Department of Infectious Diseases, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden.
Panzi Hospital, Bukavu, Democratic Republic of the Congo.
BMC Infect Dis. 2021 Aug 19;21(1):837. doi: 10.1186/s12879-021-06570-1.
Acute pneumonia remains a leading cause of death among children below 5 years of age in the Democratic Republic of the Congo (DR Congo), despite introduction of the 13-valent pneumococcal conjugate vaccine (PCV13) in 2013. Potential pathogens in the nasopharynx of hospitalised children with pneumonia have not been studied previously in DR Congo. Here we compare clinical characteristics, risk factors and nasopharyngeal occurrence of bacteria and viruses between children with severe and non-severe pneumonia.
Between June 2015 and June 2017, 116 children aged from 2 to 59 months hospitalised due to radiologically confirmed pneumonia at Panzi referral university hospital, Bukavu, Eastern DR Congo were included in the study and sampled from nasopharynx. A multiplex real-time PCR assay for detection of 15 different viruses and 5 bacterial species was performed and another multiplex PCR assay was used for pneumococcal serotype/serogroup determination.
During the study period 85 (73%) of the children with radiologically confirmed pneumonia met the WHO classification criteria of severe pneumonia and 31 (27%) had non-severe pneumonia. The fatality rate was 9.5%. Almost all (87%) children were treated with antibiotics before they were hospitalised, in most cases with amoxicillin (58%) or trimethoprim-sulfamethoxazole (20%). The frequency of potential pathogens in the nasopharynx of the children was high, and any viral or bacterial nucleic acids present at high levels, irrespective of species or type, were significantly associated with severe pneumonia as compared with non-severe cases (52% versus 29%, p = 0.032). White blood cell count > 20,000/μL and C-Reactive Protein > 75 mg/dL were associated with severe pneumonia at admission. Fatal outcome was in the multivariable analysis associated with having a congenital disease as an underlying condition. One or more pneumococcal serotypes/serogroups could be identified in 61 patients, and out of all identified serotypes 31/83 (37%) were non-PCV13 serotypes.
The occurrence of any bacteria or any viruses at high levels was associated with severe pneumonia at admission. Children with congenital disorders might need a higher attention when having symptoms of acute respiratory infection, as developed pneumonia could lead to fatal outcome.
尽管 2013 年在刚果民主共和国（DRC）引入了 13 价肺炎球菌结合疫苗（PCV13），但五岁以下儿童的急性肺炎仍是导致死亡的主要原因。此前，在刚果民主共和国，尚未研究过住院肺炎患儿鼻咽部的潜在病原体。在这里，我们比较了严重和非严重肺炎患儿的临床特征、危险因素以及细菌和病毒在鼻咽部的发生情况。
2015 年 6 月至 2017 年 6 月，在布卡武潘齐转诊大学医院，因放射学证实的肺炎住院的 116 名 2 至 59 个月大的儿童被纳入研究，并从鼻咽部取样。采用多重实时 PCR 检测 15 种不同病毒和 5 种细菌，另一种多重 PCR 检测用于检测肺炎球菌血清型/血清群。
在研究期间，85 名（73%）经放射学证实患有肺炎的儿童符合世界卫生组织严重肺炎分类标准，31 名（27%）患有非严重肺炎。死亡率为 9.5%。几乎所有（87%）患儿在住院前均接受过抗生素治疗，最常使用阿莫西林（58%）或复方磺胺甲噁唑（20%）。患儿鼻咽部潜在病原体的频率很高，无论物种或类型如何，高浓度存在的任何病毒或细菌核酸与严重肺炎相比，与非严重肺炎相比均显著相关（52%与 29%，p=0.032）。入院时白细胞计数>20,000/μL 和 C 反应蛋白>75mg/dL 与严重肺炎相关。在多变量分析中，致命结局与作为潜在疾病的先天性疾病有关。在 61 名患者中可鉴定出一种或多种肺炎球菌血清型/血清群，在所有鉴定出的血清型中，31/83（37%）是非 PCV13 血清型。
高水平存在任何细菌或任何病毒与入院时的严重肺炎相关。患有先天性疾病的儿童在出现急性呼吸道感染症状时可能需要更高的关注，因为发生肺炎可能导致致命后果。
