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Daningrat WOD, Paramaiswari WT, Putri HFM, Aanensen D, Safari D. Prevalence, serotype distribution and antimicrobial susceptibility profile of Streptococcus pneumoniae in sea nomads children <5 years of age in Wakatobi, Southeast Sulawesi, Indonesia: A cross-sectional study. J Glob Antimicrob Resist 2024:S2213-7165(24)00159-0. [PMID: 39197656 DOI: 10.1016/j.jgar.2024.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 08/16/2024] [Accepted: 08/20/2024] [Indexed: 09/01/2024] Open
Abstract
OBJECTIVES Indonesia started the nationwide introduction of pneumococcal conjugate vaccine (PCV) in 2022. Pre-vaccine data of Streptococcus pneumoniae across the country would be critical to enable vaccine impact evaluation in the future. This study evaluates colonization prevalence, factors associated with colonization, serotype distribution, and antimicrobial susceptibility profile of S. pneumoniae. METHODS We enrolled children <5 years old from the settlements of Bajau Tribe in Wakatobi, Southeast Sulawesi, Indonesia, from October 2018 to February 2019. Nasopharyngeal (NP) swab specimens were analyzed by culture, and isolates were serotyped using sequential multiplex PCR. Antibiotic susceptibility was performed by disc-diffusion method. Multivariable logistic regression was performed for risk factors analysis. RESULTS We collected 499 NP swab specimens. 61.9% were colonized with S. pneumoniae and 48,9 % of the isolates were PCV13-vaccine type. The most common serotypes were 23F, 6B, 19F, and 6A with 13.2%, 9.8%, 8.9%, and 8.0%, respectively. Exposure to cigarette smoke in the household and runny nose were significant risk factors to colonization with aOR 1.6 (1.1 - 2.3) and 2.1 (1.4 - 3.3), respectively. CONCLUSION Findings in this study may contribute to the baseline pre-vaccine data in the country that would be critical for the vaccine impact evaluation.
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Affiliation(s)
- Wa Ode Dwi Daningrat
- Centre for Genomic Pathogen Surveillance, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Wisiva Tofriska Paramaiswari
- Master's Programme in Biomedical Sciences, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia; Cluster of Infectious Diseases and Immunology. Indonesian Medical Education and Research Institute (IMERI), Indonesia
| | - Hanifah Fajri Maharani Putri
- Cluster of Infectious Diseases and Immunology. Indonesian Medical Education and Research Institute (IMERI), Indonesia
| | - David Aanensen
- Centre for Genomic Pathogen Surveillance, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Dodi Safari
- Eijkman Research Centre for Molecular Biology, National Research and Innovation Agency, Cibinong, West Java, Indonesia.
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Di Caprio A, Coccolini E, Zagni P, Vaccina E, Lucaccioni L, Lugli L, Iughetti L, Berardi A. Pneumococcal septic shock after neonatal respiratory syncytial virus bronchiolitis: A case report and literature review. ACTA BIO-MEDICA : ATENEI PARMENSIS 2021; 92:e2021111. [PMID: 33944814 PMCID: PMC8142759 DOI: 10.23750/abm.v92is1.11209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 01/07/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Bronchiolitis is a common cause of hospitalisation of infants less than a year old, with most infants recovering without complications. Respiratory syncytial virus (RSV) is a leading cause of bronchiolitis. Antimicrobial stewardship programmes do not recommend antibiotics for viral infections in neonates unless documented evidence of secondary bacterial infection is present. CASE REPORT We present the case of a 7-day-old infant admitted to hospital with chest retractions and fever. The baby was hospitalised, empirical antibiotic therapy was administered, and non-invasive ventilation was started. When the viral aetiology was identified and clinical conditions improved, antibiotics were discontinued. However, after 48 hours, the newborn's condition worsened because of pneumococcal septic shock. Intravenous fluids, catecholamine support, and wide-spectrum antibiotics were administered. Non-invasive ventilation was re-started and continued until the full recovery. CONCLUSIONS There is increasing evidence that RSV and S. pneumoniae co-infect and interact with each other, thus increasing respiratory diseases' severity. We provide a brief overview of the main international guidelines for managing bronchiolitis. Guidelines suggest avoidance of antibiotics use when the diagnosis of viral bronchiolitis is confirmed. We discuss the uncertainties regarding antibiotic use, especially in younger infants, who are more exposed to risks of bacterial superinfection.
