title: Burden of respiratory tract infections at post mortem in Zambian children.
abstract: BACKGROUND
  Autopsy studies are the gold standard for determining cause-of-death and can inform on improved diagnostic strategies and algorithms to improve patient care. We conducted a cross-sectional observational autopsy study to describe the burden of respiratory tract infections in inpatient children who died at the University Teaching Hospital in Lusaka, Zambia.
  
  
  METHODS
  Gross pathology was recorded and lung tissue was analysed by histopathology and molecular diagnostics. Recruitment bias was estimated by comparing recruited and non-recruited cases.
  
  
  RESULTS
  Of 121 children autopsied, 64 % were male, median age was 19 months (IQR, 12-45 months). HIV status was available for 97 children, of whom 34 % were HIV infected. Lung pathology was observed in 92 % of cases. Bacterial bronchopneumonia was the most common pathology (50 %) undiagnosed ante-mortem in 69 % of cases. Other pathologies included interstitial pneumonitis (17 %), tuberculosis (TB; 8 %), cytomegalovirus pneumonia (7 %) and pneumocystis Jirovecii pneumonia (5 %). Comorbidity between lung pathology and other communicable and non-communicable diseases was observed in 80 % of cases. Lung tissue from 70 % of TB cases was positive for Mycobacterium tuberculosis by molecular diagnostic tests. A total of 80 % of TB cases were comorbid with malnutrition and only 10 % of TB cases were on anti-TB therapy when they died.
  
  
  CONCLUSIONS
  More proactive testing for bacterial pneumonia and TB in paediatric inpatient settings is needed.
authors.affiliation: HerpeZ, University Teaching Hospital, Lusaka, Zambia. matthew.bates@ucl.ac.uk.|University of Zambia and University College London Medical School (UNZA-UCLMS) Research and Training Programme, University Teaching Hospital, Lusaka, Zambia. matthew.bates@ucl.ac.uk.|Department of Infection, Division of Infection and Immunity, University College London, and NIHR Biomedical Research centre at UCL Hospitals, London, UK. matthew.bates@ucl.ac.uk.
authors.forename: Matthew
authors.initials: M
authors.lastname: Bates
authors.affiliation: Department of Pathology & Microbiology, University Teaching Hospital, Lusaka, Zambia.
authors.forename: Aaron
authors.initials: A
authors.lastname: Shibemba
authors.affiliation: Department of Pathology & Microbiology, University Teaching Hospital, Lusaka, Zambia.
authors.forename: Victor
authors.initials: V
authors.lastname: Mudenda
authors.affiliation: HerpeZ, University Teaching Hospital, Lusaka, Zambia.|University of Zambia and University College London Medical School (UNZA-UCLMS) Research and Training Programme, University Teaching Hospital, Lusaka, Zambia.
authors.forename: Charles
authors.initials: C
authors.lastname: Chimoga
authors.affiliation: HerpeZ, University Teaching Hospital, Lusaka, Zambia.|University of Zambia and University College London Medical School (UNZA-UCLMS) Research and Training Programme, University Teaching Hospital, Lusaka, Zambia.|Institute for Infectious Diseases, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
authors.forename: John
authors.initials: J
authors.lastname: Tembo
authors.affiliation: HerpeZ, University Teaching Hospital, Lusaka, Zambia.|University of Zambia and University College London Medical School (UNZA-UCLMS) Research and Training Programme, University Teaching Hospital, Lusaka, Zambia.
authors.forename: Mwila
authors.initials: M
authors.lastname: Kabwe
authors.affiliation: HerpeZ, University Teaching Hospital, Lusaka, Zambia.|University of Zambia and University College London Medical School (UNZA-UCLMS) Research and Training Programme, University Teaching Hospital, Lusaka, Zambia.
authors.forename: Moses
authors.initials: M
authors.lastname: Chilufya
authors.affiliation: Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich, Munich, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Hoelscher
authors.affiliation: Therapeutic Immunology, Department of Laboratory Medicine, Department of Microbiology, and Department of Tumour and Cell Biology, Karolinska Institute, Stockholm, Sweden.
authors.forename: Markus
authors.initials: M
authors.lastname: Maeurer
authors.affiliation: Department of Paediatrics & Child Health, University Teaching Hospital, Lusaka, Zambia.
authors.forename: Sylvester
authors.initials: S
authors.lastname: Sinyangwe
authors.affiliation: University of Zambia and University College London Medical School (UNZA-UCLMS) Research and Training Programme, University Teaching Hospital, Lusaka, Zambia.|Ministry of Health, Lusaka, Zambia.
authors.forename: Peter
authors.initials: P
authors.lastname: Mwaba
authors.affiliation: University of Zambia and University College London Medical School (UNZA-UCLMS) Research and Training Programme, University Teaching Hospital, Lusaka, Zambia.|National Tuberculosis Control Programme, Ministry of Community Development, Maternal and Child Health, Lusaka, Zambia.
authors.forename: Nathan
authors.initials: N
authors.lastname: Kapata
authors.affiliation: University of Zambia and University College London Medical School (UNZA-UCLMS) Research and Training Programme, University Teaching Hospital, Lusaka, Zambia.|Department of Infection, Division of Infection and Immunity, University College London, and NIHR Biomedical Research centre at UCL Hospitals, London, UK.
authors.forename: Alimuddin
authors.initials: A
authors.lastname: Zumla
mesh_terms: D001344:Autopsy; D002648:Child; D015362:Child Nutrition Disorders / Q000453:epidemiology; D002675:Child, Preschool; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D012141:Respiratory Tract Infections / Q000453:epidemiology* / Q000382:microbiology*; D015024:Zambia / Q000453:epidemiology
keywords: Africa; Autopsy; Children; Cytomegalovirus; Pneumocystis Jirovecii pneumonia; Pneumonia; Post mortem; Tuberculosis; Zambia