Etiology of serious infections in young Gambian infants.

BACKGROUND: Despite improvements in infant mortality rates in many developing countries including The Gambia, neonatal mortality remains high and many neonatal deaths are caused by infection. The study described in this paper was conducted to determine the bacterial and viral etiology of serious infections in Gambian infants younger than 91 days old. METHODS: At a first level health facility 497 infants with symptoms that could indicate serious infection were enrolled, of whom 239 with 1 or more signs of serious infection and 55 with no signs were investigated, yielding 17 cases with positive bacterial cultures of blood and/or cerebrospinal fluid. At a nearby pediatric referral hospital 198 infants were seen and 182 were investigated, yielding 35 positive bacterial cultures. RESULTS: There were 15 culture positive cases of meningitis caused by Streptococcus pneumoniae (7), Streptococcus pyogenes (2), Enterobacter cloacae (2), Escherichia coli (1), Haemophilus influenzae type b (1), Streptococcus agalactiae (1) and Salmonella spp. (1). Six of these children died. Thirty-three infants without meningitis had positive blood cultures for Staphylococcus aureus (17), S. pneumoniae (3), Salmonella spp. (5), E. coli (3), other enterobacteria (4) and S. agalactiae (1), of whom 14 died. Nasopharyngeal aspirates from 438 children were investigated for common respiratory viruses. Respiratory syncytial virus was found in 51, influenza A in 46, influenza B in 22, parainfluenza in 26 and adenovirus in 16. Respiratory syncytial virus and influenza A isolates were found most frequently toward the end of the wet season. Nasopharyngeal carriage of S. pneumoniae and H. influenzae was studied in 320 infants recruited during the first year. Of these 184 (58%) were positive for S. pneumoniae and 141 (44%) were positive for H. influenzae, 18 of which were type b. Infants with a bacterial isolate from blood or cerebrospinal fluid were more likely than the rest to die, whereas those with a viral isolate were less likely to die. CONCLUSIONS: The most important causes of serious infections in young Gambian infants are Staphylococcus aureus, S. pneumoniae and Salmonella spp.

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

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.