Limited Utility of Polymerase Chain Reaction in Induced Sputum Specimens for Determining the Causes of Childhood Pneumonia in Resource-Poor Settings: Findings From the Pneumonia Etiology Research for Child Health (PERCH) Study

被引：28

作者：

Thea, Donald M. ^{[1
]}

Seidenberg, Phil ^{[1
,2
]}

Park, Daniel E. ^{[3
,4
]}

Mwananyanda, Lawrence ^{[1
,5
]}

Fu, Wei ^{[3
,6
]}

Shi, Qiyuan ^{[3
]}

Baggett, Henry C. ^{[7
,8
]}

Brooks, W. Abdullah ^{[9
,10
,11
]}

Feikin, Daniel R. ^{[3
,12
]}

Howie, Stephen R. C. ^{[13
,14
,15
]}

Knoll, Maria Deloria ^{[3
]}

Kotloff, Karen L. ^{[16
]}

Levine, Orin S. ^{[3
,17
]}

Madhi, Shabir A. ^{[18
,19
]}

O'Brien, Katherine L. ^{[3
]}

Scott, J. Anthony G. ^{[20
,21
]}

Antonio, Martin ^{[13
,22
,23
]}

Awori, Juliet O. ^{[20
]}

Baillie, Vicky L. ^{[18
,19
]}

DeLuca, Andrea N. ^{[3
,24
]}

Driscoll, Amanda J. ^{[3
]}

Higdon, Melissa M. ^{[3
]}

Hossain, Lokman ^{[10
,11
]}

Jahan, Yasmin ^{[10
,11
]}

Karron, Ruth A. ^{[25
]}

Kazungu, Sidi ^{[20
]}

Li, Mengying ^{[3
,26
]}

Moore, David P. ^{[18
,19
,27
,28
]}

Morpeth, Susan C. ^{[20
,21
,29
]}

Ofordile, Ogochukwu ^{[13
]}

Prosperi, Christine ^{[3
]}

Sangwichian, Ornuma ^{[7
]}

Sawatwong, Pongpun ^{[7
]}

Sylla, Mamadou ^{[30
]}

Tapia, Milagritos D. ^{[16
]}

Zeger, Scott L. ^{[31
]}

Murdoch, David R. ^{[32
,33
]}

Hammitt, Laura L. ^{[3
,20
]}

机构：

[1] Boston Univ, Sch Publ Hlth, Ctr Global Hlth & Dev, Boston, MA 02118 USA

[2] Univ New Mexico, Dept Emergency Med, Albuquerque, NM 87131 USA

[3] Johns Hopkins Bloomberg Sch Publ Hlth, Int Vaccine Access Ctr, Dept Int Hlth, Baltimore, MD USA

[4] George Washington Univ, Milken Inst, Sch Publ Hlth, Dept Epidemiol & Biostat, Washington, DC USA

[5] Univ Teaching Hosp, Lusaka, Zambia

[6] Johns Hopkins Sch Med, Dept Rheumatol, Baltimore, MD USA

[7] Thailand Minist Publ Health, US Centers Dis Control & Prevent Collaborat, Global Dis Detect Ctr, Nonthaburi, Thailand

[8] Ctr Dis Control & Prevent, Div Global Hlth Protect, Ctr Global Hlth, Atlanta, GA USA

[9] Johns Hopkins Bloomberg Sch Publ Hlth, Dept Int Hlth, Baltimore, MD USA

[10] Int Ctr Diarrhoeal Dis Res Bangladesh Icddr B, Dhaka, Bangladesh

[11] Int Ctr Diarrhoeal Dis Res Bangladesh Icddr B, Matlab, Bangladesh

[12] Natl Ctr Immunizat & Resp Dis, Ctr Dis Control & Prevent, Div Viral Dis, Atlanta, GA USA

[13] MRC Unit, Basse, Gambia

[14] Univ Auckland, Dept Pediat, Dunedin, New Zealand

[15] Univ Otago, Ctr Int Hlth, Dunedin, New Zealand

[16] Univ Maryland, Sch Med, Inst Global Hlth, Ctr Vaccine Dev,Dept Pediat,Div Infect Dis & Trop, Baltimore, MD 21201 USA

