A Prospective Study of the Prevalence of Tuberculosis and Bacteraemia in Bangladeshi Children with Severe Malnutrition and Pneumonia Including an Evaluation of Xpert MTB/RIF Assay
Identifieur interne : 001777 ( Pmc/Checkpoint ); précédent : 001776; suivant : 001778A Prospective Study of the Prevalence of Tuberculosis and Bacteraemia in Bangladeshi Children with Severe Malnutrition and Pneumonia Including an Evaluation of Xpert MTB/RIF Assay
Auteurs : Mohammod Jobayer Chisti [Bangladesh, Australie] ; Stephen M. Graham [Australie, France] ; Trevor Duke [Australie] ; Tahmeed Ahmed [Bangladesh] ; Hasan Ashraf [Bangladesh] ; Abu Syed Golam Faruque [Bangladesh] ; Sophie La Vincente [Australie] ; Sayera Banu [Bangladesh] ; Rubhana Raqib [Bangladesh] ; Mohammed Abdus Salam [Bangladesh]Source :
- PLoS ONE [ 1932-6203 ] ; 2014.
Abstract
Severe malnutrition is a risk factor for pneumonia due to a wide range of pathogens but aetiological data are limited and the role of
We prospectively investigated severely malnourished young children (<5 years) with radiological pneumonia admitted over a 15-month period. Investigations included blood culture, sputa for microscopy and mycobacterial culture. Xpert MTB/RIF assay was introduced during the study. Study children were followed for 12 weeks following their discharge from the hospital.
405 eligible children were enrolled, with a median age of 10 months. Bacterial pathogens were isolated from blood culture in 18 (4.4%) children, of which 72% were Gram negatives. Tuberculosis was confirmed microbiologically in 7% (27/396) of children that provided sputum - 10 by culture, 21 by Xpert MTB/RIF assay, and 4 by both tests. The diagnostic yield from induced sputum was 6% compared to 3.5% from gastric aspirate. Sixty (16%) additional children had tuberculosis diagnosed clinically that was not microbiologically confirmed. Most confirmed tuberculosis cases did not have a positive contact history or positive tuberculin test. The sensitivity and specificity of Xpert MTB/RIF assay compared to culture was 67% (95% CI: 24–94) and 92% (95% CI: 87–95) respectively. Overall case-fatality rate was 17% and half of the deaths occurred in home following discharge from the hospital.
TB was common in severely malnourished Bangladeshi children with pneumonia. X-pert MTB/RIF assay provided higher case detection rate compared to sputum microscopy and culture. The high mortality among the study children underscores the need for further research aimed at improved case detection and management for better outcomes.
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DOI: 10.1371/journal.pone.0093776
PubMed: 24695758
PubMed Central: 3973596
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Graham</name><affiliation wicri:level="3"><nlm:aff id="aff2"><addr-line>Centre for International Child Health, The University of Melbourne Department of Paediatrics and Murdoch Childrens Research Institute, Royal Children’s Hospital, Melbourne, Australia</addr-line></nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea>Centre for International Child Health, The University of Melbourne Department of Paediatrics and Murdoch Childrens Research Institute, Royal Children’s Hospital, Melbourne</wicri:regionArea><placeName><settlement type="city">Melbourne</settlement><region type="état">Victoria (État)</region></placeName></affiliation><affiliation wicri:level="3"><nlm:aff id="aff3"><addr-line>International Union Against Tuberculosis and Lung Disease, Paris, France</addr-line></nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>International Union Against Tuberculosis and Lung Disease, Paris</wicri:regionArea><placeName><region 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uniqKey="Ahmed T" first="Tahmeed" last="Ahmed">Tahmeed Ahmed</name><affiliation wicri:level="1"><nlm:aff id="aff1"><addr-line>International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh</addr-line></nlm:aff><country xml:lang="fr">Bangladesh</country><wicri:regionArea>International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka</wicri:regionArea><wicri:noRegion>Dhaka</wicri:noRegion></affiliation></author><author><name sortKey="Ashraf, Hasan" sort="Ashraf, Hasan" uniqKey="Ashraf H" first="Hasan" last="Ashraf">Hasan Ashraf</name><affiliation wicri:level="1"><nlm:aff