title: Increased Nasopharyngeal Density and Concurrent Carriage of Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis Are Associated with Pneumonia in Febrile Children.
abstract: BACKGROUND
  We assessed nasopharyngeal (NP) carriage of five pathogens in febrile children with and without acute respiratory infection (ARI) of the upper (URTI) or lower tract, attending health facilities in Tanzania.
  
  
  METHODS
  NP swabs collected from children (N = 960) aged 2 months to 10 years, and with a temperature ≥38°C, were utilized to quantify bacterial density of S. pneumoniae (Sp), H. influenzae (Hi), M. catarrhalis (Mc), S. aureus (Sa), and N. meningitidis (Nm). We determined associations between presence of individual species, densities, or concurrent carriage of all species combination with respiratory diseases including clinical pneumonia, pneumonia with normal chest radiography (CXR) and endpoint pneumonia.
  
  
  RESULTS
  Individual carriage, and NP density, of Sp, Hi, or Mc, but not Sa, or Nm, was significantly associated with febrile ARI and clinical pneumonia when compared to febrile non-ARI episodes. Density was also significantly increased in severe pneumonia when compared to mild URTI (Sp, p<0.002; Hi p<0.001; Mc, p = 0.014). Accordingly, concurrent carriage of Sp+, Hi+, and Mc+, in the absence of Sa- and Nm-, was significantly more prevalent in children with ARI (p = 0.03), or clinical pneumonia (p<0.001) than non-ARI, and in children with clinical pneumonia (p = 0.0007) than URTI. Furthermore, Sp+, Hi+, and Mc+ differentiated children with pneumonia with normal CXR, or endpoint pneumonia, from those with URTI, and non-ARI cases.
  
  
  CONCLUSIONS
  Concurrent NP carriage of Sp, Hi, and Mc was a predictor of clinical pneumonia and identified children with pneumonia with normal CXR and endpoint pneumonia from those with febrile URTI, or non-ARI episodes.
authors.affiliation: Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America.
authors.forename: Sopio
authors.initials: S
authors.lastname: Chochua
authors.affiliation: Swiss Tropical and Public Health Institute and University of Basel, Basel, Switzerland.|Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland.
authors.forename: Valérie
authors.initials: V
authors.lastname: D'Acremont
authors.affiliation: Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America.
authors.forename: Christiane
authors.initials: C
authors.lastname: Hanke
authors.affiliation: Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America.
authors.forename: David
authors.initials: D
authors.lastname: Alfa
authors.affiliation: Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America.
authors.forename: Joshua
authors.initials: J
authors.lastname: Shak
authors.affiliation: Amana Hospital, Dar es Salaam, United Republic of Tanzania.
authors.forename: Mary
authors.initials: M
authors.lastname: Kilowoko
authors.affiliation: St. Francis Hospital, Ifakara, United Republic of Tanzania.
authors.forename: Esther
authors.initials: E
authors.lastname: Kyungu
authors.affiliation: Laboratory of Virology, Division of Infectious Diseases and Division of Laboratory Medicine, University Hospital of Geneva, and Faculty of Medicine, University of Geneva, Geneva, Switzerland.
authors.forename: Laurent
authors.initials: L
authors.lastname: Kaiser
authors.affiliation: Swiss Tropical and Public Health Institute and University of Basel, Basel, Switzerland.|Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland.|Infectious Diseases Service, University Hospital, Lausanne, Switzerland.
authors.forename: Blaise
authors.initials: B
authors.lastname: Genton
authors.affiliation: Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America.
authors.forename: Keith P
authors.initials: KP
authors.lastname: Klugman
authors.affiliation: Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America.
authors.forename: Jorge E
authors.identifier: http://orcid.org/0000-0003-0573-5658
authors.initials: JE
authors.lastname: Vidal
mesh_terms: D002648:Child; D002675:Child, Preschool; D005260:Female; D006193:Haemophilus influenzae / Q000302:isolation & purification / Q000472:pathogenicity*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D001936:Moraxella catarrhalis / Q000302:isolation & purification / Q000472:pathogenicity*; D009305:Nasopharynx / Q000382:microbiology / Q000473:pathology; D011014:Pneumonia / Q000175:diagnosis* / Q000453:epidemiology / Q000382:microbiology / Q000473:pathology; D011379:Prognosis; D013296:Streptococcus pneumoniae / Q000302:isolation & purification / Q000472:pathogenicity*; D013636:Tanzania