Etiology of severe pneumonia in Ecuadorian children.
BACKGROUND
In Latin America, community-acquired pneumonia remains a major cause of morbidity and mortality among children. Few studies have examined the etiology of pneumonia in Ecuador.


METHODS
This observational study was part of a randomized, double blind, placebo-controlled clinical trial conducted among children aged 2-59 months with severe pneumonia in Quito, Ecuador. Nasopharyngeal and blood samples were tested for bacterial and viral etiology by polymerase chain reaction. Risk factors for specific respiratory pathogens were also evaluated.


RESULTS
Among 406 children tested, 159 (39.2%) had respiratory syncytial virus (RSV), 71 (17.5%) had human metapneumovirus (hMPV), and 62 (15.3%) had adenovirus. Streptococcus pneumoniae was identified in 37 (9.2%) samples and Mycoplasma pneumoniae in three (0.74%) samples. The yearly circulation pattern of RSV (P = 0.0003) overlapped with S. pneumoniae, (P = 0.03) with most cases occurring in the rainy season. In multivariable analysis, risk factors for RSV included younger age (adjusted odds ratio [aOR] = 1.9, P = 0.01) and being underweight (aOR = 1.8, P = 0.04). Maternal education (aOR = 0.82, P = 0.003), pulse oximetry (aOR = 0.93, P = 0.005), and rales (aOR = 0.25, P = 0.007) were associated with influenza A. Younger age (aOR = 3.5, P = 0.007) and elevated baseline respiratory rate were associated with HPIV-3 infection (aOR = 0.94, P = 0.03).


CONCLUSIONS
These results indicate the importance of RSV and influenza, and potentially modifiable risk factors including undernutrition and future use of a RSV vaccine, when an effective vaccine becomes available.


BACKGROUND
ClinicalTrials.gov NCT 00513929.
Center for Global Health and Development, Boston University School of Public Health, Boston, Massachusetts, United States of America.
Sivani
S
Jonnalagadda
Corporación Ecuatoriana de Biotecnología, Quito, Ecuador.
Oswaldo
O
Rodríguez
Corporación Ecuatoriana de Biotecnología, Quito, Ecuador.|Universidad Central del Ecuador, Escuela de Medicina, Quito, Ecuador.
Bertha
B
Estrella
Center for Global Health and Development, Boston University School of Public Health, Boston, Massachusetts, United States of America.|Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United States of America.
Lora L
LL
Sabin
Corporación Ecuatoriana de Biotecnología, Quito, Ecuador.|Universidad Central del Ecuador, Escuela de Medicina, Quito, Ecuador.
Fernando
F
Sempértegui
Center for Global Health and Development, Boston University School of Public Health, Boston, Massachusetts, United States of America.|Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United States of America.|Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, United States of America.|Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, United States of America.
Davidson H
http://orcid.org/0000-0002-4700-1495
DH
Hamer
D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D017668:Age of Onset; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology / Q000821:virology; D019587:Dietary Supplements; D004311:Double-Blind Method; D004484:Ecuador / Q000453:epidemiology; D009305:Nasopharynx / Q000382:microbiology / Q000821:virology; D010919:Placebos; D011014:Pneumonia / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D012720:Severity of Illness Index; D015032:Zinc / Q000008:administration & dosage; D016032:Randomized Controlled Trials as Topic
D010919:Placebos; D015032:Zinc