TABLE 1: Studies on pneumonia aetiology from developing countries

 

Author, study design

Setting

Sample size

Inclusion criteria

Investigations

Results

Bakeera-Kitaka27, 2004

Case series

Uganda, Teaching Referral Hospital

121

Children aged 2-60 months presenting to hospital with severe pneumonia

Sputum fluorescence microscopy

PCP prevalence: 16.5% (20 out of 121)

18/43-HIV infected

2/78-not HIV infected

Vuori-Holopainen11, 2001

Systematic review*

Studies from all 6 continents. (Selected studies from Africa, Asia and Papua New Guinea.)

546**

(aetiological agent identified in 278 cases)

Original reports on the use of lung tap in cases of childhood pneumonia described in medical literature up to 2001.

Lung tap

S. Pneumoniae 93/278(33%), Haemophilus influenzae 50/278(18%), and Staphylococcus aureus 78/278(26%).

 

Graham26, 2000

Case series

Malawi, hospital

150

Children aged between 2 months and 5 years who were in hospital with a diagnosis of severe pneumonia (radiologically confirmed)

Blood cultures and immunofluoresence on nasopharyngeal aspirate samples used to test for PCP.

16 cases of PCP among 150 children; all cases were HIV positive.

Bacterial pathogen: 21/150 cultures showed growth; S.pneumoniae (8) and non-typhoidal salmonellae (7).

10/ 16 children with PCP and 6/21 with bacterial pneumonia died (relative risk 2.19 [95% CI 1.0-4.7]).

Zar28, 2000

Case series

South Africa, teaching hospital

151

HIV infected children hospitalized with pneumonia

Immunoflourescence and silver stain

PCP prevalence: 15/150 (9.9%; 95% CI 5.5 to 15.5)

PCP was the AIDS-defining infection in 13 of 64 (20.3%; 95% confidence interval, 11.8 to 31.5).  

1/59 children receiving prophylaxis (1.7%) developed PCP vs. 14 of 92 (15.2%) not taking prophylaxis [relative risk, 0.11 (0.02 to 0.82), P = 0.007].

Scott3, 1999

Systematic review*

N/A

2862(total of subjects in case series for children)

Studies reporting etiologic yield and complications of lung aspirate studies done in patients with clinical findings compatible with severe pneumonia

Lung puncture for lung aspirates

 

S. Pneumoniae (12%), Haemophilus influenzae (6%), and Staphylococcus aureus (15%).

 African studies: S. pneumoniae (17%). H. Influenzae (8%) and s.aureus (12%)

Shann12, 1986 Systematic Review*

Studies done in developing countries (Asia, Africa, Latin America and Papua New Guinea)

1029- bacteriologic studies; 1212- viral studies

Studies on pneumonia aetiology conducted in developing countries

Lung aspirate; viral culture and serology

Bacterial infection: 640/1029 (62%)

H.influenzae 176(27%), S.peumoniae180 (27%), S.aureus 109(17%), others 192(29%)

Viral infection:

281/1212 (23%)

Viral vs. bacterial infection: 54/222(24%) vs. 160/320(50%) in 4 comparative studies

 

* Same patients reported in these reviews

**Total number of aspirates from Africa, Asia and Papua New Guinea