Journal of Immigrant and Minority Health

, Volume 14, Issue 1, pp 140–145 | Cite as

Epidemiology of Respiratory Infections Caused by Atypical Bacteria in Two Kenyan Refugee Camps

  • Curi Kim
  • Raymond Nyoka
  • Jamal A. Ahmed
  • Jonas M. Winchell
  • Stephanie L. Mitchell
  • M. Kariuki Njenga
  • Erick Auko
  • Wagacha Burton
  • Robert F. Breiman
  • Rachel B. Eidex
Original Paper

Abstract

Chlamydia pneumoniae, Mycoplasma pneumoniae, and Legionella spp. are common causes of atypical pneumonia; however, data about these atypical pathogens are limited in the refugee setting. Paired nasopharyngeal and oropharyngeal specimens were collected from patients with respiratory illness presenting to healthcare centers in two refugee camps in Kenya. The specimens were tested for C. pneumoniae, M. pneumoniae, and Legionella spp. as well as eight respiratory viruses. Atypical pathogens were detected in 5.5% of the specimens of which 54% were co-infected with at least one of the eight viruses tested. Patients positive for atypical bacteria co-infected with virus were significantly more likely to have severe acute respiratory illness than patients infected with only atypical bacteria (P = 0.04). While the percentage of atypical pathogens identified was lower than expected, we found a significant relationship between atypical bacterial-viral co-infection and severity of disease in this refugee population.

Keywords

Refugee health Atypical bacteria Atypical pneumonia PCR 

Notes

Acknowledgments

We gratefully acknowledge Ms. Shifaq Kamili, Mr. George Gallucci, Ms. Xiaoyan Lu, and Dr. Melisa Willby for laboratory technical assistance in testing performed at CDC-Atlanta; and the International Rescue Committee and Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH for technical support in the field. We also thank Drs. Dean Erdman and Mark Katz for their review of the manuscript and helpful suggestions. This manuscript is published with permission of the director of the Kenya Medical Research Institute.

