Burden of respiratory tract infections at post mortem in Zambian children

Bates, Matthew, Shibemba, Aaron, Mudenda, Victor , Chimoga, Charles, Tembo, John, Kabwe, Mwila, Chilufya, Moses, Hoelscher, Michael, Maeurer, Markus, Sinyangwe, Sylvester, Mwaba, Peter, Kapata, Nathan and Zumla, Alimuddin (2016) Burden of respiratory tract infections at post mortem in Zambian children. BMC Medicine, 14 . p. 99. ISSN 1741-7015

Full content URL: https://doi.org/10.1186/s12916-016-0645-z

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Burden of respiratory tract infections at post mortem in Zambian children
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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:Autops, Post mortem, Children, Zambia, Africa, Tuberculosis, Pneumonia, Cytomegalovirus, Pneumocystis Jirovecii pneumonia}
Subjects:C Biological Sciences > C520 Medical and Veterinary Microbiology
A Medicine and Dentistry > A300 Clinical Medicine
Divisions:College of Science > School of Life Sciences
ID Code:28349
Deposited On:07 Sep 2017 16:05

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