Evaluation of Pneumococcal Load in Blood by Polymerase Chain Reaction for the Diagnosis of Pneumococcal Pneumonia in Young Children in the PERCH Study.

Autor:	Deloria Knoll M; Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland., Morpeth SC; Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi.; Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, United Kingdom.; Microbiology Laboratory, Middlemore Hospital, Counties Manukau District Health Board, Auckland, New Zealand., Scott JAG; Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi.; Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, United Kingdom., Watson NL; Emmes Corporation, Rockville, Maryland., Park DE; Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.; Milken Institute School of Public Health, Department of Epidemiology and Biostatistics, George Washington University, District of Columbia., Baggett HC; Global Disease Detection Center, Thailand Ministry of Public Health-US Centers for Disease Control and Prevention Collaboration, Nonthaburi.; Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia., Brooks WA; International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka and Matlab.; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland., Feikin DR; Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.; Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia., Hammitt LL; Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.; Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi., Howie SRC; Medical Research Council Unit, Basse, The Gambia.; Department of Paediatrics, University of Auckland and.; Centre for International Health, University of Otago, Dunedin, New Zealand., Kotloff KL; Division of Infectious Disease and Tropical Pediatrics, Department of Pediatrics, Center for Vaccine Development, Institute of Global Health, University of Maryland School of Medicine, Baltimore., Levine OS; Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.; Bill & Melinda Gates Foundation, Seattle, Washington., O'Brien KL; Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland., Thea DM; Center for Global Health and Development, Boston University School of Public Health, Massachusetts., Ahmed D; International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka and Matlab., Antonio M; Medical Research Council Unit, Basse, The Gambia.; Department of Pathogen Molecular Biology, London School of Hygiene & Tropical Medicine, United Kingdom.; Microbiology and Infection Unit, Warwick Medical School, University of Warwick, Coventry, United Kingdom., Awori JO; Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi., Baillie VL; Medical Research Council, Respiratory and Meningeal Pathogens Research Unit and.; Department of Science and Technology/National Research Foundation, Vaccine Preventable Diseases Unit, University of the Witwatersrand, Johannesburg, South Africa., Chipeta J; Department of Paediatrics and Child Health, University of Zambia School of Medicine, and University Teaching Hospital, Lusaka., Deluca AN; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland., Dione M; Medical Research Council Unit, Basse, The Gambia.; International Livestock Research Institute, Kampala, Uganda., Driscoll AJ; Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland., Higdon MM; Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland., Jatapai A; Global Disease Detection Center, Thailand Ministry of Public Health-US Centers for Disease Control and Prevention Collaboration, Nonthaburi., Karron RA; Department of International Health, Center for Immunization Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland., Mazumder R; International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka and Matlab., Moore DP; Medical Research Council, Respiratory and Meningeal Pathogens Research Unit and.; Department of Science and Technology/National Research Foundation, Vaccine Preventable Diseases Unit, University of the Witwatersrand, Johannesburg, South Africa.; Department of Paediatrics and Child Health, Chris Hani Baragwanath Academic Hospital and University of the Witwatersrand, Johannesburg, South Africa., Mwansa J; Department of Pathology and Microbiology, University Teaching Hospital and.; Zambia Center for Applied Health Research and Development, Lusaka., Nyongesa S; Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi., Prosperi C; Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland., Seidenberg P; Center for Global Health and Development, Boston University School of Public Health, Massachusetts.; Department of Emergency Medicine, University of New Mexico, Albuquerque., Siludjai D; Global Disease Detection Center, Thailand Ministry of Public Health-US Centers for Disease Control and Prevention Collaboration, Nonthaburi., Sow SO; Centre pour le Développement des Vaccins (CVD-Mali), Bamako., Tamboura B; Centre pour le Développement des Vaccins (CVD-Mali), Bamako., Zeger SL; Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland., Murdoch DR; Department of Pathology, University of Otago, and.; Microbiology Unit, Canterbury Health Laboratories, Christchurch, New Zealand., Madhi SA; Medical Research Council, Respiratory and Meningeal Pathogens Research Unit and.; Department of Science and Technology/National Research Foundation, Vaccine Preventable Diseases Unit, University of the Witwatersrand, Johannesburg, South Africa.
Jazyk:	angličtina
Zdroj:	Clinical infectious diseases : an official publication of the Infectious Diseases Society of America [Clin Infect Dis] 2017 Jun 15; Vol. 64 (suppl_3), pp. S357-S367.
DOI:	10.1093/cid/cix149
Abstrakt:	Background.: Detection of pneumococcus by lytA polymerase chain reaction (PCR) in blood had poor diagnostic accuracy for diagnosing pneumococcal pneumonia in children in 9 African and Asian sites. We assessed the value of blood lytA quantification in diagnosing pneumococcal pneumonia. Methods.: The Pneumonia Etiology Research for Child Health (PERCH) case-control study tested whole blood by PCR for pneumococcus in children aged 1-59 months hospitalized with signs of pneumonia and in age-frequency matched community controls. The distribution of load among PCR-positive participants was compared between microbiologically confirmed pneumococcal pneumonia (MCPP) cases, cases confirmed for nonpneumococcal pathogens, nonconfirmed cases, and controls. Receiver operating characteristic analyses determined the "optimal threshold" that distinguished MCPP cases from controls. Results.: Load was available for 290 of 291 cases with pneumococcal PCR detected in blood and 273 of 273 controls. Load was higher in MCPP cases than controls (median, 4.0 × 103 vs 0.19 × 103 copies/mL), but overlapped substantially (range, 0.16-989.9 × 103 copies/mL and 0.01-551.9 × 103 copies/mL, respectively). The proportion with high load (≥2.2 log10 copies/mL) was 62.5% among MCPP cases, 4.3% among nonconfirmed cases, 9.3% among cases confirmed for a nonpneumococcal pathogen, and 3.1% among controls. Pneumococcal load in blood was not associated with respiratory tract illness in controls (P = .32). High blood pneumococcal load was associated with alveolar consolidation on chest radiograph in nonconfirmed cases, and with high (>6.9 log10 copies/mL) nasopharyngeal/oropharyngeal load and C-reactive protein ≥40 mg/L (both P < .01) in nonconfirmed cases but not controls. Conclusions.: Quantitative pneumococcal PCR in blood has limited diagnostic utility for identifying pneumococcal pneumonia in individual children, but may be informative in epidemiological studies. (© The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America.)
Databáze:	MEDLINE
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