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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
High pneumococcal DNA loads are associated with mortality in Malawian children with invasive pneumococcal disease
Pediatric Infectious Disease Journal, Volume 26, No. 5, Year 2007
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Description
BACKGROUND: In bacteremia owing to Streptococcus pneumoniae, high bacterial counts at presentation have been shown to be predictive of the development of serious invasive disease. Using real-time PCR, we aimed to determine pneumococcal DNA loads in blood and CSF, and their relationship to cytokine concentrations, clinical presentation and outcome. METHODS: Children with confirmed meningitis (n = 82) or pneumonia (n = 13) were prospectively recruited, and blood and CSF samples taken for pneumococcal bacterial DNA loads and cytokine determination. RESULTS: At the time of admission, the median bacterial load in blood was 1.6 × 10 DNA copies/mL (range 0.00-1.54 × 10) and in CSF it was 5.77 × 10 DNA copies/mL (range 4.42 × 10 to 6.15 × 10). Median blood and CSF bacterial loads (log DNA copies/mL) were significantly higher in nonsurvivors than in survivors; blood (3.80 vs. 2.97, P = 0.003), CSF (8.17 vs. 7.50, P = 0.03). In HIV-infected children (n = 59), blood and CSF loads and plasma tumor necrosis factor-α, interleukin-1β (IL-1β), IL-6 and IL-10 were all significantly higher in nonsurvivors than in survivors, but in HIV-uninfected children (n = 36) this difference was not significant. Blood bacterial loads and plasma cytokine concentrations were significantly associated, and were all significantly higher in children with meningitis than in those with pneumonia. In children with meningitis, median CSF cytokine concentrations were significantly higher than median plasma cytokine concentrations (P < 0.001) and CSF bacterial loads were significantly associated with CSF IL-1β (P = 0.002) and IL-10 (P = 0.001) concentrations. CONCLUSIONS: Pneumococcal DNA loads are associated with plasma cytokine concentrations, and are higher in meningitis than in pneumonia. High blood and CSF pneumococcal DNA loads are associated with a fatal outcome. © 2007 Lippincott Williams & Wilkins, Inc.
Authors & Co-Authors
Carrol, Enitan D.
Malawi, Zomba
University of Malawi
United Kingdom, Liverpool
University of Liverpool
Malawi, Blantyre
Malawi-liverpool-wellcome Trust Clinical Research Programme
Guiver, Malcolm
United Kingdom, London
Public Health England
Nkhoma, Standwell C.
Malawi, Zomba
University of Malawi
Mankhambo, Limangeni A.
Malawi, Zomba
University of Malawi
Marsh, John
United Kingdom, London
Public Health England
Balmer, Paul
United Kingdom, London
Public Health England
Banda, Daniel Lawadi
Malawi, Zomba
University of Malawi
Jeffers, Graham
United Kingdom, Liverpool
University of Liverpool
White, Sarah Ann
Malawi, Zomba
University of Malawi
Molyneux, Elizabeth M.
Malawi, Zomba
University of Malawi
Molyneux, Malcolm Edward
Malawi, Zomba
University of Malawi
Smyth, Rosalind L.
United Kingdom, Liverpool
University of Liverpool
Hart, Charles Anthony
United Kingdom, Liverpool
University of Liverpool
Antonio, C.
Malawi, Zomba
University of Malawi
Chinamale, M.
Malawi, Zomba
University of Malawi
Jere, L.
Malawi, Zomba
University of Malawi
Mnapo, D.
Malawi, Zomba
University of Malawi
Munthali, V.
Malawi, Zomba
University of Malawi
Nyalo, Flora
Malawi, Zomba
University of Malawi
Simwinga, J.
Malawi, Zomba
University of Malawi
Kaole, M.
Malawi, Zomba
University of Malawi
Manyika, A.
Malawi, Zomba
University of Malawi
Phiri, Kamija Samuel
Malawi, Zomba
University of Malawi
Statistics
Citations: 108
Authors: 23
Affiliations: 4
Identifiers
Doi:
10.1097/01.inf.0000260253.22994.61
ISSN:
08913668
Research Areas
Cancer
Genetics And Genomics
Infectious Diseases
Maternal And Child Health