References

  1. 1.
    Cunha BA. The atypical pneumonias: clinical diagnosis and importance. Clin Microbiol Infect. 2006;12(Suppl 3):12–24.PubMedCrossRefGoogle Scholar
  2. 2.
    Principi N, Esposito S. Emerging role of Mycoplasma pneumoniae and Chlamydia pneumoniae in paediatric respiratory-tract infections. Lancet Infect Dis. 2001;1(5):334–44.PubMedCrossRefGoogle Scholar
  3. 3.
    Gray GC, Rodie GR, Matras-Maslin VC, Honein MA, Ismail EA, Botros BA, Soliman AK, Merrell BR, Wang SP, Grayston JT. Serologic evidence of respiratory and rickettsial infections among Somali refugees. Am J Trop Med Hyg. 1995;52(4):349–53.PubMedGoogle Scholar
  4. 4.
    World Health Organization: WHO Regional Office for Europe guidance for influenza surveillance in humans. Available from: http://www.euro.who.int/__data/assets/pdf_file/0020/90443/E92738.pdf (2009).
  5. 5.
    World Health Organization: IMCI integrated management of childhood illness. Available from: http://whqlibdoc.who.int/publications/2005/9241546441.pdf (2005).
  6. 6.
    Winchell JM, Thurman KA, Mitchell SL, Thacker WL, Fields BS. Evaluation of three real-time PCR assays for detection of Mycoplasma pneumoniae in an outbreak investigation. J Clin Microbiol. 2008;46(9):3116–8.PubMedCrossRefGoogle Scholar
  7. 7.
    Olsen SJ, Thamthitiwat S, Chantra S, Chittaganpitch M, Fry AM, Simmerman JM, Baggett HC, Peret TC, Erdman D, Benson R, Talkington D, Thacker L, Tondella ML, Winchell J, Fields B, Nicholson WL, Maloney S, Peruski LF, Ungchusak K, Sawapanyalert P, Dowell SF. Incidence of respiratory pathogens in persons hospitalized with pneumonia in two provinces in Thailand. Epidemiol Infect. 2010;138(12):1811–22.PubMedCrossRefGoogle Scholar
  8. 8.
    Bii CC, Yamaguchi H, Kai M, Nagai K, Sugiura Y, Taguchi H, Chakaya JM, Mbugua GG, Kamiya H. Mycoplasma pneumoniae in children with pneumonia at Mbagathi District Hospital, Nairobi. East Afr Med J. 2002;79(6):317–22.PubMedGoogle Scholar
  9. 9.
    Peng D, Zhao D, Liu J, Wang X, Yang K, Xicheng H, Li Y, Wang F. Multipathogen infections in hospitalized children with acute respiratory infections. Virol J. 2009;6:155.PubMedCrossRefGoogle Scholar
  10. 10.
    Michelow IC, Olsen K, Lozano J, Rollins NK, Duffy LB, Ziegler T, Kauppila J, Leinonen M, McCracken GH. Epidemiology and clinical characteristics of community-acquired pneumonia in hospitalized children. Pediatrics. 2004;113(4):701–7.PubMedCrossRefGoogle Scholar
  11. 11.
    Marrie TJ, Peeling RW, Fine MJ, Singer DE, Coley CM, Kapoor WN. Ambulatory patients with community-acquired pneumonia: the frequency of atypical agents and clinical course. Am J Med. 1996;101(5):508–15.PubMedCrossRefGoogle Scholar
  12. 12.
    Principi N, Esposito S, Blasi F, Allegra L. Role of Mycoplasma pneumoniae and Chlamydia pneumoniae in children with community-acquired lower respiratory tract infections. Clin Infect Dis. 2001;32(9):1281–9.PubMedCrossRefGoogle Scholar
  13. 13.
    Parry E, Godfrey R, Mabey D, Gill G. Principles of medicine in Africa. 3rd ed. Cambridge: Cambridge University Press; 2004.Google Scholar
  14. 14.
    Pereira HG. Persistent infection by adenoviruses. J Clin Pathol Suppl (R Coll Pathol). 1972;6:39–42.Google Scholar
  15. 15.
    Drews AL, Atmar RL, Glezen WP, Baxter BD, Piedra PA, Greenberg SB. Dual respiratory virus infections. Clin Infect Dis. 1997;25(6):1421–9.PubMedCrossRefGoogle Scholar
  16. 16.
    Aberle JH, Pracher E, Hutter HP, Kundi M, Popow-Kraupp T. Single versus dual respiratory virus infections in hospitalized infants: impact on clinical course of disease and interferon-gamma response. Pediatr Infect Dis J. 2005;24(7):605–10.PubMedCrossRefGoogle Scholar
  17. 17.
    Cilla G, Onate E, Perez-Yarza EG, Montes M, Vicente D, Perez-Trallero E. Viruses in community-acquired pneumonia in children aged less than 3 years old: high rate of viral coinfection. J Med Virol. 2008;80(10):1843–9.PubMedCrossRefGoogle Scholar
  18. 18.
    ARUP Laboratories: ARUP Consult. Content version. 3.9 ed. Available from: http://www.arupconsult.com.

Copyright information

© Springer Science+Business Media, LLC (Outside the USA) 2011

Authors and Affiliations

  • Curi Kim
    • 1
  • Raymond Nyoka
    • 2
  • Jamal A. Ahmed
    • 2
  • Jonas M. Winchell
    • 1
  • Stephanie L. Mitchell
    • 1
  • M. Kariuki Njenga
    • 2
  • Erick Auko
    • 3
  • Wagacha Burton
    • 4
  • Robert F. Breiman
    • 2
  • Rachel B. Eidex
    • 2
  1. 1.U.S. Centers for Disease Control and Prevention (CDC)AtlantaUSA
  2. 2.CDC-KenyaKEMRI ComplexVillage Market, NairobiKenya
  3. 3.Kenya Medical Research Institute (KEMRI)NairobiKenya
  4. 4.United Nations High Commissioner for RefugeesNairobiKenya

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