THE ETIOLOGY OF PNEUMONIA IN MALNOURISHED AND WELL-NOURISHED GAMBIAN CHILDREN

During a a-year period 159 malnourished children ages 3 months to 5 ye ars with radiologic evidence of pneumonia were investigated to determi ne the cause of their pneumonia. In addition 119 malnourished children without pneumonia, 119 well-nourished children with pneumonia and 52 well-nourished children without pneumonia were studied as controls. Pe rcutaneous lung aspiration was performed on 35 malnourished and 59 wel l-nourished children with pneumonia. Bacteria were isolated from the b lood, lung or pleural fluid of 28 (18%) malnourished children with pne umonia, 42 (35%) well-nourished children with pneumonia and from the b lood of 5 (4%) malnourished children without pneumonia. Streptococcus pneumoniae and Haemophilus influenzae, which were the two organisms is olated most frequently in both groups of children with pneumonia, were found in 17 (11%) malnourished and 39 (33%) well-nourished children w ith pneumonia. Mycobacterium tuberculosis was detected in 5 malnourish ed children with pneumonia. A potentially pathogenic virus was identif ied in 35% of malnourished children with pneumonia and 40% of well-nou rished children with pneumonia, and from 25% of children without pneum onia. The viruses identified most frequently were adenovirus and respi ratory syncytial virus. There were 26 viral isolates from lung aspirat e specimens. Respiratory syncytial virus was more frequently isolated from well-nourished children, while herpes simplex was more often foun d in malnourished children. Both bacterial and viral agents were ident ified in 25 children. In situations where measles and kwashiorkor are uncommon, the likely bacterial causes of community-acquired pneumonia in both well-nourished and malnourished children are S. pneumoniae and H. influenzae but, in malnourished children, particularly those with edema, the possibility of other causes, particularly M. tuberculosis, must always be kept in mind.