Bacterial aetiology of pneumonia and its abstract relation to nutritional status among infants and children

ABSTRACT

Pneumonia is one of the leading cause of death among children under 5 years. No data are available in Egypt about organisms causing pneumonia among severe protein energy malnutrition [PEM]. The aim of this study was to assess the difference between well nourished and severely malnourished children regarding the bacterial aetiology of pneumonia. The study was an analytical one which carried out for one year among the attendants of Bab El-Sha'reya University Hospital. All study patients had an age 3 months up to 5 years with duration of illness less than 3 days. They were divided into two groups pneumonia with severe PEM [n=70] and pneumonia with normal nutritional status [n=70]. Pneumonia was diagnosed if there was rapid breathing, chest indrawing or positive X-ray for pneumonia. Severe PEM was considered if any of the following was present weight for length < 80% of the reference median or pitting oedema. Exclusion criteria were history of wheezing, chronic illness or use of antibiotic for the present illness for more than 2 doses. Severity of pneumonia was classified according to WHO. All enrolled patients were subjected to the following investigations chest X-ray, complete blood picture, plasma proteins, BCG test and blood culture. Positive blood culture was higher among malnourished than well nourished patients [30% versus 17.1% respectively] but the difference was not statistically significant. Streptococcus pneumoniae was the most common organism in positive culture followed by Haemophilus influenzae in both severe PEM and well nourished patients and there was no statistically significant difference between them regarding the type of bacteria detected. Positive blood culture was higher among patients with severe pneumonia than those with pneumonia in both severe PEM and well nourished patients. Comparison between those with positive culture and those with negative blood culture among malnourished patients did not show any statistically significant difference. We concluded that the yield of positive blood culture with pneumonia was expected low. However relative more positive cases were found among those with severe PEM and or severe pneumonia