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Birindwa AM, Kasereka JK, Gonzales-Siles L, Geravandi S, Mwilo M, Tudiakwile LK, Mwinja NL, Muhigirwa B, Kashosi T, Manegabe JT, Bugashane EB, Saili SM, Mungo C, Nordén R, Andersson R, Skovbjerg S. Bacteria and viruses in the upper respiratory tract of Congolese children with radiologically confirmed pneumonia. BMC Infect Dis 2021; 21:837. [PMID: 34412597 PMCID: PMC8374414 DOI: 10.1186/s12879-021-06570-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 08/12/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND 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. METHODS 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. RESULTS 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. CONCLUSIONS 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.
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Affiliation(s)
- Archippe M. Birindwa
- grid.8761.80000 0000 9919 9582Department of Infectious Diseases, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden ,Panzi Hospital, Bukavu, Democratic Republic of the Congo ,grid.442835.c0000 0004 6019 1275Université Evangélique en Afrique, Bukavu, Democratic Republic of the Congo ,Hôpital Général de Référence de Panzi, BP: 266, Bukavu, Democratic Republic of the Congo
| | - Jerry K. Kasereka
- Panzi Hospital, Bukavu, Democratic Republic of the Congo ,grid.442835.c0000 0004 6019 1275Université Evangélique en Afrique, Bukavu, Democratic Republic of the Congo
| | - Lucia Gonzales-Siles
- grid.8761.80000 0000 9919 9582Department of Infectious Diseases, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden
| | - Shadi Geravandi
- grid.8761.80000 0000 9919 9582Department of Infectious Diseases, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden
| | - Mambo Mwilo
- Panzi Hospital, Bukavu, Democratic Republic of the Congo ,grid.442835.c0000 0004 6019 1275Université Evangélique en Afrique, Bukavu, Democratic Republic of the Congo
| | - Léonard K. Tudiakwile
- Panzi Hospital, Bukavu, Democratic Republic of the Congo ,grid.442835.c0000 0004 6019 1275Université Evangélique en Afrique, Bukavu, Democratic Republic of the Congo
| | - Néné L. Mwinja
- Panzi Hospital, Bukavu, Democratic Republic of the Congo ,grid.442835.c0000 0004 6019 1275Université Evangélique en Afrique, Bukavu, Democratic Republic of the Congo
| | | | - Théophile Kashosi
- grid.442835.c0000 0004 6019 1275Université Evangélique en Afrique, Bukavu, Democratic Republic of the Congo
| | | | | | - Stay M. Saili
- Panzi Hospital, Bukavu, Democratic Republic of the Congo
| | - Clement Mungo
- Panzi Hospital, Bukavu, Democratic Republic of the Congo
| | - Rickard Nordén
- grid.8761.80000 0000 9919 9582Department of Infectious Diseases, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden ,grid.1649.a000000009445082XDepartment of Clinical Microbiology, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Rune Andersson
- grid.8761.80000 0000 9919 9582Department of Infectious Diseases, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden ,grid.1649.a000000009445082XDepartment of Clinical Microbiology, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden ,grid.8761.80000 0000 9919 9582CARe – Centre for Antibiotic Resistance Research, Gothenburg University, Gothenburg, Sweden
| | - Susann Skovbjerg
- grid.8761.80000 0000 9919 9582Department of Infectious Diseases, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden ,grid.1649.a000000009445082XDepartment of Clinical Microbiology, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden ,grid.8761.80000 0000 9919 9582CARe – Centre for Antibiotic Resistance Research, Gothenburg University, Gothenburg, Sweden
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