The Prevalence of Pneumocystis in Lung Tissue of Kenyan Children Who Died Following Severe Respiratory Infection

Abstract

Background: Children in Sub-Saharan Africa have a high mortality rate from Severe Acute Respiratory Infection (SARI). The prevalence of Pneumocystis jirovecii in Kenyan children is not known. We aimed to determine the prevalence of Pneumocystis in lung tissue of children below 5 years of age who died following admission for SARIs in Kenyatta National Hospital, a referral hospital in Nairobi. Objectives: To determine the prevalence of Pneumocystis in children who died following SARI over a two year period from January 2015 to December 2016. Histological description was undertaken to identify changes in lung tissue in SARI with emphasis on presence of Pneumocystis. Methods: Methods of 138 children with fatal respiratory infection at Kenyatta National Hospital, 64 consented autopsies were performed. Lung samples were stained with Haematoxylin and eosin (H and E) and Grocott’s Methenamine Silver stain (GMS), to identify Pneumocystis. Results: Pneumocystis has 17% prevalence by GMS in lung samples from children who died following SARI. Children between 0-6 months comprised 41% of the total number autopsied, out of which 31% were positive for Pneumocystis. In the 7-12 month old category only 9% were Pneumocystis positive. Children between 13-24 months comprised 23% of the autopsies, amongst whom 7% showed presence of Pneumocystis. All children who died following admission for SARI in this crosssection were less than 2 years old. Conclusions: Mortality following admission for SARI and prevalence of Pneumocystis decreased with increasing age. A prevalence of 17% Pneumocystis was seen in lung tissue of the 64 children who died following admission for SARI. Pneumocystis colonisation and Pneumocystis Pneumonia should be a consideration in children who present with SARIs particularly in 0-6 month age group, regardless of HIV status. Further studies are warranted to better understand the implication of presence of Pneumocystis in lung biopsies in children for insight into its precise contribution to lung pathology.