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Open Access Research article

Acute lower respiratory infections in ≥5 year -old hospitalized patients in Cambodia, a low-income tropical country: clinical characteristics and pathogenic etiology

Sirenda Vong1*, Bertrand Guillard1, Laurence Borand1, Blandine Rammaert1, Sophie Goyet1, Vantha Te2, Patrich Lorn Try3, Sopheak Hem1, Sareth Rith1, Sowath Ly1, Philippe Cavailler1, Charles Mayaud4 and Philippe Buchy1

Author Affiliations

1 Institut Pasteur in Cambodia, Réseau International des Instituts Pasteur, Phnom Penh, Cambodia

2 Takeo provincial hospital, Takeo, Cambodia

3 Kampong Cham provincial hospital, Kampong Cham, Cambodia

4 Hôpital Tenon, Assistance Publique - Hôpitaux de Paris, Paris, France

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BMC Infectious Diseases 2013, 13:97  doi:10.1186/1471-2334-13-97

Published: 22 February 2013

Abstract

Background

Few data exist on viral and bacterial etiology of acute lower respiratory infections (ALRI) in ≥5 year –old persons in the tropics.

Methods

We conducted active surveillance of community-acquired ALRI in two hospitals in Cambodia, a low-income tropical country. Patients were tested for acid-fast bacilli (AFB) by direct sputum examination, other bacteria by blood and/or sputum cultures, and respiratory viruses using molecular techniques on nasopharyngeal/throat swabs. Pulmonologists reviewed clinical/laboratory data and interpreted chest X-rays (CXR) to confirm ALRI.

Results

Between April 2007 - December 2009, 1,904 patients aged ≥5 years were admitted with acute pneumonia (50.4%), lung sequelae-associated ALRI (24.3%), isolated pleural effusions (8.9%) or normal CXR-related ALRI (17.1%); 61 (3.2%) died during hospitalization. The two former diagnoses were predominantly due to bacterial etiologies while viral detection was more frequent in the two latter diagnoses. AFB-positive accounted for 25.6% of acute pneumonia. Of the positive cultures (16.8%), abscess-prone Gram-negative bacteria (39.6%) and Haemophilus influenzae (38.0%) were most frequent, followed by Streptococcus pneumoniae (17.7%). Of the identified viruses, the three most common viruses included rhinoviruses (49.5%), respiratory syncytial virus (17.7%) and influenza viruses (12.1%) regardless of the diagnostic groups. Wheezing was associated with viral identification (31.9% vs. 13.8%, p < 0.001) independent of age and time-to-admission.

Conclusions

High frequency of H. influenzae and S. pneumoniae infections support the need for introduction of the respective vaccines in the national immunization program. Tuberculosis was frequent in patients with acute pneumonia, requiring further investigation. The relationship between respiratory viruses and wheezing merits further studies.

Keywords:
Cambodia; Acute lower respiratory infection; Tropics; Hospitalized patients; Viruses; Bacteria; Adults; Older children