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Affiliation(s)
- Antonella Di Caprio
- Scuola di Specializzazione in Pediatria, Università di Modena e Reggio Emilia, 41124 Modena, Italy.
| | - Elena Coccolini
- Terapia Intensiva Pediatrica e Neonatale, Ospedale M. Bufalini, 47521 Cesena, Italy; .
| | - Paola Zagni
- Terapia Intensiva Neonatale, Ospedale Fatebenefratelli P.O. Macedonio Melloni, 20129 Milano, Italy;.
| | - Eleonora Vaccina
- Scuola di Specializzazione in Pediatria, Università di Modena e Reggio Emilia, 41124 Modena, Italy.
| | - Laura Lucaccioni
- UO di Pediatria, Dipartimento di Scienze Mediche e Chirurgiche Materno-Infantili e dell'Adulto, AOU Policlinico di Modena, Modena.
| | - Licia Lugli
- UO di Terapia Intensiva Neonatale, Dipartimento di Scienze Mediche e Chirurgiche Materno-Infantili e dell'Adulto, AOU Policlinico di Modena, Modena.
| | - Lorenzo Iughetti
- UO di Pediatria, Dipartimento di Scienze Mediche e Chirurgiche Materno-Infantili e dell'Adulto, AOU Policlinico di Modena, Modena.
| | - Alberto Berardi
- UO di Terapia Intensiva Neonatale, Dipartimento di Scienze Mediche e Chirurgiche Materno-Infantili e dell'Adulto, AOU Policlinico di Modena, Modena.
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Birindwa AM, Emgård M, Nordén R, Samuelsson E, Geravandi S, Gonzales-Siles L, Muhigirwa B, Kashosi T, Munguakonkwa E, Manegabe JT, Cibicabene D, Morisho L, Mwambanyi B, Mirindi J, Kabeza N, Lindh M, Andersson R, Skovbjerg S. High rate of antibiotic resistance among pneumococci carried by healthy children in the eastern part of the Democratic Republic of the Congo. BMC Pediatr 2018; 18:361. [PMID: 30453916 PMCID: PMC6241069 DOI: 10.1186/s12887-018-1332-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 10/31/2018] [Indexed: 12/02/2022] Open
Abstract
Background Pneumococcal conjugate vaccines have been introduced in the infant immunisation programmes in many countries to reduce the rate of fatal pneumococcal infections. In the Democratic Republic of the Congo (DR Congo) a 13-valent vaccine (PCV13) was introduced in 2013. Data on the burden of circulating pneumococci among children after this introduction are lacking. In this study, we aimed to determine the risk factors related to pneumococcal carriage in healthy Congolese children after the vaccine introduction and to assess the antibiotic resistance rates and serotype distribution among the isolated pneumococci. Methods In 2014 and 2015, 794 healthy children aged one to 60 months attending health centres in the eastern part of DR Congo for immunisation or growth monitoring were included in the study. Data on socio-demographic and medical factors were collected by interviews with the children’s caregivers. Nasopharyngeal swabs were obtained from all the children for bacterial culture, and isolated pneumococci were further tested for antimicrobial resistance using disc diffusion tests and, when indicated, minimal inhibitory concentration (MIC) determination, and for serotype/serogroup by molecular testing. Results The pneumococcal detection rate was 21%, being higher among children who had not received PCV13 vaccination, lived in rural areas, had an enclosed kitchen, were malnourished or presented with fever (p value < 0.05). The predominant serotypes were 19F, 11, 6A/B/C/D and 10A. More than 50% of the pneumococcal isolates belonged to a serotype/serogroup not included in PCV13. Eighty per cent of the isolates were not susceptible to benzylpenicillin and non-susceptibility to ampicillin and ceftriaxone was also high (42 and 37% respectively). Almost all the isolates (94%) were resistant to trimethoprim-sulphamethoxazole, while 43% of the strains were resistant to ≥3 antibiotics. Conclusions Our study shows alarmingly high levels of reduced susceptibility to commonly used antibiotics in pneumococci carried by healthy Congolese children. This highlights the importance of local antibiotic resistance surveillance and indicates the needs for the more appropriate use of antibiotics in the area. The results further indicate that improved living conditions are needed to reduce the pneumococcal burden, in addition to PCV13 vaccination. Electronic supplementary material The online version of this article (10.1186/s12887-018-1332-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Archippe M Birindwa
- Department of Infectious Diseases, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden. .,Panzi Hospital, Bukavu, Democratic Republic of the Congo. .,Université Evangélique en Afrique, Bukavu, Democratic Republic of the Congo. .,Hôpital Général de Référence de Panzi, BP: 266, Bukavu, DR, Congo.
