Related Experiment Video
Updated: May 4, 2026
An Affordable HIV-1 Drug Resistance Monitoring Method for Resource Limited Settings
Published on: March 30, 2014
Pneumocystis pneumonia in South African children diagnosed by molecular methods
Brenda M Morrow1, Catherine M Samuel, Marco Zampoli
1Department of Paediatics and Child Health, Red Cross War Memorial Children's Hospital (RCWMCH), University of Cape Town, 5th Floor Institute of Child Health Building, Klipfontein Road, Rondebosch 7700, Cape Town, South Africa. Brenda.morrow@uct.ac.za.
Insights
Polymerase chain reaction (PCR) significantly improves Pneumocystis pneumonia (PCP) diagnosis in South African children, revealing it as a common cause of severe pneumonia with high mortality, especially in HIV-infected infants.
Area of Science:
- Pediatric Infectious Diseases
- Diagnostic Microbiology
- HIV/AIDS Research
Background:
- Pneumocystis pneumonia (PCP) is a critical cause of mortality in HIV-infected children.
- Traditional diagnostic methods for PCP have low sensitivity, leading to underestimation of incidence.
- Polymerase chain reaction (PCR) offers a more sensitive and reliable diagnostic approach.
Purpose of the Study:
- To determine the incidence, clinical features, and outcomes of PCP in South African children.
- To evaluate the diagnostic performance of PCR compared to traditional methods for PCP detection.
- To identify risk factors and predictors of mortality for PCP in this population.
Main Methods:
- Prospective study of hospitalized children with suspected PCP in South Africa (Nov 2006 - Aug 2008).
- Collection of clinical, laboratory, and radiological data.
- Analysis of lower respiratory tract specimens, nasopharyngeal aspirates, and blood using immunofluorescence (IF), PCR, and bacterial/mycobacterial cultures.
Main Results:
- PCR identified PCP in 54% of children, significantly higher than IF (21%) (p < 0.0001).
- PCP was most common in HIV-infected children (81%), but also occurred in HIV-negative children with other risk factors.
- Predictive factors for PCP included HIV infection, lack of fever, high respiratory rate, and low oxygen saturation; cotrimoxazole prophylaxis was protective.
- Case fatality rate for PCP was higher (32.1%) than for non-PCP cases (17.2%).
- In HIV-infected children, CD4 count < 15% predicted mortality.
Conclusions:
- PCR provides a diagnostic yield over 2.5 times higher than conventional methods for PCP.
- PCP is a frequent cause of severe hypoxic pneumonia in African infants.
- PCP is associated with substantial mortality, particularly in HIV-infected infants.
Background:
Pneumocystis pneumonia (PCP) is an important cause of hospitalization and mortality in HIV-infected children. However, the incidence of PCP has been underestimated due to poor sensitivity of diagnostic tests. The use of polymerase chain reaction (PCR) for pneumocystis has enabled more reliable diagnosis. This study describes the incidence, clinical features and outcome of PCP in South African children diagnosed using PCR.
Methods:
A prospective study of children hospitalised in South Africa with suspected PCP was done from November 2006 to August 2008. Clinical, laboratory and radiological information were collected. Lower respiratory tract specimens were obtained for PCP immunofluorescence (IF), real- time PCR for pneumocystis, bacterial and mycobacterial culture. Nasopharyngeal aspirates were taken for immunofluorescence (IF), real-time PCR for pneumocystis and PCR for respiratory viruses. A blood specimen for bacterial culture and for cytomegalovirus PCR was taken. Children were followed for the duration of their hospitalisation and the outcome was recorded.
Results:
202 children [median (interquartile range, IQR) age 3.2 (2.1- 4.6) months] were enrolled; 124 (61.4%) were HIV infected. PCP was identified in 109 (54%) children using PCR, compared to 43 (21%) using IF and Grocott staining (p < 0.0001). Most PCP cases (88, 81%) occurred in HIV-infected children. All 21 cases (19%) occurring in HIV- negative children had another risk factor for PCP. On logistic regression, predictive factors for PCP were HIV infection, lack of fever, high respiratory rate and low oxygen saturation whilst cotrimoxazole prophylaxis was protective (OR 0.24; 95% CI 0.1 to 0.5; p < 0.002). The case fatality of children with PCP was higher than those without PCP (32.1% versus 17.2%; relative risk 1.87; 95% confidence interval (CI) 1.11 - 3.15). Amongst HIV-infected children, a CD4 less than 15% was the only independent predictor of mortality.
Conclusions:
The diagnostic yield for PCP is more than 2.5 times higher on PCR than other detection methods. PCP is a very common cause of severe hypoxic pneumonia and is associated with high mortality in HIV-infected African infants.
Related Concept Videos
01:30Pneumonia III: Complications and Assessment
01:14Atypical Pneumonia
01:29Pneumonia II: Pathophysiology
01:20Sputum Studies II: Culture and Sensitivity
Sputum culture and sensitivity is a medical procedure used to diagnose bacterial infections in the respiratory tract and select the most appropriate antibiotics for treatment. This process involves analyzing sputum samples of thick and opaque secretions produced in the lungs and airways. These samples are collected from patients and then sent to the laboratory for analysis.
The test can identify various pathogens responsible for respiratory infections, including Streptococcus,...
01:30Pneumonia I: Introduction
Risk Factors
Various factors influence the likelihood of developing pneumonia. Age plays a crucial role, with infants, children under two, and individuals over 65 at increased risk due to their...
01:29Pneumonia I: Introduction