Influenza-like illness is associated with high pneumococcal carriage density in Malawian children - 22/09/20

Doi : 10.1016/j.jinf.2020.06.079

Tinashe K. Nyazika ^a,^b,^c,^{^{1
TKN and AL contributed equally to this work.},}^⁎ , Alice Law ^d,^{^{1
TKN and AL contributed equally to this work.}}, Todd D. Swarthout ^a,^e, Lusako Sibale ^a, Danielle ter Braake ^d,^f, Neil French ^d, Robert S. Heyderman ^e, Dean Everett ^g, Aras Kadioglu ^d,^{^{2
AK, KCJ and DRN contributed equally to this work.}}, Kondwani C. Jambo ^a,^b,^{^{2
AK, KCJ and DRN contributed equally to this work.},}^⁎ , Daniel R. Neill ^d,^{^{2
AK, KCJ and DRN contributed equally to this work.}}
^a Malawi-Liverpool-Wellcome Trust Clinical Research Programme, University of Malawi College of Medicine, Blantyre, Malawi
^b Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
^c Department of Pathology, College of Health Sciences, University of Malawi, Blantyre, Malawi
^d Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom
^e Division of Infection and Immunity, NIHR Global Health Research Unit on Mucosal Pathogens, University College London, London, United Kingdom
^f Department of Biomolecular Health Sciences, Division of Infectious Diseases & Immunology, Faculty of Veterinary Medicine, Utrecht, the Netherlands
^g The Queens Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom

^⁎Corresponding authors at: Malawi-Liverpool-Wellcome Trust Clinical Research Programme, University of Malawi College of Medicine, Blantyre, Malawi.Malawi-Liverpool-Wellcome Trust Clinical Research ProgrammeUniversity of Malawi College of MedicineBlantyreMalawi

Highlights

•	Influenza-like illness (ILI) in children is associated with high pneumococcal carriage density.
•	Children with ILI harboured more viral organisms than asymptomatic healthy children.
•	Children with ILI patients had higher IL-8 levels in nasal aspirates than asymptomatic healthy children.

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Summary

Background

High pneumococcal carriage density is a risk factor for invasive pneumococcal disease (IPD) and transmission, but factors that increase pneumococcal carriage density are still unclear.

Methods

We undertook a cross-sectional study to evaluate the microbial composition, cytokine levels and pneumococcal carriage densities in samples from children presenting with an influenza-like illness (ILI) and asymptomatic healthy controls (HC).

Results

The proportion of children harbouring viral organisms (Relative risk (RR) 1.4, p = 0.0222) or ≥ 4 microbes at a time (RR 1.9, p < 0.0001), was higher in ILI patients than HC. ILI patients had higher IL-8 levels in nasal aspirates than HC (median [IQR], 265.7 [0 – 452.3] vs. 0 [0 – 127.3] pg/ml; p = 0.0154). Having an ILI was associated with higher pneumococcal carriage densities compared to HC (RR 4.2, p < 0.0001).

Conclusion

These findings suggest that children with an ILI have an increased propensity for high pneumococcal carriage density. This could in part contribute to increased susceptibility to IPD and transmission in the community.

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Keywords : Influenza-like illness, Carriage density, Pneumococcal, IL-8, Children

Plan

Introduction

Methods

Study design and participants

Nasopharyngeal swab

Nasal aspirates

Streptococcus pneumoniae culture and lytA PCR

Multiplex real-time PCR detection of 33 respiratory microbes

Cytokine measurements

Statistical analyses

Results

Demographic characteristics of study population

ILI patients exhibit increased propensity for harbouring a viral organism and/or multiple microbes in nasal aspirates

ILI patients harbour higher levels of pro-inflammatory IL-8 in the URT than asymptomatic healthy controls

ILI patients exhibit higher likelihood of greater pneumococcal carriage densities than asymptomatic healthy controls

Discussion

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Vol 81 - N° 4

P. 549-556 - octobre 2020 Retour au numéro

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Influenza-like illness is associated with high pneumococcal carriage density in Malawian children - 22/09/20

Highlights

Summary

Background

Methods

Results

Conclusion

Plan

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