Etiology of Severe Childhood Pneumonia in The Gambia, West Africa, Determined by Conventional and Molecular Microbiological Analyses of Lung and Pleural Aspirate Samples

Abstract

Molecular analyses of lung aspirates from Gambian children with severe pneumonia detected pathogens more frequently than did culture and showed a predominance of bacteria, principally Streptococcus pneumoniae, >75% being of serotypes covered by current pneumococcal conjugate vaccines. Multiple pathogens were detected frequently, notably Haemophilus influenzae (mostly nontypeable) together with S. pneumoniae.

Respiratory viruses associated with community-acquired pneumonia in children: matched case–control study

“…Several studies both in mice and in humans indicate that certain viral infections predispose for bacterial superinfection 32–34. A recent study of lung aspirates in children with CAP in the Gambia showed S. pneumoniae in 90% of the samples, yet this was prior to introduction of PCV and most detected pneumococci were serotypes included in the PCV 35. They did not find any hMPV which might indicate that the aetiology of CAP in high- and low-income countries differ 10.…”

Advances in the diagnosis of pneumonia in children

“…76 In a report from the Gambia, the diagnostic yield depended on the method of testing, with a potential pathogen identified by a combination of culture and molecular testing in 53 of 56 samples (including 47 lung aspirates and nine pleural fluids). 102 Streptococcus pneumoniae was identified in 91% of samples by molecular testing, but only 25% of samples by culture. 102 Because case-control studies are not possible with this specimen type, inferences regarding causality are not straightforward.…”

“…102 Streptococcus pneumoniae was identified in 91% of samples by molecular testing, but only 25% of samples by culture. 102 Because case-control studies are not possible with this specimen type, inferences regarding causality are not straightforward. It seems probable that contamination with upper respiratory tract flora is less likely with lung aspirates; however, highly sensitive nucleic acid amplification assays may detect very small amounts of nucleic acid and do not necessarily imply the presence of viable organisms in large numbers.…”

Childhood pneumonia – the Drakenstein Child Health Study

“…[17] Globally RSV was estimated to cause approximately 34 million episodes of acute lower respiratory tract infections (ALRIs) in children aged <5 years, or 22% of all ALRIs; 10% of episodes resulted in severe illness and hospitalisation, and 99% of deaths occurred in LMICs. Further studies in African children preceding the availability of PCV, [18,19] and several recent case-control studies in children well vaccinated with PCV13, mostly from high-income countries, have reported RSV to be a predominant pathogen in children hospitalised with pneumonia. [20,21] Consistent with other studies, RSV occurred in young infants with the peak incidence under 6 months.…”