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Risk factors for death among children 0-59 months of age with moderate-to-severe diarrhea in Manhiça district, southern Mozambique. BMC Infect Dis 2019; 19:322. [PMID: 30987589 PMCID: PMC6466733 DOI: 10.1186/s12879-019-3948-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 04/03/2019] [Indexed: 02/06/2023] Open
Abstract
Background Despite major improvements in child survival rates, the number of deaths due to diarrhea remains unacceptably high. We aimed to describe diarrhea-associated mortality and evaluate risk factors for death among Mozambican children with moderate-to-severe diarrhea (MSD). Methods Between December 2007 and November 2012, children under-five with MSD were enrolled in Manhiça district, as part of the Global Enteric Multicenter study (GEMS). Clinical, epidemiological, and socio-demographic characteristics were collected. Anthropometric measurements were performed and stool samples collected upon recruitment. A follow-up visit ~ 60 days post-enrolment was conducted and verbal autopsies performed in all death cases. Results Of the 916 MSD-cases analyzed; 90% (821/916) completed 60 days follow-up and 69 patients died. The case fatality rate at follow-up was 8% (69/821), and the mortality rate 10.2 (95%CI: 7.75–13.59) deaths per 1000 persons-week at risk. Nearly half of the deaths 48% (33/69) among study participants clustered within 2 weeks of the onset of diarrhea. Typical enteropathogenic Escherichia coli (typical EPEC) and Cryptosporidium were the two pathogens associated to an increased risk of death in the univariate analysis with (HR = 4.16, p = 0.0461) and (H = 2.84, p = 0.0001) respectively. Conversely, Rotavirus infection was associated to a decreased risk of death (HR = 0.52, p = 0.0198). According to the multivariate analysis, risk factors for death included co-morbidities such as malnutrition (HR = 4.13, p < 0.0001), pneumonia/lower respiratory infection (HR = 3.51, p < 0.0001) or invasive bacterial disease (IBD) (HR = 6.80, p = 0.0009), presenting on arrival with lethargy or overt unconsciousness (HR = 1.73, p = 0.0302) or wrinkled skin (HR = 1.71, p = 0.0393), and cryptosporidium infection (HR = 2.14, p = 0.0038). When restricting the analysis to those with available HIV results (n = 191, 22% of the total study sample), HIV was shown to be a significant risk factor for death (HR = 5.05, p = 0.0009). Verbal autopsies were conducted in 100% of study deaths, and highlighted diarrhea as the main underlying cause of death 39%, (27/69); followed by HIV/AIDS related deaths 29.0% (20/69) and sepsis 11.6% (8/69). Conclusion Preventive strategies targeting Cryptosporidium, malnutrition and early identification and treatment of associated co-morbidities could contribute to the prevention of the majority of diarrhea associated deaths in Mozambican children. Electronic supplementary material The online version of this article (10.1186/s12879-019-3948-9) contains supplementary material, which is available to authorized users.
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Acácio S, Nhampossa T, Quintó L, Vubil D, Sacoor C, Kotloff K, Farag T, Dilruba N, Macete E, Levine MM, Alonso P, Mandomando I, Bassat Q. The role of HIV infection in the etiology and epidemiology of diarrheal disease among children aged 0-59 months in Manhiça District, Rural Mozambique. Int J Infect Dis 2018; 73:10-17. [PMID: 29852260 PMCID: PMC6069671 DOI: 10.1016/j.ijid.2018.05.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 04/30/2018] [Accepted: 05/22/2018] [Indexed: 01/05/2023] Open
Abstract
HIV prevalence was higher among cases with moderate-to-severe diarrhea (MSD) than controls. Mortality was higher among HIV-infected children with diarrhea than HIV-uninfected ones. HIV-infected children were more likely to have MSD. Cryptosporidium was the most common pathogen in HIV-infected children with MSD. Escherichia coli producing heat-stable toxin (enterotoxigenic Escherichia coli, any sequence type) was the most common pathogen in HIV-infected children with less severe diarrhea.
