Background
Methods
Study design
Recruitment and consent
Autopsy examination and sampling
Histopathology
Molecular analysis
Data management and statistical analysis
Results
Case recruitment and descriptives
Population (n = 3604)a | Study (n = 121) |
P
b
| |
---|---|---|---|
Age (months) | |||
Median (IQR) | NA | 19 (12–45) | NA |
<1 years | 48.7 % (1787) | 29 % (35) | <0.001 |
1–4 years | 36.7 % (1321) | 48 % (58) | |
4–15 years | 13.8 % (496) | 23 % (28) | |
Male sex | 50.2 % (1810) | 64 % (77) | 0.005 |
HIV infected | 39.4 % (85/216)c | 34 % (33/97)d | 0.368 |
Lung pathologies and stratification by HIV status
Non-weighted | Weighted for age and sex | ||||
---|---|---|---|---|---|
Overall | HIV uninfected | HIV Infected | HIV status unknown | Overall | |
(n = 121) | (n = 62) | (n = 34) | (n = 25) | (n = 121) | |
Count (%) | Count (%) | Count (%) | Count (%) | Count (%, SE) | |
Lung pathology | 111 (92 %) | 53 (86 %) | 34 (100 %) | 24 (96 %) | 112 (93 %, 2.4) |
Bronchopneumonia | 60 (50 %) | 28 (45 %) | 16 (47 %) | 16 (64 %) | 52 (43 %, 4.5) |
Interstitial pneumonitis | 20 (17 %) | 9 (15 %) | 7 (21 %) | 4 (16 %) | 21 (17 %, 3.4) |
Tuberculosis (All forms) (PTB and/or EPTB) | 10 (8 %) | 4 (6 %) | 5 (15 %) | 1 (4 %) | 11 (9 %, 2.6) |
EPTB | 1 (1 %) | 0 (0 %) | 1 (3 %) | 0 (0 %) | 1 (1 %, 0.8) |
PTB | 9 (7 %) | 4 (6 %) | 4 (12 %) | 0 (0 %) | 10 (8 %, 2.5) |
Cytomegalovirus pneumonia | 8 (7 %) | 4 (6 %) | 3 (9 %) | 1 (4 %) | 10 (9 %, 2.5) |
Pneumocystis Jirovecii Pneumonia | 6 (5 %) | 2 (3 %) | 3 (9 %) | 1 (4 %) | 13 (11 %, 2.9) |
Pulmonary oedema | 6 (5 %) | 5 (8 %) | 0 (0 %) | 1 (4 %) | 4 (4 %. 1.7) |
Candidiasis | 3 2 %) | 3 (5 %) | 0 (0 %) | 0 (0 %) | 1 (1 %, 0.9) |
Pleuritis | 2 (2 %) | 1 (2 %) | 0 (0 %) | 1 (4 %) | 1 (1 %, 0.8) |
Lymphoid interstitial pneumonitis | 2 (2 %) | 0 (0 %) | 1 (3 %) | 1 (4 %) | 1 (1 %, 0.7) |
Lobar pneumonia | 1 (1 %) | 0 (0 %) | 1 (3 %) | 0 (0 %) | 1 (1 %, 0.8) |
Acute respiratory distress | 1 (1 %) | 1 (2 %) | 0 (0 %) | 0 (0 %) | 3 (3 %, 1.5) |
Pulmonary haemorrhage | 1 (1 %) | 1 (2 %) | 0 (0 %) | 0 (0 %) | 1 (1 %, 0.7) |
Normal lungs | 10 (8 %) | 9 (15 %) | 0 (0 %) | 1 (4 %) | 9 (8 %, 2.4) |
Comparison between lung pathology and diagnosis given by the attending physician
Lung pathology from post mortem | |||||||
---|---|---|---|---|---|---|---|
Attending physician diagnosis | No lung pathology | Any lung pathology | Bronchopneumonia | Interstitial pneumonitis | Tuberculosis | CMV pneumonia | PCP |
(n = 10) | (n = 111) | (n = 59) | (n = 20) | (n=10) | (n = 8) | (n = 6) | |
Communicable diseasesa | |||||||
Pneumonia | 20 % (2/10) | 30 % (33/111) | 31 % (18/59) | 15 % (3/20) | 40 % (4/10) | 50 % (4/8) | 50 % (3/6) |
Sepsis/septic shock | 40 % (4/10) | 23 % (25/111) | 22 % (13/59) | 15 % (3/20) | 20 % (2/10) | 50 % (4/8) | 17 % (1/6) |
Acute diarrhoea and dehydration | 40 % (4/10 | 23 % (26/111) | 27 % (16/59) | 35 % (7/20) | 0 % (0/10) | 25 % (2/8) | 0 % (0/6) |
Meningitis | 30 % (3/10) | 14 % (15/111) | 8 % (5/59) | 15 % (3/20) | 30 % (3/10) | 0 %(0/8) | 17 % (1/6) |
Tuberculosis | 0 % (0/10) | 8 % (9/111) | 3 % (2/59) | 5 % (1/20) | 40 % (4/10) | 13 % (1/8) | 17 % (1/6) |
Malaria | 0 % (0/10) | 5 % (5/111) | 3 % (2/59) | 15 % (3/20) | 0 % (0/10) | 0 % (0/8) | 0 % (0/6) |
Typhoid/enteric fever | 10 % (1/10) | 3 % (3/111) | 2 % (1/59) | 5 % (1/20) | 0 % (0/10) | 0 % (0/8) | 17 % (1/6) |
