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Background  Although  Haemophilus influenzae type b  (Hib),  Staphylococcus aureus  and  Moraxella catarrhalis  are important causes of invasive and mucosal bacterial disease among children, co-carriage with  Streptococcus pneumoniae  during infancy has not been determined in West Africa.    Methods  Species specific PCR was applied to detect each microbe using purified genomic DNA from 498 nasopharyngeal (NP) swabs collected from 30 Gambian neonates every two weeks from 0 to 6 months and bi-monthly up to 12 months.    Results  All infants carried  S. pneumoniae, H. influenzae  and  M. catarrhalis  at several time points during infancy. S. pneumoniae  co-colonized the infant nasopharynx with at least one other pathogen nine out of ten times. There was early colonization of the newborns and neonates, the average times to first detection were 5, 7, 3 and 14 weeks for  S. pneumoniae, H. influenzae, M. catarrhalis  and  S. aureus  respectively. The prevalence of  S. pneumoniae, H. influenzae  and  M. catarrhalis  increased among the neonates and exceeded 80% by 13, 15 and 23 weeks respectively. In contrast, the prevalence of  S. aureus  decreased from 50% among the newborns to 20% amongst nine-week old neonates.  S. pneumoniae  appeared to have a strong positive association with  H. influenzae  (OR 5.03; 95% CI 3.02, 8.39; p < 0.01)  and M. catarrhalis  (OR 2.20; 95% CI 1.29; p < 0.01) but it was negatively associated with  S. aureus  (OR 0.53; 95% CI 0.30, 0.94; p = 0.03).    Conclusion  This study shows early acquisition and high co-carriage of three important respiratory pathogens with  S. pneumoniae  in the nasopharyngeal mucosa among Gambian neonates and infants. This has important potential implications for the aetiology of respiratory polymicrobial infections, biofilm formation and vaccine strategies.

bmc infectious diseases

Early acquisition and high nasopharyngeal co-colonisation by Streptococcus pneumoniae and three respiratory pathogens amongst Gambian new-borns and infants