Etiology and Risk Factors for Mortality in an Adult Community-acquired Pneumonia Cohort in Malawi

Abstract

Rationale: In the context of rapid antiretroviral therapy rollout and an increasing burden of noncommunicable diseases, there are few contemporary data describing the etiology and outcome of community-acquired pneumonia (CAP) in sub-Saharan Africa. Objectives: To describe the current etiology of CAP in Malawi and identify risk factors for mortality. Methods: We conducted a prospective observational study of adults hospitalized with CAP to a teaching hospital in Blantyre, Malawi. Etiology was defined by blood culture, Streptococcus pneumoniae urinary antigen detection, sputum mycobacterial culture and Xpert MTB/RIF, and nasopharyngeal aspirate multiplex PCR. Measurements and Main Results: In 459 patients (285 [62.1%] males; median age, 34.7 [interquartile range, 29.4–41.9] yr), 30-day mortality was 14.6% (64/439) and associated with male sex (adjusted odds ratio, 2.60 [95% confidence interval, 1.17–5.78]), symptom duration greater than 7 days (2.78 [1.40–5.54]), tachycardia (2.99 [1.48–6.06]), hypoxemia (4.40 [2.03–9.51]), and inability to stand (3.59 [1.72–7.50]). HIV was common (355/453; 78.4%), frequently newly diagnosed (124/355; 34.9%), but not associated with mortality. S. pneumoniae (98/458; 21.4%) and Mycobacterium tuberculosis (75/326; 23.0%) were the most frequently identified pathogens. Viral infection occurred in 32.6% (148/454) with influenza (40/454; 8.8%) most common. Bacterial–viral coinfection occurred in 9.1% (28/307). Detection of M. tuberculosis was associated with mortality (adjusted odds ratio, 2.44 [1.19–5.01]). Conclusions: In the antiretroviral therapy era, CAP in Malawi remains predominantly HIV associated, with a large proportion attributable to potentially vaccine-preventable pathogens. Strategies to increase early detection and treatment of tuberculosis and improve supportive care, in particular the correction of hypoxemia, should be evaluated in clinical trials to address CAP-associated mortality.

HIV infection is associated with elevated biomarkers of immune activation in Ugandan adults with pneumonia

“…Furthermore, a recent cohort study in Malawi of a similar population of adult patients with pneumonia revealed that, after tuberculosis, the most common etiology of pneumonia was Streptococcus pneumoniae , followed by respiratory viruses, in both HIV-infected and HIV-uninfected patients. [46] Therefore, the likelihood of substantial differences in pneumonia etiology between HIV-infected and HIV-uninfected participants is small and we do not think that this possibility invalidates our results.…”

Characteristics of bacterial etiology in lower respiratory tract infection: a surveillance report from a Chinese large teaching hospital from 2015 to 2019

“…[10] However, the most common pathogens of adult community-acquired pneumonia in Malawi, a developing country in Africa were S. pneumoniae, Mycobacterium tuberculosis and non-Mycobacterium tuberculosis. [11] We found that in different regions of the world, the pathogenic bacteria of LRIs were signi cantly different. Therefore, it was of great signi cance to analyze the distribution of local pathogens for epidemiological research and clinical experience.…”

Academic careers in global pulmonary and critical care medicine: perspectives from experts in the field

“…27 The next study of that scale was completed only recently in Malawi. 28 Clinically Relevant-Our group studies alveolar macrophage function in HIV in Malawi. While working on this, however, we also noted high levels of carbonaceous material.…”