随机接受母乳喂养或配方奶喂养的暴露于HIV的婴儿发生腹泻、肺炎及呼吸道定植的病因。
The aetiology of diarrhoea, pneumonia and respiratory colonization of HIV-exposed infants randomized to breast- or formula-feeding.
作者信息
Zash Rebecca M, Shapiro Roger L, Leidner Jean, Wester Carolyn, McAdam Alexander J, Hodinka Richard L, Thior Ibou, Moffat Claire, Makhema Joseph, McIntosh Kenneth, Essex Max, Lockman Shahin
机构信息
a Division of Infectious Diseases , Beth Israel Deaconess Medical Center , Boston , MA USA.
b Botswana Harvard Partnership , Gaborone , Botswana.
出版信息
Paediatr Int Child Health. 2016 Aug;36(3):189-97. doi: 10.1179/2046905515Y.0000000038.
BACKGROUND
Diarrhoea and pneumonia are common causes of childhood death in sub-Saharan Africa but there are few studies describing specific pathogens.
OBJECTIVES
The study aimed to describe the pathogens associated with diarrhoea, pneumonia and oropharyngeal colonization in children born to HIV-infected women (HIV-exposed infants).
METHODS
The Mashi Study randomized 1200 HIV-infected women and their infants to breastfeed for 6 months with ZDV prophylaxis or formula-feed with 4 weeks of ZDV. Children were tested for HIV by PCR at 1, 4, 7, 9 and 12 months and by ELISA at 18 months. Pre-defined subsets of children were sampled during episodes of diarrhoea (n = 300) and pneumonia (n = 85). Stool was tested for bacterial pathogens, rotavirus and parasites. Children with pneumonia underwent bacterial blood culture, and testing of nasopharyngeal aspirates for viral pathogens by PCR. Oropharyngeal swabs were collected from a consecutive subset of 561 infants at the routine 3-month visit for bacterial culture.
RESULTS
The median age (range) at sampling was 181 days for diarrhoea (0-730) and 140 days for pneumonia (2-551). Pathogens were identified in 55 (18%) children with diarrhoea and 32 (38%) with pneumonia. No differences in pathogens by child HIV status (HIV-infected vs HIV-uninfected) or feeding strategy were identified. Campylobacter was the most common diarrhoeal pathogen (7%). Adenovirus (22%) and other viruses (19%) were the primary pathogens isolated during pneumonias. More formula-fed infants had oropharyngeal colonization by pathogenic Gram-negative bacteria (16.8% vs 6.2%, P = 0.003), which was associated with a non-significant increased risk of pneumonia (OR 2.2, 95% CI 0.8-5.7).
CONCLUSION
A trend toward oropharyngeal bacterial colonization was observed in formula-fed infants. Although viruses were most commonly detected during pneumonia, respiratory colonization by Gram-negative bacteria may have contributed to pneumonia in formula-fed infants.
背景
腹泻和肺炎是撒哈拉以南非洲儿童死亡的常见原因，但描述特定病原体的研究很少。
目的
本研究旨在描述感染艾滋病毒妇女所生儿童（暴露于艾滋病毒的婴儿）腹泻、肺炎和口咽定植相关的病原体。
方法
马希研究将1200名感染艾滋病毒的妇女及其婴儿随机分为两组，一组进行6个月的母乳喂养并接受齐多夫定预防，另一组进行4周齐多夫定的配方奶喂养。儿童在1、4、7、9和12个月时通过聚合酶链反应（PCR）检测艾滋病毒，在18个月时通过酶联免疫吸附测定（ELISA）检测。在腹泻发作期间（n = 300）和肺炎发作期间（n = 85）对预先定义的儿童亚组进行采样。对粪便进行细菌病原体、轮状病毒和寄生虫检测。患有肺炎的儿童进行细菌血培养，并通过PCR检测鼻咽抽吸物中的病毒病原体。在常规3个月访视时，从连续的561名婴儿亚组中采集口咽拭子进行细菌培养。
结果
腹泻采样时的中位年龄（范围）为181天（0 - 730天），肺炎为140天（2 - 551天）。在55名（18%）腹泻儿童和32名（38%）肺炎儿童中鉴定出病原体。未发现病原体在儿童艾滋病毒感染状态（感染艾滋病毒与未感染艾滋病毒）或喂养策略方面存在差异。弯曲杆菌是最常见的腹泻病原体（7%）。腺病毒（22%）和其他病毒（19%）是肺炎期间分离出的主要病原体。更多配方奶喂养的婴儿口咽部有致病性革兰氏阴性菌定植（16.8%对6.2%，P = 0.003），这与肺炎风险非显著增加相关（比值比2.2，95%置信区间0.8 - 5.7）。
结论
在配方奶喂养的婴儿中观察到口咽细菌定植的趋势。虽然肺炎期间最常检测到病毒，但革兰氏阴性菌的呼吸道定植可能导致了配方奶喂养婴儿的肺炎。
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