id="aff1"><addr-line>International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh</addr-line></nlm:aff><country xml:lang="fr">Bangladesh</country><wicri:regionArea>International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka</wicri:regionArea><wicri:noRegion>Dhaka</wicri:noRegion></affiliation></author><author><name sortKey="Faruque, Abu Syed Golam" sort="Faruque, Abu Syed Golam" uniqKey="Faruque A" first="Abu Syed Golam" last="Faruque">Abu Syed Golam Faruque</name><affiliation wicri:level="1"><nlm:aff id="aff1"><addr-line>International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh</addr-line></nlm:aff><country xml:lang="fr">Bangladesh</country><wicri:regionArea>International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka</wicri:regionArea><wicri:noRegion>Dhaka</wicri:noRegion></affiliation></author><author><name sortKey="La Vincente, Sophie" sort="La Vincente, Sophie" uniqKey="La Vincente S" first="Sophie" last="La Vincente">Sophie La Vincente</name><affiliation wicri:level="3"><nlm:aff id="aff2"><addr-line>Centre for International Child Health, The University of Melbourne Department of Paediatrics and Murdoch Childrens Research Institute, Royal Children’s Hospital, Melbourne, Australia</addr-line></nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea>Centre for International Child Health, The University of Melbourne Department of Paediatrics and Murdoch Childrens Research Institute, Royal Children’s Hospital, Melbourne</wicri:regionArea><placeName><settlement type="city">Melbourne</settlement><region type="état">Victoria (État)</region></placeName></affiliation></author><author><name sortKey="Banu, Sayera" sort="Banu, Sayera" uniqKey="Banu S" first="Sayera" last="Banu">Sayera Banu</name><affiliation wicri:level="1"><nlm:aff id="aff1"><addr-line>International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh</addr-line></nlm:aff><country xml:lang="fr">Bangladesh</country><wicri:regionArea>International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka</wicri:regionArea><wicri:noRegion>Dhaka</wicri:noRegion></affiliation></author><author><name sortKey="Raqib, Rubhana" sort="Raqib, Rubhana" uniqKey="Raqib R" first="Rubhana" last="Raqib">Rubhana Raqib</name><affiliation wicri:level="1"><nlm:aff id="aff1"><addr-line>International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh</addr-line></nlm:aff><country xml:lang="fr">Bangladesh</country><wicri:regionArea>International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka</wicri:regionArea><wicri:noRegion>Dhaka</wicri:noRegion></affiliation></author><author><name sortKey="Salam, Mohammed Abdus" sort="Salam, Mohammed Abdus" uniqKey="Salam M" first="Mohammed Abdus" last="Salam">Mohammed Abdus Salam</name><affiliation wicri:level="1"><nlm:aff id="aff1"><addr-line>International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh</addr-line></nlm:aff><country xml:lang="fr">Bangladesh</country><wicri:regionArea>International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka</wicri:regionArea><wicri:noRegion>Dhaka</wicri:noRegion></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">24695758</idno><idno type="pmc">3973596</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3973596</idno><idno type="RBID">PMC:3973596</idno><idno type="doi">10.1371/journal.pone.0093776</idno><date when="2014">2014</date><idno type="wicri:Area/Pmc/Corpus">002B57</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">002B57</idno><idno type="wicri:Area/Pmc/Curation">002A07</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">002A07</idno><idno type="wicri:Area/Pmc/Checkpoint">001777</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Checkpoint">001777</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">A Prospective Study of the Prevalence of Tuberculosis and Bacteraemia in Bangladeshi Children with Severe Malnutrition and Pneumonia Including an Evaluation of Xpert MTB/RIF Assay</title><author><name sortKey="Chisti, Mohammod Jobayer" sort="Chisti, Mohammod Jobayer" uniqKey="Chisti M" first="Mohammod Jobayer" last="Chisti">Mohammod Jobayer Chisti</name><affiliation wicri:level="1"><nlm:aff id="aff1"><addr-line>International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh</addr-line></nlm:aff><country xml:lang="fr">Bangladesh</country><wicri:regionArea>International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka</wicri:regionArea><wicri:noRegion>Dhaka</wicri:noRegion></affiliation><affiliation