Rusen I D, Fraser-Roberts L, Slaney L, Ombette J, Lovgren M, Datta P, Ndinya-Achola J, Talbot J A, Nagelkerke N, Plummer F A, Embree J E
Department of Medical Microbiology, University of Manitoba, Winnipeg, Canada.
Pediatr Infect Dis J. 1997 Jul;16(7):656-62. doi: 10.1097/00006454-199707000-00007.
To compare pneumococcal nasopharyngeal colonization rates among HIV-1-infected children with those of uninfected children born to seropositive mothers and those of seronegative controls. To determine the predominant serotypes and antimicrobial susceptibility among pneumococcal isolates in Kenya.
Nasopharyngeal pneumococcal colonization was examined in 207 children recruited from the Perinatal HIV-1 Transmission Study conducted in Nairobi, Kenya. Colonization was compared among HIV-1-infected children, uninfected children born to seropositive mothers and control seronegative children. Isolates were serotyped and tested for antibiotic susceptibility to penicillin, tetracycline, erythromycin, chloramphenicol, clindamycin and rifampin.
Colonization was higher among HIV-1-infected and uninfected children than among controls only when associated with respiratory illnesses (86% of 7 and 60% of 20 vs. 29% of 31, P = 0.004). No differences were observed when children were asymptomatic (20% of 35, 35% of 94 and 22% of 101). Intermediate penicillin resistance was found in 60% of 94 isolates, 28% were resistant to tetracycline and all isolates were susceptible to the other antibiotics tested. Sixteen serotypes were identified, with 13, 15, 14, 6B and 19F comprising 73% of isolates. Serotype 13 was found in 31% of colonized children. This serotype and 2 others isolated are not found in the current 23-valent polysaccharide vaccine. Overall 41% of colonized children harbored nonvaccine strains.
Although nasopharyngeal pneumococcal colonization was high among children with respiratory illness born to HIV-1-seropositive mothers, increased asymptomatic colonization did not explain the increased risk of invasive pneumococcal disease associated with HIV-1 infection. Intermediate penicillin resistance was common but high level penicillin and multiple antibiotic resistance were not seen. The prevalence of the unique strains circulating in this region will need to be considered in the design of effective pneumococcal vaccines for use in East Africa.
比较感染HIV-1的儿童、血清反应阳性母亲所生未感染儿童以及血清反应阴性对照儿童的肺炎球菌鼻咽部定植率。确定肯尼亚肺炎球菌分离株中的主要血清型及抗菌药敏情况。
对从肯尼亚内罗毕进行的围产期HIV-1传播研究中招募的207名儿童进行了鼻咽部肺炎球菌定植检查。比较了感染HIV-1的儿童、血清反应阳性母亲所生未感染儿童和血清反应阴性对照儿童的定植情况。对分离株进行血清分型，并检测其对青霉素、四环素、红霉素、氯霉素、克林霉素和利福平的抗生素敏感性。
仅在伴有呼吸道疾病时，感染HIV-1的儿童和未感染儿童的定植率高于对照儿童（7例中的86%和20例中的60% 对比31例中的29%，P = 0.004）。儿童无症状时未观察到差异（35例中的20%、94例中的35%和101例中的22%）。在94株分离株中，60%发现有青霉素中度耐药，28%对四环素耐药，所有分离株对其他检测抗生素敏感。鉴定出16种血清型，其中13、15、14、6B和19F型占分离株的73%。在31%的定植儿童中发现了13型血清型。当前的23价多糖疫苗中未发现该血清型及另外两种分离出的血清型。总体而言，41%的定植儿童携带非疫苗菌株。
尽管血清反应阳性母亲所生患有呼吸道疾病的儿童鼻咽部肺炎球菌定植率较高，但无症状定植增加并不能解释与HIV-1感染相关侵袭性肺炎球菌疾病风险增加的原因。青霉素中度耐药很常见，但未发现高水平青霉素耐药和多重抗生素耐药情况。在设计用于东非的有效肺炎球菌疫苗时，需要考虑该地区流行的独特菌株的流行情况。
