Morpeth Susan C, Deloria Knoll Maria, Scott J Anthony G, Park Daniel E, Watson Nora L, Baggett Henry C, Brooks W Abdullah, Feikin Daniel R, Hammitt Laura L, Howie Stephen R C, Kotloff Karen L, Levine Orin S, Madhi Shabir A, O'Brien Katherine L, Thea Donald M, Adrian Peter V, Ahmed Dilruba, Antonio Martin, Bunthi Charatdao, DeLuca Andrea N, Driscoll Amanda J, Githua Louis Peter, Higdon Melissa M, Kahn Geoff, Karani Angela, Karron Ruth A, Kwenda Geoffrey, Makprasert Sirirat, Mazumder Razib, Moore David P, Mwansa James, Nyongesa Sammy, Prosperi Christine, Sow Samba O, Tamboura Boubou, Whistler Toni, Zeger Scott L, Murdoch David R
Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi.
Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, United Kingdom.
Clin Infect Dis. 2017 Jun 15;64(suppl_3):S347-S356. doi: 10.1093/cid/cix145.
BACKGROUND.: We investigated the performance of polymerase chain reaction (PCR) on blood in the diagnosis of pneumococcal pneumonia among children from 7 low- and middle-income countries.
METHODS.: We tested blood by PCR for the pneumococcal autolysin gene in children aged 1-59 months in the Pneumonia Etiology Research for Child Health (PERCH) study. Children had World Health Organization-defined severe or very severe pneumonia or were age-frequency-matched community controls. Additionally, we tested blood from general pediatric admissions in Kilifi, Kenya, a PERCH site. The proportion PCR-positive was compared among cases with microbiologically confirmed pneumococcal pneumonia (MCPP), cases without a confirmed bacterial infection (nonconfirmed), cases confirmed for nonpneumococcal bacteria, and controls.
RESULTS.: In PERCH, 7.3% (n = 291/3995) of cases and 5.5% (n = 273/4987) of controls were blood pneumococcal PCR-positive (P < .001), compared with 64.3% (n = 36/56) of MCPP cases and 6.3% (n = 243/3832) of nonconfirmed cases (P < .001). Blood pneumococcal PCR positivity was higher in children from the 5 African countries (5.5%-11.5% among cases and 5.3%-10.2% among controls) than from the 2 Asian countries (1.3% and 1.0% among cases and 0.8% and 0.8% among controls). Among Kilifi general pediatric admissions, 3.9% (n = 274/6968) were PCR-positive, including 61.7% (n = 37/60) of those with positive blood cultures for pneumococcus.
DISCUSSION.: The utility of pneumococcal PCR on blood for diagnosing childhood pneumococcal pneumonia in the 7 low- and middle-income countries studied is limited by poor specificity and by poor sensitivity among MCPP cases.
我们调查了聚合酶链反应（PCR）检测血液在7个低收入和中等收入国家儿童肺炎球菌肺炎诊断中的表现。
在儿童肺炎病因研究（PERCH）中，我们对1至59个月大儿童的血液进行了肺炎球菌自溶素基因的PCR检测。这些儿童患有世界卫生组织定义的重度或极重度肺炎，或者是按年龄频率匹配的社区对照。此外，我们还检测了肯尼亚基利菲（PERCH研究地点之一）普通儿科住院患儿的血液。比较了微生物学确诊的肺炎球菌肺炎（MCPP）病例、未确诊细菌感染的病例（未确诊）、确诊为非肺炎球菌细菌感染的病例以及对照中PCR阳性的比例。
在PERCH研究中，7.3%（n = 291/3995）的病例和5.5%（n = 273/4987）的对照血液肺炎球菌PCR检测呈阳性（P <.001），而MCPP病例中的阳性率为64.3%（n = 36/56），未确诊病例中的阳性率为6.3%（n = 243/3832）（P <.001）。来自5个非洲国家的儿童血液肺炎球菌PCR阳性率（病例中为5.5% - 11.5%，对照中为5.3% - 10.2%）高于来自2个亚洲国家的儿童（病例中为1.3%和1.0%，对照中为0.8%和0.8%）。在基利菲普通儿科住院患儿中，3.9%（n = 274/6968）的PCR检测呈阳性，其中肺炎球菌血培养阳性的患儿中61.7%（n = 37/60）PCR检测呈阳性。
在所研究的7个低收入和中等收入国家中，血液肺炎球菌PCR检测在诊断儿童肺炎球菌肺炎方面的实用性受到特异性差以及MCPP病例中敏感性低的限制。
