From the South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Department of Paediatrics & Child Health, Chris Hani Baragwanath Academic Hospital and University of the Witwatersrand, Johannesburg, South Africa.
Pediatr Infect Dis J. 2021 Sep 1;40(9S):S69-S78. doi: 10.1097/INF.0000000000002651.
HIV-1 infection predisposes to an increased burden of pneumonia caused by community-acquired and opportunistic pathogens.
Within the context of the Pneumonia Etiology Research for Child Health case-control study of under 5 pneumonia, we investigated the etiology of World Health Organization-defined severe/very severe pneumonia requiring hospitalization in South African HIV-infected children. Nasopharyngeal-oropharyngeal swabs and blood, collected from cases and age- and season-matched HIV-infected controls attending outpatient antiretroviral therapy (ART) clinics, were analyzed using molecular diagnostic methods. Cases were also investigated for tuberculosis. Etiologic fractions among cases with radiologically confirmed pneumonia were derived using Bayesian analytic techniques.
Of 115 HIV-infected cases, 89 (77.4%) had radiologically confirmed pneumonia. Severe immunosuppression (adjusted odds ratio, 32.60; 95% confidence interval, 7.25-146.64) was significantly associated with radiologically confirmed pneumonia. Cotrimoxazole prophylaxis (46.4% vs. 77.4%) and ART (28.2% vs. 83.1%) coverage were significantly lower in cases compared with ART-clinic controls. An etiologic agent was identified in 99.0% of the radiologically confirmed cases. The 'top 4' pathogens associated with radiologically confirmed pneumonia were Pneumocystis jirovecii [23.0%; 95% credible interval (CrI), 12.4%-31.5%], Staphylococcus aureus (10.6%; 95% CrI, 2.2%-20.2%), pneumococcus (9.5%; 95% CrI, 2.2%-18.0%) and respiratory syncytial virus (9.3%; 95% CrI, 2.2%-14.6%). Bacteremia (6.7%) and in-hospital death (10.1%) were frequent among those with radiologically confirmed disease.
Pneumocystis jirovecii, S. aureus, pneumococcus and respiratory syncytial virus contribute a considerable burden of radiologically confirmed pneumonia in South African HIV-infected children under 5 years. Expediting access to ART and cotrimoxazole prophylaxis would decrease the burden of pneumonia in these children.
HIV-1 感染会增加社区获得性和机会性病原体引起的肺炎负担。
在儿童肺炎病因研究（Pneumonia Etiology Research for Child Health）的病例对照研究中，我们调查了南非 HIV 感染儿童中需要住院治疗的世界卫生组织定义的严重/非常严重肺炎的病因。从在门诊接受抗逆转录病毒治疗（ART）的病例和年龄及季节匹配的 HIV 感染对照中采集鼻咽和口咽拭子及血液，使用分子诊断方法进行分析。还对病例进行了结核病检查。使用贝叶斯分析技术得出有放射学确诊肺炎的病例的病因分数。
在 115 例 HIV 感染病例中，89 例（77.4%）有放射学确诊肺炎。严重免疫抑制（校正优势比，32.60；95%置信区间，7.25-146.64）与放射学确诊肺炎显著相关。与 ART 门诊对照相比，磺胺甲噁唑预防（46.4%比 77.4%）和 ART（28.2%比 83.1%）覆盖率显著较低。99.0%的放射学确诊病例确定了病因。与放射学确诊肺炎相关的前 4 种病原体是卡氏肺孢子虫（23.0%；95%可信区间，12.4%-31.5%）、金黄色葡萄球菌（10.6%；95%可信区间，2.2%-20.2%）、肺炎球菌（9.5%；95%可信区间，2.2%-18.0%）和呼吸道合胞病毒（9.3%；95%可信区间，2.2%-14.6%）。放射学确诊疾病患者中经常出现菌血症（6.7%）和院内死亡（10.1%）。
卡氏肺孢子虫、金黄色葡萄球菌、肺炎球菌和呼吸道合胞病毒在南非 5 岁以下 HIV 感染儿童中导致相当大比例的放射学确诊肺炎。加快获得 ART 和磺胺甲噁唑预防的机会将降低这些儿童的肺炎负担。
