High Prevalence of Mycoplasma pneumoniae and Chlamydia pneumoniae in Children with Acute Respiratory Infections from Lima, Peru

Background Mycoplasma pneumoniae and Chlamydia pneumoniae are atypical pathogens responsible for pneumonia and a leading cause of morbidity and mortality in low income countries. The study objective is to determine the prevalence of this pathogens in Peruvian children with acute respiratory infections. Methods A consecutive cross-sectional study was conducted in Lima, Peru from May 2009 to September 2010. A total of 675 children admitted with clinical diagnoses of acute respiratory infections were tested for Mycoplasma pneumoniae and Chlamydia pneumoniae detection by polymerase chain reaction (PCR), and clinical symptoms were registered by the attending physician. Results Mycoplasma pneumonia was detected in 25.19% (170/675) of nasopharyngeal samples and Chlamydia pneumonia in 10.52% (71/675). The most common symptoms in patients with these atypical pathogens were rhinorrhea, cough and fever. A higher prevalence of Mycoplasma pneumoniae cases were registered in summer, between December 2009 and March 2010. Conclusions Mycoplasma pneumoniae and Chlamydia pneumonia are a significant cause of morbidity in Peruvian children with acute respiratory infections (ARI). Further studies should evaluate the use of reliable techniques such as PCR in Peru in order to avoid underdiagnoses of these atypical pathogens

Prevalencia de Haemophilus influenzae en lactantes hospitalizados menores de 1 año en Perú

Las infecciones respiratorias agudas (IRAs) constituyen una de las cinco primeras causas de morbilidad y mortalidad a nivel mundial. Una bacteria causante de infecciones respiratorias agudas, principalmente en niños menores de 5 años es Haemophilus influenzae tipo b. “Se estima que provoca por lo menos tres millones de casos de enfermedad grave al año y alrededor de 86.000 de funciones, la mayor parte se registra en países en desarrollo”.El objetivo fue identificar Haemophilus influenzae tipo b en lactantes menores de 1año hospitalizados con diagnóstico de infección respiratoria aguda y presencia de tos coqueluchoide

Diagnosis of Carrion’s Disease by Direct Blood PCR in Thin Blood Smear Negative Samples.

Bartonella bacilliformis is the etiologic agent of Carrion’s disease. This disease has two well established phases, the most relevant being the so called Oroya Fever, in which B. bacilliformis infect the erythrocytes resulting in severe anemia and transient immunosuppression, with a high lethality in the absence of adequate antibiotic treatment. The presence of B. bacilliformis was studied in 113 blood samples suspected of Carrion’s disease based on clinical criteria, despite the absence of a positive thin blood smear, by two different PCR techniques (using Bartonella-specific and universal 16S rRNA gene primers), and by bacterial culture. The specific 16S rRNA gene primers revealed the presence of 21 B. bacilliformis and 1 Bartonella elizabethae, while universal primers showed both the presence of 3 coinfections in which a concomitant pathogen was detected plus Bartonella, in addition to the presence of infections by other microorganisms such as Agrobacterium or Bacillus firmus. These data support the need to implement molecular tools to diagnose Carrion’s disease

Characteristics of the population studied.

†<p>Positive samples using specific primers for <i>Bartonella 16S rRNA</i>.</p>††<p>Includes a <i>B. elizabethae</i> isolate.</p

<i>C</i>. <i>pneumoniae</i> and <i>M</i>. <i>pneumoniae</i>. seasonal prevalence (May 2009 –Sep 2010).

<p><i>C</i>. <i>pneumoniae</i> and <i>M</i>. <i>pneumoniae</i>. seasonal prevalence (May 2009 –Sep 2010).</p

Clinical symptoms in PCR confirmed cases for <i>Chlamydia pneumoniae</i> and <i>Chlamydia pneumoniae</i>.

<p>Clinical symptoms in PCR confirmed cases for <i>Chlamydia pneumoniae</i> and <i>Chlamydia pneumoniae</i>.</p

Signs and symptoms.^*

†<p>p<0.001††p<0.05 (Statistical significance established using the Fisher exact test).</p><p>* Symptoms considered on the basis of standard solicited data for the surveillance of Carrion’s disease.</p><p>¥Others: cyanosis, drowsiness, itching, back pain, chest pain, petechiae, congestion.</p

Information about culture and direct blood PCR in positive Samples.

<p>* All positive cultures but No. 76 were identified as <i>B. bacilliformis</i> or <i>B. elizabethae</i> (culture No. 28). Culture 76 was identified as <i>Bacillus firmus,</i> in accordance with direct blood PCR assays.</p

Demographic characteristics of children with acute respiratory infections.

<p>Demographic characteristics of children with acute respiratory infections.</p

Comparison of the techniques used to identify <i>Bartonella</i> spp.

<p>* Twenty-one <i>B. bacilliformis</i>, 1 <i>B. elizabethae.</i></p>†<p>Also include other microorganisms: <i>Rhodoccus</i> spp. (3 isolates) <i>Bacillus firmus</i> (3 isolates), <i>Achromobacter xylosoxidans,</i><i>Agrobacterium</i> spp., <i>Artrhobacter</i> spp, <i>Bacillus cereus</i>, <i>Blastococcus</i> spp., <i>Pseudomonas putida</i> and <i>Staphylococcus pettenkoferi</i>.</p