Aetiology of lobar pneumonia determined by multiplex molecular analyses of lung and pleural aspirate specimens in the Gambia: findings from population-based pneumonia surveillance
Objectives To determine the causes of lobar pneumonia in rural Gambia.Design and setting Population-based pneumonia surveillance at seven peripheral health facilities and two regional hospitals in rural Gambia. 7-valent pneumococcal conjugate vaccine (PCV7) was introduced routinely in August 2009 an...
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BMJ Publishing Group
2022-03-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/12/3/e056706.full |
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| author | Jayani Pathirana Brian Greenwood Ilias Hossain Grant Austin Mackenzie Jessica McLellan Eunice Machuka Malick Ndiaye Augustin Fombah Baderinwa Abatan Ahmed Manjang Philip Hill |
| author_facet | Jayani Pathirana Brian Greenwood Ilias Hossain Grant Austin Mackenzie Jessica McLellan Eunice Machuka Malick Ndiaye Augustin Fombah Baderinwa Abatan Ahmed Manjang Philip Hill |
| author_sort | Jayani Pathirana |
| collection | DOAJ |
| description | Objectives To determine the causes of lobar pneumonia in rural Gambia.Design and setting Population-based pneumonia surveillance at seven peripheral health facilities and two regional hospitals in rural Gambia. 7-valent pneumococcal conjugate vaccine (PCV7) was introduced routinely in August 2009 and replaced by PCV13 from May 2011.Methods Prospective pneumonia surveillance was undertaken among all ages with referral of suspected pneumonia cases to the regional hospitals. Blood culture and chest radiographs were performed routinely while lung or pleural aspirates were collected from selected, clinically stable patients with pleural effusion on radiograph and/or large, dense, peripheral consolidation. We used conventional microbiology, and from 8 April 2011 to 17 July 2012, used a multiplex PCR assay on lung and pleural aspirates. We calculated proportions with pathogens, associations between coinfecting pathogens and PCV effectiveness.Participants 2550 patients were admitted with clinical pneumonia; 741 with lobar pneumonia or pleural effusion. We performed 181 lung or pleural aspirates and multiplex PCR on 156 lung and 4 pleural aspirates.Results Pathogens were detected in 116/160 specimens, the most common being Streptococcus pneumoniae(n=68), Staphylococcus aureus (n=26) and Haemophilus influenzae type b (n=11). Bacteria (n=97) were more common than viruses (n=49). Common viruses were bocavirus (n=11) and influenza (n=11). Coinfections were frequent (n=55). Moraxella catarrhalis was detected in eight patients and in every case there was coinfection with S. pneumoniae. The odds ratio of vaccine-type pneumococcal pneumonia in patients with two or three compared with zero doses of PCV was 0.17 (95% CI 0.06 to 0.51).Conclusions Lobar pneumonia in rural Gambia was caused primarily by bacteria, particularly S. pneumoniae and S. aureus. Coinfection was common and M. catarrhalis always coinfected with S. pneumoniae. PCV was highly efficacious against vaccine-type pneumococcal pneumonia. |
| format | Article |
| id | doaj-art-e92876fe0bad48509d282a230197cdec |
| institution | OA Journals |
| issn | 2044-6055 |
| language | English |
| publishDate | 2022-03-01 |
| publisher | BMJ Publishing Group |
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| series | BMJ Open |
| spelling | doaj-art-e92876fe0bad48509d282a230197cdec2025-08-20T01:48:07ZengBMJ Publishing GroupBMJ Open2044-60552022-03-0112310.1136/bmjopen-2021-056706Aetiology of lobar pneumonia determined by multiplex molecular analyses of lung and pleural aspirate specimens in the Gambia: findings from population-based pneumonia surveillanceJayani Pathirana0Brian Greenwood1Ilias Hossain2Grant Austin Mackenzie3Jessica McLellan4Eunice Machuka5Malick Ndiaye6Augustin Fombah7Baderinwa Abatan8Ahmed Manjang9Philip Hill101 Disease Control and Elimination, Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, GambiaFaculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UKDisease Control and Elimination, Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia1 Disease Control and Elimination, Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, Gambia4 Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada1 