Factors That Negatively Affect the Prognosis of Pediatric Community-Acquired Pneumonia in District Hospital in Tanzania.
Community-acquired pneumonia (CAP) is still the most important cause of death in countries with scarce resources. All children (33 months ± 35 DS) discharged from the Pediatric Unit of Itigi Hospital, Tanzania, with a diagnosis of CAP from August 2014 to April 2015 were enrolled. Clinical data were gathered. Dried blood spot (DBS) samples for quantitative real-time polymerase chain reaction (PCR) for bacterial detection were collected in all 100 children included. Twenty-four percent of patients were identified with severe CAP and 11% died. Surprisingly, 54% of patients were admitted with a wrong diagnosis, which increased complications, the need for antibiotics and chest X-rays, and the length of hospitalization. Comorbidity, found in 32% of children, significantly increased severity, complications, deaths, need for chest X-rays, and oxygen therapy. Malnourished children (29%) required more antibiotics. Microbiologically, Streptococcus pneumonia (S. p.), Haemophilus influenza type b (Hib) and Staphylococcus aureus (S. a.) were the bacteria more frequently isolated. Seventy-five percent of patients had mono-infection. Etiology was not correlated with severity, complications, deaths, oxygen demand, or duration of hospitalization. Our study highlights that difficult diagnoses and comorbidities negatively affect clinical evolution. S. p. and Hib still play a large role; thus, implementation of current vaccine strategies is needed. DBS is a simple and efficient diagnostic method for bacterial identification in countries with scarce resources.
Respiratory Unit, Bambino Gesù Children's Hospital, 00165 Rome, Italy. serena.caggiano@opbg.net.|Department of Pediatrics, Sapienza University of Rome, Umberto I Hospital, 00161 Rome, Italy. serena.caggiano@opbg.net.
Serena
S
Caggiano
Respiratory Unit, Bambino Gesù Children's Hospital, 00165 Rome, Italy. nicola.ullmann@opbg.net.
Nicola
N
Ullmann
Department of Clinical Immunology, University of Florence and Children's University Hospital A. Meyer, 50139 Florence, Italy. ely87_dv@hotmail.it.
Elisa
E
De Vitis
Department of Pediatrics, Sapienza University of Rome, Umberto I Hospital, 00161 Rome, Italy. marzia.trivelli@gmail.com.
Marzia
M
Trivelli
Department of Pediatrics, Sapienza University of Rome, Umberto I Hospital, 00161 Rome, Italy. chiaramariani23@yahoo.it.
Chiara
C
Mariani
Department of Pediatrics, Sapienza University of Rome, Umberto I Hospital, 00161 Rome, Italy. maripod@hotmail.com.
Maria
M
Podagrosi
Department of Pediatrics, Sapienza University of Rome, Umberto I Hospital, 00161 Rome, Italy. fabianaursitti@gmail.com.
Fabiana
F
Ursitti
Department of Pediatrics, Sapienza University of Rome, Umberto I Hospital, 00161 Rome, Italy. chiara.bertolaso@hotmail.it.
Chiara
C
Bertolaso
Department of Pediatrics, Sapienza University of Rome, Umberto I Hospital, 00161 Rome, Italy. caro_85@hotmail.it.
Carolina
C
Putotto
Department of Pediatrics, Sapienza University of Rome, Umberto I Hospital, 00161 Rome, Italy. marta_unolt@hotmail.it.
Marta
M
Unolt
Department of Pediatrics, Sapienza University of Rome, Umberto I Hospital, 00161 Rome, Italy. apietravalle@gmail.com.
Andrea
A
Pietravalle
Department of Pediatrics, Sapienza University of Rome, Umberto I Hospital, 00161 Rome, Italy. pansa.paola@gmail.com.
Paola
P
Pansa
Pediatric Unit, St. Gaspar Hospital, Box 12, Itigi, Tanzania. akajoroa@yahoo.com.
Kajoro
K
Mphayokulela
Pediatric Unit, St. Gaspar Hospital, Box 12, Itigi, Tanzania. waursulitigi@yahoo.it.
Maria Incoronata
MI
Lemmo
Pediatric Unit, St. Gaspar Hospital, Box 12, Itigi, Tanzania. mikaelimkwambe@rocketmail.com.
Michael
M
Mkwambe
Pediatric Unit, St. Gaspar Hospital, Box 12, Itigi, Tanzania. sereka@hotmail.it.
Joseph
J
Kazaura
Department of Pediatrics, Sapienza University of Rome, Umberto I Hospital, 00161 Rome, Italy. marzia.duse@gmail.com.
Marzia
M
Duse
Department of Clinical Immunology, University of Florence and Children's University Hospital A. Meyer, 50139 Florence, Italy. francesco.nieddu@meyer.it.
Francesco
F
Nieddu
Department of Clinical Immunology, University of Florence and Children's University Hospital A. Meyer, 50139 Florence, Italy. chiara.azzari@unifi.it.
Chiara
C
Azzari
Respiratory Unit, Bambino Gesù Children's Hospital, 00165 Rome, Italy. renato.cutrera@opbg.net.
Renato
R
Cutrera
D002648:Child; D002675:Child, Preschool; D017714:Community-Acquired Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D015897:Comorbidity; D005260:Female; D006767:Hospitals, District; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007902:Length of Stay; D008297:Male; D010641:Phenotype; D018410:Pneumonia, Bacterial / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D011379:Prognosis; D012307:Risk Factors; D012720:Severity of Illness Index; D013636:Tanzania / Q000453:epidemiology
antibiotic therapy; community-acquired pneumonia; developing countries; molecular diagnostic; prevention; vaccines