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Seeking diagnostic and prognostic biomarkers for childhood bacterial pneumonia in sub-Saharan Africa: study protocol
Clarissa Valim1, Yekin Ajauoi Olatunji2, Yasir Shitu Isa2
1Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA cvalim@bu.edu.
Insights
This study validates protein biomarkers to accurately detect bacterial pneumonia in children, aiming to improve diagnosis and reduce antibiotic overprescription. Findings will aid in developing point-of-care tests for better pediatric pneumonia management.
Area of Science:
- Biomarker discovery
- Infectious disease diagnostics
- Pediatric medicine
Background:
- Pneumonia is a major cause of childhood hospitalization and mortality.
- Current diagnostic methods for bacterial pneumonia in children lack high sensitivity, leading to antibiotic overuse.
- Malaria can mimic bacterial pneumonia, complicating diagnosis and treatment.
Purpose of the Study:
- To validate and improve existing protein biomarker combinations for detecting bacterial pneumonia in children.
- To identify new diagnostic and prognostic signatures for clinical pneumonia using machine learning.
- To develop biomarkers for future point-of-care diagnostic tests for pediatric pneumonia.
Main Methods:
- Enrollment of 900 children aged 2-59 months with clinical pneumonia in The Gambia.
- Classification of bacterial aetiology using microbiological tests and chest radiographs.
- Measurement of proteins via Luminex immunoassays and analysis using machine learning algorithms.
Main Results:
- Previous protein combinations showed 96% sensitivity and 86% specificity for bacterial disease.
- The study aims to assess accuracy of previously identified signatures.
- New diagnostic and prognostic signatures will be explored using machine learning.
Conclusions:
- Accurate identification of bacterial pneumonia in children is crucial for appropriate treatment.
- Validated protein biomarkers can enhance diagnostic accuracy and guide antibiotic use.
- This research may lead to improved point-of-care diagnostics for pediatric pneumonia.
Introduction:
Clinically diagnosed pneumonia in children is a leading cause of paediatric hospitalisation and mortality. The aetiology is usually bacterial or viral, but malaria can cause a syndrome indistinguishable from clinical pneumonia. There is no method with high sensitivity to detect a bacterial infection in these patients and, as result, antibiotics are frequently overprescribed. Conversely, unrecognised concomitant bacterial infection in patients with malarial infections occur with omission of antibiotic therapy from patients with bacterial infections. Previously, we identified two combinations of blood proteins with 96% sensitivity and 86% specificity for detecting bacterial disease. The current project aimed to validate and improve these combinations by evaluating additional biomarkers in paediatric patients with clinical pneumonia. Our goal was to describe combinations of a limited number of proteins with high sensitivity and specificity for bacterial infection to be incorporated in future point-of-care tests. Furthermore, we seek to explore signatures to prognosticate clinical pneumonia.
Methods And Analysis:
Patients (n=900) aged 2-59 months presenting with clinical pneumonia at two Gambian hospitals will be enrolled and classified according to criteria for definitive bacterial aetiology (based on microbiological tests and chest radiographs). We will measure proteins at admission using Luminex-based immunoassays in 90 children with definitive and 160 with probable bacterial aetiology, and 160 children classified according to the prognosis of their disease. Previously identified diagnostic signatures will be assessed through accuracy measures. Moreover, we will seek new diagnostic and prognostic signatures through machine learning methods, including support vector machine, penalised regression and classification trees.
Ethics And Dissemination:
Ethics approval has been obtained from the Gambia Government/Medical Research Council Unit The Gambia Joint Ethics Committee (protocol 1616) and the institutional review board of Boston University Medical Centre (STUDY00000958). Study results will be disseminated to the staff of the study hospitals, in scientific seminars and meetings, and in publications.
Trial Registration Number:
H-38462.
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