Disease Control and Elimination, Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, Gambia1 Disease Control and Elimination, Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, Gambia1 Disease Control and Elimination, Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, Gambia1 Disease Control and Elimination, Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, Gambia1 Disease Control and Elimination, Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, GambiaCentre for International Health, University of Otago, Dunedin, New ZealandObjectives To determine the causes of lobar pneumonia in rural Gambia.Design and setting Population-based pneumonia surveillance at seven peripheral health facilities and two regional hospitals in rural Gambia. 7-valent pneumococcal conjugate vaccine (PCV7) was introduced routinely in August 2009 and replaced by PCV13 from May 2011.Methods Prospective pneumonia surveillance was undertaken among all ages with referral of suspected pneumonia cases to the regional hospitals. Blood culture and chest radiographs were performed routinely while lung or pleural aspirates were collected from selected, clinically stable patients with pleural effusion on radiograph and/or large, dense, peripheral consolidation. We used conventional microbiology, and from 8 April 2011 to 17 July 2012, used a multiplex PCR assay on lung and pleural aspirates. We calculated proportions with pathogens, associations between coinfecting pathogens and PCV effectiveness.Participants 2550 patients were admitted with clinical pneumonia; 741 with lobar pneumonia or pleural effusion. We performed 181 lung or pleural aspirates and multiplex PCR on 156 lung and 4 pleural aspirates.Results Pathogens were detected in 116/160 specimens, the most common being Streptococcus pneumoniae(n=68), Staphylococcus aureus (n=26) and Haemophilus influenzae type b (n=11). Bacteria (n=97) were more common than viruses (n=49). Common viruses were bocavirus (n=11) and influenza (n=11). Coinfections were frequent (n=55). Moraxella catarrhalis was detected in eight patients and in every case there was coinfection with S. pneumoniae. The odds ratio of vaccine-type pneumococcal pneumonia in patients with two or three compared with zero doses of PCV was 0.17 (95% CI 0.06 to 0.51).Conclusions Lobar pneumonia in rural Gambia was caused primarily by bacteria, particularly S. pneumoniae and S. aureus. Coinfection was common and M. catarrhalis always coinfected with S. pneumoniae. PCV was highly efficacious against vaccine-type pneumococcal pneumonia.https://bmjopen.bmj.com/content/12/3/e056706.full |
| spellingShingle | Jayani Pathirana Brian Greenwood Ilias Hossain Grant Austin Mackenzie Jessica McLellan Eunice Machuka Malick Ndiaye Augustin Fombah Baderinwa Abatan Ahmed Manjang Philip Hill Aetiology of lobar pneumonia determined by multiplex molecular analyses of lung and pleural aspirate specimens in the Gambia: findings from population-based pneumonia surveillance BMJ Open |
| title | Aetiology of lobar pneumonia determined by multiplex molecular analyses of lung and pleural aspirate specimens in the Gambia: findings from population-based pneumonia surveillance |
| title_full | Aetiology of lobar pneumonia determined by multiplex molecular analyses of lung and pleural aspirate specimens in the Gambia: findings from population-based pneumonia surveillance |
| title_fullStr | Aetiology of lobar pneumonia determined by multiplex molecular analyses of lung and pleural aspirate specimens in the Gambia: findings from population-based pneumonia surveillance |
| title_full_unstemmed | Aetiology of lobar pneumonia determined by multiplex molecular analyses of lung and pleural aspirate specimens in the Gambia: findings from population-based pneumonia surveillance |
| title_short | Aetiology of lobar pneumonia determined by multiplex molecular analyses of lung and pleural aspirate specimens in the Gambia: findings from population-based pneumonia surveillance |
| title_sort | aetiology of lobar pneumonia determined by multiplex molecular analyses of lung and pleural aspirate specimens in the gambia findings from population based pneumonia surveillance |
| url | https://bmjopen.bmj.com/content/12/3/e056706.full |
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