PDF(Pubmed)
Abstract：
Pneumonia is the leading cause of death in children, however, the microbial aetiology of pneumonia is not well elucidated in low- and middle-income countries. Our study was aimed at determining the microbial aetiologies of childhood pneumonia and associated risk factors in HIV and non-HIV infected children. We conducted a case-control study that enrolled children with pneumonia as cases and non-pneumonia as controls from July 2017 to May 2020. Induced sputum and blood samples were investigated for microbial organisms using standard microbiological techniques. DNA/RNA was extracted from sputum samples and tested for viral and bacterial agents. Four hundred and four (404) subjects consisting of 231 (57.2%) cases and 173 (42.8%) controls were enrolled. We identified a significant (p = 0.011) proportion of viruses in cases (125; 54.1%, 95%CI: 47.4-60.7) than controls (71; 33.6%, 95%CI: 33.6-48.8) and these were mostly contributed to by Respiratory Syncytial Virus. Staphylococcus aureus (16; 4.0%), Klebsiella spp. (15, 3.7%) and Streptococcus pneumoniae (8, 2.0%) were the main bacterial agents identified in sputum or induced sputum samples. HIV infected children with viral-bacterial co-detection were found to have very severe pneumonia compared to those with only viral or bacterial infection. Indoor cooking (OR = 2.36; 95%CI:1.41-3.96) was found to be associated with pneumonia risk in patients. This study demonstrates the importance of various microbial pathogens, particularly RSV, in contributing to pneumonia in HIV and non-HIV paediatric populations. There is a need to accelerate clinical trials of RSV vaccines in African populations to support improvement of patient care.
摘要：
肺炎是儿童死亡的主要原因，然而,在低收入和中等收入国家，肺炎的微生物病因尚未得到很好的阐明。我们的研究旨在确定儿童肺炎的微生物病因以及HIV和非HIV感染儿童的相关危险因素。我们进行了一项病例对照研究，从2017年7月至2020年5月，将肺炎患儿作为病例，非肺炎患儿作为对照。使用标准微生物技术研究了诱导痰和血液样品中的微生物。从痰样品中提取DNA/RNA并测试病毒和细菌试剂。纳入了由231例（57.2％）病例和173例（42.8％）对照组成的四百四（404）名受试者。我们确定了病例中病毒的显着比例（p=0.011）（125;54.1％，95CI：47.4-60.7）比对照组（71；33.6%，95CI：33.6-48.8），这些主要由呼吸道合胞病毒引起。金黄色葡萄球菌（16；4.0%），克雷伯菌属。（15，3.7％）和肺炎链球菌（8，2.0％）是痰或诱导痰样品中鉴定的主要细菌。与仅有病毒或细菌感染的儿童相比，病毒-细菌共同检测的HIV感染儿童被发现患有非常严重的肺炎。发现室内烹饪（OR=2.36；95CI：1.41-3.96）与患者的肺炎风险相关。这项研究证明了各种微生物病原体的重要性，特别是RSV,在艾滋病毒和非艾滋病毒儿科人群中导致肺炎。有必要加快非洲人群中RSV疫苗的临床试验，以支持改善患者护理。
