Pneumococcal Carriage Among HIV Positive Children At The Korle-Bu Teaching Hospital

ABSTRACT

Background: The pneumococcus is carried as a normal flora of the upper respiratory tract and carriage is the precursor for development of pneumococcal disease, and is also responsible for pneumococcal transmission from person-to-person. HIV positive children have about forty times greater risk of invasive pneumococcal disease compared to healthy children. In Africa, little is known about the pneumococcus in relation to people with HIV infection.

Aim: The aim of the study was to investigate the epidemiology of pneumococcal carriage among HIV positive children at the Korle-Bu Teaching Hospital.

Method: One hundred and eighteen HIV positive children were recruited at the Korle-Bu Teaching Hospital in Accra and nasopharyngeal swabs were collected from them. The specimens were cultured for S. pneumoniae and other bacteria, and isolates were identified by standard microbiological methods. Antibiotic susceptibility testing was carried out on S. pneumoniae isolates by the Kirby Bauer method. Epidemiological data on demographic, household and clinical features of the study participant were collected.

Results: Bacterial agents isolated from the study subjects included Moraxella catarrhalis (39.8%), coagulase negative staphylococci (33.1%), Streptococcus pneumoniae (30.5%), viridans streptococci (27.1%), diptheroids (29.7%), Staphylococcus aureus (22.0%), Citrobacter spp. (4.2%) and Neisseria meningitidis (0.9%). Pneumococcal carriage among different age groups were 33.3% ( 9 years). The only determinant of pneumococcal carriage among the study participants was the presence of respiratory symptoms (p=0.008). Pneumococcal resistance, to the various antibiotics tested, were to cotrimoxazole (58.3%), tetracycline (33.3%), erythromycin (33.3%), oxacillin (27.8%) and ceftriaxone (5.6%).

Conclusion: About a third of the HIV positive children carried the pneumococcus as normal flora in the nasopharynx and carriage appears to be unaffected by demographic and household characteristics. The presence of respiratory symptoms may probably be the main risk factor of pneumococcal carriage among HIV positive children. Ceftriaxone may be a relatively suitable antibiotic for treating pneumococcal infections among HIV positive children in Accra.