A Preliminary Study of Pneumonia Etiology Among Hospitalized Children in Kenya

Hammitt, Laura L.; Kazungu, Sidi; Morpeth, Susan; Gibson, Dustin G.; Mvera, Benedict; Brent, Andrew; Mwarumba, Salim; Onyango, Clayton; Bett, Anne; Akech, Donald; Murdoch, David R.; Nokes, D. James; Scott, John A.

doi:10.1093/cid/cir1071

Cited by 132 publications

(158 citation statements)

References 18 publications

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“…Patients who die may be less likely to be enrolled, which could lead to underestimation of mortality. 48 We were only able to estimate incidence from 1 large urban site for 2 of the study years, which may limit the generalizability of our findings to other settings in South Africa. Low case numbers may have reduced our power to detect differences in incidence for certain pathogens.…”

Section: Discussionmentioning

confidence: 96%

Epidemiology of Acute Lower Respiratory Tract Infection in HIV-Exposed Uninfected Infants

et al. 2016

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Section: Discussionmentioning

confidence: 96%

Epidemiology of Acute Lower Respiratory Tract Infection in HIV-Exposed Uninfected Infants

et al. 2016

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“…The finding of Bordetella infection does not preclude the possibility of co-infections that may have modified the disease presentation. [32][33][34] As only hospitalized cases were included in the study, the findings may not be generalizable to children with less severe forms of illness. The small number of confirmed cases limits the interpretation of stratified B. parapertussis incidence.…”

Section: Discussionmentioning

confidence: 99%

Incidence and Diagnosis of Pertussis in South African Children Hospitalized With Lower Respiratory Tract Infection

Muloiwa

Dube

Nicol

et al. 2016

The Pediatric Infectious Disease Journal

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“…Alternatively, seropositivity might not be specific for symptomatic infection for some viruses. Among 7 viruses tested for by serology in coastal Kenya, only seropositivity for RSV was statistically more common among children with pneumonia than healthy controls (14). Our evaluation was limited by a small sample size, lack of serology data on children, and no serology results for viruses where serology might be more informative of acute infection, like rhinovirus and human bocavirus (15,16).…”

mentioning

confidence: 96%

Additional Diagnostic Yield of Adding Serology to PCR in Diagnosing Viral Acute Respiratory Infections in Kenyan Patients 5 Years of Age and Older

Feikin

Njenga

Bigogo

et al. 2013

Clin Vaccine Immunol

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The role of serology in the setting of PCR-based diagnosis of acute respiratory infections (ARIs) is unclear. We found that acuteand convalescent-phase paired-sample serologic testing increased the diagnostic yield of naso/oropharyngeal swabs for influenza virus, respiratory syncytial virus (RSV), human metapneumovirus, adenovirus, and parainfluenza viruses beyond PCR by 0.4% to 10.7%. Although still limited for clinical use, serology, along with PCR, can maximize etiologic diagnosis in epidemiologic studies. Serology was until recently the principal method for diagnosing viral pneumonia (1-6). Serology, however, can yield false-negative results if the collection of acute-or convalescent-phase blood samples is delayed or too early (4). Moreover, serology is logistically cumbersome and clinically uninformative, because people must return several weeks after the acute illness has resolved (if they survive) for convalescent-phase blood collection. The advent of nucleic acid-based tests (e.g., PCR) of upper respiratory tract specimens offers sensitive, timely diagnostic alternatives (6). The role of serologic testing in the setting of PCR-based diagnosis is unclear.We enrolled persons that were Ն5 years old (median, 11.0 years; range, 5 to 81 years) presenting with acute respiratory illness, defined as cough, difficulty breathing, or chest pain and a documented temperature of Ն38.0°C or oxygen saturation of Ͻ90%, in rural western Kenya from 1 January 2009 and 28 February 2010 (7). At the time of presentation to the clinic, we collected acute-phase blood and nasopharyngeal and oropharyngeal swab specimens in viral transport media. Patients were asked to return 4 to 6 weeks later for a convalescent-phase serum blood draw. Quantitative real-time reverse transcription-PCR (qRT-PCR) of specimens was carried out for adenovirus, respiratory syncytial virus (RSV), human metapneumovirus (hMPV), influenza A and B viruses, and parainfluenza virus (PIV) types 1 to 3 using singleplex qRT-PCR assay (7,8). The qRT-PCR results were considered positive if the threshold cycle (C T ) was Ͻ40.0. Paired sera were tested for antibodies to influenza viruses using hemagglutination inhibition assays and for antibodies to RSV, hMPV, adenovirus, and PIV using standard methods for indirect IgG enzyme-linked immunoassay, in which all assays were optimized for reagent/ diluent composition and concentration and incubation time/ temperatures to obtain the highest limit of detection for anti- a The study was performed on samples collected from individuals in western Kenya. The samples were collected 1 January 2009 to 28 February 2010. The median number of days between acute-and convalescent-phase sera was 42, and the range was 32 to 72 days. b Although the acute and convalescent-phase sera for 232 patients were tested for all viruses, the serum samples for fewer of these patients had qRT-PCR results for some pathogens, resulting in lower denominators (i.e., 203 or 204). c One patient was positive for both parainfluenza virus 1 and parainfluenza vir...

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A Preliminary Study of Pneumonia Etiology Among Hospitalized Children in Kenya

Abstract: A potential etiology was detected in >75% of children admitted with SP or VSP. Except for RSV, the case-control analysis did not detect an association between viral detection in the nasopharynx and hospitalization for pneumonia.

Cited by 132 publications

References 18 publications

Epidemiology of Acute Lower Respiratory Tract Infection in HIV-Exposed Uninfected Infants

Epidemiology of Acute Lower Respiratory Tract Infection in HIV-Exposed Uninfected Infants

Incidence and Diagnosis of Pertussis in South African Children Hospitalized With Lower Respiratory Tract Infection

Additional Diagnostic Yield of Adding Serology to PCR in Diagnosing Viral Acute Respiratory Infections in Kenyan Patients 5 Years of Age and Older

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