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Background  We assessed nasopharyngeal (NP) carriage of five pathogens in febrile children with and without acute respiratory infection (ARI) of the upper (URTI) or lower tract, attending health facilities in Tanzania.    Methods  NP swabs collected from children (N = 960) aged 2 months to 10 years, and with a temperature ≥38°C, were utilized to quantify bacterial density of  S .  pneumoniae (Sp) ,  H .  influenzae (Hi) ,  M .  catarrhalis (Mc) ,  S .  aureus (Sa) ,  and N .  meningitidis (Nm) . We determined associations between presence of individual species, densities, or concurrent carriage of all species combination with respiratory diseases including clinical pneumonia, pneumonia with normal chest radiography (CXR) and endpoint pneumonia.    Results  Individual carriage, and NP density, of  Sp ,  Hi , or  Mc , but not  Sa ,  or Nm , was significantly associated with febrile ARI and clinical pneumonia when compared to febrile non-ARI episodes. Density was also significantly increased in severe pneumonia when compared to mild URTI ( Sp ,  p <0.002;  Hi p <0.001;  Mc ,  p  = 0.014). Accordingly, concurrent carriage of  Sp   +  ,  Hi   +  , and  Mc   +  , in the absence of  Sa   -   and  Nm   -  , was significantly more prevalent in children with ARI ( p  = 0.03), or clinical pneumonia ( p <0.001) than non-ARI, and in children with clinical pneumonia ( p  = 0.0007) than URTI. Furthermore,  Sp   +  ,  Hi   +  , and  Mc   +   differentiated children with pneumonia with normal CXR, or endpoint pneumonia, from those with URTI, and non-ARI cases.    Conclusions  Concurrent NP carriage of  Sp ,  Hi , and  Mc  was a predictor of clinical pneumonia and identified children with pneumonia with normal CXR and endpoint pneumonia from those with febrile URTI, or non-ARI episodes.

plos one

Increased Nasopharyngeal Density and Concurrent Carriage of Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis Are Associated with Pneumonia in Febrile Children