Detection of Pneumococcal DNA in Blood by Polymerase Chain Reaction for Diagnosing Pneumococcal Pneumonia in Young Children From Low- and Middle-Income Countries.

Journal: Clinical infectious diseases : an official publication of the Infectious Diseases Society of America

Volume: 64

Issue: suppl_3

Year of Publication: 2018

Affiliated Institutions:  Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi. Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland. The Emmes Corporation, Rockville, Maryland. Global Disease Detection Center, Thailand Ministry of Public Health-US Centers for Disease Control and Prevention Collaboration, Nonthaburi. Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland. Department of Paediatrics, University of Auckland. Division of Infectious Disease and Tropical Pediatrics, Department of Pediatrics, Center for Vaccine Development, Institute of Global Health, University of Maryland School of Medicine, Baltimore. Medical Research Council: Respiratory and Meningeal Pathogens Research Unit. Center for Global Health and Development, Boston University School of Public Health, Massachusetts. International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka and Matlab. Medical Research Council Unit, Basse, The Gambia. International Health, Center for Immunization Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland. Department of Biomedical Sciences, School of Health Sciences, University of Zambia. Zambia Center for Applied Health Research and Development, Lusaka. Centre pour le Développement des Vaccins, Bamako, Mali. Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland. Department of Pathology, University of Otago, and.

Abstract summary 

We investigated the performance of polymerase chain reaction (PCR) on blood in the diagnosis of pneumococcal pneumonia among children from 7 low- and middle-income countries.We tested blood by PCR for the pneumococcal autolysin gene in children aged 1-59 months in the Pneumonia Etiology Research for Child Health (PERCH) study. Children had World Health Organization-defined severe or very severe pneumonia or were age-frequency-matched community controls. Additionally, we tested blood from general pediatric admissions in Kilifi, Kenya, a PERCH site. The proportion PCR-positive was compared among cases with microbiologically confirmed pneumococcal pneumonia (MCPP), cases without a confirmed bacterial infection (nonconfirmed), cases confirmed for nonpneumococcal bacteria, and controls.In PERCH, 7.3% (n = 291/3995) of cases and 5.5% (n = 273/4987) of controls were blood pneumococcal PCR-positive (P < .001), compared with 64.3% (n = 36/56) of MCPP cases and 6.3% (n = 243/3832) of nonconfirmed cases (P < .001). Blood pneumococcal PCR positivity was higher in children from the 5 African countries (5.5%-11.5% among cases and 5.3%-10.2% among controls) than from the 2 Asian countries (1.3% and 1.0% among cases and 0.8% and 0.8% among controls). Among Kilifi general pediatric admissions, 3.9% (n = 274/6968) were PCR-positive, including 61.7% (n = 37/60) of those with positive blood cultures for pneumococcus.The utility of pneumococcal PCR on blood for diagnosing childhood pneumococcal pneumonia in the 7 low- and middle-income countries studied is limited by poor specificity and by poor sensitivity among MCPP cases.

Authors & Co-authors:  Morpeth Deloria Knoll Scott Park Watson Baggett Brooks Feikin Hammitt Howie Kotloff Levine Madhi O'Brien Thea Adrian Ahmed Antonio Bunthi DeLuca Driscoll Githua Higdon Kahn Karani Karron Kwenda Makprasert Mazumder Moore Mwansa Nyongesa Prosperi Sow Tamboura Whistler Zeger Murdoch

Study Outcome 

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Statistics
Citations :  Cutts FT, Zaman SM, Enwere G, et al. ; Gambian Pneumococcal Vaccine Trial Group. Efficacy of nine-valent pneumococcal conjugate vaccine against pneumonia and invasive pneumococcal disease in The Gambia: randomised, double-blind, placebo-controlled trial. Lancet 2005; 365:1139–46.
Authors :  39
Identifiers
Doi : 10.1093/cid/cix145
SSN : 1537-6591
Study Population
Male,Female
Mesh Terms
Child, Hospitalized
Other Terms
PCR;blood;diagnosis.;pneumococcus;pneumonia
Study Design
Study Approach
Country of Study
Kenya
Publication Country
United States