Etiology of Suspected Pneumonia in Adults Admitted to a High-Dependency Unit in Blantyre, Malawi

Thomas K. Hartung Department of Medicine, College of Medicine, University of Malawi, Blantyre, Malawi; Institute of Tropical Medicine and International Health, Charité – Universitätsmedizin, Berlin, Germany; Malawi Liverpool Wellcome Trust Program, Blantyre, Malawi; Department of Virology, Erasmus Medical Centre, Rotterdam, The Netherlands; Department of Medical Microbiology, Leiden University Medical Centre, Leiden, The Netherlands; Department of Medical Microbiology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands

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Daniel Chimbayo Department of Medicine, College of Medicine, University of Malawi, Blantyre, Malawi; Institute of Tropical Medicine and International Health, Charité – Universitätsmedizin, Berlin, Germany; Malawi Liverpool Wellcome Trust Program, Blantyre, Malawi; Department of Virology, Erasmus Medical Centre, Rotterdam, The Netherlands; Department of Medical Microbiology, Leiden University Medical Centre, Leiden, The Netherlands; Department of Medical Microbiology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands

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Joep J. G. van Oosterhout Department of Medicine, College of Medicine, University of Malawi, Blantyre, Malawi; Institute of Tropical Medicine and International Health, Charité – Universitätsmedizin, Berlin, Germany; Malawi Liverpool Wellcome Trust Program, Blantyre, Malawi; Department of Virology, Erasmus Medical Centre, Rotterdam, The Netherlands; Department of Medical Microbiology, Leiden University Medical Centre, Leiden, The Netherlands; Department of Medical Microbiology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands

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Tarsizio Chikaonda Department of Medicine, College of Medicine, University of Malawi, Blantyre, Malawi; Institute of Tropical Medicine and International Health, Charité – Universitätsmedizin, Berlin, Germany; Malawi Liverpool Wellcome Trust Program, Blantyre, Malawi; Department of Virology, Erasmus Medical Centre, Rotterdam, The Netherlands; Department of Medical Microbiology, Leiden University Medical Centre, Leiden, The Netherlands; Department of Medical Microbiology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands

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Gerard J. J. van Doornum Department of Medicine, College of Medicine, University of Malawi, Blantyre, Malawi; Institute of Tropical Medicine and International Health, Charité – Universitätsmedizin, Berlin, Germany; Malawi Liverpool Wellcome Trust Program, Blantyre, Malawi; Department of Virology, Erasmus Medical Centre, Rotterdam, The Netherlands; Department of Medical Microbiology, Leiden University Medical Centre, Leiden, The Netherlands; Department of Medical Microbiology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands

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Eric C. J. Claas Department of Medicine, College of Medicine, University of Malawi, Blantyre, Malawi; Institute of Tropical Medicine and International Health, Charité – Universitätsmedizin, Berlin, Germany; Malawi Liverpool Wellcome Trust Program, Blantyre, Malawi; Department of Virology, Erasmus Medical Centre, Rotterdam, The Netherlands; Department of Medical Microbiology, Leiden University Medical Centre, Leiden, The Netherlands; Department of Medical Microbiology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands

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Willem J. G. Melchers Department of Medicine, College of Medicine, University of Malawi, Blantyre, Malawi; Institute of Tropical Medicine and International Health, Charité – Universitätsmedizin, Berlin, Germany; Malawi Liverpool Wellcome Trust Program, Blantyre, Malawi; Department of Virology, Erasmus Medical Centre, Rotterdam, The Netherlands; Department of Medical Microbiology, Leiden University Medical Centre, Leiden, The Netherlands; Department of Medical Microbiology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands

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Malcolm E. Molyneux Department of Medicine, College of Medicine, University of Malawi, Blantyre, Malawi; Institute of Tropical Medicine and International Health, Charité – Universitätsmedizin, Berlin, Germany; Malawi Liverpool Wellcome Trust Program, Blantyre, Malawi; Department of Virology, Erasmus Medical Centre, Rotterdam, The Netherlands; Department of Medical Microbiology, Leiden University Medical Centre, Leiden, The Netherlands; Department of Medical Microbiology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands

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Ed E. Zijlstra Department of Medicine, College of Medicine, University of Malawi, Blantyre, Malawi; Institute of Tropical Medicine and International Health, Charité – Universitätsmedizin, Berlin, Germany; Malawi Liverpool Wellcome Trust Program, Blantyre, Malawi; Department of Virology, Erasmus Medical Centre, Rotterdam, The Netherlands; Department of Medical Microbiology, Leiden University Medical Centre, Leiden, The Netherlands; Department of Medical Microbiology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands

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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%), Pneumocystis jirovecii 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.

Author Notes

*Address correspondence to Thomas K. Hartung, Institute of Tropical Medicine and International Health, Charité – Universitätsmedizin, Berlin, Germany. E-mail: thomas.hartung@nhs.net

Authors' addresses: Thomas K. Hartung, Institute of Tropical Medicine and International Health, Charité – Universitätsmedizin, Berlin, Germany, E-mail: thomas.hartung@nhs.net. Daniel Chimbayo, Lifeline Malawe, PO Box 41, Chipoka, Salima, Malawi, E-mail: danielchimbayo@yahoo.com. Joep J. G. van Oosterhout and Ed E. Zijlstra, Department of Medicine, College of Medicine, University of Malawi, Blantyre, Malawi, E-mail: joepvanoosterhout@gmail.com and e.e.zijlstra@gmail.com. Tarsizio Chikaonda and Malcom E. Molyneux, Malawi-Liverpool Wellcome Trust Clinical Research Program, PO Box 30096, Chichiri, Blantyre 3, Malawi, E-mails: t.chikaonda@yahoo.co.uk and mmolyneux999@gmail.com. Gerard J. J. van Doornum, Department of Virology, Unit Diagnostics, L359, Erasmus Medical Centre, Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands, E-mail: g.vandoornum@erasmusmc.nl. Eric C. J. Claas, Department of Medical Microbiology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA Leiden, The Netherlands, E-mail: e.c.j.claas@lumc.nl. Willem J. G. Melchers, Department of Medical Microbiology, Radboud University Nijmegen Medical Centre, PO Box 9101, 6500HB Nijmegen, The Netherlands, E-mail: w.melchers@mmb.umcn.nl.

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