The Etiology of Pneumonia in HIV-infected Zambian Children: Findings From the Pneumonia Etiology Research for Child Health (PERCH) Study.
The Etiology of Pneumonia in HIV-infected Zambian Children: Findings From the Pneumonia Etiology Research for Child Health (PERCH) Study.
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DOI：
10.1097/inf.0000000000002649
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发表时间：
2021-09-01
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影响因子：
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通讯作者：
Thea DM
中科院分区：
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作者：
Seidenberg P;Mwananyanda L;Chipeta J;Kwenda G;Mulindwa JM;Mwansa J;Mwenechanya M;Wa Somwe S;Feikin DR;Haddix M;Hammitt LL;Higdon MM;Murdoch DR;Prosperi C;O'Brien KL;Deloria Knoll M;Thea DM
补充数字内容可在正文中找到。尽管最近儿童艾滋病毒新感染和儿童艾滋病毒相关死亡有所下降，肺炎仍然是5岁以下艾滋病毒感染儿童死亡的主要原因。我们描述了赞比亚艾滋病毒感染儿童肺炎的患者群体、病因和结果。作为肺炎病原学研究儿童健康研究的9个站点之一，我们招募了1-59个月大的儿童到赞比亚卢萨卡的大学教学医院就诊，患有世界卫生组织定义的严重和非常严重的肺炎。在年龄组和艾滋病毒感染状况方面频率匹配的对照组来自卢萨卡儿童艾滋病毒诊所以及周围社区。临床评估、胸片(CXR；病例)和微生物样本(鼻咽/口咽拭子、血液、尿液、诱导痰)都是在高度标准化的程序下获得的。病因学是用贝叶斯方法估计的，并解释了测量的不完全敏感性和特异性。在赞比亚24个月期间登记的617例病例和686名对照中，103名病例(16.7%)和85名对照(12.4%)感染了艾滋病毒，并纳入了本分析。在艾滋病毒感染者中，75%的人年龄在1岁以下，35%的人接受了甲氧苄氨嘧啶-磺胺甲恶唑的预防性治疗，13.6%的人接受了抗逆转录病毒治疗，36.9%的照顾者报告在登记时知道他们孩子的艾滋病毒状况。35%的病例有非常严重的肺炎，56.3%的病例有浸润性肺炎。在CXR阳性病例中，细菌致病菌[50.6%，可信区间(CRI)：32.8~67.2]、日本肺孢子虫(24.9%，CRI：15.5~36.2)和结核分枝杆菌(4.5%，CRI：1.7~12.1)占75%以上。最常见的致病菌为肺炎链球菌(19.8%，CRI：8.6~36.2)，其次为金黄色葡萄球菌(12.7%，CRI：0.0~25.9)。预后较差，41例(39.8%)在医院死亡。在赞比亚，感染艾滋病毒的儿童患有严重和非常严重的肺炎，结果很差，获得护理的机会仍然有限，主要原因是细菌病原体、吉罗夫西氏杆菌和结核分枝杆菌。
Supplemental Digital Content is available in the text. Despite recent declines in new pediatric HIV infections and childhood HIV-related deaths, pneumonia remains the leading cause of death in HIV-infected children under 5. We describe the patient population, etiology and outcomes of childhood pneumonia in Zambian HIV-infected children. As one of the 9 sites for the Pneumonia Etiology Research for Child Health study, we enrolled children 1–59 months of age presenting to University Teaching Hospital in Lusaka, Zambia, with World Health Organization–defined severe and very severe pneumonia. Controls frequency-matched on age group and HIV infection status were enrolled from the Lusaka Pediatric HIV Clinics as well as from the surrounding communities. Clinical assessments, chest radiographs (CXR; cases) and microbiologic samples (nasopharyngeal/oropharyngeal swabs, blood, urine, induced sputum) were obtained under highly standardized procedures. Etiology was estimated using Bayesian methods and accounted for imperfect sensitivity and specificity of measurements. Of the 617 cases and 686 controls enrolled in Zambia over a 24-month period, 103 cases (16.7%) and 85 controls (12.4%) were HIV infected and included in this analysis. Among the HIV-infected cases, 75% were <1 year of age, 35% received prophylactic trimethoprim-sulfamethoxazole, 13.6% received antiretroviral therapy and 36.9% of caregivers reported knowing their children’s HIV status at time of enrollment. A total of 35% of cases had very severe pneumonia and 56.3% had infiltrates on CXR. Bacterial pathogens [50.6%, credible interval (CrI): 32.8–67.2], Pneumocystis jirovecii (24.9%, CrI: 15.5–36.2) and Mycobacterium tuberculosis (4.5%, CrI: 1.7–12.1) accounted for over 75% of the etiologic fraction among CXR-positive cases. Streptococcus pneumoniae (19.8%, CrI: 8.6–36.2) was the most common bacterial pathogen, followed by Staphylococcus aureus (12.7%, CrI: 0.0–25.9). Outcomes were poor, with 41 cases (39.8%) dying in hospital. HIV-infected children in Zambia with severe and very severe pneumonia have poor outcomes, with continued limited access to care, and the predominant etiologies are bacterial pathogens, P. jirovecii and M. tuberculosis.