Respiratory viruses in young South African children with acute lower respiratory infections and interactions with HIV

Annamalay, Alicia A.; Abbott, Salome; Sikazwe, Chisha; Khoo, Siew-Kim; Bizzintino, Joelene; Zhang, Guicheng; Laing, Ingrid A.; Chidlow, Glenys; Smith, David W.; Gern, James E.; Goldblatt, Jack; Lehmann, Deborah; Green, Robin J.; Souëf, Peter N. Le

doi:10.1016/j.jcv.2016.06.002

Cited by 24 publications

(27 citation statements)

References 38 publications

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“…Respiratory viruses isolated from nasopharyngeal throat swabs were low in numbers but in accordance qualitatively with what is found in the same age population in other African settings 22 .…”

Section: Discussionsupporting

confidence: 87%

Causes of fever in Gabonese children: a cross-sectional hospital-based study

Fernandes

Held

Dorn

et al. 2020

Sci Rep

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The causes of infections in pediatric populations differ between age groups and settings, particularly in the tropics. Such differences in epidemiology may lead to misdiagnosis and ineffective empirical treatment. Here, we investigated the current spectrum of pathogens causing febrile diseases leading to pediatric hospitalization in Lambaréné, Gabon. From August 2015 to March 2016, we conducted a prospective, cross-sectional, hospital-based study in a provincial hospital. Patients were children ≤ 15 years with fever ≥ 38 °C and required hospitalization. A total of 600 febrile patients were enrolled. Malaria was the main diagnosis found in 52% (311/600) patients. Blood cultures revealed septicemia in 3% (17/593), among them four cases of typhoid fever. The other causes of fever were heterogeneously distributed between both bacteria and viruses. Severe infections identified by Lambaréné Organ Dysfunction Score (LODS) were also most often caused by malaria, but children with danger signs did not have more coinfections than others. In 6% (35/600) of patients, no pathogen was isolated. In Gabon, malaria is still the major cause of fever in children, followed by a bacterial and viral disease. Guidelines for both diagnosis and management should be tailored to the spectrum of pathogens and resources available locally.Causes of fever in African pediatric populations are more diverse than previously thought. A landmark study conducted in Tanzania showed that due to a change in epidemiology, a broad spectrum of pathogens replaced P. falciparum malaria as the most common cause of disease in children in this area 1 . However, a few years later, P. falciparum malaria, is still seen to be the main cause of febrile illnesses in Ghana, West Africa 2 . When unaware, these differences in epidemiology might lead to misdiagnosis as well as inefficient treatment by the medical personnel. The process of medical diagnosis includes the joint interpretation of symptoms, clinical signs and laboratory findings. Careful selection and prioritization of a diagnostic setup are informed by a priori knowledge of the seasonal, local and worldwide frequency and distribution of a given disease 3,4 .Our study describes the distribution of infections, co-infections, and co-morbidities in children hospitalized for febrile illnesses at the Albert Schweitzer Hospital (HAS) in Lambaréné, Gabon, as an example for a hospital in a semiurban Central African region. In addition, we present the current spectrum of pathogens causing severe disease identified by Lambaréné Organ Dysfunction Score (LODS) in these children. ResultsStudy patients. A total of 600 febrile patients ≤ 15 years were enrolled in our study. Of these, 280 (47%) were females; 69% (415/600) patients were < 5 years, and median (IQR) age was 29 [12-68] months (Table 1). Seven percent (40/549, NA = 51) had at least one known chronic medical condition prior to admission, among the main ones: 4% (23/600) patients had homozygous sickle cell disease; 1% (6/600) were HIV positive. Vaccination coverage...

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Section: Discussionsupporting

confidence: 87%

Causes of fever in Gabonese children: a cross-sectional hospital-based study

Fernandes

Held

Dorn

et al. 2020

Sci Rep

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“…However, viruses -most often human rhinovirus -were commonly isolated from healthy children; RSV was seldom isolated from HIV-infected children. [30] Although pneumonia-associated mortality was very low in the Drakenstein study, early-life pneumonia was associated with impaired lung function in early childhood, possibly setting a trajectory for the development of lifelong respiratory or other non- [27] (GE = gastroenteritis; TB = tuberculosis.) [47] RESEARCH communicable diseases.…”

