Pneumocystis pneumonia in South African children diagnosed by molecular methods

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dc.contributor.authorMorrow, Brenda M
dc.contributor.authorSamuel, Catherine M
dc.contributor.authorZampoli, Marco
dc.contributor.authorWhitelaw, Andrew
dc.contributor.authorZar, Heather J
dc.date.accessioned2015-01-27T12:31:00Z
dc.date.available2015-01-27T12:31:00Z
dc.date.issued2014-01-10
dc.date.updated2015-01-15T17:55:16Z
dc.description.abstractBackground: 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.identifier.apacitationMorrow, B. M., Samuel, C. M., Zampoli, M., Whitelaw, A., & Zar, H. J. (2014). Pneumocystis pneumonia in South African children diagnosed by molecular methods. <i>BMC Research Notes</i>, http://hdl.handle.net/11427/12335en_ZA
dc.identifier.chicagocitationMorrow, Brenda M, Catherine M Samuel, Marco Zampoli, Andrew Whitelaw, and Heather J Zar "Pneumocystis pneumonia in South African children diagnosed by molecular methods." <i>BMC Research Notes</i> (2014) http://hdl.handle.net/11427/12335en_ZA
dc.identifier.citationMorrow et al. : Pneumocystis pneumonia in South African children diagnosed by molecular methods. BMC Research Notes. 2014 7(1):26en_ZA
dc.identifier.issn1756-0500en_ZA
dc.identifier.ris TY - Journal Article AU - Morrow, Brenda M AU - Samuel, Catherine M AU - Zampoli, Marco AU - Whitelaw, Andrew AU - Zar, Heather J AB - 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. DA - 2014-01-10 DB - OpenUCT DO - 10.1186/1756-0500-7-26 DP - University of Cape Town J1 - BMC Research Notes LK - https://open.uct.ac.za PB - University of Cape Town PY - 2014 SM - 1756-0500 T1 - Pneumocystis pneumonia in South African children diagnosed by molecular methods TI - Pneumocystis pneumonia in South African children diagnosed by molecular methods UR - http://hdl.handle.net/11427/12335 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/12335
dc.identifier.urihttp://dx.doi.org/10.1186/1756-0500-7-26
dc.identifier.vancouvercitationMorrow BM, Samuel CM, Zampoli M, Whitelaw A, Zar HJ. Pneumocystis pneumonia in South African children diagnosed by molecular methods. BMC Research Notes. 2014; http://hdl.handle.net/11427/12335.en_ZA
dc.languageengen_ZA
dc.language.rfc3066en
dc.publisherBioMed Centralen_ZA
dc.publisher.departmentDepartment of Paediatrics and Child Healthen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rightsAttribution 2.0 Generic (CC BY 2.0)*
dc.rights.holderMorrow et al.; licensee BioMed Central Ltd.
dc.rights.urihttp://creativecommons.org/licenses/by/2.0/en_ZA
dc.sourceBMC Research Notesen_ZA
dc.source.urihttp://www.biomedcentral.com/1756-0500
dc.subject.otherPneumocystis pneumoniaen_ZA
dc.subject.otherHIVen_ZA
dc.subject.otherProphylaxisen_ZA
dc.titlePneumocystis pneumonia in South African children diagnosed by molecular methodsen_ZA
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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