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Published in: BMC Medicine 1/2016

Open Access 01-12-2016 | Research article

Burden of respiratory tract infections at post mortem in Zambian children

Authors: Matthew Bates, Aaron Shibemba, Victor Mudenda, Charles Chimoga, John Tembo, Mwila Kabwe, Moses Chilufya, Michael Hoelscher, Markus Maeurer, Sylvester Sinyangwe, Peter Mwaba, Nathan Kapata, Alimuddin Zumla

Published in: BMC Medicine | Issue 1/2016

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Abstract

Background

Autopsy studies are the gold standard for determining cause-of-death and can inform on improved diagnostic strategies and algorithms to improve patient care. We conducted a cross-sectional observational autopsy study to describe the burden of respiratory tract infections in inpatient children who died at the University Teaching Hospital in Lusaka, Zambia.

Methods

Gross pathology was recorded and lung tissue was analysed by histopathology and molecular diagnostics. Recruitment bias was estimated by comparing recruited and non-recruited cases.

Results

Of 121 children autopsied, 64 % were male, median age was 19 months (IQR, 12–45 months). HIV status was available for 97 children, of whom 34 % were HIV infected. Lung pathology was observed in 92 % of cases. Bacterial bronchopneumonia was the most common pathology (50 %) undiagnosed ante-mortem in 69 % of cases. Other pathologies included interstitial pneumonitis (17 %), tuberculosis (TB; 8 %), cytomegalovirus pneumonia (7 %) and pneumocystis Jirovecii pneumonia (5 %). Comorbidity between lung pathology and other communicable and non-communicable diseases was observed in 80 % of cases. Lung tissue from 70 % of TB cases was positive for Mycobacterium tuberculosis by molecular diagnostic tests. A total of 80 % of TB cases were comorbid with malnutrition and only 10 % of TB cases were on anti-TB therapy when they died.

Conclusions

More proactive testing for bacterial pneumonia and TB in paediatric inpatient settings is needed.
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Metadata
Title
Burden of respiratory tract infections at post mortem in Zambian children
Authors
Matthew Bates
Aaron Shibemba
Victor Mudenda
Charles Chimoga
John Tembo
Mwila Kabwe
Moses Chilufya
Michael Hoelscher
Markus Maeurer
Sylvester Sinyangwe
Peter Mwaba
Nathan Kapata
Alimuddin Zumla
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Medicine / Issue 1/2016
Electronic ISSN: 1741-7015
DOI
https://doi.org/10.1186/s12916-016-0645-z

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