Table 2.
Characteristics Associated With Whole-Blood Pneumococcal Polymerase Chain Reaction Load in Human Immunodeficiency Virus–Uninfected Cases and Controls at All Sites
| Characteristic | Pneumococcal Blood PCR Load (Log10 Copies/mL) | MCPPa Cases (n = 43) | Nonconfirmed Cases (n = 3621) | Nonconfirmed CXR+b Cases (n = 1601) | Confirmed Nonpneumococcal Casesc (n = 93) | Controls (n = 4779) | |||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| No. (%d) | P Valuee | No. (%) | P Value | No. (%) | P Value | No. (%) | P Value | No. (%) | P Value | ||
| Total (column %d) | 0 | 17 (39.5) | 3402 (94.0) | 1493 (93.3) | 84 (90.3) | 4525 (94.7) | |||||
| <2.2 | 1 (2.3) | 72 (2.0) | 34 (2.1) | 2 (2.2) | 110 (2.3) | ||||||
| 2.2–3.5 | 11 (25.6) | 117 (3.2) | 59 (3.7) | 5 (5.4) | 131 (2.7) | ||||||
| ≥3.5 | 14 (32.6) | 30 (0.8) | 15 (0.9) | 2 (2.2) | 13 (0.3) | ||||||
| Female sex (row %d) | 0 | 5 (29.4) | .04 | 1420 (41.7) | .61 | 649 (43.5) | .47 | 49 (58.3) | .74 | 2240 (49.5) | .16 |
| <2.2 | 0 (0.0) | 25 (34.7) | 12 (35.3) | 1 (50.0) | 65 (59.1) | ||||||
| 2.2–3.5 | 4 (36.4) | .08 | 50 (42.7) | .60 | 30 (50.8) | .30 | 4 (80.0) | .63 | 69 (52.7) | .39 | |
| ≥3.5 | 10 (71.4) | 11 (36.7) | 7 (46.7) | 0 (0.0) | 7 (53.8) | ||||||
| At least 1 dose of PCVf (row %) | 0 | 14 (82.4) | .69 | 1730 (52.7) | .002 | 788 (54.6) | .09 | 37 (45.7) | .33 | 2190 (49.6) | <.001 |
| <2.2 | 1 (100) | 45 (64.3) | 24 (72.7) | 2 (100) | 83 (77.6) | ||||||
| 2.2–3.5 | 6 (60.0) | .71 | 71 (64.0) | >.99 | 33 (60.0) | .53 | 2 (50.0) | >.99 | 99 (78.6) | >.99 | |
| ≥3.5 | 11 (78.6) | 19 (65.5) | 10 (66.7) | 1 (100) | 10 (76.9) | ||||||
| Preceding antibioticsg (row %) | 0 | 3 (17.6) | .34 | 1283 (39.4) | .91 | 581 (40.8) | .04 | 39 (48.1) | .63 | 78 (1.8) | .05 |
| <2.2 | 0 (0.0) | 23 (34.3) | 12 (36.4) | 2 (100) | 2 (1.9) | ||||||
| 2.2–3.5 | 3 (27.3) | .71 | 46 (40.7) | .51 | 28 (50.0) | .05 | 1 (20.0) | .63 | 5 (3.9) | .23 | |
| ≥3.5 | 4 (33.3) | 12 (41.4) | 10 (66.7) | 1 (50.0) | 1 (7.7) | ||||||
| Pneumococcal NP/ OP PCR load >6.9 log10 copies/mL (row %) | 0 | 10 (62.5) | .71 | 379 (11.3) | <.001 | 175 (11.9) | <.001 | 22 (26.8) | .46 | 344 (7.8) | .37 |
| <2.2 | 0 (0.0) | 11 (15.5) | 8 (24.2) | 0 (0.0) | 10 (9.2) | ||||||
| 2.2–3.5 | 8 (80.0) | > .99 | 20 (17.4) | .09 | 12 (20.7) | .24 | 1 (25.0) | > .99 | 13 (10.0) | > .99 | |
| ≥3.5 | 9 (64.3) | 10 (33.3) | 7 (46.7) | 0 (0.0) | 1 (7.7) | ||||||
| Very severe pneumonia (row %) | 0 | 8 (47.1) | .56 | 1064 (31.3) | .04 | 423 (28.3) | .018 | 37 (44.0) | > .99 | … | |
| <2.2 | 1 (100) | 23 (31.9) | 9 (26.5) | 2 (100) | … | ||||||
| 2.2–3.5 | 7 (63.6) | .73 | 42 (35.9) | 0.13 | 24 (40.7) | .13 | 3 (60.0) | .16 | … | ||
| ≥3.5 | 8 (57.1) | 15 (50.0) | 7 (46.7) | 0 (0.0) | … | ||||||
| CXR+ (row %) | 0 | 14 (100) | .02 | 1493 (51.2) | .05 | 1493 (100) | 41 (62.1) | .59 | … | ||
| <2.2 | 1 (100) | 34 (50.0) | 34 (100) | 0 (0.0) | … | ||||||
| 2.2–3.5 | 7 (87.5) | .40 | 59 (59.0) | .14 | 59 (100) | 3 (60.0) | .52 | … | |||
| ≥3.5 | 7 (63.6) | 15 (68.2) | 15 (100) | 2 (100) | … | ||||||
| CXR with alveolar consolidation (row %) | 0 | 11 (78.6) | .13 | 678 (23.3) | <.001 | 678 (45.4) | <.001 | 28 (42.4) | > .99 | … | |
| <2.2 | 1 (100) | 16 (23.5) | 16 (47.1) | 0 (0.0) | … | ||||||
