Aetiology and outcome of pneumonia in human immunodeficiency virus-infected children hospitalized in South Africa.
To determine the aetiology and outcome of pneumonia in human immunodeficiency virus (HIV)-infected children, we prospectively investigated 250 children hospitalized with pneumonia who were known or clinically suspected to be HIV-positive, or who required intensive care support in Cape Town, South Africa. Blood culture, induced sputum or bronchoalveolar lavage, nasopharyngeal aspirate and gastric lavage were performed. Of the total, 151 children (60.4%) were HIV-infected. Pneumocystis carinii pneumonia (PCP), occurring in 19 (7.6%) children (15 HIV-positive), was the AIDS-defining infection in 20.3%. The incidence and type of bacteraemia (14.3%) were similar in HIV-positive and HIV-negative patients; S. pneumoniae (5%) and S. aureus (2%) were the predominant isolates. Sputum or BAL cultures yielded bacteria in 145 of 243 (60%) specimens; viruses were cultured in 37 (15.2%). Bacterial prevalence (including M. tuberculosis in 8%) and anti-microbial resistance did not differ by HIV status except for S. aureus which was more common in HIV-infected children. Thirty-one (20%) HIV-positive and 8 (8%) HIV-negative children died [RR 1.16 (95% CI 1.05-1.28), p=0.008]; using multiple logistic regression, PCP was the only risk factor for mortality (p = 0.03).


CONCLUSIONS
In South Africa, PCP is an important AIDS-defining infection in children; bacterial pathogens occur commonly and with a similar prevalence in HIV-positive and HIV-negative children hospitalized for pneumonia. HIV-infected children with pneumonia have a worse outcome than HIV-negative patients.
Department of Paediatrics, University of Cape Town South Africa. heather@rmh.uct.ac.za
H J
HJ
Zar
D
D
Hanslo
E
E
Tannenbaum
M
M
Klein
A
A
Argent
B
B
Eley
J
J
Burgess
K
K
Magnus
E D
ED
Bateman
G
G
Hussey
D005260:Female; D006679:HIV Seropositivity / Q000401:mortality / Q000534:rehabilitation*; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D010100:Oxygen / Q000627:therapeutic use; D016720:Pneumocystis Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology*; D011014:Pneumonia / Q000382:microbiology* / Q000401:mortality / Q000628:therapy*; D011175:Positive-Pressure Respiration / Q000379:methods; D011446:Prospective Studies; D012307:Risk Factors; D013019:South Africa / Q000453:epidemiology; D013203:Staphylococcal Infections / Q000453:epidemiology / Q000382:microbiology
D010100:Oxygen