Background Diarrhea is an important health problem among HIV-infected patients. This study evaluated the role of HIV in the epidemiology, etiology, and severity of diarrheal disease among children. Methods The Global Enteric Multicenter Study enrolled children with moderate-to-severe diarrhea (MSD) and less-severe diarrhea (LSD) between December 2007 and November 2012. One to three controls for MSD cases and one per LSD case were enrolled and matched by age, sex, and neighborhood. All children were tested for HIV. Clinical data, anthropometric data, and stool samples were collected. Follow-up was performed at 60 days. Results Two hundred and fourteen MSD cases and 418 controls, together with 349 LSD cases and 214 controls were tested. HIV prevalence was 25% among MSD cases (4% for matched controls) and 6% among LSD cases (6% among matched controls). HIV-infected children were more likely to have MSD (odds ratio 5.6, p < 0.0001). Mortality rates were higher among HIV-infected children than among the uninfected (34 vs. 5 per 1000 child-weeks at risk; p = 0.0039). Cryptosporidium, Giardia, and enteroaggregative Escherichia coli (aatA only) were more prevalent among HIV-infected MSD cases than among uninfected ones. Conclusion HIV is an important risk factor for MSD. The high mortality rate implies that children with MSD should be screened for HIV and managed accordingly.
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Affiliation(s)
- Sozinho Acácio
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique; Instituto Nacional de Saúde, Ministério de Saúde, Maputo, Mozambique
| | - Tacilta Nhampossa
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique; Instituto Nacional de Saúde, Ministério de Saúde, Maputo, Mozambique
| | - Llorenç Quintó
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Delfino Vubil
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Charfudin Sacoor
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Karen Kotloff
- Center for Vaccine Development (CVD), University of Maryland School of Medicine, Baltimore, MD, USA
| | - Tamer Farag
- Center for Vaccine Development (CVD), University of Maryland School of Medicine, Baltimore, MD, USA
| | - Nasrin Dilruba
- Center for Vaccine Development (CVD), University of Maryland School of Medicine, Baltimore, MD, USA
| | - Eusebio Macete
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique; Instituto Nacional de Saúde, Ministério de Saúde, Maputo, Mozambique
| | - Myron M Levine
- Center for Vaccine Development (CVD), University of Maryland School of Medicine, Baltimore, MD, USA
| | - Pedro Alonso
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique; ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Inácio Mandomando
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique; Instituto Nacional de Saúde, Ministério de Saúde, Maputo, Mozambique
| | - Quique Bassat
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique; ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain; ICREA, Pg. Lluís Companys 23, 08010 Barcelona, Spain; Pediatric Infectious Diseases Unit, Pediatrics Department, Hospital Sant Joan de Déu (University of Barcelona), Barcelona, Spain.
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Abstract
In every epidemic some individuals become sick and some may die, whereas others recover from illness and still others show no signs or symptoms of disease. These differences highlight a fundamental question of microbial pathogenesis: why are some individuals susceptible to infectious diseases while others who acquire the same microbe remain well? For most of human history, the answer assumed the hand of providence. With the advent of the germ theory of disease, the focus on disease causality became the microbe, but this did not explain how there can be different outcomes of infection in different individuals with the same microbe. Here we examine the attributes of susceptibility in the context of the "damage-response framework" of microbial pathogenesis. We identify 11 attributes that, although not independent, are sufficiently distinct to be considered separately: microbiome, inoculum, sex, temperature, environment, age, chance, history, immunity, nutrition, and genetics. We use the first letter of each to create the mnemonic MISTEACHING, underscoring the need for caution in accepting dogma and attributing disease causality to any single factor. For both populations and individuals, variations in the attributes that assemble into MISTEACHING can create an enormity of combinations that can in turn translate into different outcomes of host-microbe encounters. Combinatorial diversity among the 11 attributes makes identifying "signatures" of susceptibility possible. However, with their inevitable uncertainties and propensity to change, there may still be a low likelihood for prediction with regard to individual host-microbe interactions, although probabilistic prediction may be possible.