| 2.2–3.5 | 6 (75.0) | .26 | 38 (38.0) | <.001 | 38 (64.4) | .003 | 2 (40.0) | > .99 | … | ||
| ≥3.5 | 5 (45.5) | 14 (63.6) | 14 (93.3) | 1 (50.0) | … | ||||||
| Hypoxemia (row %) | 0 | 4 (23.5) | .23 | 1220 (35.9) | .20 | 637 (42.7) | .78 | 43 (51.8) | .07 | … | |
| <2.2 | 0 (0.0) | 19 (26.4) | 13 (38.2) | 1 (50.0) | … | ||||||
| 2.2–3.5 | 5 (45.5) | > .99 | 54 (46.2) | .11 | 28 (47.5) | .77 | 1 (20.0) | .61 | … | ||
| ≥3.5 | 6 (42.9) | 11 (36.7) | 4 (26.7) | 0 (0.0) | … | ||||||
| CRP ≥40 mg/L (row %) | 0 | 12 (75) | .23 | 726 (24.7) | <.001 | 413 (31.8) | <.001 | 53 (72.6) | .79 | … | |
| <2.2 | 1 (100) | 18 (29.0) | 13 (41.9) | 0 (0.0) | … | ||||||
| 2.2–3.5 | 8 (100) | .58 | 38 (38.8) | <.001 | 22 (44.0) | .06 | 2 (100) | > .99 | … | ||
| ≥3.5 | 9 (90.0) | 17 (73.9) | 10 (83.3) | 1 (50.0) | … | ||||||
| WBC count >15/mm3 (row %) | 0 | 9 (52.9) | .48 | 1208 (37.2) | .19 | 581 (40.9) | .91 | 34 (42) | .32 | … | |
| <2.2 | 1 (100) | 25 (37.9) | 12 (40.0) | 0 (0.0) | … | ||||||
| 2.2–3.5 | 5 (50.0) | .49 | 39 (35.1) | .26 | 25 (44.6) | .75 | 2 (40.0) | > .99 | … | ||
| ≥3.5 | 5 (38.5) | 6 (21.4) | 4 (28.6) | 0 (0.0) | … | ||||||
| Died in hospital (row %) | 0 | 3 (17.6) | .34 | 174 (5.1) | .03 | 70 (4.7) | .09 | 24 (28.6) | .85 | … | |
| <2.2 | 0 (0.0) | 2 (2.8) | 2 (5.9) | 2 (100) | … | ||||||
| 2.2–3.5 | 2 (18.2) | .45 | 10 (8.5) | .05 | 3 (5.1) | .26 | 2 (40.0) | .16 | … | ||
| ≥3.5 | 5 (35.7) | 4 (13.3) | 3 (20.0) | 0 (0.0) | … | ||||||
Table excludes human immunodeficiency virus (HIV)–infected children; children with unknown HIV status are included.
Abbreviations: CRP, C-reactive protein; CXR, chest radiograph; MCPP, microbiologically confirmed pneumococcal pneumonia; NP/OP, nasopharyngeal/oropharyngeal; PCR, polymerase chain reaction; PCV, pneumococcal conjugate vaccine; WBC, white blood cell; …, not applicable for controls.
aMCPP defined as pneumococcus isolated from culture of blood, lung aspirate, pleural fluid, PCR of lung aspirate or pleural fluid, or detection of Streptococcus pneumoniae antigen on BinaxNOW testing of pleural fluid.
bCXR positive (CXR+) defined as radiographic evidence of pneumonia (consolidation and/or other infiltrates).
cCase with any nonpneumococcal bacterial pathogen detected by blood culture, by lung aspirate culture or PCR, or by pleural fluid culture or PCR.
dPercentages in the “Total” row represent column percentages. In all subsequent rows, the number and percentage represent children in the corresponding case/control group and whole-blood pneumococcal load category who had the characteristic.
eTest for trend from Cochran-Armitage in binomial proportions: The first P value listed is across all 4 whole-blood PCR quantity categories and the second P value is across the last 3 PCR quantity categories for which pneumococcus was detected in the blood.
fFour sites had introduced PCV prior to start of enrollment: Kenya, The Gambia, Mali, and South Africa. Results restricted to PCV-using sites only are shown in Supplementary Table 4A, where there was no longer an association observed among controls.
gPrior antibiotic use defined as serum bioassay positive (cases and controls), antibiotic administration at the referral facility, or antibiotic administration prior to whole-blood specimen collection at the study facility (cases only).