Research

An opportunistic fungus is a frequent cause of severe pneumonia in sub-Saharan Africa

Pneumocystis jirovecii-associated pneumonias are common and life-threatening among Mozambican children under five years of age

31.08.2015

A study led by Dr. Quique Bassat from ISGlobal, together with researchers from the Manhiça Health Research Center (CISM), reveals a high prevalence of Pneumocystits jiroveccii in young children with severe pneumonia, particularly among those infected with HIV. The study involved more than 800 Mozambican children diagnosed with severe pneumonia, and was published in the journal Clinical Microbiology and Infection.

Pneumocystis jirovecii pneumonia (PCP) is a common opportunistic infection in immunosuppressed patients, particularly those with HIV. Although the incidence of this type of infection has greatly diminished worldwide thanks to antiretroviral therapies and prophylactic measures, there are few data on paediatric PCP in developing countries, especially in sub-Saharan Africa where HIV prevalence is high.   

The goal of the study was to determine PCP prevalence in children under 5 years of age, admitted to the hospital with severe clinical pneumonia, compare the clinical features of the disease in children with or without PCP, and investigate the PCP-associated risk factors. Using a highly sensitive molecular diagnosis technique for the fungus, the authors found a PCP prevalence of 7%. Children positive for P. jirovecii displayed a higher frequency of co-infections with virus and bacteria, a worse evolution of the disease and a significantly higher mortality (of 20%) as compared to children without PCP. 

Unfortunately, the clinical symptoms and routine laboratory tests and do not allow to distinguish P. jirovecii infections. The authors recommend that PCP should be suspected in infants that experience clinical worsening during admission despite receiving the recommended antibiotic treatment, particularly those who are HIV-positive. Other clinical symptoms such as grunting and digital clubbing are also associated to PCP and can guide clinicians for its presumptive diagnosis. Dr. Miguel Lanaspa, first author of the study, concludes: "new diagnosis tools need to be urgently developed for the populations at risk, and the prevention of mother-to-child HIV transmission should be strengthened if needed".   

Reference :

Lanaspa M, O'Callaghan-Gordo C, Machevo S, Madrid L, Nhampossa T, Acácio S, Horra C5, Friaza V, Campano E, Alonso PL, Calderón E, Roca A, Bassat Q. High prevalence of Pneumocystis jirovecii pneumonia among Mozambican children < 5 years of age admitted to hospital with clinical severe pneumonia. Clin Microbiol Infect. 2015 Jul 28. doi: 10.1016/j.cmi.2015.07.011.