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Velasquez DE, Parashar U, Jiang B. Decreased performance of live attenuated, oral rotavirus vaccines in low-income settings: causes and contributing factors. Expert Rev Vaccines 2017; 17:145-161. [PMID: 29252042 DOI: 10.1080/14760584.2018.1418665] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Numerous studies have shown that the oral rotavirus vaccines are less effective in infants born in low income countries compared to those born in developed countries. Identifying the specific factors in developing countries that decrease and/or compromise the protection that rotavirus vaccines offer, could lead to a path for designing new strategies for the vaccines' improvement. AREAS COVERED We accessed PubMed to identify rotavirus vaccine performance studies (i.e., efficacy, effectiveness and immunogenicity) and correlated performance with several risk factors. Here, we review the factors that might contribute to the low vaccine efficacy, including passive transfer of maternal rotavirus antibodies, rotavirus seasonality, oral polio vaccine (OPV) administered concurrently, microbiome composition and concomitant enteric pathogens, malnutrition, environmental enteropathy, HIV, and histo blood group antigens. EXPERT COMMENTARY We highlight two major factors that compromise rotavirus vaccines' efficacy: the passive transfer of rotavirus IgG antibodies to infants and the co-administration of rotavirus vaccines with OPV. We also identify other potential risk factors that require further research because the data about their interference with the efficacy of rotavirus vaccines are inconclusive and at times conflicting.
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Affiliation(s)
- Daniel E Velasquez
- a Division of Viral Diseases , Centers for Disease Control and Prevention , Atlanta , GA , USA
| | - Umesh Parashar
- a Division of Viral Diseases , Centers for Disease Control and Prevention , Atlanta , GA , USA
| | - Baoming Jiang
- a Division of Viral Diseases , Centers for Disease Control and Prevention , Atlanta , GA , USA
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Safety and immunogenicity of a live attenuated pentavalent rotavirus vaccine in HIV-exposed infants with or without HIV infection in Africa. AIDS 2017; 31:49-59. [PMID: 27662551 DOI: 10.1097/qad.0000000000001258] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Although many HIV-infected (HIV+) and HIV-exposed but uninfected (HEU) infants have received live rotavirus vaccines since the WHO recommended universal administration of these vaccines to infants, there has been limited prospective information on their safety and immunogenicity in either group of infants. DESIGN/METHODS We performed a randomized, double-blinded, placebo-controlled trial of the safety and immunogenicity of oral pentavalent rotavirus vaccine (RV5) administered to HIV+ and HEU infants in four African countries. Ninety-three percent of HIV+ infants were receiving antiretroviral therapy prior to vaccination. Participants were followed for safety. Immune responses were measured 14 days after three doses of RV5, including serum antirotavirus neutralizing and IgA antibodies, IgA antibody in stool, and antirotavirus memory B and T-cell FluoroSpot. Shedding of RV5 in stool was monitored. RESULTS A total of 76 HIV+ and 126 HEU infants were enrolled from 2009 to 2013. No significant differences were found in adverse event rates, including grade 3 events, between RV5 and placebo recipients, for either HIV+ or HEU infants. The proportion of antirotavirus IgA responders (at least three-fold increase from baseline) after RV5 administration was 81% in both HIV+ and HEU infants, which was approximately 2.5-fold higher than in placebo recipients (P < 0.001). Neutralizing antibody responses to three of five serotypes were significantly higher after RV5 regardless of HIV status, and those of HIV+ infants were equal or greater than responses of HEU infants to all five serotypes. Only one HIV+ RV5 recipient had RV5 isolated from stool. CONCLUSION RV5 was immunogenic in both HIV+ and HEU infants and no safety signals were observed.
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Awotiwon OF, Pillay-van Wyk V, Dhansay A, Day C, Bradshaw D. Diarrhoea in children under five years of age in South Africa (1997-2014). Trop Med Int Health 2016; 21:1060-70. [PMID: 27314457 DOI: 10.1111/tmi.12739] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To present evidence from available reliable published data on the prevalence, incidence and severity of diarrhoea in children aged under five years in South Africa. METHODS We searched seven electronic databases. Two reviewers assessed the studies independently and extracted outcome data. The heterogeneity of the studies did not allow for a meta-analysis. RESULTS We found only one nationally representative study conducted in 1998 reporting a diarrhoea prevalence of 13% in children under five. Other studies were conducted in smaller settings across the country. Diarrhoea incidence was 10.13 per 1000 person years in children admitted to a tertiary hospital. Three studies reported severity of diarrhoea; however, they differed across study settings and time period. CONCLUSION The paucity of nationally representative prevalence data for SA necessitates more national surveys with standardised data-collection methods to allow for more effective comparisons.
