Limited Utility of Polymerase Chain Reaction in Induced Sputum Specimens for Determining the Causes of Childhood Pneumonia in Resource-Poor Settings: Findings From the Pneumonia Etiology Research for Child Health (PERCH) Study.
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Thea Donald M, Seidenberg Phil, Park Daniel E, Mwananyanda Lawrence, Fu Wei, Shi Qiyuan, Baggett Henry C, Brooks W Abdullah, Feikin Daniel R, Howie Stephen R C, Knoll Maria Deloria, Kotloff Karen L, Levine Orin S, Madhi Shabir A, O'Brien Katherine L, Scott J Anthony G, Antonio Martin, Awori Juliet O, Baillie Vicky L, DeLuca Andrea N, Driscoll Amanda J, Higdon Melissa M, Hossain Lokman, Jahan Yasmin, Karron Ruth A, Kazungu Sidi, Li Mengying, Moore David P, Morpeth Susan C, Ofordile Ogochukwu, Prosperi Christine, Sangwichian Ornuma, Sawatwong Pongpun, Sylla Mamadou, Tapia Milagritos D, Zeger Scott L, Murdoch David R, Hammitt Laura L, PERCH Study Group
Аннотация
METHODS.: Among children aged 1-59 months, we compared organism detection by multiplex PCR in IS and nasopharyngeal/oropharyngeal (NP/OP) specimens. To assess whether organism presence or density in IS specimens was associated with chest radiographic evidence of pneumonia (radiographic pneumonia), we compared prevalence and density in IS specimens from children with radiographic pneumonia and children with suspected pneumonia but without chest radiographic changes or clinical or laboratory findings suggestive of pneumonia (nonpneumonia group).
RESULTS.: Among 4232 cases with World Health Organization-defined severe or very severe pneumonia, we identified 1935 (45.7%) with radiographic pneumonia and 573 (13.5%) with nonpneumonia. The organism detection yield was marginally improved with IS specimens (96.2% vs 92.4% for NP/OP specimens for all viruses combined [P = .41]; 96.9% vs 93.3% for all bacteria combined [P = .01]). After accounting for presence in NP/OP specimens, no organism was detected more frequently in the IS specimens from the radiographic pneumonia compared with the nonpneumonia cases. Among high-quality IS specimens, there were no statistically significant differences in organism density, except with cytomegalovirus, for which there was a higher quantity in the IS specimens from cases with radiographic pneumonia compared with the nonpneumonia cases (median cycle threshold value, 27.9 vs 28.5, respectively; P = .01).
CONCLUSIONS.: Using advanced molecular methods with IS specimens provided little additional diagnostic information beyond that obtained with NP/OP swab specimens.