Aetiological agents of pneumonia among HIV and non-HIV infected children in Ghana: A case-control study

PLoS One. 2024 Mar 22;19(3):e0299222. doi: 10.1371/journal.pone.0299222. eCollection 2024.

Abstract

Pneumonia is the leading cause of death in children, however, the microbial aetiology of pneumonia is not well elucidated in low- and middle-income countries. Our study was aimed at determining the microbial aetiologies of childhood pneumonia and associated risk factors in HIV and non-HIV infected children. We conducted a case-control study that enrolled children with pneumonia as cases and non-pneumonia as controls from July 2017 to May 2020. Induced sputum and blood samples were investigated for microbial organisms using standard microbiological techniques. DNA/RNA was extracted from sputum samples and tested for viral and bacterial agents. Four hundred and four (404) subjects consisting of 231 (57.2%) cases and 173 (42.8%) controls were enrolled. We identified a significant (p = 0.011) proportion of viruses in cases (125; 54.1%, 95%CI: 47.4-60.7) than controls (71; 33.6%, 95%CI: 33.6-48.8) and these were mostly contributed to by Respiratory Syncytial Virus. Staphylococcus aureus (16; 4.0%), Klebsiella spp. (15, 3.7%) and Streptococcus pneumoniae (8, 2.0%) were the main bacterial agents identified in sputum or induced sputum samples. HIV infected children with viral-bacterial co-detection were found to have very severe pneumonia compared to those with only viral or bacterial infection. Indoor cooking (OR = 2.36; 95%CI:1.41-3.96) was found to be associated with pneumonia risk in patients. This study demonstrates the importance of various microbial pathogens, particularly RSV, in contributing to pneumonia in HIV and non-HIV paediatric populations. There is a need to accelerate clinical trials of RSV vaccines in African populations to support improvement of patient care.

MeSH terms

  • Case-Control Studies
  • Child
  • Ghana / epidemiology
  • HIV Infections* / complications
  • HIV Infections* / epidemiology
  • Humans
  • Infant
  • Pneumonia* / epidemiology
  • Pneumonia* / etiology
  • Staphylococcal Infections* / complications

Grants and funding

This project is part of the EDCTP2 programme supported by the European Union (grant number TMA 2015 CDF - 1033) and awarded under the Career Development Fellowship to Dr Michael Owusu. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. http://www.edctp.org/project/studentships-under-edctp-career-development-fellow-dr-michael-owusu/.