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Aetiology and Risk Factors for Mortality in an Adult Community-Acquired Pneumonia Cohort in Malawi.

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Aston, Stephen J, Ho, Antonia, Jary, Hannah, Huwa, Jacqueline, Mitchell, Tamara, Ibitoye, Sarah, Greenwood, Simon, Joekes, Elizabeth, Daire, Arthur, Mallewa, Jane, Everett, Dean, Nyirenda, Mulinda, Faragher, Brian, Mwandumba, Henry C, Heyderman, Robert S and Gordon, Stephen ORCID: https://orcid.org/0000-0001-6576-1116 (2019) 'Aetiology and Risk Factors for Mortality in an Adult Community-Acquired Pneumonia Cohort in Malawi.'. American Journal of Respiratory and Critical Care Medicine. (In Press)

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Abstract

RATIONALE
In the context of rapid antiretroviral therapy (ART) rollout and an increasing burden of non-communicable diseases, there are few contemporary data describing the aetiology and outcome of community-acquired pneumonia (CAP) in sub-Saharan Africa.
OBJECTIVES
To describe the current aetiology of CAP in Malawi and identify risk factors for mortality.
METHODS
We conducted a prospective observational study of adults hospitalised with CAP to a teaching hospital in Blantyre, Malawi. Aetiology was defined by blood culture, Streptococcus pneumoniae urinary antigen detection, sputum mycobacterial culture and Xpert MTB/RIF, and nasopharyngeal aspirate multiplex PCR.
MEASUREMENTS AND MAIN RESULTS
In 459 patients (285 [62.1%] males; median age 34.7 [IQR: 29.4-41.9] years), 30-day mortality was 14.6% (64/439) and associated with male sex (adjusted odds ratio 2.60 [95% CI: 1.17-5.78]), symptom duration >7 days (2.78 [1.40-5.54]), tachycardia (2.99 [1.48-6.06]), hypoxaemia (4.40 [2.03-9.51]) and inability to stand (3.59 [1.72-7.50]). HIV was common (355/453; 78.4%), frequently newly diagnosed (124/355; 34.9%), but not associated with mortality. S. pneumoniae (98/458 [21.4%]) and Mycobacterium tuberculosis (75/326 [23.0%]) were the most frequently identified pathogens. Viral infection occurred in 32.6% (148/454) with influenza (40/454 [8.8%]) most common. Bacterial-viral co-infection occurred in 9.1% (28/307). Detection of M. tuberculosis was associated with mortality (aOR 2.44 [1.19-5.01]).
CONCLUSIONS
In the ART era, CAP in Malawi remains predominantly HIV-associated with a large proportion attributable to potentially vaccine-preventable pathogens. Strategies to increase early detection and treatment of tuberculosis and improve supportive care, in particular the correction of hypoxaemia, should be evaluated in clinical trials to address CAP-associated mortality.

Item Type: Article
Subjects: WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries
WC Communicable Diseases > Infection. Bacterial Infections > Bacterial Infections > WC 202 Pneumonia (General or not elsewhere classified)
WF Respiratory System > Lungs > WF 600 Lungs
Faculty: Department: Clinical Sciences & International Health > Clinical Sciences Department
Clinical Sciences & International Health > International Public Health Department
Clinical Sciences & International Health > Malawi-Liverpool-Wellcome Programme (MLW)
Digital Object Identifer (DOI): https://doi.org/10.1164/rccm.201807-1333OC
Depositing User: Stacy Murtagh
Date Deposited: 18 Jan 2019 13:58
Last Modified: 27 Jun 2019 11:06
URI: https://archive.lstmed.ac.uk/id/eprint/9971

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