Pneumocystis pneumonia in South African children diagnosed by molecular methods

 

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dc.contributor.author Morrow, Brenda M
dc.contributor.author Samuel, Catherine M
dc.contributor.author Zampoli, Marco
dc.contributor.author Whitelaw, Andrew
dc.contributor.author Zar, Heather J
dc.date.accessioned 2015-01-27T12:31:00Z
dc.date.available 2015-01-27T12:31:00Z
dc.date.issued 2014-01-10
dc.identifier.citation Morrow et al. : Pneumocystis pneumonia in South African children diagnosed by molecular methods. BMC Research Notes. 2014 7(1):26 en_ZA
dc.identifier.issn 1756-0500 en_ZA
dc.identifier.uri http://hdl.handle.net/11427/12335
dc.identifier.uri http://dx.doi.org/10.1186/1756-0500-7-26
dc.description.abstract Background: Pneumocystis pneumonia (PCP) is an important cause of hospitalization and mortality in HIV-infected children. However, the incidence of PCP has been underestimated due to poor sensitivity of diagnostic tests. The use of polymerase chain reaction (PCR) for pneumocystis has enabled more reliable diagnosis. This study describes the incidence, clinical features and outcome of PCP in South African children diagnosed using PCR. Methods: A prospective study of children hospitalised in South Africa with suspected PCP was done from November 2006 to August 2008. Clinical, laboratory and radiological information were collected. Lower respiratory tract specimens were obtained for PCP immunofluorescence (IF), real- time PCR for pneumocystis, bacterial and mycobacterial culture. Nasopharyngeal aspirates were taken for immunofluorescence (IF), real-time PCR for pneumocystis and PCR for respiratory viruses. A blood specimen for bacterial culture and for cytomegalovirus PCR was taken. Children were followed for the duration of their hospitalisation and the outcome was recorded. Results: 202 children [median (interquartile range, IQR) age 3.2 (2.1– 4.6) months] were enrolled; 124 (61.4%) were HIV infected. PCP was identified in 109 (54%) children using PCR, compared to 43 (21%) using IF and Grocott staining (p < 0.0001). Most PCP cases (88, 81%) occurred in HIV-infected children. All 21 cases (19%) occurring in HIV- negative children had another risk factor for PCP. On logistic regression, predictive factors for PCP were HIV infection, lack of fever, high respiratory rate and low oxygen saturation whilst cotrimoxazole prophylaxis was protective (OR 0.24; 95% CI 0.1 to 0.5; p < 0.002). The case fatality of children with PCP was higher than those without PCP (32.1% versus 17.2%; relative risk 1.87; 95% confidence interval (CI) 1.11 – 3.15). Amongst HIV-infected children, a CD4 less than 15% was the only independent predictor of mortality. Conclusions: The diagnostic yield for PCP is more than 2.5 times higher on PCR than other detection methods. PCP is a very common cause of severe hypoxic pneumonia and is associated with high mortality in HIV-infected African infants. en_ZA
dc.language eng en_ZA
dc.publisher BioMed Central en_ZA
dc.rights Attribution 2.0 Generic (CC BY 2.0) *
dc.rights.uri http://creativecommons.org/licenses/by/2.0/ en_ZA
dc.source BMC Research Notes en_ZA
dc.source.uri http://www.biomedcentral.com/1756-0500
dc.subject.other Pneumocystis pneumonia en_ZA
dc.subject.other HIV en_ZA
dc.subject.other Prophylaxis en_ZA
dc.title Pneumocystis pneumonia in South African children diagnosed by molecular methods en_ZA
dc.type Journal Article en_ZA
dc.date.updated 2015-01-15T17:55:16Z
dc.language.rfc3066 en
dc.rights.holder Morrow et al.; licensee BioMed Central Ltd.
uct.type.publication Research en_ZA
uct.type.resource Article en_ZA
dc.publisher.institution University of Cape Town
dc.publisher.faculty Faculty of Health Sciences en_ZA
dc.publisher.department Department of Paediatrics and Child Health en_ZA
uct.type.filetype Text
uct.type.filetype Image


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