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Invasive Pneumococcal Infections in Children with Nephrotic Syndrome in Bangladesh

Malaker, Roly MS*; Saha, Senjuti PhD*,†; Hanif, Mohammed FCPS; Ahmed, ASMNU FCPS*,‡; Saha, Shampa MPH*; Hasanuzzaman, Md. MS*; Khondakar, Tarannum FCPS; Islam, Maksuda BA*; Baqui, Abdullah H. DrPH§; Santosham, Mathuram MD§; Darmstadt, Gary L. MD; Whitney, Cynthia G. MD; Saha, Samir K. PhD*,‡

The Pediatric Infectious Disease Journal: August 2019 - Volume 38 - Issue 8 - p 798–803
doi: 10.1097/INF.0000000000002386
Original Studies

Introduction: Children with nephrotic syndrome are susceptible to invasive bacterial infections. In this study, we aimed to: (1) determine the pathogens associated with infections in children with nephrotic syndrome and (2) describe antimicrobial susceptibility and serotype distribution of Streptococcus pneumoniae to guide evidence-based treatment and prevention policies.

Methods: From June 2013 to March 2015, we collected blood and/or ascitic fluid from children hospitalized with nephrotic syndrome and suspected bacterial disease in the largest pediatric hospital of Bangladesh. We cultured all samples and performed polymerase chain reaction (PCR) and immunochromatographic test on ascitic fluid for detection of S. pneumoniae. Pneumococcal isolates were tested for antibiotic susceptibility using disc diffusion and serotyped using Quellung reaction and PCR.

Results: We identified 1342 children hospitalized with nephrotic syndrome. Among them, 608 children had suspected bacterial disease from whom blood and/or ascitic fluid were collected. A pathogen was identified in 8% (48/608) of cases, 94% (45/48) of which were S. pneumoniae. Most (73%, 33/45) pneumococcal infections were identified through culture of blood and ascitic fluid and 27% (12/45) through immunochromatographic test and PCR of ascitic fluid. In total, 24 different pneumococcal serotypes were detected; 51% are covered by PCV10 (+6A), 53% by PCV13 and 60% by PPSV23. All pneumococcal isolates were susceptible to penicillin.

Conclusions: Because S. pneumoniae was the primary cause of invasive infections, pneumococcal vaccines may be considered as a preventive intervention in children with nephrotic syndrome. Additionally, penicillin can be used to prevent and treat pneumococcal infections in children with nephrotic syndrome in Bangladesh.

From the *Child Health Research Foundation, Department of Microbiology, Dhaka Shishu Hospital, Dhaka, Bangladesh

Department of Infectious Diseases, Stanford University School of Medicine, Stanford, California

Bangladesh Institute of Child Health, Dhaka Shishu Hospital, Dhaka, Bangladesh

§Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland

Department of Pediatrics, Stanford University School of Medicine, Stanford, California

Centers for Disease Control and Prevention, Atlanta, Georgia.

Accepted for publication April 1, 2019.

S.K.S. has received grants from GlaxoSmithKline, Sanofi Pasteur, and Pfizer outside the scope of this work. A.H.B. has received grants from GlaxoSmithKline outside the scope of this work. M.S. has served on the scientific advisory committees of GlaxoSmithKline and Pfizer and also accepted honoraria for speaking engagements for both the companies outside the scope of this work. The other authors have no conflicts of interest to disclose.

Presentated at the International Symposium on Pneumococci and Pneumococcal Diseases, ISPPD-10; 2016; Glasgow, Scotland.

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Address for correspondence: Samir K. Saha, PhD, Department of Microbiology, Dhaka Shishu Hospital, Child Health Research Foundation, Sher-E-Bangla Nagar, Dhaka 1207, Bangladesh.

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