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Identifying Pediatric Pneumocystis jirovecii Pneumonia in High HIV Prevalence Settings: Simple and Accurate Diagnostics

This study aims to develop a clinical algorithm for timely identification of pediatric Pneumocystis jirovecii pneumonia (PcP) cases in high HIV prevalence settings without laboratory support. It highlights the importance of PcP diagnosis in HIV+ children and recommends high dose Cotrimoxazole therapy for treatment.

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Identifying Pediatric Pneumocystis jirovecii Pneumonia in High HIV Prevalence Settings: Simple and Accurate Diagnostics

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  1. Capturing Pneumocystis jirovecii pneumonia in High HIV Prevalence Settings: Simple and accurate identification of paediatric PcP cases for timely treatment in resource poor environments. Danielle Mielnik Centre For International Child Health, Melbourne Australian National University, Canberra

  2. A Little Background • 20-30% all deaths <5 yrs due to ARI • 90% due specifically to pneumonia • Almost 99% occur in developing countries • HIV is a major factor • PcP is a common infection in HIV+ children

  3. Why is PcP Important • PcP is often an AIDs defining illness • PcP does not respond to standard pneumonia antibiotic therapy • Normally requires laboratory diagnosis • High mortality • WHO recommendation: High dose Cotrimoxazole (CTX) therapy for children<5yrs with severe or very severe pneumonia in high HIV settings • CTX prophylaxis is recommended by WHO for all HIV exposed children

  4. Aim • To develop a clinical algorithm to accurately and swiftly identify children with PcP infection in high HIV environments without laboratory support

  5. The Study • 438 children recruited consecutively from admissions to a tertiary referral hospital • 2 Cohorts: 1996 & 2006 • All children had either severe or very severe pneumonia • 7.3% (32/438) Laboratory confirmed PcP • Comparison of clinical characteristics of PcP and bacterial infections. • Designed clinical diagnostic algorithms • Compared to lab diagnosis

  6. PcP in the Study Population • 93.3% (30/32) of all children with PcP were <6mth of age • 14.7% (29/197) of HIV+ children had PcP • Odds of dying were 3 times greater in children with HIV • Odds of dying were 7 times greater in HIV+ children with PcP compared to bacterial pneumonia

  7. Age of Children by Diagnosis

  8. Diagnostic Algorithm

  9. Example: Theoretical Cohort of 1000 Children • 66/73 correctly identified with PcP • 7/73 missed • 551 children avoid unnecessary treatment

  10. Recommendation High dose Cotrimoxazole for children <6mths Benefits: • Reduced treatment costs • Most PcP children easily identified • Enables swift treatment initiation

  11. Improvements needed • Development of accurate and cheap rapid HIV tests • Widespread adoption of Cotrimoxazole prophylaxis in high HIV settings • Programs aimed at reducing mother to child HIV transmission

  12. Acknowledgements • Australian Government Department of Health and Aging • NCEPH • Centre for International Child Health • Steve Graham • Supervisors: • Kamalini Lokuge • Sophie La Vincente Photographs: Kristen Ashburn “I Am Because We Are”

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