title: Acute lower respiratory infections in ≥ 5 year -old hospitalized patients in Cambodia, a low-income tropical country: clinical characteristics and pathogenic etiology.
abstract: BACKGROUND
  Few data exist on viral and bacterial etiology of acute lower respiratory infections (ALRI) in ≥ 5 year -old persons in the tropics.
  
  
  METHODS
  We conducted active surveillance of community-acquired ALRI in two hospitals in Cambodia, a low-income tropical country. Patients were tested for acid-fast bacilli (AFB) by direct sputum examination, other bacteria by blood and/or sputum cultures, and respiratory viruses using molecular techniques on nasopharyngeal/throat swabs. Pulmonologists reviewed clinical/laboratory data and interpreted chest X-rays (CXR) to confirm ALRI.
  
  
  RESULTS
  Between April 2007 - December 2009, 1,904 patients aged ≥5 years were admitted with acute pneumonia (50.4%), lung sequelae-associated ALRI (24.3%), isolated pleural effusions (8.9%) or normal CXR-related ALRI (17.1%); 61 (3.2%) died during hospitalization. The two former diagnoses were predominantly due to bacterial etiologies while viral detection was more frequent in the two latter diagnoses. AFB-positive accounted for 25.6% of acute pneumonia. Of the positive cultures (16.8%), abscess-prone Gram-negative bacteria (39.6%) and Haemophilus influenzae (38.0%) were most frequent, followed by Streptococcus pneumoniae (17.7%). Of the identified viruses, the three most common viruses included rhinoviruses (49.5%), respiratory syncytial virus (17.7%) and influenza viruses (12.1%) regardless of the diagnostic groups. Wheezing was associated with viral identification (31.9% vs. 13.8%, p  <  0.001) independent of age and time-to-admission.
  
  
  CONCLUSIONS
  High frequency of H. influenzae and S. pneumoniae infections support the need for introduction of the respective vaccines in the national immunization program. Tuberculosis was frequent in patients with acute pneumonia, requiring further investigation. The relationship between respiratory viruses and wheezing merits further studies.
authors: Institut Pasteur in Cambodia, Réseau International des Instituts Pasteur, Phnom Penh, Cambodia. sirenda.vong@gmail.com
authors: Sirenda
authors: S
authors: Vong
authors: Bertrand
authors: B
authors: Guillard
authors: Laurence
authors: L
authors: Borand
authors: Blandine
authors: B
authors: Rammaert
authors: Sophie
authors: S
authors: Goyet
authors: Vantha
authors: V
authors: Te
authors: Patrich
authors: P
authors: Lorn Try
authors: Sopheak
authors: S
authors: Hem
authors: Sareth
authors: S
authors: Rith
authors: Sowath
authors: S
authors: Ly
authors: Philippe
authors: P
authors: Cavailler
authors: Charles
authors: C
authors: Mayaud
authors: Philippe
authors: P
authors: Buchy
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000704:Analysis of Variance; D002160:Cambodia / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D017714:Community-Acquired Infections / Q000453:epidemiology* / Q000382:microbiology / Q000473:pathology / Q000821:virology; D005260:Female; D006193:Haemophilus influenzae / Q000302:isolation & purification; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D012141:Respiratory Tract Infections / Q000453:epidemiology* / Q000382:microbiology / Q000473:pathology / Q000821:virology; D012307:Risk Factors; D018709:Statistics, Nonparametric; D013296:Streptococcus pneumoniae / Q000302:isolation & purification; D014780:Viruses / Q000302:isolation & purification