-acquired pneumonia. BMC Infect Dis 7: 10.[Crossref] [Google Scholar]
  36. Wongsrichanalai C, Barcus MJ, Muth S, Sutamihardja A, Wernsdorfer WH, , 2007. A review of malaria diagnostic tools: microscopy and rapid diagnostic test (RDT). Am J Trop Med Hyg 77: 119127. [Google Scholar]
  37. World Health Organization, 2010. Guidelines for the Treatment of Malaria, Second Edition. Available at: http://whqlibdoc.who.int/publications/2010/9789241547925.pdf. [Google Scholar]
  38. Graham SM, Mankhambo L, Phiri A, Kaunda S, Chikaonda T, Mukaka M, Molyneux EM, Carrol ED, Molyneux ME, , 2011. Impact of human immunodeficiency virus infection on the etiology and outcome of severe pneumonia in Malawian children. Pediatr Infect Dis J 30: 3338.[Crossref] [Google Scholar]
  39. O'Meara WP, Mangeni JN, Steketee R, Greenwood B, , 2010. Changes in the burden of malaria in sub-Saharan Africa. Lancet Infect Dis 10: 545555.[Crossref] [Google Scholar]
  40. O'Brien KL, Wolfson LJ, Watt JP, Henkle E, Deloria-Knoll M, McCall N, Lee E, Mulholland K, Levine OS, Cherian T, , 2009. Burden of disease caused by Streptococcus pneumoniae in children younger than 5 years: global estimates. Lancet 374: 893902.[Crossref] [Google Scholar]
  41. Watt JP, Wolfson LJ, O'Brien KL, Henkle E, Deloria-Knoll M, McCall N, Lee E, Levine OS, Hajjeh R, Mulholland K, Cherian T, , 2009. Burden of disease caused by Haemophilus influenzae type b in children younger than 5 years: global estimates. Lancet 374: 903911.[Crossref] [Google Scholar]
  42. Zwi K, Pettifor J, Soderlund N, Meyers T, , 2000. HIV infection and in-hospital mortality at an academic hospital in South Africa. Arch Dis Child 83: 227230.[Crossref] [Google Scholar]
  43. Greenwood B, , 1999. The epidemiology of pneumococcal infection in children in the developing world. Philos Trans R Soc Lond B Biol Sci 354: 777785.[Crossref] [Google Scholar]
  44. Berkley JA, Lowe BS, Mwangi I, Williams T, Bauni E, Mwarumba S, Ngetsa C, Slack MP, Njenga S, Hart CA, Maitland K, English M, Marsh K, Scott JA, , 2005. Bacteremia among children admitted to a rural hospital in Kenya. N Engl J Med 352: 3947.[Crossref] [Google Scholar]
  45. Laufer MK, van Oosterhout JJ, Thesing PC, Thumba F, Zijlstra EE, Graham SM, Taylor TE, Plowe CV, , 2006. Impact of HIV-associated immunosuppression on malaria infection and disease in Malawi. J Infect Dis 193: 872878.[Crossref] [Google Scholar]
  46. Zwi KJ, Pettifor JM, Soderlund N, , 1999. Paediatric hospital admissions at a South African urban regional hospital: the impact of HIV, 1992–1997. Ann Trop Paediatr 19: 135142.[Crossref] [Google Scholar]
  47. Enarson PM, Gie RP, Enarson DA, Mwansambo C, Graham SM, , 2011. Impact of HIV on standard case management for severe pneumonia in children. Expert Rev Respir Med 4: 211220.[Crossref] [Google Scholar]
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  • Received : 12 Apr 2011
  • Accepted : 18 Jun 2011
  • Published online : 01 Oct 2011

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