wicri:level="3"><nlm:aff id="aff2"><addr-line>Centre for International Child Health, The University of Melbourne Department of Paediatrics and Murdoch Childrens Research Institute, Royal Children’s Hospital, Melbourne, Australia</addr-line></nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea>Centre for International Child Health, The University of Melbourne Department of Paediatrics and Murdoch Childrens Research Institute, Royal Children’s Hospital, Melbourne</wicri:regionArea><placeName><settlement type="city">Melbourne</settlement><region type="état">Victoria (État)</region></placeName></affiliation></author><author><name sortKey="Graham, Stephen M" sort="Graham, Stephen M" uniqKey="Graham S" first="Stephen M." last="Graham">Stephen M. Graham</name><affiliation wicri:level="3"><nlm:aff id="aff2"><addr-line>Centre for International Child Health, The University of Melbourne Department of Paediatrics and Murdoch Childrens Research Institute, Royal Children’s Hospital, Melbourne, Australia</addr-line></nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea>Centre for International Child Health, The University of Melbourne Department of Paediatrics and Murdoch Childrens Research Institute, Royal Children’s Hospital, Melbourne</wicri:regionArea><placeName><settlement type="city">Melbourne</settlement><region type="état">Victoria (État)</region></placeName></affiliation><affiliation wicri:level="3"><nlm:aff id="aff3"><addr-line>International Union Against Tuberculosis and Lung Disease, Paris, France</addr-line></nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>International Union Against Tuberculosis and Lung Disease, Paris</wicri:regionArea><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation></author><author><name sortKey="Duke, Trevor" sort="Duke, Trevor" uniqKey="Duke T" first="Trevor" last="Duke">Trevor Duke</name><affiliation wicri:level="3"><nlm:aff id="aff2"><addr-line>Centre for International Child Health, The University of Melbourne Department of Paediatrics and Murdoch Childrens Research Institute, Royal Children’s Hospital, Melbourne, Australia</addr-line></nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea>Centre for International Child Health, The University of Melbourne Department of Paediatrics and Murdoch Childrens Research Institute, Royal Children’s Hospital, Melbourne</wicri:regionArea><placeName><settlement type="city">Melbourne</settlement><region type="état">Victoria (État)</region></placeName></affiliation></author><author><name sortKey="Ahmed, Tahmeed" sort="Ahmed, Tahmeed" uniqKey="Ahmed T" first="Tahmeed" last="Ahmed">Tahmeed Ahmed</name><affiliation wicri:level="1"><nlm:aff id="aff1"><addr-line>International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh</addr-line></nlm:aff><country xml:lang="fr">Bangladesh</country><wicri:regionArea>International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka</wicri:regionArea><wicri:noRegion>Dhaka</wicri:noRegion></affiliation></author><author><name sortKey="Ashraf, Hasan" sort="Ashraf, Hasan" uniqKey="Ashraf H" first="Hasan" last="Ashraf">Hasan Ashraf</name><affiliation wicri:level="1"><nlm:aff id="aff1"><addr-line>International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh</addr-line></nlm:aff><country xml:lang="fr">Bangladesh</country><wicri:regionArea>International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka</wicri:regionArea><wicri:noRegion>Dhaka</wicri:noRegion></affiliation></author><author><name sortKey="Faruque, Abu Syed Golam" sort="Faruque, Abu Syed Golam" uniqKey="Faruque A" first="Abu Syed Golam" last="Faruque">Abu Syed Golam Faruque</name><affiliation wicri:level="1"><nlm:aff id="aff1"><addr-line>International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh</addr-line></nlm:aff><country xml:lang="fr">Bangladesh</country><wicri:regionArea>International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka</wicri:regionArea><wicri:noRegion>Dhaka</wicri:noRegion></affiliation></author><author><name sortKey="La Vincente, Sophie" sort="La Vincente, Sophie" uniqKey="La Vincente S" first="Sophie" last="La Vincente">Sophie La Vincente</name><affiliation wicri:level="3"><nlm:aff id="aff2"><addr-line>Centre for International Child Health, The University of Melbourne Department of Paediatrics and Murdoch Childrens Research Institute, Royal