{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T03:19:11Z","timestamp":1792811951436,"version":"4.5.0"},"reference-count":31,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2017,7,12]]},"abstract":"<jats:p>Pneumonia is the leading cause of death in children. The objectives were to evaluate the microbiological agents linked with hypoxemia in hospitalized children with pneumonia from developing countries, to identify predictors of hypoxemia, and to characterize factors associated with in-hospital mortality. A multicenter, observational study was conducted in five hospitals, from India (Lucknow, Vadu), Madagascar (Antananarivo), Mali (Bamako), and Paraguay (San Lorenzo). Children aged 2\u201360 months with radiologically confirmed pneumonia were enrolled prospectively. Respiratory and whole blood specimens were collected, identifying viruses and bacteria by real-time multiplex polymerase chain reaction (PCR). Microbiological agents linked with hypoxemia at admission (oxygen saturation &lt; 90%) were analyzed by multivariate logistic regression, and factors associated with 14-day in-hospital mortality were assessed by bivariate Cox regression. Overall, 405 pneumonia cases (3,338 hospitalization days) were analyzed; 13 patients died within 14 days of hospitalization. Hypoxemia prevalence was 17.3%. Detection of human metapneumovirus (hMPV) and respiratory syncytial virus (RSV) in respiratory samples was independently associated with increased risk of hypoxemia (adjusted odds ratio [aOR] = 2.4, 95% confidence interval [95% CI] = 1.0\u20135.8 and aOR = 2.5, 95% CI = 1.1\u20135.3, respectively). Lower chest indrawing and cyanosis were predictive of hypoxemia (positive likelihood ratios = 2.3 and 2.4, respectively). Predictors of death were <jats:italic>Streptococcus pneumoniae<\/jats:italic> detection by blood PCR (crude hazard ratio [cHR] = 4.6, 95% CI = 1.5\u201314.0), procalcitonin \u2265 50 ng\/mL (cHR = 22.4, 95% CI = 7.3\u201368.5) and hypoxemia (cHR = 4.8, 95% CI = 1.6\u201314.4). These findings were consistent on bivariate analysis. hMPV and RSV in respiratory samples were linked with hypoxemia, and <jats:italic>S. pneumoniae<\/jats:italic> in blood was associated with increased risk of death among hospitalized children with pneumonia in developing countries.<\/jats:p>","DOI":"10.4269\/ajtmh.16-0733","type":"journal-article","created":{"date-parts":[[2017,5,2]],"date-time":"2017-05-02T07:00:06Z","timestamp":1493708406000},"page":"68-76","source":"Crossref","is-referenced-by-count":65,"title":["Severity of Pneumonia in Under 5-Year-Old Children from Developing Countries: A Multicenter, Prospective, Observational Study"],"prefix":"10.4269","volume":"97","author":[{"given":"Thomas","family":"B\u00e9net","sequence":"first","affiliation":[{"name":"Laboratoire des Pathog\u00e8nes Emergents, Fondation M\u00e9rieux, Centre International de Recherche en Infectiologie (CIRI), INSERM U1111, CNRS, UMR5308, ENS de Lyon, UCBL1, Lyon, France"},{"name":"Service d'Hygi\u00e8ne, Epid\u00e9miologie et Pr\u00e9vention, H\u00f4pital Edouard Herriot, Hospices Civils de Lyon, Lyon, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valentina Sanchez","family":"Picot","sequence":"additional","affiliation":[{"name":"Laboratoire des Pathog\u00e8nes Emergents, Fondation M\u00e9rieux, Centre International de Recherche en Infectiologie (CIRI), INSERM U1111, CNRS, UMR5308, ENS de Lyon, UCBL1, Lyon, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shally","family":"Awasthi","sequence":"additional","affiliation":[{"name":"Chhatrapati Shahu Ji Maharaj University, Lucknow, India;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nitin","family":"Pandey","sequence":"additional","affiliation":[{"name":"Chhatrapati Shahu Ji Maharaj University, Lucknow, India;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashish","family":"Bavdekar","sequence":"additional","affiliation":[{"name":"KEM Hospital Research Centre, Pune, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anand","family":"Kawade","sequence":"additional","affiliation":[{"name":"KEM Hospital Research Centre, Pune, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annick","family":"Robinson","sequence":"additional","affiliation":[{"name":"H\u00f4pital Femme-M\u00e8re-Enfant, Antananarivo, Madagascar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mala","family":"Rakoto-Andrianarivelo","sequence":"additional","affiliation":[{"name":"Fondation M\u00e9rieux, Centre d'Infectiologie Charles M\u00e9rieux (CICM), Antananarivo, Madagascar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maryam","family":"Sylla","sequence":"additional","affiliation":[{"name":"Gabriel Tour\u00e9 Hospital, Bamako, Mali"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Souleymane","family":"Diallo","sequence":"additional","affiliation":[{"name":"Centre d'Infectiologie Charles M\u00e9rieux (CICM), Bamako, Mali"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Graciela","family":"Russomando","sequence":"additional","affiliation":[{"name":"Health Research Institute, Asuncion, Paraguay"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wilma","family":"Basualdo","sequence":"additional","affiliation":[{"name":"Hospital Pedi\u00e1trico \u201cNi\u00f1os de Acosta \u00d1u,\u201d San Lorenzo, Paraguay"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florence","family":"Komurian-Pradel","sequence":"additional","affiliation":[{"name":"Laboratoire des Pathog\u00e8nes Emergents, Fondation M\u00e9rieux, Centre International de Recherche en Infectiologie (CIRI), INSERM U1111, CNRS, UMR5308, ENS de Lyon, UCBL1, Lyon, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hubert","family":"Endtz","sequence":"additional","affiliation":[{"name":"Laboratoire des Pathog\u00e8nes Emergents, Fondation M\u00e9rieux, Centre International de Recherche en Infectiologie (CIRI), INSERM U1111, CNRS, UMR5308, ENS de Lyon, UCBL1, Lyon, France"},{"name":"Department of Medical Microbiology and Infectious Diseases, Erasmus MC, Rotterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philippe","family":"Vanhems","sequence":"additional","affiliation":[{"name":"Laboratoire des Pathog\u00e8nes Emergents, Fondation M\u00e9rieux, Centre International de Recherche en Infectiologie (CIRI), INSERM U1111, CNRS, UMR5308, ENS de Lyon, UCBL1, Lyon, France"},{"name":"Service d'Hygi\u00e8ne, Epid\u00e9miologie et Pr\u00e9vention, H\u00f4pital Edouard Herriot, Hospices Civils de Lyon, Lyon, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gl\u00e1ucia","family":"Paranhos-Baccal\u00e0","sequence":"additional","affiliation":[{"name":"Laboratoire des Pathog\u00e8nes Emergents, Fondation M\u00e9rieux, Centre International de Recherche en Infectiologie (CIRI), INSERM U1111, CNRS, UMR5308, ENS de Lyon, UCBL1, Lyon, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"_","family":"_","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2795","reference":[{"key":"ref1","series-title":"Lancet","first-page":"430","article-title":"Global, regional, and national causes of child mortality in 2000\u201313, with projections to inform post-2015 priorities: an updated systematic analysis","volume":"385","author":"Liu","year":"2015"},{"key":"ref2","series-title":"Lancet Infect Dis","first-page":"219","article-title":"The prevalence of hypoxaemia among ill children in developing countries: a systematic review","volume":"9","author":"Subhi","year":"2009"},{"key":"ref3","series-title":"Cochrane Database Syst Rev","first-page":"CD005975","article-title":"Oxygen therapy for lower respiratory tract infections in children between 3 months and 15 years of 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