Publication: RISK FACTORS AND URINARY ANTIGEN TEST SENSITIVITY AND SPECIFICITY ANALYSIS FOR PAEDIATRIC PNEUMOCOCCAL PNEUMONIA IN THE EAST-COAST OF PENINSULAR MALAYSIA: A CASE-CONTROL STUDY.
Date
2024
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
International Medical University
Abstract
Introduction: The high burden of paediatric pneumonia warrants investigation on its occurrence and risk factors, particularly among children aged five years old and below.
Objectives: To determine the a) risk factors associated with paediatric pneumonia, b) occurrence of PCR positivity, c) sensitivity and specificity of pneumococcal urinary antigen test (UAT) in detecting pneumococcal pneumonia and d) colonisers among children aged five years and below in east-coast of Peninsular Malaysia.
Methods: This case-control study was conducted over two years at the east-coast of Peninsular Malaysia. Cases were hospitalised children ≤5 years old with clinical and radiological diagnosis by sentinel site paediatrician while controls were children without any features suggestive of pneumonia. Nasopharyngeal swab for polymerase chain reaction (PCR) and urine samples for pneumococcal UAT were collected within 24 hours of admission.
Results: Six hundred children, with mean age of 20.99 ± 15.35 months for cases and 21.57 ± 16.96 months for controls, were included in the study. Regression analysis revealed factors associated with pneumococcal pneumonia are children living in household of 3-5 occupants (OR, 1.821; 95%, CI 1.191-2.787, p=0.006), unknown history of hospitalisation (OR, 1.672; 95%, CI 1.034-2.703, p=0.036), and underaged children for vaccination up-to-age (UTA) (OR, 1.552; 95%, CI 1.013-2.378, p=0.044) were found to be significant factors among subjects. PCR testing revealed a positivity rate of 13.5% (n=81) among cases and 5.2% (n=31) among controls, accounting 18.7% (n=112) of all subjects. Additionally, UAT testing showed positivity rate of 8.7% (n=52) cases and 6.8% (n=41) controls, comprising 15.5% (n=93) of the subjects. The sensitivity and specificity of UAT were 38.4% and 89.8% respectively with positive predictive value (PPV) of 46.2% and negative predictive value (NPV) of 86.4%. UAT sensitivity and specificity among cases were 37% and 90% respectively while PPV of 57.7% and NPV of 79.4%. UAT sensitivity and specificity among controls were 41.9% and 89.6% respectively while PPV of 31.7% and NPV of 93.1%.
Conclusion: Emphasise on risk factor prevention should be the preference over clinical management. Surveillance on local aetiology is essential. UAT was found to be an unsuitable rapid tool in diagnosing pneumococcal pneumonia nor detecting colonisers in paediatrics. Thus, research focus on higher valency vaccines production and invention of simpler, rapid, and non-invasive diagnostic method to reduce disease burden and improve disease prognosis.
Description
Keywords
Risk Factors, Pediatrics, Pneumonia, Pneumococcal, Case-Control Studies, Child