Upper airway viruses and bacteria detection in clinical pneumonia in a population with high nasal colonisation do not relate to clinical signs

Abstract

Indigenous Australian children have high (up to 90%) rates of nasopharyngeal microbial colonisation and of hospitalisation for pneumonia. In Indigenous children hospitalised with pneumonia in Central Australia, we describe the nasopharyngeal detection of viruses and bacteria and assessed whether their presence related to signs of pneumonia (tachypnoea and/or chest in-drawing) on hospital admission and during subsequent days. Nasopharyngeal swabs (NPS) and data were prospectively collected from 145 children (median age = 23.5 months, interquartile range [IQR] 8.7-50) hospitalised with pneumonia at Alice Springs Hospital, Australia, between April 2001 and July 2002. The cohort was enrolled in a randomised controlled study using zinc and/or vitamin A supplementation. NPS were taken within 24 hours of hospitalisation and kept frozen at-80°C until analysed in 2014. Polymerase chain reaction (PCR) was used to detect Moraxella catarrhalis, Haemophilus influenzae, Streptococcus pneumoniae, Staphylococcus aureus, Chlamydophila pneumoniae, Mycoplasma pneumoniae , and 16 respiratory viruses. Uni- and multi-variate analyses were used to examine the relationships. One or more organisms were present in 137 (94.5%) NPS; 133 (91.7%) detected ≥ 1 bacterium, 34 (37.2%) for ≥ 1 virus and 50 (34.5%) were positive for both viruses and bacteria. C. pneumoniae (n = 3) and M. pneumoniae (n = 2) were rare. In multi-variate analyses, age < 12 months (odds ratio [OR] 6.6 [95% confidence interval {CI} 1.7-25.4]) and fever (OR 4.1 [95% CI 1.7-10.4]) were associated with tachypnoea and chest in-drawing. However the presence of bacteria and/or virus type was not associated with tachypnoea and/or chest in-drawing on admission or during recovery. In children with high nasopharyngeal microbial colonisation rates, the utility of NPS in determining the diagnosis of clinical pneumonia or duration of tachypnoea or in-drawing is likely limited. Larger cohort and case-control studies are required to confirm our findings. (© The Author(s) 2015.)eCollection. Cited Medium: Print. NLM ISO Abbr: Pneumonia (Nathan). PubMed Central ID: PMC5922338. Linked References: BMJ. 2010 Oct 04;341:c4978. (PMID: 20921080); J Clin Virol. 2013 Dec;58(4):683-8. (PMID: 24125830); PLoS One. 2013 Sep 18;8(9):e74756. (PMID: 24058625); Pediatr Infect Dis J. 2005 May;24(5):423-8. (PMID: 15876941); Pediatr Infect Dis J. 2006 Sep;25(9):779-81. (PMID: 16940833); Trop Med Int Health. 2011 Jun;16(6):766-72. (PMID: 21418445); J Microbiol Methods. 2013 Mar;92(3):270-2. (PMID: 23266579); Curr Opin Pulm Med. 2012 May;18(3):271-8. (PMID: 22366993); BMC Infect Dis. 2011 Jun 07;11:161. (PMID: 21649905); J Microbiol Methods. 2011 Sep;86(3):364-7. (PMID: 21736904); Med J Aust. 2010 May 17;192(10):592-5. (PMID: 20477736); J Med Virol. 2006 Sep;78(9):1232-40. (PMID: 16847968); Eur J Clin Microbiol Infect Dis. 2012 Nov;31(11):3173-82. (PMID: 22850740); Med J Aust. 2006 Feb 6;184(3):107-12. (PMID: 16460294); J Clin Microbiol. 2014 May;52(5):1590-4. (PMID: 24599973); Front Pediatr. 2015 Feb 13;3:9. (PMID: 25741502); PLoS One. 2011 Apr 18;6(4):e18928. (PMID: 21533115); Front Pediatr. 2013 Oct 23;1:29. (PMID: 24400275); BMC Ear Nose Throat Disord. 2012 Oct 03;12:11. (PMID: 23033913); Pediatr Infect Dis J. 1994 Nov;13(11):983-9. (PMID: 7845752); PLoS One. 2014 Feb 03;9(2):e86448. (PMID: 24498274); Pediatr Infect Dis J. 1999 Aug;18(8):714-21. (PMID: 10462342); Pediatr Infect Dis J. 2012 Dec;31(12):1221-6. (PMID: 22739572); Pediatr Infect Dis J. 1999 Feb;18(2):98-104. (PMID: 10048679); Emerg Infect Dis. 2008 Feb;14(2):217-21. (PMID: 18258113); Pediatr Infect Dis J. 2011 Jan;30(1):11-8. (PMID: 20686433); Pediatr Infect Dis J. 2008 Dec;27(12):1103-7. (PMID: 18978518). Linking ISSN: 22006133. Subset: PubMed not MEDLINE; Date of Electronic Publication: 2015 Dec 01. Current Imprints: Publication: 2016->: London : BioMed Central; Original Imprints: Publication: [Nathan], Qld. : Griffith University ePress, [2012]- <br />