Children’s Hospital, Melbourne, Australia</addr-line></nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea>Centre for International Child Health, The University of Melbourne Department of Paediatrics and Murdoch Childrens Research Institute, Royal Children’s Hospital, Melbourne</wicri:regionArea><placeName><settlement type="city">Melbourne</settlement><region type="état">Victoria (État)</region></placeName></affiliation></author><author><name sortKey="Banu, Sayera" sort="Banu, Sayera" uniqKey="Banu S" first="Sayera" last="Banu">Sayera Banu</name><affiliation wicri:level="1"><nlm:aff id="aff1"><addr-line>International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh</addr-line></nlm:aff><country xml:lang="fr">Bangladesh</country><wicri:regionArea>International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka</wicri:regionArea><wicri:noRegion>Dhaka</wicri:noRegion></affiliation></author><author><name sortKey="Raqib, Rubhana" sort="Raqib, Rubhana" uniqKey="Raqib R" first="Rubhana" last="Raqib">Rubhana Raqib</name><affiliation wicri:level="1"><nlm:aff id="aff1"><addr-line>International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh</addr-line></nlm:aff><country xml:lang="fr">Bangladesh</country><wicri:regionArea>International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka</wicri:regionArea><wicri:noRegion>Dhaka</wicri:noRegion></affiliation></author><author><name sortKey="Salam, Mohammed Abdus" sort="Salam, Mohammed Abdus" uniqKey="Salam M" first="Mohammed Abdus" last="Salam">Mohammed Abdus Salam</name><affiliation wicri:level="1"><nlm:aff id="aff1"><addr-line>International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh</addr-line></nlm:aff><country xml:lang="fr">Bangladesh</country><wicri:regionArea>International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka</wicri:regionArea><wicri:noRegion>Dhaka</wicri:noRegion></affiliation></author></analytic><series><title level="j">PLoS ONE</title><idno type="eISSN">1932-6203</idno><imprint><date when="2014">2014</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>Severe malnutrition is a risk factor for pneumonia due to a wide range of pathogens but aetiological data are limited and the role of <italic>Mycobacterium tuberculosis</italic> is uncertain.</p></sec><sec><title>Methods</title><p>We prospectively investigated severely malnourished young children (<5 years) with radiological pneumonia admitted over a 15-month period. Investigations included blood culture, sputa for microscopy and mycobacterial culture. Xpert MTB/RIF assay was introduced during the study. Study children were followed for 12 weeks following their discharge from the hospital.</p></sec><sec><title>Results</title><p>405 eligible children were enrolled, with a median age of 10 months. Bacterial pathogens were isolated from blood culture in 18 (4.4%) children, of which 72% were Gram negatives. Tuberculosis was confirmed microbiologically in 7% (27/396) of children that provided sputum - 10 by culture, 21 by Xpert MTB/RIF assay, and 4 by both tests. The diagnostic yield from induced sputum was 6% compared to 3.5% from gastric aspirate. Sixty (16%) additional children had tuberculosis diagnosed clinically that was not microbiologically confirmed. Most confirmed tuberculosis cases did not have a positive contact history or positive tuberculin test. The sensitivity and specificity of Xpert MTB/RIF assay compared to culture was 67% (95% CI: 24–94) and 92% (95% CI: 87–95) respectively. Overall case-fatality rate was 17% and half of the deaths occurred in home following discharge from the hospital.</p></sec><sec><title>Conclusion and Significance</title><p>TB was common in severely malnourished Bangladeshi children with pneumonia. X-pert MTB/RIF assay provided higher case detection rate compared to sputum microscopy and culture. The high mortality among the study children underscores the need for further research aimed at improved case detection and management for better outcomes.