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BMC Med. 2016 Jul 1;14:99. doi: 10.1186/s12916-016-0645-z.

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

Author information

1
HerpeZ, University Teaching Hospital, Lusaka, Zambia. matthew.bates@ucl.ac.uk.
2
University of Zambia and University College London Medical School (UNZA-UCLMS) Research and Training Programme, University Teaching Hospital, Lusaka, Zambia. matthew.bates@ucl.ac.uk.
3
Department of Infection, Division of Infection and Immunity, University College London, and NIHR Biomedical Research centre at UCL Hospitals, London, UK. matthew.bates@ucl.ac.uk.
4
Department of Pathology & Microbiology, University Teaching Hospital, Lusaka, Zambia.
5
HerpeZ, University Teaching Hospital, Lusaka, Zambia.
6
University of Zambia and University College London Medical School (UNZA-UCLMS) Research and Training Programme, University Teaching Hospital, Lusaka, Zambia.
7
Institute for Infectious Diseases, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
8
Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich, Munich, Germany.
9
Therapeutic Immunology, Department of Laboratory Medicine, Department of Microbiology, and Department of Tumour and Cell Biology, Karolinska Institute, Stockholm, Sweden.
10
Department of Paediatrics & Child Health, University Teaching Hospital, Lusaka, Zambia.
11
Ministry of Health, Lusaka, Zambia.
12
National Tuberculosis Control Programme, Ministry of Community Development, Maternal and Child Health, Lusaka, Zambia.
13
Department of Infection, Division of Infection and Immunity, University College London, and NIHR Biomedical Research centre at UCL Hospitals, London, UK.

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.

KEYWORDS:

Africa; Autopsy; Children; Cytomegalovirus; Pneumocystis Jirovecii pneumonia; Pneumonia; Post mortem; Tuberculosis; Zambia

PMID:
27363601
PMCID:
PMC4929772
DOI:
10.1186/s12916-016-0645-z
[Indexed for MEDLINE]
Free PMC Article

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