[17] Bill & Melinda Gates Fdn, Seattle, WA USA

[18] Univ Witwatersrand, Med Res Council, Resp & Meningeal Pathogens Res Unit, Johannesburg, South Africa

[19] Univ Witwatersrand, Natl Res Fdn, Dept Sci & Technol, Vaccine Preventable Dis Unit, Johannesburg, South Africa

[20] Kenya Govt Med Res Ctr, Wellcome Trust Res Programme, Kilifi, Kenya

[21] London Sch Hyg & Trop Med, Dept Infect Dis Epidemiol, London, England

[22] London Sch Hyg & Trop Med, London, England

[23] Univ Warwick, Warwick Med Sch, Microbiol & Infect Unit, Coventry, W Midlands, England

[24] Ctr Immunizat Res, Dept Epidemiol, Baltimore, MD USA

[25] Ctr Immunizat Res, Dept Int Hlth, Baltimore, MD USA

[26] Johns Hopkins Bloomberg Sch Publ Hlth, Dept Populat Family & Reprod Hlth, Baltimore, MD USA

[27] Chris Hani Baragwanath Acad Hosp, Dept Pediat & Child Hlth, Soweto, South Africa

[28] Univ Witwatersrand, Johannesburg, South Africa

[29] Middlemore Hosp, Counties Manukau Dist Hlth Board, Microbiol Lab, Auckland, New Zealand

[30] Ctr Deloppement Vaccins CVD Mali, Bamako, Mali

[31] Johns Hopkins Bloomberg Sch Publ Hlth, Dept Biostat, Baltimore, MD USA

[32] Univ Otago, Dept Pathol, Christchurch, New Zealand

[33] Canterbury Hlth Labs, Microbiol Unit, Christchurch, New Zealand

来源：

CLINICAL INFECTIOUS DISEASES | 2017年 / 64卷

基金：

比尔及梅琳达.盖茨基金会; 英国惠康基金;

关键词：

induced sputum; PCR; pneumonia etiology; nasopharyngeal swab; community-acquired pneumonia; COMMUNITY-ACQUIRED PNEUMONIA; STANDARDIZED INTERPRETATION; PNEUMOCYSTIS PNEUMONIA; CLINICAL MANAGEMENT; CHEST RADIOGRAPHS; RAPID INFLUENZA; DIAGNOSIS; INFANTS; COLLECTION; INFECTION;

D O I：

10.1093/cid/cix098

中图分类号：

R392 [医学免疫学]; Q939.91 [免疫学];

学科分类号：

100102 ;

摘要：

Background. Sputum examination can be useful in diagnosing the cause of pneumonia in adults but is less well established in children. We sought to assess the diagnostic utility of polymerase chain reaction (PCR) for detection of respiratory viruses and bacteria in induced sputum (IS) specimens from children hospitalized with severe or very severe pneumonia. Methods. Among children aged 1-59 months, we compared organism detection by multiplex PCR in IS and nasopharyngeal/oropharyngeal (NP/OP) specimens. To assess whether organism presence or density in IS specimens was associated with chest radiographic evidence of pneumonia (radiographic pneumonia), we compared prevalence and density in IS specimens from children with radiographic pneumonia and children with suspected pneumonia but without chest radiographic changes or clinical or laboratory findings suggestive of pneumonia (nonpneumonia group). Results. Among 4232 cases with World Health Organization-defined severe or very severe pneumonia, we identified 1935 (45.7%) with radiographic pneumonia and 573 (13.5%) with nonpneumonia. The organism detection yield was marginally improved with IS specimens (96.2% vs 92.4% for NP/OP specimens for all viruses combined [P = .41]; 96.9% vs 93.3% for all bacteria combined [P = .01]). After accounting for presence in NP/OP specimens, no organism was detected more frequently in the IS specimens from the radiographic pneumonia compared with the nonpneumonia cases. Among high-quality IS specimens, there were no statistically significant differences in organism density, except with cytomegalovirus, for which there was a higher quantity in the IS specimens from cases with radiographic pneumonia compared with the nonpneumonia cases (median cycle threshold value, 27.9 vs 28.5, respectively; P = .01). Conclusions. Using advanced molecular methods with IS specimens provided little additional diagnostic information beyond that obtained with NP/OP swab specimens.

引用

页码：S289 / S300

页数：12

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