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Liu, L" uniqKey="Liu L">L Liu</name></author><author><name sortKey="Johnson, Hl" uniqKey="Johnson H">HL Johnson</name></author><author><name sortKey="Cousens, S" uniqKey="Cousens S">S Cousens</name></author><author><name sortKey="Perin, J" uniqKey="Perin J">J Perin</name></author><author><name sortKey="Scott, S" uniqKey="Scott S">S Scott</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Chisti, Mj" uniqKey="Chisti M">MJ Chisti</name></author><author><name sortKey="Ahmed, T" uniqKey="Ahmed T">T Ahmed</name></author><author><name sortKey="Faruque, As" uniqKey="Faruque A">AS Faruque</name></author><author><name sortKey="Abdus Salam, M" uniqKey="Abdus Salam M">M Abdus 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Uddin</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kim, Bj" uniqKey="Kim B">BJ Kim</name></author><author><name sortKey="Lee, Sh" uniqKey="Lee S">SH Lee</name></author><author><name sortKey="Lyu, Ma" uniqKey="Lyu M">MA Lyu</name></author><author><name sortKey="Kim, Sj" uniqKey="Kim S">SJ Kim</name></author><author><name sortKey="Bai, Gh" uniqKey="Bai G">GH Bai</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Chisti, Mj" uniqKey="Chisti M">MJ Chisti</name></author><author><name sortKey="Saha, S" uniqKey="Saha S">S Saha</name></author><author><name sortKey="Roy, Cn" uniqKey="Roy C">CN Roy</name></author><author><name sortKey="Salam, Ma" uniqKey="Salam M">MA Salam</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Cherian, T" uniqKey="Cherian T">T Cherian</name></author><author><name sortKey="Mulholland, Ek" uniqKey="Mulholland E">EK Mulholland</name></author><author><name sortKey="Carlin, Jb" uniqKey="Carlin J">JB Carlin</name></author><author><name sortKey="Ostensen, H" uniqKey="Ostensen H">H Ostensen</name></author><author><name sortKey="Amin, R" uniqKey="Amin R">R Amin</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Azim, T" uniqKey="Azim T">T Azim</name></author><author><name sortKey="Rahman, M" uniqKey="Rahman M">M Rahman</name></author><author><name sortKey="Alam, Ms" uniqKey="Alam M">MS Alam</name></author><author><name sortKey="Chowdhury, Ia" uniqKey="Chowdhury I">IA Chowdhury</name></author><author><name sortKey="Khan, R" uniqKey="Khan R">R Khan</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Waterlow, Jc" uniqKey="Waterlow J">JC Waterlow</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Berkowitz, Fe" uniqKey="Berkowitz F">FE 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<front><journal-meta><journal-id journal-id-type="nlm-ta">PLoS One</journal-id><journal-id journal-id-type="iso-abbrev">PLoS ONE</journal-id><journal-id journal-id-type="publisher-id">plos</journal-id><journal-id journal-id-type="pmc">plosone</journal-id><journal-title-group><journal-title>PLoS ONE</journal-title></journal-title-group><issn pub-type="epub">1932-6203</issn><publisher><publisher-name>Public Library of Science</publisher-name><publisher-loc>San Francisco, USA</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">24695758</article-id><article-id pub-id-type="pmc">3973596</article-id><article-id pub-id-type="publisher-id">PONE-D-13-49546</article-id><article-id pub-id-type="doi">10.1371/journal.pone.0093776</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group><subj-group subj-group-type="Discipline-v2"><subject>Biology and Life Sciences</subject><subj-group><subject>Nutrition</subject><subj-group><subject>Malnutrition</subject></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v2"><subject>Medicine and Health Sciences</subject><subj-group><subject>Epidemiology</subject><subj-group><subject>Infectious Disease Epidemiology</subject><subject>Pediatric Epidemiology</subject></subj-group></subj-group><subj-group><subject>Infectious Diseases</subject><subj-group><subject>Bacterial Diseases</subject><subj-group><subject>Tuberculosis</subject></subj-group></subj-group></subj-group><subj-group><subject>Pediatrics</subject><subj-group><subject>Child Health</subject><subject>Pediatric Pulmonology</subject></subj-group></subj-group><subj-group><subject>Public and Occupational Health</subject><subj-group><subject>Global Health</subject></subj-group></subj-group><subj-group><subject>Pulmonology</subject><subj-group><subject>Respiratory Infections</subject></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v2"><subject>Research and Analysis Methods</subject><subj-group><subject>Research Design</subject><subj-group><subject>Clinical Research Design</subject><subject>Observational Studies</subject><subject>Prospective Studies</subject></subj-group></subj-group></subj-group></article-categories><title-group><article-title>A Prospective Study of the Prevalence of Tuberculosis and Bacteraemia in Bangladeshi Children with Severe Malnutrition and Pneumonia Including an Evaluation of Xpert MTB/RIF Assay</article-title><alt-title alt-title-type="running-head">Childhood Tuberculosis and Bacteraemia</alt-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Chisti</surname><given-names>Mohammod Jobayer</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref><xref ref-type="aff" rid="aff2"><sup>2</sup></xref></contrib><contrib contrib-type="author"><name><surname>Graham</surname><given-names>Stephen M.