Aetiology of pneumonia in children aged 2 - 59months with severe and very severe pneumonia in the HIV and the post Hib Vaccination era at Kenyatta national Hospital.

Abstract

Pneumonia is the leading cause of death in children under five. Knowledge of the current pathogens causing paediatric pneumonia is scarce. We hope to demonstrate the bacterial pathogens currently contributing to the burden of pneumonia in children less than 59 months. OBJECTIVES The goal of this study was to determine the patterns of bacterial pathogens isolated from blood cultures in children aged 2 to 59 months admitted with severe and very severe • pneumonia. Our secondary objectives were to determine the correlates of culture positive bacterial pneumonia and the prevalence of Pneumocystis jirovecii pneumonia in those children also infected with HlV. DESIGN Descriptive cross-sectional study SETTING Kenyatta National Hospital situated in Nairobi, Kenya and is one of the 2 national tertiary hospitals and is also the teaching hospital ofthe University of Nairobi. STUDY DURATION June 2009 to September 2009 Vlll POPULATION Children aged 2-59 months who presented at Paediatric Emergency Unit with WHO criteria of severe and very severe pneumonia. METHOD Blood for culture was collected from 335 patients who met the inclusion criteria. mv antibody tests were done on 306 patients. Confirmatory PCR was done seroreactive patients aged less than 18 months. NPA was done on 29 seropositive children aged between 2 - 24 months to screen for PCP. • RESULTS Bacteremia was found in eleven patients giving a prevalence of 3.3%. The significant pathogens isolated were Streptococcus pneumonia 5(45.5%), Salmonella typhimurium 3(27.3%), Escherichia coli 2(18.2%) and Pseudomonas 1 (9<>10). H.influenza was not isolated. Pneumocystis jirovecii was isolated in 4 out of 29 HIV infected children, giving a prevalence of 13.8%. CONCLUSION The bacterial yield obtained was low (3.3%) making conclusions difficult. Hinfluenza was not isolated. PCP prevalence among HIV infected children was 13.8% and therefore remains an important cause of morbidity.