Etiology and risk factors for mortality in an adult community-acquired pneumonia cohort in Malawi

Aston, S. J. et al. (2019) Etiology and risk factors for mortality in an adult community-acquired pneumonia cohort in Malawi. American Journal of Respiratory and Critical Care Medicine, 200(3), pp. 359-369. (doi: 10.1164/rccm.201807-1333OC) (PMID:30625278) (PMCID:PMC6680311)

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Rationale: In the context of rapid antiretroviral therapy (ART) rollout and an increasing burden of non-communicable diseases, there are few contemporary data describing the aetiology and outcome of community-acquired pneumonia (CAP) in sub-Saharan Africa. Objectives: To describe the current aetiology of CAP in Malawi and identify risk factors for mortality. Methods: We conducted a prospective observational study of adults hospitalised with CAP to a teaching hospital in Blantyre, Malawi. Aetiology was defined by blood culture, Streptococcus pneumoniae urinary antigen detection, sputum mycobacterial culture and Xpert MTB/RIF, and nasopharyngeal aspirate multiplex PCR. Measurements and Main Results: In 459 patients (285 [62.1%] males; median age 34.7 [IQR: 29.4-41.9] years), 30-day mortality was 14.6% (64/439) and associated with male sex (adjusted odds ratio 2.60 [95% CI: 1.17-5.78]), symptom duration >7 days (2.78 [1.40-5.54]), tachycardia (2.99 [1.48-6.06]), hypoxaemia (4.40 [2.03-9.51]) and inability to stand (3.59 [1.72-7.50]). HIV was common (355/453; 78.4%), frequently newly diagnosed (124/355; 34.9%), but not associated with mortality. S. pneumoniae (98/458 [21.4%]) and Mycobacterium tuberculosis (75/326 [23.0%]) were the most frequently identified pathogens. Viral infection occurred in 32.6% (148/454) with influenza (40/454 [8.8%]) most common. Bacterial-viral co-infection occurred in 9.1% (28/307). Detection of M. tuberculosis was associated with mortality (aOR 2.44 [1.19-5.01]). Conclusions: In the ART era, CAP in Malawi remains predominantly HIV-associated with a large proportion attributable to potentially vaccine-preventable pathogens. Strategies to increase early detection and treatment of tuberculosis and improve supportive care, in particular the correction of hypoxaemia, should be evaluated in clinical trials to address CAP-associated mortality.

Item Type:Articles
Additional Information:This work was supported by a Wellcome Trust award to S.J.A. (grant 099962). A Strategic award from the Wellcome Trust supports the Malawi–Liverpool– Wellcome Trust Clinical Research Programme. The respiratory pathogen molecular diagnostic assays were partly supported by a grant from the Centers for Disease Control and Prevention (1U01 IP000848).
Glasgow Author(s) Enlighten ID:Ho, Dr Antonia
Authors: Aston, S. J., Ho, A., Jary, H., Huwa, J., Mitchell, T., Ibitoye, S., Greenwood, S., Joekes, E., Daire, A., Mallewa, J., Everett, D., Nyirenda, M., Faragher, B., Mwandumba, H. C., Heyderman, R. S., and Gordon, S. B.
College/School:College of Medical Veterinary and Life Sciences > Institute of Infection Immunity and Inflammation
Journal Name:American Journal of Respiratory and Critical Care Medicine
Publisher:American Thoracic Society
ISSN (Online):1535-4970
Published Online:09 January 2019
Copyright Holders:Copyright © 2019 American Thoracic Society
First Published:First published in American Journal of Respiratory and Critical Care Medicine 200(3):359-369
Publisher Policy:Reproduced under a Creative Commons License

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