Burden of respiratory tract infections at post mortem in Zambian children.

Matthew Bates, Aaron Shibemba, Victor Mudenda, Charles Chimoga, John Tembo, Mwila Kabwe, Moses Chilufya, Michael Hoelscher, Markus Maeurer, Sylvester Sinyangwe, Peter Mwaba, Nathan Kapata, Alimuddin Zumla

Journal: BMC medicine 2016;14():99

PMID: 27363601

Free Full Text on BioMed Central View on PubMed

Abstract

BACKGROUND

Autopsy studies are the gold standard for determining cause-of-death and can inform on improved diagnostic strategies and algorithms to improve patient care. We conducted a cross-sectional observational autopsy study to describe the burden of respiratory tract infections in inpatient children who died at the University Teaching Hospital in Lusaka, Zambia.

METHODS

Gross pathology was recorded and lung tissue was analysed by histopathology and molecular diagnostics. Recruitment bias was estimated by comparing recruited and non-recruited cases.

RESULTS

Of 121 children autopsied, 64 % were male, median age was 19 months (IQR, 12-45 months). HIV status was available for 97 children, of whom 34 % were HIV infected. Lung pathology was observed in 92 % of cases. Bacterial bronchopneumonia was the most common pathology (50 %) undiagnosed ante-mortem in 69 % of cases. Other pathologies included interstitial pneumonitis (17 %), tuberculosis (TB; 8 %), cytomegalovirus pneumonia (7 %) and pneumocystis Jirovecii pneumonia (5 %). Comorbidity between lung pathology and other communicable and non-communicable diseases was observed in 80 % of cases. Lung tissue from 70 % of TB cases was positive for Mycobacterium tuberculosis by molecular diagnostic tests. A total of 80 % of TB cases were comorbid with malnutrition and only 10 % of TB cases were on anti-TB therapy when they died.

CONCLUSIONS

More proactive testing for bacterial pneumonia and TB in paediatric inpatient settings is needed.

Address: HerpeZ, University Teaching Hospital, Lusaka, Zambia. [email protected].; University of Zambia and University College London Medical School (UNZA-UCLMS) Research and Training Programme, University Teaching Hospital, Lusaka, Zambia. [email protected].; Department of Infection, Division of Infection and Immunity, University College London, and NIHR Biomedical Research centre at UCL Hospitals, London, UK. [email protected].; Department of Pathology & Microbiology, University Teaching Hospital, Lusaka, Zambia.; HerpeZ, University Teaching Hospital, Lusaka, Zambia.; University of Zambia and University College London Medical School (UNZA-UCLMS) Research and Training Programme, University Teaching Hospital, Lusaka, Zambia.; Institute for Infectious Diseases, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.; Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich, Munich, Germany.; Therapeutic Immunology, Department of Laboratory Medicine, Department of Microbiology, and Department of Tumour and Cell Biology, Karolinska Institute, Stockholm, Sweden.; Department of Paediatrics & Child Health, University Teaching Hospital, Lusaka, Zambia.; Ministry of Health, Lusaka, Zambia.; National Tuberculosis Control Programme, Ministry of Community Development, Maternal and Child Health, Lusaka, Zambia.; Department of Infection, Division of Infection and Immunity, University College London, and NIHR Biomedical Research centre at UCL Hospitals, London, UK.

DOI: 10.1186/s12916-016-0645-z

Link outs

Free resources

Full Text Sources:

Other Literature Sources:

https://scite.ai/reports/27363601

MeSH Terms: Autopsy, Child, Child Nutrition Disorders, Child, Preschool, Comorbidity, Cross-Sectional Studies, Female, Humans, Infant, Male, Respiratory Tract Infections, Zambia