tetano
Editor, Senior Moderator
J Infect Dis. (2013) doi: 10.1093/infdis/jit427 First published online: August 6, 2013
HIV and Influenza Infection Are Associated with Increased Blood Pneumococcal Load, South Africa, 2009-2011
Nicole Wolter1,2,*,
Cheryl Cohen1,2,
Stefano Tempia1,3,
Shabir A. Madhi1,4,
Marietjie Venter1,5,
Jocelyn Moyes1,
Sibongile Walaza1,
Babatyi Malope Kgokong1,
Michelle Groome4,
Mignon du Plessis1,2,
Marthi Pretorius1,
Halima Dawood6,
Kathleen Kahn7,8,9,
Ebrahim Variava10,
Keith P. Klugman1,11 and
Anne von Gottberg1,2
+ Author Affiliations
1Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases (NICD) of the National Health Laboratory Service (NHLS), Johannesburg, South Africa
2Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
3Influenza Division, US Centers for Disease Control and Prevention, Atlanta, GA, USA
4Department of Science and Technology/National Research Foundation: Vaccine-Preventable Diseases, South Africa
5Department of Medical Virology, University of Pretoria, South Africa
6Edendale Hospital, Pietermaritzburg Metropolitan Hospitals, KwaZulu Natal, South Africa
7MRC/Wits Rural Public Health and Health Transition Research Unit (Agincourt), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
8Centre for Global Health Research, Ume? University, Ume?, Sweden
9INDEPTH Network, Accra, Ghana
10Klerksdorp-Tshepong Hospital, North West Province,South Africa
11Hubert Department of Global Health, Rollins School of Public Health, and Division of Infectious Diseases, School of Medicine, Emory University, Atlanta, GA, USA
↵*Corresponding author: Nicole Wolter, Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, Private Bag X4, Sandringham, 2131, Gauteng, South Africa. Telephone: +27 11 555 0352, Fax: +27 11 555 0437, Mobile: +27 83 285 8708, E-mail: nicolew@nicd.ac.za
Alternate corresponding author: Cheryl Cohen, Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, Private Bag X4, Sandringham, 2131, Gauteng, South Africa. Telephone: +27 11 386 6593, Fax: +27 11 882 9979, E-mail: cherylc@nicd.ac.za
Abstract
Background. Increased pneumococcal loads are associated with severe outcomes. We determined the prevalence of pneumococcal DNA in blood of patients hospitalized with acute lower respiratory tract infection and identified factors associated with invasive pneumococcal pneumonia, bacterial loads and death.
Methods. 8523 patients were enrolled as part of prospective hospital-based surveillance. Blood was collected for quantitative pneumococcal (lytA) detection, and nasopharyngeal specimens for detection of influenza and other respiratory viruses by real-time PCR.
Results. Of 6396 (75%) cases with lytA results, 422 (7%) were positive for pneumoccal DNA. HIV and influenza prevalence were 51% (2965/5855) and 8% (485/6358), respectively. On multivariable analysis, HIV infection [adjusted odds ratio (aOR): 2.4, 95% confidence interval (CI): 1.6-3.6], influenza co-infection [aOR: 1.4, CI: 1.2-2.1], oxygen therapy during admission [aOR: 1.6, CI: 1.1-2.3] and in-hospital death [aOR: 2.1, CI: 1.1-4.0] were significantly associated with increased pneumococcal load. Amongst lytA-positive patients, adjusting for length of hospitalization, duration of symptoms and oxygen therapy during admission, pneumococcal loads ≥10,000 DNA copies/ml [aOR: 3.6, CI: 1.8-7.2] were associated with increased risk of death.
Conclusions. HIV and influenza virus infection were associated with elevated pneumococcal loads which, in turn, were associated with increased risk of death.
http://jid.oxfordjournals.org/content/early/2013/08/06/infdis.jit427.abstract
HIV and Influenza Infection Are Associated with Increased Blood Pneumococcal Load, South Africa, 2009-2011
Nicole Wolter1,2,*,
Cheryl Cohen1,2,
Stefano Tempia1,3,
Shabir A. Madhi1,4,
Marietjie Venter1,5,
Jocelyn Moyes1,
Sibongile Walaza1,
Babatyi Malope Kgokong1,
Michelle Groome4,
Mignon du Plessis1,2,
Marthi Pretorius1,
Halima Dawood6,
Kathleen Kahn7,8,9,
Ebrahim Variava10,
Keith P. Klugman1,11 and
Anne von Gottberg1,2
+ Author Affiliations
1Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases (NICD) of the National Health Laboratory Service (NHLS), Johannesburg, South Africa
2Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
3Influenza Division, US Centers for Disease Control and Prevention, Atlanta, GA, USA
4Department of Science and Technology/National Research Foundation: Vaccine-Preventable Diseases, South Africa
5Department of Medical Virology, University of Pretoria, South Africa
6Edendale Hospital, Pietermaritzburg Metropolitan Hospitals, KwaZulu Natal, South Africa
7MRC/Wits Rural Public Health and Health Transition Research Unit (Agincourt), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
8Centre for Global Health Research, Ume? University, Ume?, Sweden
9INDEPTH Network, Accra, Ghana
10Klerksdorp-Tshepong Hospital, North West Province,South Africa
11Hubert Department of Global Health, Rollins School of Public Health, and Division of Infectious Diseases, School of Medicine, Emory University, Atlanta, GA, USA
↵*Corresponding author: Nicole Wolter, Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, Private Bag X4, Sandringham, 2131, Gauteng, South Africa. Telephone: +27 11 555 0352, Fax: +27 11 555 0437, Mobile: +27 83 285 8708, E-mail: nicolew@nicd.ac.za
Alternate corresponding author: Cheryl Cohen, Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, Private Bag X4, Sandringham, 2131, Gauteng, South Africa. Telephone: +27 11 386 6593, Fax: +27 11 882 9979, E-mail: cherylc@nicd.ac.za
Abstract
Background. Increased pneumococcal loads are associated with severe outcomes. We determined the prevalence of pneumococcal DNA in blood of patients hospitalized with acute lower respiratory tract infection and identified factors associated with invasive pneumococcal pneumonia, bacterial loads and death.
Methods. 8523 patients were enrolled as part of prospective hospital-based surveillance. Blood was collected for quantitative pneumococcal (lytA) detection, and nasopharyngeal specimens for detection of influenza and other respiratory viruses by real-time PCR.
Results. Of 6396 (75%) cases with lytA results, 422 (7%) were positive for pneumoccal DNA. HIV and influenza prevalence were 51% (2965/5855) and 8% (485/6358), respectively. On multivariable analysis, HIV infection [adjusted odds ratio (aOR): 2.4, 95% confidence interval (CI): 1.6-3.6], influenza co-infection [aOR: 1.4, CI: 1.2-2.1], oxygen therapy during admission [aOR: 1.6, CI: 1.1-2.3] and in-hospital death [aOR: 2.1, CI: 1.1-4.0] were significantly associated with increased pneumococcal load. Amongst lytA-positive patients, adjusting for length of hospitalization, duration of symptoms and oxygen therapy during admission, pneumococcal loads ≥10,000 DNA copies/ml [aOR: 3.6, CI: 1.8-7.2] were associated with increased risk of death.
Conclusions. HIV and influenza virus infection were associated with elevated pneumococcal loads which, in turn, were associated with increased risk of death.
http://jid.oxfordjournals.org/content/early/2013/08/06/infdis.jit427.abstract