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Affiliation(s)
- Oluwatoyin F Awotiwon
- Burden of Disease Research Unit, South African Medical Research Council, Tygerberg, South Africa
| | - Victoria Pillay-van Wyk
- Burden of Disease Research Unit, South African Medical Research Council, Tygerberg, South Africa
| | - Ali Dhansay
- Burden of Disease Research Unit, South African Medical Research Council, Tygerberg, South Africa.,Division of Human Nutrition, Faculty of Health Sciences, Stellenbosch University, Tygerberg, South Africa.,Department of Paediatrics and Child Health, Faculty of Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Candy Day
- Health Systems Research Unit, Health Systems Trust, Westville, South Africa
| | - Debbie Bradshaw
- Burden of Disease Research Unit, South African Medical Research Council, Tygerberg, South Africa
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Dicko F, Desmonde S, Koumakpai S, Dior-Mbodj H, Kouéta F, Baeta N, Koné N, Akakpo J, Signate Sy H, Ye D, Renner L, Lewden C, Leroy V. Reasons for hospitalization in HIV-infected children in West Africa. J Int AIDS Soc 2014; 17:18818. [PMID: 24763078 PMCID: PMC3999943 DOI: 10.7448/ias.17.1.18818] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Revised: 02/17/2014] [Accepted: 03/12/2014] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Current knowledge on morbidity and mortality in HIV-infected children comes from data collected in specific research programmes, which may offer a different standard of care compared to routine care. We described hospitalization data within a large observational cohort of HIV-infected children in West Africa (IeDEA West Africa collaboration). METHODS We performed a six-month prospective multicentre survey from April to October 2010 in five HIV-specialized paediatric hospital wards in Ouagadougou, Accra, Cotonou, Dakar and Bamako. Baseline and follow-up data during hospitalization were recorded using a standardized clinical form, and extracted from hospitalization files and local databases. Event validation committees reviewed diagnoses within each centre. HIV-related events were defined according to the WHO definitions. RESULTS From April to October 2010, 155 HIV-infected children were hospitalized; median age was 3 years [1-8]. Among them, 90 (58%) were confirmed for HIV infection during their stay; 138 (89%) were already receiving cotrimoxazole prophylaxis and 64 children (40%) had initiated antiretroviral therapy (ART). The median length of stay was 13 days (IQR: 7-23); 25 children (16%) died during hospitalization and four (3%) were transferred out. The leading causes of hospitalization were WHO stage 3 opportunistic infections (37%), non-AIDS-defining events (28%), cachexia and other WHO stage 4 events (25%). CONCLUSIONS Overall, most causes of hospitalizations were HIV related but one hospitalization in three was caused by a non-AIDS-defining event, mostly in children on ART. HIV-related fatality is also high despite the scaling-up of access to ART in resource-limited settings.