| | - Matilda Emgård
- Department of Infectious Diseases, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden
| | - Rickard Nordén
- Department of Infectious Diseases, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden
| | - Ebba Samuelsson
- Department of Infectious Diseases, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden
| | - Shadi Geravandi
- Department of Infectious Diseases, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden
| | - Lucia Gonzales-Siles
- Department of Infectious Diseases, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden
| | | | - Théophile Kashosi
- Université Evangélique en Afrique, Bukavu, Democratic Republic of the Congo
| | | | | | | | | | | | | | - Nadine Kabeza
- Panzi Hospital, Bukavu, Democratic Republic of the Congo
| | - Magnus Lindh
- Department of Infectious Diseases, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden
| | - Rune Andersson
- Department of Infectious Diseases, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden.,CARe - Center for Antibiotic Resistance Research, Gothenburg University, Gothenburg, Sweden
| | - Susann Skovbjerg
- Department of Infectious Diseases, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden
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Roca A, Camara B, Oluwalana C, Lette K, Bottomley C, D’Alessandro U. Long-lasting effect of oral azithromycin taken by women during labour on infant nutrition: Follow-up cohort of a randomized clinical trial in western Gambia. PLoS One 2018; 13:e0206348. [PMID: 30359447 PMCID: PMC6201939 DOI: 10.1371/journal.pone.0206348] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 10/11/2018] [Indexed: 11/20/2022] Open
Abstract
Objective To assess the effect of administering an oral dose of 2g of azithromycin in Gambian women during labour on infant growth. Methods Children whose mothers had been randomized to receive either an oral dose of 2g of azithromycin or placebo during labour were visited at home at the end of infancy by trained study nurses blind to the treatment allocation. The follow-up visit of these cohorts (exposed and non-exposed to azithromycin), which was not part of the original trial design, was conducted between November 2014 and May 2015 when the infants were 11 to 13 months of age. During visits, nurses recorded anthropometrical measurements and transcribed information from the infants’ welfare cards. Results Four-hundred and sixty-five (79.6%) of the 584 infants aged 11–13 months at the time of the survey were recruited. The proportion of children with an age-adjusted Z-score <-2SD for mid-upper-arm circumference (MUAC) was lower among those exposed to azithromycin [1.3% versus 6.3%, OR = 0.21 95%CI (0.06,0.72), p = 0.006] and there was weak evidence of a difference in the proportion of infants with weight-for-age (WAZ) Z-score <-2SD [7.1% versus 12.1%, OR = 0.58 95%CI (0.33,1.04), p = 0.065]. For all other malnutrition indicators the proportions were similar in the exposed and un-exposed cohort. Conclusions Our results show that azithromycin in labour may have a beneficial effect in MUAC among children who are below the curve. Larger studies with closer follow-up are warranted. Trial registration (main trial) ClinicalTrials.gov Identifier NCT01800942.
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Affiliation(s)
- Anna Roca
- MRC Unit at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
- * E-mail:
| | - Bully Camara
- MRC Unit at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Claire Oluwalana
- MRC Unit at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Kodou Lette
- MRC Unit at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | | | - Umberto D’Alessandro
- MRC Unit at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
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Hansen NS, Byberg S, Hervig Jacobsen L, Bjerregaard-Andersen M, Jensen AKG, Martins C, Aaby P, Skov Jensen J, Stabell Benn C, Whittle H. Effect of early measles vaccine on pneumococcal colonization: A randomized trial from Guinea-Bissau. PLoS One 2017; 12:e0177547. [PMID: 28545041 PMCID: PMC5435222 DOI: 10.1371/journal.pone.0177547] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 04/27/2017] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Measles vaccine (MV) may have non-specific beneficial effects for child health and particularly seems to prevent respiratory infections. Streptococcus pneumoniae is the leading cause of bacterial pneumonia among children worldwide, and nasopharyngeal colonization precedes infection. OBJECTIVE We investigated whether providing early MV at 18 weeks of age reduced pneumococcal colonization and/or density up to 9 months of age. METHOD The study was conducted in 2013-2014 in Guinea-Bissau. Pneumococcal vaccine was not part of the vaccination program. Infants aged 18 weeks were block-randomized 2:1 to early or no early MV; at age 9 months, all children were offered MV as per current policy. Nasopharyngeal