Section: Respiratory Diseases In Childrenmentioning

confidence: 99%

Neonatal, infant and child health in South Africa: Reflecting on the past towards a better future

et al. 2019

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This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0. Although the neonatal mortality rate in South Africa (SA) has remained stagnant at 12 deaths per 1 000 live births, the infant and under-5 mortality rates have significantly declined since peaking in 2003. Policy changes that have influenced this decline include policies to prevent vertical HIV transmission, earlier treatment of children living with HIV, expanded immunisation policies, strengthening breastfeeding practices, and health policies to contain tobacco and sugar use. The Sustainable Development Goals (2016-2030) have shifted the focus from keeping children alive, as expressed in the Millennium Development Goals (1990-2015), to achieving optimal health through the 'Survive, thrive and transform' global agenda. This paper focuses on important remaining causes of childhood mortality and morbidity in SA, specifically respiratory illness, environmental pollution, tuberculosis, malnutrition and vaccine-preventable conditions. The monitoring of maternal and child health (MCH) outcomes is crucial, and has improved in SA through both the District Health Information and Civil Registration and Vital Statistics systems, although gaps remain. Intermittent surveys and research augment the routinely collected data. However, availability and use of local data to inform quality and effectiveness of care is critical, and this requires ownership at the collection point to facilitate local redress. Potential game changers to improve MCH outcomes include mobile health and community-based interventions. In SA, improved MCH remains a crucial factor for human capital development. There is a pressing need to focus beyond childhood mortality and to ensure that each child thrives.

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“…HIV is associated with an increased risk of tuberculosis, and recurrent viral and bacterial pulmonary infections [7**,17,23,24,25*,26]. However, some data suggest that HIV predisposes to bronchiectasis independently of infection, likely due to HIV-mediated defects in innate immunity and accompanying airway neutrophilic inflammation [17,21*,22*,27].…”

Section: Spectrum Of Chronic Lung Diseasementioning

confidence: 99%

“…It is very rarely reported among HIV-uninfected children after community-acquired respiratory viral infections. The high incidence of viral infections among children and adolescents with HIV may play an important role in development of cOB, particularly in those with delayed diagnosis and treatment of HIV [25*]. Additionally, decreased attenuation was strongly correlated with bronchiectasis and bronchial wall thickening and dilatation on HRCT [8*], suggesting a continuum of pathological processes that links small and large airways involvement.…”

Section: Spectrum Of Chronic Lung Diseasementioning

confidence: 99%

Bronchiectasis and other chronic lung diseases in adolescents living with HIV

Attia

Miller

Ferrand

2017

Current Opinion in Infectious Diseases

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Purpose of review The incidence of pulmonary infections has declined dramatically with improved access to antiretroviral therapy (ART) and co-trimoxazole prophylaxis, but chronic lung disease (CLD) is an increasingly recognized but poorly understood complication in adolescents with perinatally-acquired HIV. Recent findings There is a high prevalence of chronic respiratory symptoms, abnormal spirometry and chest radiographic abnormalities among HIV-infected adolescents in sub-Saharan Africa, where 90% of the world’s HIV-infected children live. The incidence of lymphocytic interstitial pneumonitis, the most common cause of CLD in the pre-ART era, has declined with increased ART access. Small airways disease, particularly constrictive obliterative bronchiolitis and bronchiectasis are emerging as leading causes of CLD among HIV-infected adolescents in low- and middle-income countries. Asthma may be more common in high-income settings. Likely risk factors for CLD include recurrent pulmonary infections, air pollution, HIV-related immune dysfunction and untreated HIV infection, particularly during critical stages of lung development. Summary Globally, the importance of HIV-associated CLD as a cause of morbidity and mortality is increasing, especially as survival has improved dramatically with ART and growing numbers of children living with HIV enter adolescence. Further research is urgently needed to elucidate the natural history and pathogenesis of CLD, and to determine optimal screening, diagnostic and treatment strategies.

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Respiratory viruses in young South African children with acute lower respiratory infections and interactions with HIV

Cited by 24 publications

References 38 publications

Causes of fever in Gabonese children: a cross-sectional hospital-based study

Causes of fever in Gabonese children: a cross-sectional hospital-based study

Neonatal, infant and child health in South Africa: Reflecting on the past towards a better future

Bronchiectasis and other chronic lung diseases in adolescents living with HIV

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