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Potential of Minimally Invasive Tissue Sampling for Attributing Specific Causes of Childhood Deaths in South Africa: A Pilot, Epidemiological Study

BACKGROUND: Current estimates for causes of childhood deaths are mainly premised on modeling of vital registration and limited verbal autopsy data and generally only characterize the underlying cause of death (CoD). We investigated the potential of minimally invasive tissue sampling (MITS) for ascer...

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Autores principales: Chawana, Richard, Baillie, Vicky, Izu, Alane, Solomon, Fatima, Bassat, Quique, Blau, Dianna M, Breiman, Robert F, Hale, Martin, Houpt, Eric R, Lala, Sanjay G, Martines, Roosecelis B, Mathunjwa, Azwifarwi, Nzenze, Susan, Pathirana, Jayani, Petersen, Karen L, Raghunathan, Pratima L, Ritter, Jana M, Wadula, Jeannette, Zaki, Sherif R, Madhi, Shabir A
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6785686/
https://www.ncbi.nlm.nih.gov/pubmed/31598659
http://dx.doi.org/10.1093/cid/ciz550
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author Chawana, Richard
Baillie, Vicky
Izu, Alane
Solomon, Fatima
Bassat, Quique
Blau, Dianna M
Breiman, Robert F
Hale, Martin
Houpt, Eric R
Lala, Sanjay G
Martines, Roosecelis B
Mathunjwa, Azwifarwi
Nzenze, Susan
Pathirana, Jayani
Petersen, Karen L
Raghunathan, Pratima L
Ritter, Jana M
Wadula, Jeannette
Zaki, Sherif R
Madhi, Shabir A
author_facet Chawana, Richard
Baillie, Vicky
Izu, Alane
Solomon, Fatima
Bassat, Quique
Blau, Dianna M
Breiman, Robert F
Hale, Martin
Houpt, Eric R
Lala, Sanjay G
Martines, Roosecelis B
Mathunjwa, Azwifarwi
Nzenze, Susan
Pathirana, Jayani
Petersen, Karen L
Raghunathan, Pratima L
Ritter, Jana M
Wadula, Jeannette
Zaki, Sherif R
Madhi, Shabir A
author_sort Chawana, Richard
collection PubMed
description BACKGROUND: Current estimates for causes of childhood deaths are mainly premised on modeling of vital registration and limited verbal autopsy data and generally only characterize the underlying cause of death (CoD). We investigated the potential of minimally invasive tissue sampling (MITS) for ascertaining the underlying and immediate CoD in children 1 month to 14 years of age. METHODS: MITS included postmortem tissue biopsies of brain, liver, and lung for histopathology examination; microbial culture of blood, cerebrospinal fluid (CSF), liver, and lung samples; and molecular microbial testing on blood, CSF, lung, and rectal swabs. Each case was individually adjudicated for underlying, antecedent, and immediate CoD by an international multidisciplinary team of medical experts and coded using the International Classification of Diseases, Tenth Revision (ICD-10). RESULTS: An underlying CoD was determined for 99% of 127 cases, leading causes being congenital malformations (18.9%), complications of prematurity (14.2%), human immunodeficiency virus/AIDS (12.6%), diarrheal disease (8.7%), acute respiratory infections (7.9%), injuries (7.9%), and malignancies (7.1%). The main immediate CoD was pneumonia, sepsis, and diarrhea in 33.9%, 19.7%, and 10.2% of cases, respectively. Infection-related deaths were either an underlying or immediate CoD in 78.0% of cases. Community-acquired pneumonia deaths (n = 32) were attributed to respiratory syncytial virus (21.9%), Pneumocystis jirovecii (18.8%), cytomegalovirus (15.6%), Klebsiella pneumoniae (15.6%), and Streptococcus pneumoniae (12.5%). Seventy-one percent of 24 sepsis deaths were hospital-acquired, mainly due to Acinetobacter baumannii (47.1%) and K. pneumoniae (35.3%). Sixty-two percent of cases were malnourished. CONCLUSIONS: MITS, coupled with antemortem clinical information, provides detailed insight into causes of childhood deaths that could be informative for prioritization of strategies aimed at reducing under-5 mortality.
