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    The Etiology of Childhood Pneumonia in Mali: Findings From the Pneumonia Etiology Research for Child Health (PERCH) Study

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    Author
    Tapia, Milagritos D
    Sylla, Mamadou
    Driscoll, Amanda J
    Touré, Aliou
    Kourouma, Nana
    Sissoko, Seydou
    Tamboura, Boubou
    Diakité, Abdoul Aziz
    Panchalingam, Sandra
    Keïta, Adama M
    Tennant, Sharon
    Onwuchekwa, Uma
    Roose, Anna
    Deloria Knoll, Maria
    Higdon, Melissa M
    Prosperi, Christine
    Hammitt, Laura L
    Feikin, Daniel R
    Murdoch, David R
    O'Brien, Katherine L
    Sow, Samba O
    Kotloff, Karen L
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    Date
    2021-09-01
    Journal
    Pediatric Infectious Disease Journal
    Publisher
    Wolters Kluwer Health
    Type
    Article
    
    Metadata
    Show full item record
    See at
    https://doi.org/10.1097/INF.0000000000002767
    http://www.ncbi.nlm.nih.gov/pmc/articles/pmc8448406/
    Abstract
    Background: We present findings from the Pneumonia Etiology Research for Child Health (PERCH) site in Bamako, Mali. Methods: Cases were patients 28 days to 59 months of age, admitted to hospital with severe or very severe pneumonia (2005 World Health Organization definition). Community controls were frequency matched by age. Both provided nasopharyngeal and oropharyngeal swabs for multiplex polymerase chain reaction and Streptococcus pneumoniae culture. Cases underwent blood culture and induced sputum culture for Mycobacterium tuberculosis. A subset had pleural fluid and lung aspirates collected for culture and polymerase chain reaction. Primary analyses included participants with negative or unknown HIV status (HIV-) and cases with abnormal chest radiographs (CXR+). Cases and controls were compared using logistic regression adjusting for age. Etiologic fractions were calculated by a Bayesian nested partially latent class analysis, the PERCH integrated analysis. Results: Between January 1, 2012, and January 14, 2014, we enrolled 241 CXR+/HIV- cases and 725 HIV- controls. Compared with controls, cases were more likely to have moderate-to-severe wasting (43.1% vs. 14.1%, P < 0.001) and stunting (26.6% vs. 9.4%, P < 0.001). Predominant etiologies were respiratory syncytial virus [24.0%; 95% credible interval (CrI): 18.3%-31.1%], S. pneumoniae (15.2%; 95% CrI: 9.5-21.6), human metapneumovirus (11.8%; 95% CrI: 8.3%-16.2%) and parainfluenza virus type 3 (9.0%; 95% CrI: 5.8%-13.3%). Case fatality was 13.3%, with Staphylococcus aureus, Pneumocystis jirovecii and Haemophilus influenzae type b predominating (40% of fatal cases). Conclusions: PERCH uncovered high case fatality among children with severe pneumonia in Mali, highlighting a role for new interventions (eg, respiratory syncytial virus vaccines) and a need to improve vaccine coverage and strengthen healthcare delivery.
    Rights/Terms
    Copyright © 2021 The Author(s). Published by Wolters Kluwer Health, Inc.
    Keyword
    Pneumonia Etiology Research for Child Health
    Child
    Streptococcus pneumoniae
    Child Health
    Mali
    Multiplex Polymerase Chain Reaction
    Mycobacterium tuberculosis
    HIV Infections
    Identifier to cite or link to this item
    http://hdl.handle.net/10713/16703
    ae974a485f413a2113503eed53cd6c53
    10.1097/INF.0000000000002767
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