title: High prevalence of Pneumocystis jirovecii pneumonia among Mozambican children <5 years of age admitted to hospital with clinical severe pneumonia.
abstract: We aimed to describe Pneumocystis jirovecii pneumonia (PCP) prevalence and features in children from sub-Saharan Africa and to investigate PCP-associated risk factors. During 2006-2007 we used molecular methods to test children younger than 5 years old admitted with severe pneumonia to a hospital in southern Mozambique for Pneumocystis infection. We recruited 834 children. PCP prevalence was 6.8% and HIV prevalence was 25.7%. The in-hospital and delayed mortality were significantly higher among children with PCP (20.8% vs. 10.2%, p 0.021, and 11.5% vs. 3.6%, p 0.044, respectively). Clinical features were mostly overlapping between the two groups. Independent risk factors for PCP were age less than a year (odds ratio (OR) 6.34, 95% confidence interval (CI) 1.86-21.65), HIV infection (OR 2.99, 95% CI 1.16-7.70), grunting (OR 2.64, 95% CI 1.04-6.73) and digital clubbing (OR 10.75, 95% CI 1.21-95.56). PCP is a common and life-threatening cause of severe pneumonia in Mozambican children. Mother-to-child HIV transmission prevention should be strengthened. Better diagnostic tools are needed.
authors.affiliation: ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain; Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique.
authors.forename: M
authors.initials: M
authors.lastname: Lanaspa
authors.affiliation: ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain; Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique; Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain.
authors.forename: C
authors.initials: C
authors.lastname: O'Callaghan-Gordo
authors.affiliation: Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique.
authors.forename: S
authors.initials: S
authors.lastname: Machevo
authors.affiliation: ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain; Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique.
authors.forename: L
authors.initials: L
authors.lastname: Madrid
authors.affiliation: Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique; National Institute of Health (INS), Ministry of Health, Mozambique.
authors.forename: T
authors.initials: T
authors.lastname: Nhampossa
authors.affiliation: Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique; National Institute of Health (INS), Ministry of Health, Mozambique.
authors.forename: S
authors.initials: S
authors.lastname: Acácio
authors.affiliation: CIBER de Epidemiología y Salud Pública and Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain.
authors.forename: C
authors.initials: C
authors.lastname: de la Horra
authors.affiliation: CIBER de Epidemiología y Salud Pública and Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain.
authors.forename: V
authors.initials: V
authors.lastname: Friaza
authors.affiliation: CIBER de Epidemiología y Salud Pública and Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Campano
authors.affiliation: ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain; Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique.
authors.forename: P L
authors.initials: PL
authors.lastname: Alonso
authors.affiliation: CIBER de Epidemiología y Salud Pública and Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain. Electronic address: sandube@cica.es.
authors.forename: E J
authors.initials: EJ
authors.lastname: Calderón
authors.affiliation: Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique; Medical Research Council Unit, Banjul, The Gambia.
authors.forename: A
authors.initials: A
authors.lastname: Roca
authors.affiliation: ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain; Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique.
authors.forename: Q
authors.initials: Q
authors.lastname: Bassat
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D005260:Female; D015658:HIV Infections / Q000150:complications; D006760:Hospitalization; D006801:Humans; D007223:Infant; D008297:Male; D009073:Mozambique / Q000453:epidemiology; D045363:Pneumocystis carinii / Q000302:isolation & purification*; D011020:Pneumonia, Pneumocystis / Q000453:epidemiology* / Q000382:microbiology* / Q000401:mortality / Q000473:pathology; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D055815:Young Adult
keywords: Child preschool; Pneumocystis jirovecii; developing countries; infant; pneumonia