D. Lehmann et al., Bacterial and viral etiology of severe infection in children less than three months old in the highlands of Papua New Guinea, PEDIAT INF, 18(10), 1999, pp. S42-S49
Objective. Determine the bacterial and viral etiology of severe infection i
n young Papua New Guinean infants as part of a multicenter study in four de
veloping countries aimed at improving case management guidelines.
Methods. Between March, 1991, and April, 1993, children aged <3 months were
recruited at the outpatient department of Goroka Base Hospital, Papua New
Guinea (PNG). Children with predefined inclusion criteria were enrolled, a
history was taken and clinical examination was performed. Blood and urine w
ere collected from children with signs suggestive of severe disease togethe
r with eye, umbilical and pernasal swabs as appropriate. Nasopharyngeal asp
irates (NPAs) were collected from children with and without signs of severe
disease for identification of viruses and Chlamydia trachomatis by direct
fluorescent antibody staining.
Results. 3280 infants were triaged and 2168 enrolled, among whom 968 had si
gns suggestive of severe disease. Group A Streptococcus (Streptococcus pyog
enes) and Staphylococcus aureus were the most important bacterial pathogens
isolated from children <1 month old with severe infections, and Streptococ
cus pneumoniae, S. pyogenes and Staphylococcus aureus were most important i
n older children. Of 292 eye swabs 19 (7%) grew Neisseria gonorrhoeae. Of 1
16 umbilical swabs 51 (44%) grew S. pyogenes and 45 (39%) grew Staphylococc
us aureus. Respiratory syncytial virus was the most important viral cause o
f acute lower respiratory infection.
Conclusions, S, pyogenes, S. pneumoniae and Staphylococcus aureus are impor
tant causes of severe infection in young children in the PNG; highlands. It
is necessary to improve access to clean water, promote hand-washing in the
hospital and at home and investigate further the use of maternal immunizat
ion for the prevention of severe disease in young infants.