Role of Streptococcus pneumoniae in Hospitalization for Acute Community-acquired Pneumonia Associated With Culture-confirmed Mycobacterium tuberculosis in Children A Pneumococcal Conjugate Vaccine Probe Study
Role of Streptococcus pneumoniae in Hospitalization for Acute Community-acquired Pneumonia Associated With Culture-confirmed Mycobacterium tuberculosis in Children A Pneumococcal Conjugate Vaccine Probe Study
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DOI：
10.1097/inf.0b013e3181eaefff
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发表时间：
2010-12-01
影响因子：
3.6
通讯作者：
Madhi, Shabir A.
中科院分区：
文献类型：
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作者：
Moore, David P.;Klugman, Keith P.;Madhi, Shabir A.
简介：非洲儿童因严重急性肺炎症状住院，经经验性抗生素治疗后缓解，有时被确定为有潜在的培养证实的肺结核（PTB）。实验研究表明，结核分枝杆菌感染易患肺炎链球菌感染;然而，诊断的局限性使得难以量化儿童中的这种关联。我们的目的是探讨肺炎球菌合并感染PTB儿童的程度，使用疫苗探针设计study.Materials和方法：PTB病例发生在39,836名参与者在第三阶段随机，双盲安慰剂对照9价肺炎球菌多糖蛋白结合疫苗（PCV 9）在南非进行试验的事后分析。在5.3年随访期间发生的因PTB而住院的患者被确定并分类为培养证实的PTB或很可能/可能的PTB。比较PCV 9疫苗接种者和安慰剂接种者之间住院PTB的发病率。因培养证实的PTB住院的比例为43.4%（95% CI，9.7%-65.1%）与安慰剂接种者（n = 53）相比，疫苗接种者（n = 30）的发生率较低，发生率为20 vs 35/100，000随访儿童年（P = 0.0117）。在HIV感染儿童中，接种疫苗者（n = 19）与安慰剂接种者（n = 36）相比，培养证实的PTB发生率低47.3%（95% CI，8.6%-69.6%），P = 0.0203。可能/可能的PTB的发病率没有不同的疫苗接种status.Conclusions：这种疫苗探针设计的研究表明，在设置高艾滋病毒和结核病的患病率，文化证实的PTB在非洲儿童，这经常出现急性肺炎的症状，可能与叠加肺炎球菌肺炎。在这些情况下，患有肺炎的儿童应调查潜在的PTB。
Introduction: African children hospitalized with symptoms of severe acute pneumonia, which resolves following empiric antibiotic therapy, are sometimes identified to have underlying culture-confirmed pulmonary tuberculosis (PTB). Experimental studies suggest Mycobacterium tuberculosis infection predisposes to Streptococcus pneumoniae infection; however, diagnostic limitations make it difficult to quantify this association in children. We aimed to probe the extent of pneumococcal coinfection in children with PTB, using a vaccine-probe design study.Materials and Methods: A post hoc analysis of PTB cases occurring among 39,836 participants in a phase III randomized, double-blind placebo-controlled 9-valent pneumococcal polysaccharide-protein conjugate vaccine (PCV9) trial in South Africa was undertaken. Hospitalization for PTB occurring during the 5.3 years of follow-up were identified and categorized as culture-confirmed PTB or probable/possible-PTB. The incidence rates of hospitalized PTB were compared between PCV9 vaccinees and placebo recipients.Results: Hospitalization for culture-confirmed PTB was 43.4% (95% CI, 9.7%-65.1%) less likely among vaccinees (n = 30) compared with placebo recipients (n = 53), incidence, 20 versus 35 per 100,000 child-years of follow-up (P = 0.0117). In HIV-infected children, culture-confirmed PTB was 47.3% (95% CI, 8.6%-69.6%) less likely among vaccinees (n = 19) compared with placebo recipients (n = 36), P = 0.0203. The incidence of possible/probable PTB did not differ by vaccination status.Conclusions: This vaccine-probe design study suggests that in a setting with high HIV and TB prevalence, culture-confirmed PTB in African children, which frequently presents with symptoms of acute pneumonia, is probably associated with superimposed pneumococcal pneumonia. Children admitted with pneumonia in these settings should be investigated for underlying PTB.