</given-names></name><xref ref-type="aff" rid="aff2"><sup>2</sup></xref><xref ref-type="aff" rid="aff3"><sup>3</sup></xref><xref ref-type="corresp" rid="cor1"><sup>*</sup></xref></contrib><contrib contrib-type="author"><name><surname>Duke</surname><given-names>Trevor</given-names></name><xref ref-type="aff" rid="aff2"><sup>2</sup></xref></contrib><contrib contrib-type="author"><name><surname>Ahmed</surname><given-names>Tahmeed</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Ashraf</surname><given-names>Hasan</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Faruque</surname><given-names>Abu Syed Golam</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>La Vincente</surname><given-names>Sophie</given-names></name><xref ref-type="aff" rid="aff2"><sup>2</sup></xref></contrib><contrib contrib-type="author"><name><surname>Banu</surname><given-names>Sayera</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Raqib</surname><given-names>Rubhana</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Salam</surname><given-names>Mohammed Abdus</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref></contrib></contrib-group><aff id="aff1"><label>1</label><addr-line>International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh</addr-line></aff><aff id="aff2"><label>2</label><addr-line>Centre for International Child Health, The University of Melbourne Department of Paediatrics and Murdoch Childrens Research Institute, Royal Children’s Hospital, Melbourne, Australia</addr-line></aff><aff id="aff3"><label>3</label><addr-line>International Union Against Tuberculosis and Lung Disease, Paris, France</addr-line></aff><contrib-group><contrib contrib-type="editor"><name><surname>Nicol</surname><given-names>Mark Patrick</given-names></name><role>Editor</role><xref ref-type="aff" rid="edit1"></xref></contrib></contrib-group><aff id="edit1"><addr-line>University of Cape Town, South Africa</addr-line></aff><author-notes><corresp id="cor1">* E-mail: <email>steve.graham@rch.org.au</email></corresp><fn fn-type="conflict"><p><bold>Competing Interests: </bold>The authors have declared that no competing interests exist.</p></fn><fn fn-type="con"><p>Conceived and designed the experiments: MJC SMG TD TA HA ASGF SLV SB RR MAS. Performed the experiments: MJC SMG TD TA HA ASGF MAS. Analyzed the data: MJC SMG TD TA HA ASGF SLV SB RR MAS. Contributed reagents/materials/analysis tools: MJC SMG TD SB RR. Wrote the paper: MJC SMG TD TA HA ASGF SLV SB RR MAS. Faced the IRB: MJC. Designed the analysis plan: MJC SMG TD TA MAS.</p></fn></author-notes><pub-date pub-type="collection"><year>2014</year></pub-date><pub-date pub-type="epub"><day>2</day><month>4</month><year>2014</year></pub-date><volume>9</volume><issue>4</issue><elocation-id>e93776</elocation-id><history><date date-type="received"><day>24</day><month>11</month><year>2013</year></date><date date-type="accepted"><day>10</day><month>3</month><year>2014</year></date></history><permissions><copyright-year>2014</copyright-year><copyright-holder>Chisti et al</copyright-holder><license><license-p>This is an open-access article distributed under the terms of the <ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/4.0/">Creative Commons Attribution License</ext-link>, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.</license-p></license></permissions><abstract><sec><title>Background</title><p>Severe malnutrition is a risk factor for pneumonia due to a wide range of pathogens but aetiological data are limited and the role of <italic>Mycobacterium tuberculosis</italic> is uncertain.</p></sec><sec><title>Methods</title><p>We prospectively investigated severely malnourished young children (<5 years) with radiological pneumonia admitted over a 15-month period. Investigations included blood culture, sputa for microscopy and mycobacterial culture. Xpert MTB/RIF assay was introduced during the study. Study children were followed for 12 weeks following their discharge from the hospital.