title: Distinguishing malaria from severe pneumonia among hospitalized children who fulfilled integrated management of childhood illness criteria for both diseases: a hospital-based study in Mozambique.
abstract: Malaria and severe pneumonia in hospitalized young children may show striking clinical similarities, making differential diagnosis challenging. We investigated ways to increase diagnostic accuracy in patients hospitalized with clinical symptoms compatible with malaria and severe pneumonia, in an area with high a prevalence of infection with human immunodeficiency virus. A total of 646 children admitted at the Manhiça District Hospital in Manhiça, Mozambique who met the World Health Organization clinical criteria for severe pneumonia and malaria were recruited for 12 months and thoroughly investigated to ascertain an accurate diagnosis. Although symptom overlap between malaria and severe pneumonia was frequent among hospitalized children, true disease overlap was uncommon. Clinical presentation and laboratory determinations were ineffective in reliably distinguishing between the two diseases. Infection with human immunodeficiency virus differentially influenced the epidemiology and clinical presentation of these two infectious diseases, further challenging their discrimination on clinical grounds, and having a greater impact on the current burden and prognosis of severe pneumonia.
authors: Barcelona Centre for International Health Research, Hospital Clínic, University of Barcelona, Spain. quique.bassat@cresib.cat
authors: Quique
authors: Q
authors: Bassat
authors: Sónia
authors: S
authors: Machevo
authors: Cristina
authors: C
authors: O'Callaghan-Gordo
authors: Betuel
authors: B
authors: Sigaúque
authors: Luís
authors: L
authors: Morais
authors: Núria
authors: N
authors: Díez-Padrisa
authors: Josep L
authors: JL
authors: Ribó
authors: Inácio
authors: I
authors: Mandomando
authors: Tacilta
authors: T
authors: Nhampossa
authors: Edgar
authors: E
authors: Ayala
authors: Sergi
authors: S
authors: Sanz
authors: Martin
authors: M
authors: Weber
authors: Anna
authors: A
authors: Roca
authors: Pedro L
authors: PL
authors: Alonso
mesh_terms: D002648:Child; D003937:Diagnosis, Differential; D006780:Hospitals, Rural; D006801:Humans; D008288:Malaria / Q000175:diagnosis*; D009073:Mozambique; D015999:Multivariate Analysis; D011014:Pneumonia / Q000175:diagnosis*; D012307:Risk Factors