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Affiliation(s)
- Fatoumata Dicko
- Service Pédiatrie Centre Hospitalier, Universitaire Gabriel Toure, Bamako, Mali
| | - Sophie Desmonde
- Inserm, Centre Inserm U897 - Epidémiologie - Biostatistiques, University of Bordeaux, Bordeaux, France; University of Bordeaux, ISPED, Centre Inserm U897 - Epidémiologie - Biostatistiques, Bordeaux, France;
| | - Sikiratou Koumakpai
- Service Pédiatrie, Centre National Hospitalier Universitaire, Cotonou, Bénin
| | | | - Fla Kouéta
- Service Pédiatrie, Hopital Général de Gaulle, Ouagadougou, Burkina Faso
| | | | - Niaboula Koné
- Service Pédiatrie Centre Hospitalier, Universitaire Gabriel Toure, Bamako, Mali
| | - Jocelyn Akakpo
- Service Pédiatrie, Centre National Hospitalier Universitaire, Cotonou, Bénin
| | | | - Diarra Ye
- Service Pédiatrie, Hopital Général de Gaulle, Ouagadougou, Burkina Faso
| | | | - Charlotte Lewden
- Inserm, Centre Inserm U897 - Epidémiologie - Biostatistiques, University of Bordeaux, Bordeaux, France; University of Bordeaux, ISPED, Centre Inserm U897 - Epidémiologie - Biostatistiques, Bordeaux, France
| | - Valériane Leroy
- Inserm, Centre Inserm U897 - Epidémiologie - Biostatistiques, University of Bordeaux, Bordeaux, France; University of Bordeaux, ISPED, Centre Inserm U897 - Epidémiologie - Biostatistiques, Bordeaux, France
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Groome MJ, Madhi SA. Five-year cohort study on the burden of hospitalisation for acute diarrhoeal disease in African HIV-infected and HIV-uninfected children: Potential benefits of rotavirus vaccine. Vaccine 2012; 30 Suppl 1:A173-8. [DOI: 10.1016/j.vaccine.2011.08.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2011] [Revised: 07/26/2011] [Accepted: 08/01/2011] [Indexed: 11/28/2022]
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Challenges in the Management of HIV-Infected Malnourished Children in Sub-Saharan Africa. AIDS Res Treat 2012; 2012:790786. [PMID: 22606378 PMCID: PMC3353143 DOI: 10.1155/2012/790786] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2011] [Revised: 11/16/2011] [Accepted: 11/17/2011] [Indexed: 12/20/2022] Open
Abstract
Infection with HIV, and oftentimes coinfection with TB, complicates the care of severely malnourished children in sub-Saharan Africa. These superimposed infections challenge clinicians faced with a population of malnourished children for whose care evidence-based guidelines have not kept up. Even as the care of HIV-uninfected malnourished children has improved dramatically with the advent of community-based care and even as there are hopeful signs that the HIV epidemic may be stabilizing or ameliorating, significant gaps remain in the care of malnourished children with HIV. Here we summarize what is currently known, what remains unknown, and what remains challenging about how to treat severely malnourished children with HIV and TB.
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Heikens GT, Manary M. Wasting disease in African children: the challenges ahead. Malawi Med J 2010; 21:101-5. [PMID: 20345017 DOI: 10.4314/mmj.v21i3.45628] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Predictors of bacteremia in infants with diarrhea and systemic inflammatory response syndrome attending an urban diarrheal treatment center in a developing country. Pediatr Crit Care Med 2010; 11:92-7. [PMID: 19593244 DOI: 10.1097/pcc.0b013e3181b063e1] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To identify clinical and laboratory predictors of bacteremia in infants with diarrhea and systemic inflammatory response syndrome and to analyze their outcome. STUDY DESIGN Retrospective, case-control study. SETTING The Special Care Ward of the Dhaka Hospital of the International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh. PATIENTS All the infants (n = 90) admitted to the Special Care Ward between May 2005 and April 2006 who had a blood culture, full peripheral blood count, and serum C-reactive protein performed were included in the study. Infant with systemic inflammatory response syndrome with confirmed bacteremia (n = 18) constituted cases, and those with systemic inflammatory response syndrome but negative blood culture (n = 72) constituted the controls. RESULTS The following features were analyzed by comparing the two groups: absent or uncountable peripheral pulses, hypothermia, sclerema, altered mental status, white blood cell count, serum C-reactive protein, total protein concentrations, and outcome. The case-fatality rate was significantly higher among bacteremic infants compared with those without bacteremia (33% vs. 6%, p < .01). In the univariate model, sclerema (56% vs. 28%, p = .05), hyperglycemia (28% vs. 6%, p < .01), immature neutrophils [3.5 (00, 6.5) vs. 0.0 (0.0, 3.25); p = .02], higher C-reactive protein [2.7 (1.2, 7.4) vs. 1.8 (0.5, 4.2); p = .02], and lower serum total protein (51.1 +/- 14.1 vs. 57.6 +/- 12.2; p = .05) were identified as potential predictors of bacteremia. However, in the logistic regression analysis, after adjusting for confounders, only hypothermia (odds ratio = 6.4, 95% confidence Interval, 1.6-25.9; p = .01) and absent or uncountable peripheral pulse (odds ratio, 12.4, 95% confidence interval, 1.9-83.4; p < .01) remained significant independent predictors of bacteremia. CONCLUSIONS Our data suggest that, in infants presenting with diarrhea and systemic inflammatory response syndrome, coexistence of hypothermia and absent or uncountable peripheral pulse is strongly associated with bacteremia. Bacteremia in this patient group is associated with high case-fatality rates.
