Density of Upper Respiratory Colonization With Streptococcus pneumoniae and Its Role in the Diagnosis of Pneumococcal Pneumonia Among Children Aged <5 Years in the PERCH Study

Baggett, HC; Watson, NL; Deloria Knoll, M; Brooks, WA; Feikin, DR; Hammitt, LL; Howie, SRC; Kotloff, KL; Levine, OS; Madhi, SA; Murdoch, DR; Scott, JAG; Thea, DM; Antonio, M; Awori, JO; Baillie, VL; Deluca, AN; Driscoll, AJ; Duncan, J; Ebruke, BE; Goswami, D; Higdon, MM; Karron, RA; Moore, DP; Morpeth, SC; Mulindwa, JM; Park, DE; Paveenkittiporn, W; Piralam, B; Prosperi, C; Sow, SO; Tapia, MD; Zaman, K; Zeger, SL; O’Brien, KL; O, KL; L, OS; K, MD; F, DR; D, AN; D, AJ; Fancourt, N; Fu, W; H, LL; H, MM; Wangeci Kagucia, E; K, RA; LI, M; P, DE; P, C; Wu, Z; Z, SL; W, NL; Crawley, J; M, DR; B, WA; Endtz, HP; Z, K; G, D; Hossain, L; Jahan, Y; Ashraf, H; C. H, SR; E, BE; A, M; McLellan, J; MacHuka, E; Shamsul, A; Zaman, SMA; MacKenzie, G; G. S, JA; A, JO; M, SC; Kamau, A; Kazungu, S; Ominde, MS; K, KL; T, MD; S, SO; Sylla, M; Tamboura, B; Onwuchekwa, U; Kourouma, N; Toure, A; M, SA; M, DP; Adrian, PV; B, VL; Kuwanda, L; Mudau, A; Groome, MJ; Mahomed, N; B, HC; Thamthitiwat, S; Maloney, SA; Bunthi, C; Rhodes, J; Sawatwong, P; Akarasewi, P; T, DM; Mwananyanda, L; Chipeta, J; Seidenberg, P; Mwansa, J; Wa Somwe, S; Kwenda, G; Anderson, TP; Mitchell, J; (2017) Density of Upper Respiratory Colonization With Streptococcus pneumoniae and Its Role in the Diagnosis of Pneumococcal Pneumonia Among Children Aged <5 Years in the PERCH Study. Clinical infectious diseases, 64 (suppl_3). S317-S327. ISSN 1058-4838 DOI:

Full text not available from this repository.


Background. Previous studies suggested an association between upper airway pneumococcal colonization density and pneumococcal pneumonia, but data in children are limited. Using data from the Pneumonia Etiology Research for Child Health (PERCH) study, we assessed this potential association. Methods. PERCH is a case-control study in 7 countries: Bangladesh, The Gambia, Kenya, Mali, South Africa, Thailand, and Zambia. Cases were children aged 1–59 months hospitalized with World Health Organization–defined severe or very severe pneumonia. Controls were randomly selected from the community. Microbiologically confirmed pneumococcal pneumonia (MCPP) was confirmed by detection of pneumococcus in a relevant normally sterile body fluid. Colonization density was calculated with quantitative polymerase chain reaction analysis of nasopharyngeal/oropharyngeal specimens. Results. Median colonization density among 56 cases with MCPP (MCPP cases; 17.28 × 106 copies/mL) exceeded that of cases without MCPP (non-MCPP cases; 0.75 × 106) and controls (0.60 × 106) (each P < .001). The optimal density for discriminating MCPP cases from controls using the Youden index was >6.9 log10 copies/mL; overall, the sensitivity was 64% and the specificity 92%, with variable performance by site. The threshold was lower (≥4.4 log10 copies/mL) when MCPP cases were distinguished from controls who received antibiotics before specimen collection. Among the 4035 non-MCPP cases, 500 (12%) had pneumococcal colonization density >6.9 log10 copies/mL; above this cutoff was associated with alveolar consolidation at chest radiography, very severe pneumonia, oxygen saturation <92%, C-reactive protein ≥40 mg/L, and lack of antibiotic pretreatment (all P< .001). Conclusions. Pneumococcal colonization density >6.9 log10 copies/mL was strongly associated with MCPP and could be used to improve estimates of pneumococcal pneumonia prevalence in childhood pneumonia studies. Our findings do not support its use for individual diagnosis in a clinical setting.

Item Type: Article
Faculty and Department: Faculty of Epidemiology and Population Health > Dept of Infectious Disease Epidemiology
PubMed ID: 28575365
Web of Science ID: 402298300017


Download activity - last 12 months
Downloads since deposit
Accesses by country - last 12 months
Accesses by referrer - last 12 months
Impact and interest
Additional statistics for this record are available via IRStats2

Actions (login required)

Edit Item Edit Item