Journal of the Pediatric Infectious Diseases Society BRIEF REPORT • JPIDS 2019:8 (September) • 361 BRIEF REPORT Respiratory Pathogens in Children 1 Month to 5 Years of Age Presenting With Undiferentiated Acute Respiratory Distress in 2 District-Level Hospitals in Ghana Patrick T. Wilson, 1,2 Frank Baiden, 3 Joshua C. Brooks, 4 Katie M. Giessler, 5 Gavin Apio, 6 Damien Punguyire, 7 Rachel T. Moresky, 8,9 Justice Sylverken, 10 Kwadwo Nyarko-Jectey, 11 Harry Tagbor, 12 and Philip S. LaRussa 1 1 Department of Pediatrics, Columbia University Medical Center, New York, New York; 3 Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, United Kingdom; 4 School of Medicine, University of Queensland-Ochsner, Brisbane, Australia; 5 Institute of Global Health Sciences, University of California San Francisco; 6 Kintampo Municipal Hospital, Kintampo, Ghana; 7 Municipal Health Directorate, Techiman, Ghana; 8 sidHARTe Strengthening Emergency Systems Programs, 2 Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, New York; 9 Department of Emergency Medicine, College of Physicians and Surgeons, Columbia University, New York, New York; 10 Department of Pediatrics, Komfo Anokye Teaching Hospital, Kumasi, Ghana; 11 Mampong Municipal Hospital, Mampong, Ghana; and 12 School of Medicine, University of Health and Allied Sciences, Ho, Ghana Ghanaian children (2176) aged <5 years who presented with undiferentiated acute respiratory distress were tested for res- piratory pathogens using a BioFire FilmArray polymerase chain reaction assay. Rhinovirus and/or enterovirus was detected in 36% of the assays, respiratory syncytial virus in 11%, and parainfuenza in 7%. Respiratory syncytial virus and metapneu- movirus were detected more frequently in the rainy season than in the dry season. Keywords: pediatrics; Picornaviridae infections; pneumo- nia; respiratory tract infections; viral diseases. Despite signifcant improvements in the survival rates of chil- dren younger than 5 years around the world, pneumonia remains a leading killer of children globally [1]. A majority of the 1 million pneumonia deaths per year in children <5 years old occur in low- and middle-income countries; most of them are clustered in Africa [1]. Laboratory diagnostics, such as bac- terial cultures and respiratory viral testing, are ofen lacking in these resource-poor settings [2], which contributes to the dearth of accurate epidemiological data and an unnecessary use of antibiotics, especially outside of tertiary care hospitals. A broad-scope assay that provides an unbiased description of a wide array of respiratory pathogens in children in developing countries is needed. A recently conducted prospective randomized controlled trial at 2 district-level hospitals in Ghana revealed that the use of continuous positive airway pressure (CPAP) reduces the all- cause mortality rate in children <1 year old who presented with undiferentiated acute respiratory distress [3]. In that study, nasopharyngeal swabs were collected from the children at the time of presentation and tested for common pediatric respi- ratory pathogens; the goal was to decrease the knowledge gap regarding the incidence of respiratory pathogens that afect children <5 years of age in low- and middle-income countries. METHODS Study Sites Te study sites were Mampong District Hospital and Kintampo Municipal Hospital in Ghana; each hospital serves as a catch- ment area of almost 100 000 people. Both hospitals have limited access to plain radiography, and neither of them can perform bacterial cultures, respiratory virus panels, or blood gas studies or measure C-reactive protein levels. Te bimodal rainy season in Ghana runs from approximately April to July as the major season and September to November as the minor season; a long dry season lasts from December through March. Study Design Our observational study was part of the prospective CPAP Survival Study [3]. Te aims of this observational study are to determine the percentage of children whose nasopharyngeal swab detected a common respiratory pathogen, describe the epidemiology of the pathogens detected, and report the char- acteristics of patients with and of those without a detectable respiratory pathogen. Te study protocol was approved by and procedures were fol- lowed in accordance with the ethical standards of the Columbia University Medical Center Institutional Review Board and local institutional review boards at the Kwame Nkrumah University of Science and Technology and the Ghana Health Services (this study is registered at ClinicalTrials.gov under identifer NCT01839474). Te Ghana Food and Drug Authority provided regulatory oversight for the trial. © The Author(s) 2018. Published by Oxford University Press on behalf of The Journal of the Pediatric Infectious Diseases Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com. DOI: 10.1093/jpids/piy090 Received 18 May 2018; editorial decision 12 August 2018; accepted 28 August 2018. Correspondence: P. T. Wilson, MD, Department of Pediatrics, Columbia University Medical Center, New York, NY 10032 (ptw2107@cumc.columbia.edu). 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