Details

Autor(en) / Beteiligte

• Johnson, Abdul-Wahab B.R., FWACP (Paed)
• Osinusi, Kikelomo, FWACP (Paed)
• Aderele, Wilson I., FRCP (Edin)
• Gbadero, Daniel A., FMCPaed
• Olaleye, Olufemi D., PhD
• Adeyemi-Doro, Folorunsho A.B., FMCPath

Titel

Etiologic Agents and Outcome Determinants of Community-Acquired Pneumonia in Urban Children: A Hospital-Based Study

Ist Teil von

• Journal of the National Medical Association, 2008-04, Vol.100 (4), p.370-385

Ort / Verlag

Thorofare, NJ: Elsevier Inc

Erscheinungsjahr

2008

Quelle

MEDLINE

Beschreibungen/Notizen

• Etiologic clues and prognostic indicators of community-acquired pneumonia (CAP) were sought in a 30-month study of under-5 admissions for acute lower respiratory infections (ALRIs). Investigative tools included blood culture, hemogram, immunofluorescence and serology. Associations of variables were tested using standard statistical tools. Of 419 ALRI, 323 (77%) had pneumonia, 234 (72.4%) bronchopneumonia, 66 (20.4%) lobar pneumonia and 23 (7.1%) both. More than 70% had poor parental socioeconomic parameters, 56.8% were overtly malnourished, 37.8% lived in overcrowded homes and 16.7% had been potentially exposed to wood smoke. Despite preconsultation antimicrobial use in 35.6%, 59 (28.8%) of 205 blood cultures proved positive; Staphylococcus aureus accounted for 22 (37.3%), Klebsiella species nine (15.3%) and Streptococcus pneumoniae three (5.1%). Ninety-two viruses were identified in 61 (50%) of 122 analyses. Respiratory syncytial virus (RSV) accounted for 28 (30.4%), parainfluenza virus type 3 (PIV-3) for 18 (19.5%) and influenza type-A (flu-A) 16 (17.3%). Twenty (16.4%) had > 2 viruses, while 40% of bacteremic cases with positive viral identification (s) had PIV-3. Pathogen detection was neither associated with hematologic parameters nor the final respiratory diagnosis. There were 35 (10.8%) deaths. Mortality was associated with maternal illiteracy (p = 0.045), wood smoke exposure (p = 0.006), preconsultation antimicrobial use (p = 0.04), malnutrition (p = 0.0003), bacteremia (p = 0.006) and polymorphonuclear leucocytosis (p = 0.023/0.013). RSV, PIV-3, flu-A, S. aureus and Klebsiella species constitute the major pathogens of pediatric CAP in urban Nigeria, while malnutrition, wood smoke exposure and bactere-mia are strong risk factors of mortality. The poor prognostic import of antimicrobial abuse, vis-a-vis the apparent selection of necrotizing pathogens, are compelling indications for a reappraisal of current regional antimicrobial policies and exploring newer frontiers of disease control, including vaccine prevention.