Etiology of severe pneumonia in Ecuadorian children

Sivani Jonnalagadda, Oswaldo Rodríguez, Bertha Estrella, Lora L Sabin, Fernando Sempértegui, Davidson H Hamer, Sivani Jonnalagadda, Oswaldo Rodríguez, Bertha Estrella, Lora L Sabin, Fernando Sempértegui, Davidson H Hamer

Abstract

Background: In Latin America, community-acquired pneumonia remains a major cause of morbidity and mortality among children. Few studies have examined the etiology of pneumonia in Ecuador.

Methods: This observational study was part of a randomized, double blind, placebo-controlled clinical trial conducted among children aged 2-59 months with severe pneumonia in Quito, Ecuador. Nasopharyngeal and blood samples were tested for bacterial and viral etiology by polymerase chain reaction. Risk factors for specific respiratory pathogens were also evaluated.

Results: Among 406 children tested, 159 (39.2%) had respiratory syncytial virus (RSV), 71 (17.5%) had human metapneumovirus (hMPV), and 62 (15.3%) had adenovirus. Streptococcus pneumoniae was identified in 37 (9.2%) samples and Mycoplasma pneumoniae in three (0.74%) samples. The yearly circulation pattern of RSV (P = 0.0003) overlapped with S. pneumoniae, (P = 0.03) with most cases occurring in the rainy season. In multivariable analysis, risk factors for RSV included younger age (adjusted odds ratio [aOR] = 1.9, P = 0.01) and being underweight (aOR = 1.8, P = 0.04). Maternal education (aOR = 0.82, P = 0.003), pulse oximetry (aOR = 0.93, P = 0.005), and rales (aOR = 0.25, P = 0.007) were associated with influenza A. Younger age (aOR = 3.5, P = 0.007) and elevated baseline respiratory rate were associated with HPIV-3 infection (aOR = 0.94, P = 0.03).

Conclusion: These results indicate the importance of RSV and influenza, and potentially modifiable risk factors including undernutrition and future use of a RSV vaccine, when an effective vaccine becomes available.

Trial registration: ClinicalTrials.gov NCT 00513929.

Trial registration: ClinicalTrials.gov NCT00513929.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1. Study profile and analysis of…
Fig 1. Study profile and analysis of sample pathogens.
Fig 2. Seasonal distribution of viral pathogens…
Fig 2. Seasonal distribution of viral pathogens among children with severe pneumonia between February 2008 and April 2010.
Fig 3. Seasonal distribution of bacterial pathogens…
Fig 3. Seasonal distribution of bacterial pathogens among children with severe pneumonia between February 2008 and April 2010.

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