The etiology of pneumonia in malnourished and well-nourished Gambian children

Abstract

During a 2-year period 159 malnourished children ages 3 months to 5 years with radiologic evidence of pneumonia were investigated to determine the cause of their pneumonia. In addition 119 malnourished children without pneumonia, 119 well-nourished children with pneumonia and 52 well-nourished children without pneumonia were studied as controls. Percutaneous lung aspiration was performed on 35 malnourished and 59 well-nourished children with pneumonia. Bacteria were isolated from the blood, lung or pleural fluid of 28 (18%) malnourished children with pneumonia, 42 (35%) well-nourished children with pneumonia and from the blood of 5 (4%) malnourished children without pneumonia. Streptococcus pneumoniae and Haemophilus influenzae, which were the two organisms isolated most frequently in both groups of children with pneumonia, were found in 17 (11%) malnourished and 39 (33%) well-nourished children with pneumonia. Mycobacterium tuberculosis was detected in 5 malnourished children with pneumonia. A potentially pathogenic virus was identified in 35% of malnourished children with pneumonia and 40% of well-nourished children with pneumonia, and from 25% of children without pneumonia. The viruses identified most frequently were adenovirus and respiratory syncytial virus.(ABSTRACT TRUNCATED AT 250 WORDS)

PIP: During November 1990-October 1992 in Banjul, Gambia, providers at a hospital enrolled 159 children with pneumonia and 119 children without pneumonia, 119 well-nourished children with pneumonia, and 52 well-nourished children without pneumonia into a study examining the bacteriologic and virologic etiology of pneumonia. Pneumonia was more common among children with marasmic kwashiorkor (12% of all malnourished children) than among other malnourished children (53% vs. 33%; p 0.05). Most malnourished children (49%) were undernourished. 11% of all malnourished children had kwashiorkor. Laboratory personnel isolated bacteria from 28 (18%) malnourished children with pneumonia, 42 (35%) well-nourished children with pneumonia, and 5 (4%) malnourished children without pneumonia. Among all pneumonia cases, Streptococcus pneumoniae and Haemophilus influenzae were the most prevalent bacteria, especially among the well-nourished children (33% vs. 11%; p 0.001). They were not present in malnourished children without pneumonia. Mycobacterium tuberculosis was isolated in 5 malnourished children with pneumonia. Pathogenic viruses were isolated more often from malnourished children with pneumonia and from well-nourished children with pneumonia than from children without pneumonia (35% and 40%, respectively, vs. 25%; p 0.01). Most common pathogenic viruses were adenovirus and respiratory syncytial virus (RSV). RSV was more common in well-nourished children with pneumonia than malnourished children with pneumonia (13% vs. 6%; p 0.05). Herpes simplex virus was more common in malnourished children with pneumonia than well-nourished children (6% vs. 2%). 25 children had both bacterial and viral pathogens. Only 4 children (all with pneumonia) had the measles virus. These findings suggest that S. pneumoniae and H. influenzae are probably the bacterial causes of pneumonia in both well-nourished and malnourished children in areas with rare cases of measles and kwashiorkor. In these areas, M. tuberculosis may be also a cause of pneumonia in malnourished children, especially if edema is present.