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Pneumocystis carinii pneumonia in Malawian children
Y Kamiya1, E Mtitimila, S M Graham
1Tropical Child Health Group, Liverpool School of Tropical Medicine, University of Liverpool, UK.
Insights
Pneumocystis pneumonia (PCP) in infants with acute lower respiratory tract infections is difficult to diagnose clinically. An immunofluorescence assay on nasopharyngeal secretions offers a viable first-line diagnostic tool in Africa.
Area of Science:
- Pediatrics
- Infectious Diseases
- Clinical Microbiology
Background:
- Infants with acute lower respiratory tract infections (ALRI) are at risk for opportunistic infections.
- Pneumocystis pneumonia (PCP) is a severe opportunistic infection that can affect immunocompromised infants.
Purpose of the Study:
- To investigate the laboratory diagnosis of PCP in Malawian infants with ALRI.
- To evaluate the utility of indirect immunofluorescence assay (IFA) for PCP diagnosis.
Main Methods:
- Sixty infants (1-23 months) with ALRI were tested for PCP using IFA on nasopharyngeal secretions.
- Clinical presentation and arterial oxygen saturation were assessed.
Main Results:
- P. carinii was detected in 5 out of 60 infants (8.3%).
- Three of the five PCP cases were associated with AIDS.
- PCP cases exhibited significantly lower arterial oxygen saturation, indicating severe hypoxemia and poor prognosis.
- Clinical presentation had limited diagnostic value.
Conclusions:
- Indirect immunofluorescence assay on nasopharyngeal secretions is a promising method for diagnosing PCP in infants in resource-limited settings.
- Early diagnosis of PCP in infants is crucial due to its high mortality rate, especially in HIV-infected children.
Abstract:
Sixty children aged between 1 and 23 months admitted to Queen Elizabeth Central Hospital in Blantyre, Malawi for diagnosis of acute lower respiratory tract infections (ALRI) were investigated for laboratory diagnosis of Pneumocystis carinii pneumonia (PCP) by indirect immunofluorescence assay on nasopharyngeal secretions. P. carinii was found in five of the 60 children. Three PCP cases had AIDS. The clinical presentation of children with PCP was of little diagnostic value and all the children were infants. Arterial oxygen saturation was significantly lower in PCP cases. Of the five PCP cases, four died, indicating that the marked hypoxaemia was associated with poor prognosis. These results indicate that an immunofluorescence assay on nasopharyngeal secretions could be used for first-line diagnosis of PCP in Africa.