swabs were taken at baseline, age 6.5 months, and age 9 months. Pneumococcal density was determined by q-PCR. Prevalence ratios of pneumococcal colonization and recent antibiotic treatment (yes/no) by age 6.5 months (PR6.5) and age 9 months (PR9) were estimated using Poisson regression with robust variance estimates while the pneumococcal geometric mean ratio (GMR6.5 and GMR9) was obtained using OLS regression. RESULTS Analyses included 512 children; 346 early MV-children and 166 controls. At enrolment, the pneumococcal colonization prevalence was 80% (411/512). Comparing early MV-children with controls, the PR6.5 was 1.02 (95%CI = 0.94-1.10), and the PR9 was 1.04 (0.96-1.12). The GMR6.5 was 1.02 (0.55-1.89), and the GMR9 was 0.69 (0.39-1.21). Early MV-children tended to be less frequently treated with antibiotics prior to follow up (PR6.5 0.60 (0.34-1.05) and PR9 0.87 (0.50-1.53)). Antibiotic treatment was associated with considerably lower colonization rates, PR6.5 0.85 (0.71-1.01) and PR9 0.66 (0.52-0.84), as well as lower pneumococcal density, GMR6.5 0.32 (0.12-0.86) and GMR9 0.52 (0.18-1.52). CONCLUSION Early MV at age 18 weeks had no measurable effect on pneumococcal colonization prevalence or density. Higher consumption of antibiotics among controls may have blurred an effect of early MV. TRIAL REGISTRATION clinicaltrials.gov NCT01486355.
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Affiliation(s)
- Nadja Skadkær Hansen
- Research Center for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
| | - Stine Byberg
- Research Center for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
| | - Lars Hervig Jacobsen
- Research Center for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
| | - Morten Bjerregaard-Andersen
- Research Center for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
| | - Aksel Karl Georg Jensen
- Research Center for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
- Section of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Cesario Martins
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
| | - Peter Aaby
- Research Center for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
| | - Jørgen Skov Jensen
- Department of Microbiology and Infection Control, Statens Serum Institut, Copenhagen, Denmark
| | - Christine Stabell Benn
- Research Center for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
- Odense Patient data Explorative Network, Odense University Hospital/Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Hilton Whittle
- The London School of Hygiene and Tropical Medicine, London, United Kingdom
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Soto-Noguerón A, Carnalla-Barajas MN, Solórzano-Santos F, Arrendondo-García JL, Arzate-Barbosa P, Tinoco-Favila JC, Anzurez-Gutiérrez A, Echániz-Aviles G. Streptococcus pneumoniae as cause of infection in infants less than 60 days of age: serotypes and antimicrobial susceptibility. Int J Infect Dis 2015; 42:69-73. [PMID: 26673859 DOI: 10.1016/j.ijid.2015.12.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Revised: 11/26/2015] [Accepted: 12/02/2015] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The aim of this study was to determine the distribution of serotypes and the antimicrobial susceptibilities of Streptococcus pneumoniae clinical isolates causing invasive and non-invasive disease in children aged ≤60 days in hospitals in Mexico. METHODS A 15-year retrospective study was conducted for the period 2000 to 2014. Pneumococcal clinical isolates were serotyped by Quellung reaction, and antimicrobial susceptibility testing was performed with the broth microdilution method. RESULTS A total of 126 pneumococcal isolates were collected. Pneumonia was the most frequent diagnosis (40.5%), followed by meningitis (29.4%), septicemia (16.7%), and other clinical entities, including otitis media and conjunctivitis (13.5%). The most frequent serotypes before the introduction of heptavalent pneumococcal conjugate vaccine (PCV7) were 19F, 23F, 7F, and 35B. Serotypes 3, 6A, 10A, 12F, and 15A/B increased after the introduction of PCV7. Serotype 19A was isolated most frequently in the pneumonia and meningitis cases only after the introduction of PCV7, and it displayed a high resistance to penicillin. CONCLUSIONS Although the number of infections in infants aged ≤60 days was low, such infections were not unusual events. New vaccination strategies should be evaluated to limit the risks in this age group.
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Affiliation(s)
- Araceli Soto-Noguerón
- Instituto Nacional de Salud Pública, Avenida Universidad 655, Cuernavaca, Morelos 62100, Mexico
| | | | - Fortino Solórzano-Santos
- Unidad Médica de Alta Especialidad, Hospital de Pediatría Centro Médico Nacional SXXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | | | | | | | | | - Gabriela Echániz-Aviles
- Instituto Nacional de Salud Pública, Avenida Universidad 655, Cuernavaca, Morelos 62100, Mexico.