</p></sec><sec><title>Results</title><p>405 eligible children were enrolled, with a median age of 10 months. Bacterial pathogens were isolated from blood culture in 18 (4.4%) children, of which 72% were Gram negatives. Tuberculosis was confirmed microbiologically in 7% (27/396) of children that provided sputum - 10 by culture, 21 by Xpert MTB/RIF assay, and 4 by both tests. The diagnostic yield from induced sputum was 6% compared to 3.5% from gastric aspirate. Sixty (16%) additional children had tuberculosis diagnosed clinically that was not microbiologically confirmed. Most confirmed tuberculosis cases did not have a positive contact history or positive tuberculin test. The sensitivity and specificity of Xpert MTB/RIF assay compared to culture was 67% (95% CI: 24–94) and 92% (95% CI: 87–95) respectively. Overall case-fatality rate was 17% and half of the deaths occurred in home following discharge from the hospital.</p></sec><sec><title>Conclusion and Significance</title><p>TB was common in severely malnourished Bangladeshi children with pneumonia. X-pert MTB/RIF assay provided higher case detection rate compared to sputum microscopy and culture. The high mortality among the study children underscores the need for further research aimed at improved case detection and management for better outcomes.</p></sec></abstract><funding-group><funding-statement>This research study was funded by the Dhaka Hospital of International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b; grant no Gr- 00233) and its donors, which provide unrestricted support to icddr, b for its operations and research. Current donors providing unrestricted support include: Australian Agency for International Development (AusAID), Government of the People’s Republic of Bangladesh, Canadian International Development Agency, Swedish International Development Cooperation Agency, and the Department for International Development, United Kingdom. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.</funding-statement></funding-group><counts><page-count count="9"></page-count></counts></article-meta></front></pmc><affiliations><list><country><li>Australie</li><li>Bangladesh</li><li>France</li></country><region><li>Victoria (État)</li><li>Île-de-France</li></region><settlement><li>Melbourne</li><li>Paris</li></settlement></list><tree><country name="Bangladesh"><noRegion><name sortKey="Chisti, Mohammod Jobayer" sort="Chisti, Mohammod Jobayer" uniqKey="Chisti M" first="Mohammod Jobayer" last="Chisti">Mohammod Jobayer Chisti</name></noRegion><name sortKey="Ahmed, Tahmeed" sort="Ahmed, Tahmeed" uniqKey="Ahmed T" first="Tahmeed" last="Ahmed">Tahmeed Ahmed</name><name sortKey="Ashraf, Hasan" sort="Ashraf, Hasan" uniqKey="Ashraf H" first="Hasan" last="Ashraf">Hasan Ashraf</name><name sortKey="Banu, Sayera" sort="Banu, Sayera" uniqKey="Banu S" first="Sayera" last="Banu">Sayera Banu</name><name sortKey="Faruque, Abu Syed Golam" sort="Faruque, Abu Syed Golam" uniqKey="Faruque A" first="Abu Syed Golam" last="Faruque">Abu Syed Golam Faruque</name><name sortKey="Raqib, Rubhana" sort="Raqib, Rubhana" uniqKey="Raqib R" first="Rubhana" last="Raqib">Rubhana Raqib</name><name sortKey="Salam, Mohammed Abdus" sort="Salam, Mohammed Abdus" uniqKey="Salam M" first="Mohammed Abdus" last="Salam">Mohammed Abdus Salam</name></country><country name="Australie"><region name="Victoria (État)"><name sortKey="Chisti, Mohammod Jobayer" sort="Chisti, Mohammod Jobayer" uniqKey="Chisti M" first="Mohammod Jobayer" last="Chisti">Mohammod Jobayer Chisti</name></region><name sortKey="Duke, Trevor" sort="Duke, Trevor" uniqKey="Duke T" first="Trevor" last="Duke">Trevor Duke</name><name sortKey="Graham, Stephen M" sort="Graham, Stephen M" uniqKey="Graham S" first="Stephen M." last="Graham">Stephen M. Graham</name><name sortKey="La Vincente, Sophie" sort="La Vincente, Sophie" uniqKey="La Vincente S" first="Sophie" last="La Vincente">Sophie La Vincente</name></country><country name="France"><region name="Île-de-France"><name sortKey="Graham, Stephen M" sort="Graham, Stephen M" uniqKey="Graham S" first="Stephen M." last="Graham">Stephen M. Graham</name></region></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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