Acute lower respiratory infections in ≥ 5 year -old hospitalized patients in Cambodia, a low-income tropical country: clinical characteristics and pathogenic etiology.

Sirenda Vong (1) , Bertrand Guillard (1) , Laurence Borand (1) , Blandine Rammaert (1) , Sophie Goyet (1) , Vantha Te (2) , Patrich Lorn Try (3) , Sopheak Hem (1) , Sareth Rith (1) , Sowath Ly (1) , Philippe Cavailler (1) , Charles Mayaud (4) , Philippe Buchy (1)

1 Institut Pasteur du Cambodge
2 Takeo Provincial Hospital
3 Kampong Cham Provincial hospital
4 CHU Tenon [AP-HP]

BACKGROUND: Few data exist on viral and bacterial etiology of acute lower respiratory infections (ALRI) in ≥ 5 year -old persons in the tropics. METHODS: We conducted active surveillance of community-acquired ALRI in two hospitals in Cambodia, a low-income tropical country. Patients were tested for acid-fast bacilli (AFB) by direct sputum examination, other bacteria by blood and/or sputum cultures, and respiratory viruses using molecular techniques on nasopharyngeal/throat swabs. Pulmonologists reviewed clinical/laboratory data and interpreted chest X-rays (CXR) to confirm ALRI. RESULTS: Between April 2007 - December 2009, 1,904 patients aged ≥5 years were admitted with acute pneumonia (50.4%), lung sequelae-associated ALRI (24.3%), isolated pleural effusions (8.9%) or normal CXR-related ALRI (17.1%); 61 (3.2%) died during hospitalization. The two former diagnoses were predominantly due to bacterial etiologies while viral detection was more frequent in the two latter diagnoses. AFB-positive accounted for 25.6% of acute pneumonia. Of the positive cultures (16.8%), abscess-prone Gram-negative bacteria (39.6%) and Haemophilus influenzae (38.0%) were most frequent, followed by Streptococcus pneumoniae (17.7%). Of the identified viruses, the three most common viruses included rhinoviruses (49.5%), respiratory syncytial virus (17.7%) and influenza viruses (12.1%) regardless of the diagnostic groups. Wheezing was associated with viral identification (31.9% vs. 13.8%, p < 0.001) independent of age and time-to-admission. CONCLUSIONS: High frequency of H. influenzae and S. pneumoniae infections support the need for introduction of the respective vaccines in the national immunization program. Tuberculosis was frequent in patients with acute pneumonia, requiring further investigation. The relationship between respiratory viruses and wheezing merits further studies.

Keywords: Cambodia; acute lower respiratory infection; tropics; hospitalized patients; viruses; bacteria; adults older children

Domains: Life Sciences [q-bio]; Microbiology and Parasitology; Virology

Sirenda Vong, Bertrand Guillard, Laurence Borand, Blandine Rammaert, Sophie Goyet, et al.. Acute lower respiratory infections in ≥ 5 year -old hospitalized patients in Cambodia, a low-income tropical country: clinical characteristics and pathogenic etiology.. BMC Infectious Diseases, 2013, 13, pp.97. ⟨10.1186/1471-2334-13-97⟩. ⟨pasteur-00853148⟩