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Semiparametric regression of multivariate panel count data with informative observation times. J MULTIVARIATE ANAL 2015. [DOI: 10.1016/j.jmva.2015.05.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Mathew JL, Singhi S. Pneumococcal disease in India: the dilemma continues. Indian J Med Res 2014; 140:165-6. [PMID: 25297348 PMCID: PMC4216489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Joseph L. Mathew
- Advanced Pediatrics Centre Postgraduate Institute of Medical Education & Research Chandigarh 160 012, India
| | - Sunit Singhi
- Advanced Pediatrics Centre Postgraduate Institute of Medical Education & Research Chandigarh 160 012, India,For correspondence:
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Verhagen LM, Gómez-Castellano K, Snelders E, Rivera-Olivero I, Pocaterra L, Melchers WJ, de Waard JH, Hermans PW. Respiratory infections in Eñepa Amerindians are related to malnutrition and Streptococcus pneumoniae carriage. J Infect 2013; 67:273-81. [PMID: 23796866 PMCID: PMC7173337 DOI: 10.1016/j.jinf.2013.06.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Revised: 06/09/2013] [Accepted: 06/12/2013] [Indexed: 01/07/2023]
Abstract
OBJECTIVES High acute respiratory tract infection (ARTI) rates are observed in indigenous populations. We assessed the role of viral infections and nasopharyngeal bacterial carriage in ARTIs in Eñepa Amerindians from Venezuela. METHODS In 40 children aged 0-10 years with ARTIs, healthy nearest-age sibling controls and their mothers the presence of Streptococcus pneumoniae, Haemophilus influenzae, Staphylococcus aureus, Moraxella catarrhalis, Mycoplasma pneumoniae, Chlamydophila pneumoniae/psittachi and 15 respiratory viruses was investigated. RESULTS S. pneumoniae was the most frequently detected pathogen, with carriage rates of 75% and 38% in children and mothers respectively. In children, S. pneumoniae carriage was associated with ARTI risk in multivariate analysis (OR 14.1, 95% CI 1.4-137.7). Viral infections were not associated with ARTI risk. S. pneumoniae carriage was common in children of all ages while viral co-infections were more frequently present in children under 4 years compared to older children (46% vs. 17%, p < 0.01). An increase of one unit height-for-age Z score (i.e. improved chronic nutritional status) was associated with decreased odds of S. pneumoniae colonization in multivariate analysis (OR 0.66, 95% CI 0.44-0.99). CONCLUSIONS In Eñepa children high S. pneumoniae carriage rates associated with a poor nutritional status contribute to the development of ARTIs.
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Affiliation(s)
- Lilly M. Verhagen
- Laboratory of Pediatric Infectious Diseases, Radboud University Medical Centre, PO Box 9101 (Internal Post 224), 6500 HB Nijmegen, The Netherlands
- Laboratorio de Tuberculosis, Instituto de Biomedicina, Universidad Central de Venezuela, 1010 Caracas, Venezuela
| | - Keyla Gómez-Castellano
- Laboratorio de Tuberculosis, Instituto de Biomedicina, Universidad Central de Venezuela, 1010 Caracas, Venezuela
| | - Eveline Snelders
- Department of Medical Microbiology, Radboud University Medical Centre, 6500 HB Nijmegen, The Netherlands
| | - Ismar Rivera-Olivero
- Laboratorio de Tuberculosis, Instituto de Biomedicina, Universidad Central de Venezuela, 1010 Caracas, Venezuela
| | - Leonor Pocaterra
- Catédra de Parasitología, Escuela de Medicina José María Vargas, Universidad Central de Venezuela, 1010 Caracas, Venezuela
| | - Willem J.G. Melchers
- Department of Medical Microbiology, Radboud University Medical Centre, 6500 HB Nijmegen, The Netherlands
| | - Jacobus H. de Waard
- Laboratorio de Tuberculosis, Instituto de Biomedicina, Universidad Central de Venezuela, 1010 Caracas, Venezuela
| | - Peter W.M. Hermans
- Laboratory of Pediatric Infectious Diseases, Radboud University Medical Centre, PO Box 9101 (Internal Post 224), 6500 HB Nijmegen, The Netherlands
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