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BMC Public Health

, 14:1304

Infectious Disease epidemiology


BackgroundAtypical pathogens such as Mycoplasma pneumoniae, Chlamydophila pneumoniae, and Legionella pneumophila are increasingly recognized as important causes of community acquired pneumonia CAP worldwide. Such etiological data for Vietnam is scarce and clinical doctors lack accurate information on which to base their diagnosis and treatment of pneumonia. This study identifies the prevalence and risk factors of severe community acquired pneumonia due to these atypical pathogens severe-ApCAP in children aged 1–15 years with CAP in a pediatric hospital in Hanoi, Vietnam.

Methods722 hospitalized children with CAP were recruited for detecting those atypical pathogens, using multiplex PCR and ELISA. Clinical and epidemiological data were collected. Multivariate logistic-regression analyses were performed to evaluate the associations of potential risk factors with severe-ApCAP.

ResultsAmong 215 atypical pathogen-positive CAP cases, 45.12% 97-215 were severe-ApCAP. Among the severe-ApCAP group, 55.67% 54-97 cases were caused by pure atypical pathogens and 44.33% 43-97 resulted from a co-infection with typical respiratory pathogens. M. pneumoniae was the most common, with 86.6% cases 84-97 in the severe-ApCAP group, whereas C. pneumoniae and L. pneumophila were less frequent 6.19% and 7.22%, respectively. The highest rate of severe-ApCAP was in children younger than two years 65.98%. The differences related to age are statistically significant P = 0.008.

The factors significantly associated with severe-ApCAP were age OR = 0.84, 95% CI = 0.75-0.93, P = 0.001, co-infection with typical bacteria OR = 4.86, 95% CI = 2.17-10.9, P < 0.0001, co-infection with respiratory viruses OR = 4.36, 95% CI = 1.46-13.0, P = 0.008, respiratory-cardiac system malformation OR = 14.8, 95% CI = 1.12 -196, P = 0.041 and neonatal pneumonia OR = 11.1, 95% CI = 1.06 -116, P = 0.044.

ConclusionsSevere-ApCAP presented at a significant rate in Vietnamese children. More than 50% of severe-ApCAP cases were associated with pure atypical pathogen infection. M. pneumoniae appeared most frequently. The highest rate of severe-ApCAP was in children younger than two years. Younger age and co-infection with typical bacteria or viruses were the most significant risk factors, while respiratory-cardiac system malformation and neonatal pneumonia were additional potential risk factors, associated with severe-ApCAP in Vietnamese children.

KeywordsPure atypical pathogens Children Prevalence Risk factor Severe community-acquired pneumonia AbbreviationsApCAPAtypical pathogen positive community-acquired pneumonia

CAPCommunity-acquired pneumonia

ELISAEnzyme-linked immunosorbent assay

PIDS and IDS of AmericaPediatric infectious diseases society and the infectious diseases society of America

PCRPolymerase chain reaction

RT-PCRReal-time polymerase chain reaction

severe-ApCAPSevere form of community-acquired pneumonia due to atypical pathogens.

Electronic supplementary materialThe online version of this article doi:10.1186-1471-2458-14-1304 contains supplementary material, which is available to authorized users.

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Autor: Phane Le Thanh Huong - Pham Thu Hien - Nguyen Thi Phong Lan - Tran Quang Binh - Dao Minh Tuan - Dang Duc Anh


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