Serum zinc levels in children with severe community acquired pneumonia

Abstract

Background : Pneumonia is one of the leading cause of death globally, among children younger than five years. South Asia has the highest incidence of pneumonia (0.36 episodes/child/year) in the world and bulk is in India. Of all cases of pneumonia in children in India, 65% were reported to be moderately severe or severely malnourished. In these children deficiency of micronutrients, particularly zinc has been shown to be associated with higher incidence and severity of pneumonia. Identification of modifiable risk factors of severe acute lower respiratory tract infection (ALRTI) like correction of protein energy malnutrition (PEM) and micronutrient deficiency may help in reducing the burden of disease with regard to both morbidity as well as mortality. Objective : Serum zinc level in children 2-60 months, hospitalized with WHO defined severe pneumonia, with the same age matched controls and its correlation with malnutrition. Methods : This was a hospital based prospective, observational cross-sectional study.150 children in the age group of 2-60 months were enrolled, out of which 75 cases had pneumonia. 43 cases were of the age group 2-12 and 32 were from 12-60 months age group. Children were divided in four groups: Group A had children with pneumonia who had grade I or grade II malnutrition; Group B had children with pneumonia who had no malnutrition, Group C had children with malnutrition who did not have pneumonia while group D had children with neither pneumonia nor malnutrition. Serum zinc levels were measured, analyzed and interpreted with regard to age, sex and nutritional status. Results : It was found that children with severe pneumonia and grade I/II malnutrition had low serum zinc levels (59.52+1.55 μg /dl), while serum zinc levels were within normal range ( >65 μg/ dl) in all other children. Thus, while serum zinc levels in children with grade I and grade II malnutrition with pneumonia were low, levels were normal in children with pneumonia who did not have malnutrition. Similarly, serum zinc levels were in normal range in well -nourished asymptomatic children as well as those with grade I and grade II malnutrition without any respiratory disease. Conclusion : Children with grade I or grade II malnutrition with lower serum zinc levels are either more prone to develop severe pneumonia or serum zinc levels decline due to poor intake in a sick malnourished child. Larger studies may help to decide whether reduced serum zinc is an independent factor or not for children with mild lower respiratory tract infection and whether zinc supplementation during treatment has any beneficial effects.