Bates Matthew, Shibemba Aaron, Mudenda Victor, Chimoga Charles, Tembo John, Kabwe Mwila, Chilufya Moses, Hoelscher Michael, Maeurer Markus, Sinyangwe Sylvester, Mwaba Peter, Kapata Nathan, Zumla Alimuddin
HerpeZ, University Teaching Hospital, Lusaka, Zambia.
University of Zambia and University College London Medical School (UNZA-UCLMS) Research and Training Programme, University Teaching Hospital, Lusaka, Zambia.
BMC Med. 2016 Jul 1;14:99. doi: 10.1186/s12916-016-0645-z.
Autopsy studies are the gold standard for determining cause-of-death and can inform on improved diagnostic strategies and algorithms to improve patient care. We conducted a cross-sectional observational autopsy study to describe the burden of respiratory tract infections in inpatient children who died at the University Teaching Hospital in Lusaka, Zambia.
Gross pathology was recorded and lung tissue was analysed by histopathology and molecular diagnostics. Recruitment bias was estimated by comparing recruited and non-recruited cases.
Of 121 children autopsied, 64 % were male, median age was 19 months (IQR, 12-45 months). HIV status was available for 97 children, of whom 34 % were HIV infected. Lung pathology was observed in 92 % of cases. Bacterial bronchopneumonia was the most common pathology (50 %) undiagnosed ante-mortem in 69 % of cases. Other pathologies included interstitial pneumonitis (17 %), tuberculosis (TB; 8 %), cytomegalovirus pneumonia (7 %) and pneumocystis Jirovecii pneumonia (5 %). Comorbidity between lung pathology and other communicable and non-communicable diseases was observed in 80 % of cases. Lung tissue from 70 % of TB cases was positive for Mycobacterium tuberculosis by molecular diagnostic tests. A total of 80 % of TB cases were comorbid with malnutrition and only 10 % of TB cases were on anti-TB therapy when they died.
More proactive testing for bacterial pneumonia and TB in paediatric inpatient settings is needed.
尸检研究是确定死因的金标准，可为改进诊断策略和算法以改善患者护理提供依据。我们开展了一项横断面观察性尸检研究，以描述在赞比亚卢萨卡大学教学医院死亡的住院儿童呼吸道感染的负担情况。
记录大体病理学情况，并通过组织病理学和分子诊断方法对肺组织进行分析。通过比较纳入和未纳入的病例来评估招募偏倚。
在接受尸检的121名儿童中，64%为男性，中位年龄为19个月（四分位间距，12 - 45个月）。97名儿童的HIV状况可用，其中34%感染了HIV。92%的病例观察到肺部病理变化。细菌性支气管肺炎是最常见的病理变化（50%），69%的病例生前未被诊断出来。其他病理变化包括间质性肺炎（17%）、结核病（8%）、巨细胞病毒肺炎（7%）和耶氏肺孢子菌肺炎（5%）。80%的病例观察到肺部病理变化与其他传染病和非传染病之间存在合并症。分子诊断检测显示，70%的结核病病例的肺组织结核分枝杆菌呈阳性。总共80%的结核病病例合并营养不良，死亡时只有10%的结核病病例正在接受抗结核治疗。
在儿科住院患者中，需要对细菌性肺炎和结核病进行更积极的检测。
