Original Article

Detection of causative agents of bacterial pneumonia in hospitalized hajj and umrah cases by multiplex real-time polymerase chain reaction

Abstract

Background and Objectives: Middle East Respiratory Syndrome Coronavirus (MERS-CoV) is commonly detected in pneumonia patients who travel from the Middle East regions. Besides MERS-CoV, many other pathogenic agents cause pneumonia. Detection of such organisms must be done swiftly, especially in case of the negative MERS-CoV samples. The aim of this study was to identify the pathogenic agents that might account for bacterial pneumonia, from Hajj and Umrah pneumonia cases.
Materials and Methods: We conducted a cross-sectional study, 38 pneumonia clinical samples from suffering of Hajj and Umrah in 2017 with negative MERS-CoV were selected. The laboratory testing was done at National Reference Laboratory in Jakarta and performed by multiplex real-time PCR using a FTD respiratory pathogens.
Results: Haemophilus influenzae (26.4%) was the most frequent bacteria detected. Other causative agents of bacterial pneumonia identified were Moraxella catarrhalis (20.8%), Klebsiella pneumoniae (13.2%), Streptococcus pneumoniae (9.4%), and Staphylococcus aureus (5.7%). From 38 samples showed that 25 (65.79%) samples were positive with bacteria, including five samples with coinfection. The coinfection were combinations among S. aureus and S. pneumoniae (1/20), S. pneumoniae and K. pneumoniae (1/20), S. pneumoniae and M. catarrhalis (2/20), S. pneumoniae and H. influenzae (2/20), K. pneumoniae and H. influenzae (5/20), and M. catarrhalis and H. influenzae (5/20).
Conclusion: Haemophilus influenzae is the most recurrent bacteria to be identified in samples of pneumonia of hajj and umrah cases.

1. World Health Organization. WHO MERS Global Summary and Assessment of Risk. [Online] Available at: https://www.who.int/publications/i/item/10665-326126 [Accessed 30 August 2019].
2. Memish ZA, Almasri M, Turkestani A, Al-Shangiti AM, Yezli S. Etiology of severe community-acquired Pneumonia during the 2013 Hajj-parts of the MERS-CoV surveillance program. Int J Infect Dis 2014; 25: 186-190.
3. Saad M, Omrani AS, Baig K, Bahloul A, Elzein F, Matin MA, et al. Clinical aspects and outcomes of 70 patients with Middle East respiratory syndrome coronavirus infection: a single-center experience in Saudi Arabia. Int J Infet Dis 2014; 29: 301-306.
4. Pane M, Kong FYM, Purnama TB, Glass K, Imari S, Samaan G, Oshitani H. Indonesian Hajj cohorts and mortality in Saudi Arabia from 2004 to 2011. J Epidemiol Glob Health 2019; 9: 11-18.
5. Loebinger MR, Robert W. Bacterial Pneumonia. Medicine 2008; 36: 285-290.
6. Murdoch DR, O’Brien KL, Driscoll AJ, Karron RA, Bhat N, Pneumonia Methods Working Group; PERCH Core Team. Laboratory methods for determining Pneumonia etiology in children. Clin Infect Dis 2012; 54 Suppl 2: S146-S152.
7. Lee H, Ki CS, Sung H, Kim S, Seong MY, Dong Y, et al. Guidelines for the laboratory diagnosis of Middle East respiratory syndrome coronavirus in Korea. Infect Chemother 2016; 48: 61-69.
8. Shirah BH, Zafar SH, Alferaidi OA, Sabir AMM. Mass Gathering Medicine (Hajj Pilgrimage in Saudi Arabia): The clinical pattern of Pneumonia among Pilgrims during Hajj. J Infect Public Health 2017; 10: 277-286.
9. Puig C, Calatayud L, Marti S, Tubau F, Garcial-Vidal C, Carratalia J, et al. Molecular epidemiology of nontypeable Haemophilus influenzae causing community-acquired Pneumonia in adults. PLoS One 2013; 8(12): e82515.
10. Blain A, MacNeil J, Wang X, Bennett N, Farley MM, Harrison LH, et al. Invasive Haemophilus influenzae disease in adults ≥65 years, United States, 2011. Open Forum Infect Dis 2014; 1(2): ofu044.
11. Asghar AH, Ashshi AM, Azhar EI, Bukhari SZ, Zafar TA, Momenah AM. Profile of bacterial Pneumonia during Hajj. Indian J Med Res 2011; 133: 510-513.
12. Chastre J, Blasi F, Masterton RG, Rello J, Torres A, Welte T. European perspective and update on the management of nosocomial Pneumonia due to methicilin-resistant Staphylococcus aureus after more than 10 years of experience with linezolid. Clin Microbiol Infect 2014; 20 Suppl 4: 19-36.
13. Kumagai S, Ishida T, Tachibana H, Ito Y, Ito A, Hashimoto T. Impact of bacterial coinfection on clinical outcomes in Pneumococcal pneumonia. Eur J Clin Microbiol Infect Dis 2015; 34: 1839-1847.
14. Tikhomirova A, Kidd SP. Haemophilus influenzae and Streptococcus pneumoniae: Living together in a biofilm. Pathog Dis 2013; 69: 114-126.
15. de Steenhuijsen Piters WA, Sanders EA, Bogaert D. The role of the local microbial ecosystem in respiratory health and disease. Philos Trans R Soc Lond B Biol Sci 2015; 370: 20140294.
16. Ito R, Shindo Y, Kobayashi D, Ando M, Jin W, Wachino J, et al. Molecular epidemiological characteristics of Klebsiella pneumoniae associated with bacteremia among patients with Pneumonia. J Clin Microbiol 2015; 53: 879-886.
17. Haarmann H, Steiner T, Schreiber F, Heinrich A, Zweigner J, N'Guessan PD, et al. The role and regulation of Moraxella catarrhalis-induced human beta-defensin 3 expression inh pulmonary epithelial cells. Biochem Biophys Res Commun 2015; 467: 46-52.
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IssueVol 14 No 3 (2022) QRcode
SectionOriginal Article(s)
DOI https://doi.org/10.18502/ijm.v14i3.9759
Keywords
Pneumonia; Multiplex real-time polymerase chain reaction; Bacteria; Hajj and umrah

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How to Cite
1.
Setiawaty V, Darmawati D, Nugraha A, Hendrati P. Detection of causative agents of bacterial pneumonia in hospitalized hajj and umrah cases by multiplex real-time polymerase chain reaction. Iran J Microbiol. 2022;14(3):300-304.