Association of Respiratory Viruses with Outcomes of Severe Childhood Pneumonia in Botswana

Abstract

BackgroundThe highest incidence of childhood acute lower respiratory tract infection (ALRI) is in low- and middle-income countries. Few studies examined whether detection of respiratory viruses predicts ALRI outcomes in these settings.MethodsWe conducted prospective cohort and case-control studies of children 1-23 months of age in Botswana. Cases met clinical criteria for pneumonia and were recruited within six hours of presentation to a referral hospital. Controls were children without pneumonia matched to cases by primary care clinic and date of enrollment. Nasopharyngeal specimens were tested for respiratory viruses using polymerase chain reaction. We compared detection rates of specific viruses in matched case-control pairs. We examined the effect of respiratory syncytial virus (RSV) and other respiratory viruses on pneumonia outcomes.ResultsBetween April 2012 and August 2014, we enrolled 310 cases, of which 133 had matched controls. Median ages of cases and controls were 6.1 and 6.4 months, respectively. One or more viruses were detected from 75% of cases and 34% of controls. RSV and human metapneumovirus were more frequent among cases than controls, but only enterovirus/rhinovirus was detected from asymptomatic controls. Compared with non-RSV viruses, RSV was associated with an increased risk of treatment failure at 48 hours [risk ratio (RR): 1.85; 95% confidence interval (CI): 1.20, 2.84], more days of respiratory support [mean difference (MD): 1.26 days; 95% CI: 0.30, 2.22 days], and longer duration of hospitalization [MD: 1.35 days; 95% CI: 0.20, 2.50 days], but lower in-hospital mortality [RR: 0.09; 95% CI: 0.01, 0.80] in children with pneumonia.ConclusionsRespiratory viruses were detected from most children hospitalized with ALRI in Botswana, but only RSV and human metapneumovirus were more frequent than among children without ALRI. Detection of RSV from children with ALRI predicted a protracted illness course but lower mortality compared with non-RSV viruses.

Prevalence of human respiratory syncytial virus infection in people with acute respiratory tract infections in Africa: A systematic review and meta‐analysis

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The Nasopharyngeal Microbiota of Children With Respiratory Infections in Botswana

“…9,10 Briefly, we recruited children one to 23 months of age with pneumonia, defined by the World Health Organization as “a cough or difficult breathing with lower chest wall indrawing,” at a tertiary hospital in Gaborone. 11 We enrolled these children within six hours of the triage time in the Emergency Department and collected a nasopharyngeal swab at enrollment.…”

Integrated DNA and RNA extraction using magnetic beads from viral pathogens causing acute respiratory infections

“…Researchers have not ceased to develop new diagnostic technologies, and nucleic acid amplification protocols to detect many viral pathogens have become mainstream in diagnostic laboratories. Among these protocols, the multiplex real-time quantitative polymerase chain reaction (qPCR) is the most frequently performed method due to its advantages of high sensitivity, specificity and throughput11. The prerequisite to implement these technologies is the extraction of high quality nucleic acids12.…”

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