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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
immunology and microbiology
Severity of pneumonia in under 5-year-old children from developing countries: A multicenter, prospective, observational study
American Journal of Tropical Medicine and Hygiene, Volume 97, No. 1, Year 2017
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Description
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 Streptococcus pneumoniae 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 S. pneumoniae in blood was associated with increased risk of death among hospitalized children with pneumonia in developing countries. © 2017 by The American Society of Tropical Medicine and Hygiene.
Available Materials
https://efashare.b-cdn.net/share/pmc/articles/PMC5508893/bin/tpmd160733.SD1.pdf
Authors & Co-Authors
Bénet, Thomas
France, Lyon
Centre International de Recherche en Infectiologie
France, Lyon
Hopital Edouard Herriot
Picot, Valentina Sánchez
France, Lyon
Centre International de Recherche en Infectiologie
Awasthi, Shally K.
India, Kanpur
Chhatrapati Shahu ji Maharaj University
Pandey, Nitin
India, Kanpur
Chhatrapati Shahu ji Maharaj University
Bavdekar, Ashish R.
India, Pune
Kem Hospital
Kawade, Anand
India, Pune
Kem Hospital
Robinson, Annick Lalaina
Madagascar, Antananarivo
Hôpital Femme-mère-enfant
Rakoto-Andrianarivelo, Mala
Madagascar, Antananarivo
Centre D'infectiologie Charles Mérieux
Sylla, Mariam Moustapha
Mali, Bamako
Gabriel Toure Hospital
Diallo, Souleymane M’bara
Mali, Bamako
Centre D'infectiologie Charles Mérieux
Russomando, Graciela
Paraguay, Asuncion
Research Institute of Health
Basualdo, Wilma
Paraguay, San Lorenzo
Hospital General Pediátrico Niños de Acosta ñu
Komurian-Pradel, Florence
France, Lyon
Centre International de Recherche en Infectiologie
Endtz, Hubert Ph
France, Lyon
Centre International de Recherche en Infectiologie
Netherlands, Rotterdam
Erasmus Mc
Vanhems, Philippe V.
France, Lyon
Centre International de Recherche en Infectiologie
France, Lyon
Hopital Edouard Herriot
Paranhos-Baccalá, Gláucia S.
France, Lyon
Centre International de Recherche en Infectiologie
Statistics
Citations: 45
Authors: 16
Affiliations: 11
Identifiers
Doi:
10.4269/ajtmh.16-0733
ISSN:
00029637
Research Areas
Environmental
Health System And Policy
Maternal And Child Health
Study Design
Cross Sectional Study
Cohort Study
Case-Control Study
Study Approach
Qualitative
Study Locations
Madagascar
Mali