High prevalence of Pneumocystis jirovecii pneumonia among Mozambican children &lt;5 years of age admitted to hospital with clinical severe pneumonia

Lanaspa, Miguel; O’Callaghan-Gordo, Cristina; Machevo, Sónia; Madrid, Lola; Nhampossa, Tacilta; Acácio, Sozinho; Horra, Carmen de la; Friaza, Vicente; Campano, Elena; Alonso, Pedro L.; Calderón, E.; Roca, Anna; Bassat, Quique

doi:10.1016/j.cmi.2015.07.011

Cited by 23 publications

(16 citation statements)

References 26 publications

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“…In Mozambique, all patients with advanced immunosuppression due to HIV are recommended to receive co-trimoxazole prophylaxis for prevention of PCP. A study by Lanaspa et al in 2015 reported a prevalence of 9.2% of PCP among children <5 years age admitted to hospital with clinical severe pneumonia diagnosed by PCR [ 16 ] ( Table 2 ). Another study in HIV-infected patients with pulmonary infections reported 16.3% of PCP among TB patients [ 17 , 18 ].…”

Section: Resultsmentioning

confidence: 99%

Estimated Burden of Serious Fungal Infections in Mozambique

Sacarlal

Denning

2018

JoF

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Mozambique is a sub-Saharan African country with limited information on the burden of fungal disease. We estimated the burden of serious fungal infections for the general healthy population and for those at risk, including those infected with HIV, patients with asthma, as well as those under intensive care. We consulted the Mozambican National Institute of Statistics Population and Housing Census report to obtain denominators for different age groups. We use modelling and HIV data to estimate the burdens of Pneumocystis jirovecii pneumonia (PCP), cryptococcal meningitis (CM) and candidiasis. Asthma, chronic obstructive pulmonary disease and tuberculosis data were used to estimate the burden of allergic bronchopulmonary aspergillosis (ABPA) and chronic pulmonary aspergillosis (CPA). In 2016, the Mozambique population was 26.4 million with 1.8 million people reported to be HIV-infected. Estimated annual incidence of fungal infections was: 33,380 PCP, 18,640 CM and 260,025 oral and oesophageal candidiasis cases. Following pulmonary tuberculosis, estimated numbers of people having chronic pulmonary aspergillosis (prevalence) and allergic bronchopulmonary aspergillosis complicating asthma are 18,475 and 15,626, respectively. Tinea capitis is common in children with over 1.1 million probably affected. We also highlight from studies in progress of high incidences of histoplasmosis, CM and Pneumocystis jirovecii in adult HIV-infected patients. Prospective epidemiology studies with sensitive diagnostics are required to validate these estimates.

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Section: Resultsmentioning

confidence: 99%

Estimated Burden of Serious Fungal Infections in Mozambique

Sacarlal

Denning

2018

JoF

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“…The presence of respiratory viruses (influenza virus A and B, respiratory syncytial virus A and B, parainfluenza virus 1, 2, 3 and 4, adenovirus, human rhinovirus, human metapneumovirus, and enterovirus) in nasopharyngeal aspirates (NPA) was determined using four different polymerase chain reactions . Pneumocystis jirovecii infections were investigated in NPA samples using molecular methods . Three specific genes were targeted: (i) mtLSU rRNA locus; (ii) mtSSU rRNA locus; and (iii) DHPS locus .…”

Section: Methodsmentioning

confidence: 99%

Hypoxaemia in Mozambican children <5 years of age admitted to hospital with clinical severe pneumonia: clinical features and performance of predictor models

Bassat

Lanaspa

Machevo

et al. 2016

Tropical Med Int Health

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Abstractobjective To determine the prevalence of hypoxaemia among under-five children admitted to hospital with clinical severe pneumonia and to assess the performance to diagnose hypoxaemia of models based on clinical signs.methods We conducted a hospital-based survey in a district hospital from Southern Mozambique. results A total of 825 children were recruited after obtaining an informed consent. The prevalence of hypoxaemia on admission was 27.9%, and 19.8% of these children died (OR compared with nonhypoxaemic children 3.22, 95% CI 1.98-5.21, P < 0.001). The model with larger area under the ROC curve (AUC-ROC) to predict hypoxaemia included cyanosis or thoracoabdominal breathing or respiratory rate ≥70 breaths per minute. None of the models performed well when tested in different case scenarios of oxygen availability through mathematical modelling, with over 50% of hypoxaemic children not receiving oxygen even in favourable case scenarios.conclusions Clinical signs alone or in combination are not suitable to diagnose hypoxaemia. The use of pulse oximeters should be strongly encouraged.

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“…For instance, when modern diagnostic methods were applied, unsuspected pneumocystis infection was found to be the cause of up to 7% of all severe pneumonia in children younger than 5 years in a hospital in southern Mozambique. 20 In regions with few laboratory facilities, the diagnosis of pneumocystis is often made on clinical grounds. Although such an approach is pragmatic, it lacks specificity, which is necessary to rapidly focus the appropriate antibiotic therapy towards pneumocystis when it is present.…”

Section: Seriesmentioning

confidence: 99%

Fungal infections in HIV/AIDS

Limper

Adenis

et al. 2017

The Lancet Infectious Diseases

391

307

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Fungi are major contributors to the opportunistic infections that affect patients with HIV/AIDS. Systemic infections are mainly with Pneumocystis jirovecii (pneumocystosis), Cryptococcus neoformans (cryptococcosis), Histoplasma capsulatum (histoplasmosis), and Talaromyces (Penicillium) marneffei (talaromycosis). The incidence of systemic fungal infections has decreased in people with HIV in high-income countries because of the widespread availability of antiretroviral drugs and early testing for HIV. However, in many areas with high HIV prevalence, patients present to care with advanced HIV infection and with a low CD4 cell count or re-present with persistent low CD4 cell counts because of poor adherence, resistance to antiretroviral drugs, or both. Affordable, rapid point-of-care diagnostic tests (as have been developed for cryptococcosis) are urgently needed for pneumocystosis, talaromycosis, and histoplasmosis. Additionally, antifungal drugs, including amphotericin B, liposomal amphotericin B, and flucytosine, need to be much more widely available. Such measures, together with continued international efforts in education and training in the management of fungal disease, have the potential to improve patient outcomes substantially.

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High prevalence of Pneumocystis jirovecii pneumonia among Mozambican children <5 years of age admitted to hospital with clinical severe pneumonia

Cited by 23 publications

References 26 publications

Estimated Burden of Serious Fungal Infections in Mozambique

Estimated Burden of Serious Fungal Infections in Mozambique

Hypoxaemia in Mozambican children <5 years of age admitted to hospital with clinical severe pneumonia: clinical features and performance of predictor models

Fungal infections in HIV/AIDS

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