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spelling pubmed-67856862019-10-15 Potential of Minimally Invasive Tissue Sampling for Attributing Specific Causes of Childhood Deaths in South Africa: A Pilot, Epidemiological Study Chawana, Richard Baillie, Vicky Izu, Alane Solomon, Fatima Bassat, Quique Blau, Dianna M Breiman, Robert F Hale, Martin Houpt, Eric R Lala, Sanjay G Martines, Roosecelis B Mathunjwa, Azwifarwi Nzenze, Susan Pathirana, Jayani Petersen, Karen L Raghunathan, Pratima L Ritter, Jana M Wadula, Jeannette Zaki, Sherif R Madhi, Shabir A Clin Infect Dis Supplement Articles BACKGROUND: Current estimates for causes of childhood deaths are mainly premised on modeling of vital registration and limited verbal autopsy data and generally only characterize the underlying cause of death (CoD). We investigated the potential of minimally invasive tissue sampling (MITS) for ascertaining the underlying and immediate CoD in children 1 month to 14 years of age. METHODS: MITS included postmortem tissue biopsies of brain, liver, and lung for histopathology examination; microbial culture of blood, cerebrospinal fluid (CSF), liver, and lung samples; and molecular microbial testing on blood, CSF, lung, and rectal swabs. Each case was individually adjudicated for underlying, antecedent, and immediate CoD by an international multidisciplinary team of medical experts and coded using the International Classification of Diseases, Tenth Revision (ICD-10). RESULTS: An underlying CoD was determined for 99% of 127 cases, leading causes being congenital malformations (18.9%), complications of prematurity (14.2%), human immunodeficiency virus/AIDS (12.6%), diarrheal disease (8.7%), acute respiratory infections (7.9%), injuries (7.9%), and malignancies (7.1%). The main immediate CoD was pneumonia, sepsis, and diarrhea in 33.9%, 19.7%, and 10.2% of cases, respectively. Infection-related deaths were either an underlying or immediate CoD in 78.0% of cases. Community-acquired pneumonia deaths (n = 32) were attributed to respiratory syncytial virus (21.9%), Pneumocystis jirovecii (18.8%), cytomegalovirus (15.6%), Klebsiella pneumoniae (15.6%), and Streptococcus pneumoniae (12.5%). Seventy-one percent of 24 sepsis deaths were hospital-acquired, mainly due to Acinetobacter baumannii (47.1%) and K. pneumoniae (35.3%). Sixty-two percent of cases were malnourished. CONCLUSIONS: MITS, coupled with antemortem clinical information, provides detailed insight into causes of childhood deaths that could be informative for prioritization of strategies aimed at reducing under-5 mortality. Oxford University Press 2019-10-15 2019-10-09 /pmc/articles/PMC6785686/ /pubmed/31598659 http://dx.doi.org/10.1093/cid/ciz550 Text en © The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America. http://creativecommons.org/licenses/by/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Supplement Articles
Chawana, Richard
Baillie, Vicky
Izu, Alane
Solomon, Fatima
Bassat, Quique
Blau, Dianna M
Breiman, Robert F
Hale, Martin
Houpt, Eric R
Lala, Sanjay G
Martines, Roosecelis B
Mathunjwa, Azwifarwi
Nzenze, Susan
Pathirana, Jayani
Petersen, Karen L
Raghunathan, Pratima L
Ritter, Jana M
Wadula, Jeannette
Zaki, Sherif R
Madhi, Shabir A
Potential of Minimally Invasive Tissue Sampling for Attributing Specific Causes of Childhood Deaths in South Africa: A Pilot, Epidemiological Study
title Potential of Minimally Invasive Tissue Sampling for Attributing Specific Causes of Childhood Deaths in South Africa: A Pilot, Epidemiological Study
title_full Potential of Minimally Invasive Tissue Sampling for Attributing Specific Causes of Childhood Deaths in South Africa: A Pilot, Epidemiological Study
title_fullStr Potential of Minimally Invasive Tissue Sampling for Attributing Specific Causes of Childhood Deaths in South Africa: A Pilot, Epidemiological Study
title_full_unstemmed Potential of Minimally Invasive Tissue Sampling for Attributing Specific Causes of Childhood Deaths in South Africa: A Pilot, Epidemiological Study
title_short Potential of Minimally Invasive Tissue Sampling for Attributing Specific Causes of Childhood Deaths in South Africa: A Pilot, Epidemiological Study
title_sort potential of minimally invasive tissue sampling for attributing specific causes of childhood deaths in south africa: a pilot, epidemiological study
topic Supplement Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6785686/
https://www.ncbi.nlm.nih.gov/pubmed/31598659
http://dx.doi.org/10.1093/cid/ciz550
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