Community-acquired Pneumonia in Hospitalized Urban Young Nigerian Children:Clinical and Haematological Correlates of Diagnosis and Outcome.

Abstract

Summary: As part of a comprehensive hospital based study of acute lower respiratory infections (ALRI) in under-five urban Nigerian children, we sought to identify the possible clinical and investigative correlates of lobar versus bronchopneumonia, and the possible determinants of mortality in community-acquired pneumonia. Over a 30-month period, 419 cases of ALRI were studied; pneumonia accounted for 323(77.1 per cent) of these. Of those with pneumonia, bronchopneumonia (BP) was diagnosed in 234 (72.4 per cent), lobar pneumonia (LP) in 66 (20.4 per cent), while 23(7.1 per cent) had features of both. BP alone (BPA) and LP alone (LPA) without concomitant respiratory syndromes were diagnosed in 127(39.4 per cent) and 39 (12.1 per cent) cases , respectively. Although there was an overall annual preponderance of BP admissions, the peak admissions for LP was recorded in the harmattan months of November through January. The overall mean age was 15.7 months, but compared with those with LPA, BPA cases were significantly younger (mean ages, 14.2 £13.8mo. for BPA vs. 19.5+14.2mo. for LPA, p=0.021), had a significantly shorter mean duration of cough (p=0.044), and a higher prevalence of convulsion (p=0.02). Furthermore, concomitant measles, heart failure, and severe anaemia were significantly commoner among cases with a diagnosis of BP (p=0.018, 0.033, & 0.009 respectively). On the other hand, LPA cases were associated with a significantly higher prevalence of cigarette smoking in the household (p=0.038; RR=1.86; 95%CI=0.93-5.80), grunting respiration (p=0.01), and a higher mean admission emperature (p=0.03). Also, pleural effusion and sickle cell disease correlated more frequently with a final diagnosis of LP (p=0.00 & 0.01 respectively). Similady, compared with BPA cases, significantly higher white blood cell (WBC) counts and polymorphs were recorded in LPA cases (p=0.002 & 0.01). A fatal outcome was recorded in 35(10.8 per cent) cases. Mortality was significantly higher in those with pre-admission antimicrobial use (p=0.04), a combination of diarrhoea and vomiting (p=0.025), domestic firewood burning (p=0.023), and malnutrition (p=0.0003). A fatal outcome was also significantly associated with longer symptom duration for cough (p=0.002), fever (p=0.002), poor feeding (p=0.016), higher mean WBC counts and polymorphs (p=0.013 & 0.023 respectively). Harmattan season, grunting respiration, longer symptom-duration, and pleural effusion correlated most frequently with a final diagnosis of LP, while a younger age, anaemia, heart failuie and measles were more frequently associated with BP. The association of fatality with malnutrition, pre-admission antibiotic use, concomitant alimentary symptoms, longer symptom-duration, and high WBC/polymorph counts suggests the need for factoring these parameters into evolving a regional paediatric pneumonia severity index and therapeutic decision algorithms.