PCP | 0 % (0/10) | 3 % (3/111) | 3 % (2/59) | 0 % (0/20) | 0 % (0/10) | 25 % (2/8) | 17 % (1/6) |
Hepatitis | 0 % (0/10) | 1 % (1/111) | 2 % (1/59) | 0 % (0/20) | 0 % (0/10) | 0 % (0/8) | 0 % (0/6) |
Tetanus | 0 % (0/10) | 1 % (1/111) | 2 % (1/59) | 0 % (0/20) | 0 % (0/10) | 0 % (0/8) | 0 % (0/6) |
Non-communicable diseasesb | |||||||
Kwashiorkor/PEM, Marasmus or PCM | 40 % (4/10) | 50 % (56/111) | 53 % (31/59) | 55 % (11/20) | 80 % (8/10) | 63 % (5/8) | 33 % (2/6) |
WAZ score < −2.0 (children aged < 10 years old) | 78 % (7/9) | 63 % (57/91) | 62 % (31/50) | 56 % (9/16) | 75 % (6/8) | 63 % (5/8) | 75 % (3/4) |
Non-malnutrition | 0 % (0/10) | 14 % (15/111) | 15 % (9/59) | 10 % (2/20) | 10 % (1/10) | 0 % (0/8) | 17 % (1/6) |
Leukaemia | 0 % (0/10) | 1 % (1/111) | 2 % (1/59) | 0 % (0/20) | 0 % (0/10) | 0 % (0/8) | 0 % (0/6) |
Kaposi’s sarcoma | 0 % (0/10) | 2 % (2/111) | 2 % (1/59) | 0 % (0/20) | 10 % (1/10) | 0 % (0/8) | 0 % (0/6) |
Cerebral palsy | 0 % (0/10) | 3 % (3/111) | 3 % (2/59) | 5 % (1/20) | 0 % (0/10) | 0 % (0/8) | 0 % (0/6) |
Congestive cardiac failure | 0 % (0/10) | 3 % (3/111) | 3 % (2/59) | 0 % (0/20) | 0 % (0/10) | 0 % (0/8) | 17 % (1/6) |
Rheumatic heart disease | 0 % (0/10) | 2 % (2/111) | 3 % (2/59) | 0 % (0/20) | 0 % (0/10) | 0 % (0/8) | 0 % (0/6) |
Sickle cell anaemia associated cardiovascular accident | 0 % (0/10) | 1 % (1/111) | 2 % (1/59) | 0 % (0/20) | 0 % (0/10) | 0 % (0/8) | 0 % (0/6) |
Primary immune deficiency | 0 % (0/10) | 1 % (1/111) | 0 % (0/59) | 5 % (1/20) | 0 % (0/10) | 0 % (0/8) | 0 % (0/6) |
ID | Age | Sex | HIV | ATT | ART | ZN | Xpert MTB/RIF Assay | PowerChek™ MTB/NTM Assay |
---|---|---|---|---|---|---|---|---|
4B072 | 3 yr | Female | Positive | No | Yes | Negative | MTB (RIF sens) | MTB |
4B083 | 3 yr, 5 m | Male | Positive | No | Yes | Positive | MTB (RIF sens) | MTB |
4B008 | 2 yr, 7 m | Female | Negative | No | No | Positive | MTB (RIF sens) | Invalid |
4B036 | 10 yr | Male | Negative | No | No | Negative | Negative | NTM |
4B120 | 8 yr | Female | Positive | No | Yes | Positive | Negative | NTM |
4B055 | 1 yr, 5 m | Male | Negative | No | No | Negative | Negative | MTB |
4B064 | 10 yr | Male | Positive | No | Yes | Positive | Negative | MTB |
4B085 | 1 yr, 4 m | Male | Positive | Yes | Yes | Negative | Negative | MTB |
4B117 | 5 m | Male | Negative | No | No | Negative | Negative | MTB |
4B076 | 14 yr | Female | Unknown | No | No | Negative | Negative | Negative |
Molecular analysis of lung tissue
Xpert MTB/RIF Assay | PowerChek™ MTB/NTM Assaya | ||
---|---|---|---|
MTB detected | MTB detected | NTM detected | |
Overall | 30 % (36/121) | 16 % (12/73) | 62 % (45/73) |
Lung pathology | |||
Bronchopneumonia | 30 % (18b/60) | 9 % (3/35) | 63 % (22/35) |
Interstitial pneumonitis | 60 % (8/20) | 17 % (2/12) | 67 % (8/12) |
Tuberculosis (All forms) (PTB and/or EPTB) | 30 % (3/10) | 67 % (6/9) | 22 % (2/9) |
EPTB | 100 % (1/1) | 100 % (1/1) | 0 % (0/1) |
PTB | 22 % (2/9) | 63 % (5/8) | 20 % (2/8) |
Cytomegalovirus pneumonia | 13 % (1/8) | 0 % (0/4) | 75 % (3/4) |
Pneumocystis Jirovecii pneumonia | 17 % (1/5) | 0 % (0/3) | 67 % (2/3) |
Pulmonary oedema | 33 % (2/6) | 20 % (1/5) | 80 % (4/5) |
Candidiasis | 0 % (0/3) | 0 % (0/2) | 50 % (1/2) |
Acute respiratory distress | 0 % (0/1) | 0 % (0/1) | 100 % (1/1) |
Normal lungs | 20 % (2/10) | 0 % (0/7) | 72 % (5/7) |