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. 2019 Jun 13:2:19.
doi: 10.12688/gatesopenres.12811.2. eCollection 2018.

Investigating Pneumonia Etiology Among Refugees and the Lebanese population (PEARL): A study protocol

Thomas Kesteman  1 , Ali Ghassani  2 , Crystel Hajjar  3 , Valentina Picot  1 , Marwan Osman  4 , Zahraa Alnajjar  5 , Florence Komurian-Pradel  1 , Melina Messaoudi  1 , Stéphane Pouzol  1 ; PEARL Study Group; Hicham Ghazi Soulaiman  6 , Philippe Vanhems  7 , Octavio Ramilo  8 , Dolla Karam-Sarkis  9   10 , Josette Najjar-Pellet  1 , Monzer Hamze  4 , Hubert Endtz  1   11
Affiliations

Investigating Pneumonia Etiology Among Refugees and the Lebanese population (PEARL): A study protocol

Thomas Kesteman et al. Gates Open Res. .

Abstract

Background: Community-acquired pneumonia (CAP), a leading cause of mortality, mainly affects children in developing countries. The harsh circumstances experienced by refugees include various factors associated with respiratory pathogen transmission, and clinical progression of CAP. Consequently, the etiology of CAP in humanitarian crisis situations may differ to that of settled populations, which would impact appropriate case management. Therefore, the Pneumonia Etiology Among Refugees and the Lebanese population (PEARL) study was initiated with the objective of identifying the causal pathogenic microorganisms in the respiratory tract of children and adults from both the refugee and host country population presenting with signs of CAP during a humanitarian crisis. Methods: PEARL, a prospective, multicentric, case-control study, will be conducted at four primary healthcare facilities in Tripoli and the Bekaa valley over 15 months (including two high-transmission seasons/winters). Sociodemographic and medical data, and biological samples will be collected from at least 600 CAP cases and 600 controls. Nasopharyngeal swabs, sputum, urine and blood samples will be analyzed at five clinical pathology laboratories in Lebanon to identify the bacterial and viral etiological agents of CAP. Transcriptomic profiling of host leukocytes will be performed. Conclusions: PEARL is an original observational study that will provide important new information on the etiology of pneumonia among refugees, which may improve case management, help design antimicrobial stewardship interventions, and reduce morbidity and mortality due to CAP in a humanitarian crisis.

Keywords: Case-Control Studies; Community-Acquired Pneumonia; Epidemiology; Etiology; Lebanon; Prevention & Control; Refugees; Risk Factors.

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Conflict of interest statement

No competing interests were disclosed.

Figures

Figure 1.
Figure 1.. Concentration of Syrian refugees in Lebanon (source: UNHCR , image adapted under CC-BY 3.0 license) and location of the PEARL study sites.
Figure 2.
Figure 2.. Sample analysis for cases.
NP, nasopharyngeal; WBC, white blood cells; AST, Antimicrobial Susceptibility Testing; Caps PCR, capsular antigen serotyping PCR.
Figure 3.
Figure 3.. Sample analysis for controls.
NP, nasopharyngeal; AST, Antimicrobial Susceptibility Testing; Caps PCR, capsular antigen serotyping PCR.
See this image and copyright information in PMC

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