Lung diseases at necropsy in African children dying from respiratory illnesses: a descriptive necropsy study.
BACKGROUND
Accurate information about specific causes of death in African children dying of respiratory illnesses is scarce, and can only be obtained by autopsy. We undertook a study of children who died from respiratory diseases at University Teaching Hospital, Lusaka, Zambia.


METHODS
137 boys (93 HIV-1-positive, 44 HIV-1-negative], and 127 girls (87 HIV-1-positive, 40 HIV-1-negative) aged between 1 month and younger than 16 years underwent autopsy restricted to the chest cavity. Outcome measures were specific lung diseases, stratified by age and HIV-1 status.


RESULTS
The presence of multiple diseases was common. Acute pyogenic pneumonia (population-adjusted prevalence 39.1%, 116/264), Pneumocystis carinii pneumonia (27.5%, 58/264), tuberculosis (18.8%, 54/264), and cytomegalovirus infection (CMV, 20.2%, 43/264) were the four most common findings overall. The three most frequent findings in the HIV-1-negative group were acute pyogenic pneumonia (50%), tuberculosis (26%), and interstitial pneumonitis (18%); and in the HIV-1-positive group were acute pyogenic pneumonia (41%), P carinii pneumonia (29%), and CMV (22%). HIV-1-positive children more frequently had P carinii pneumonia (odds ratio 5.28, 95% CI 2.12-15.68, p=0.0001), CMV (7.71, 2.33-40.0, p=0.0002), and shock lung (4.15, 1.20-22.10, p=0.03) than did HIV-1-negative children. 51/58 (88%) cases of P carinii pneumonia were in children younger than 12 months, and five in children aged over 24 months. Tuberculosis was common in all age groups, irrespective of HIV-1 status.


CONCLUSIONS
Most children dying from respiratory diseases have preventable or treatable infectious illnesses. The presence of multiple diseases might make diagnosis difficult. WHO recommendations should therefore be updated with mention of HIV-1-positive children. Improved diagnostic tests for bacterial pathogens, tuberculosis, and P carinii pneumonia are urgently needed.
Chintu
Chifumbe
C
University of Zambia-University College London Medical School Research and Training Project, University Teaching Hospital, Lusaka, Zambia.
Mudenda
Victor
V
Lucas
Sebastian
S
Nunn
Andrew
A
Lishimpi
Kennedy
K
Maswahu
Daniel
D
Kasolo
Francis
F
Mwaba
Peter
P
Bhat
Ganapati
G
Terunuma
Hiroshi
H
Zumla
Alimuddin
A
D000293:Adolescent; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D003586:Cytomegalovirus Infections / Q000401:mortality; D005260:Female; D015658:HIV Infections / Q000150:complications; D015497:HIV-1; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008171:Lung Diseases / Q000401:mortality*; D017563:Lung Diseases, Interstitial / Q000401:mortality; D008297:Male; D011014:Pneumonia / Q000401:mortality; D011020:Pneumonia, Pneumocystis / Q000401:mortality; D012128:Respiratory Distress Syndrome / Q000401:mortality; D014397:Tuberculosis, Pulmonary / Q000401:mortality; D015024:Zambia