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Tornheim JA, Manya AS, Oyando N, Kabaka S, O'Reilly CE, Breiman RF, Feikin DR. The epidemiology of hospitalization with diarrhea in rural Kenya: the utility of existing health facility data in developing countries. Int J Infect Dis 2009; 14:e499-505. [PMID: 19959387 DOI: 10.1016/j.ijid.2009.07.021] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2009] [Revised: 07/03/2009] [Accepted: 07/21/2009] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVES In developing countries where prospective surveillance is resource-intensive, existing hospital data can define incidence, mortality, and risk factors that can help target interventions and track trends in disease burden. METHODS We reviewed hospitalizations from 2001 to 2003 at all inpatient facilities in Bondo District, Kenya. RESULTS Diarrhea was responsible for 11.2% (n=2158) of hospitalizations. The annual incidence was 550 and 216 per 100,000 persons aged <5 and > or =5 years, respectively. The incidence was highest in infants (1138 per 100,000 persons), decreased in older children, peaked again among 20-29-year-olds (341 per 100,000), and declined among those > or =65 years (157 per 100,000). Female adults had higher incidence than males (rate ratio=1.84, 95% CI 1.61-2.10). Incidence decreased with distance from the district referral hospital (4.5% per kilometer, p<0.0001) and from the nearest inpatient facility (6.6% per kilometer, p=0.012). Case-fatality was high (8.0%), and was higher among adults than young children. Co-diagnosis with malaria, pneumonia, HIV, and tuberculosis was common. Peak diarrhea incidence fell one to two months after heavy rains. CONCLUSIONS The trends revealed here provide useful data for public health priority setting and planning, including preventative interventions. The utility of such data justifies renewed efforts to establish and strengthen health management information systems in developing countries.
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Affiliation(s)
- Jeffrey A Tornheim
- International Emerging Infections Program, Centers for Disease Control and Prevention, Unit 64112, APO, AE 09831, Kenya
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Routine offering of HIV testing to hospitalized pediatric patients at university teaching hospital, Lusaka, Zambia: acceptability and feasibility. J Acquir Immune Defic Syndr 2009; 51:202-8. [PMID: 19504732 DOI: 10.1097/qai.0b013e31819c173f] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The difficulties diagnosing infants and children with HIV infection have been cited as barriers to increasing the number of children receiving antiretroviral therapy worldwide. DESIGN We implemented routine HIV antibody counseling and testing for pediatric patients hospitalized at the University Teaching Hospital, a national reference center, in Lusaka, Zambia. We also introduced HIV DNA polymerase chain reaction (PCR) testing for early infant diagnosis. METHODS Caregivers/parents of children admitted to the hospital wards were routinely offered HIV counseling and testing for their children. HIV antibody positive (HIV+) children <18 months of age were tested with PCR for HIV DNA. RESULTS From January 1, 2006, to June 30, 2007, among 15,670 children with unknown HIV status, 13,239 (84.5%) received counseling and 11,571 (87.4%) of those counseled were tested. Overall, 3373 (29.2%) of those tested were seropositive. Seropositivity was associated with younger age: 69.6% of those testing HIV antibody positive were <18 months of age. The proportion of counseled children who were tested increased each quarter from 76.0% in January to March 2006 to 88.2% in April to June 2007 (P < 0.001). From April 2006 to June 2007, 1276 PCR tests were done; 806 (63.2%) were positive. The rate of PCR positivity increased with age from 22% in children <6 weeks of age to 61% at 3-6 months and to 85% at 12-18 months (P < 0.001). CONCLUSIONS Routine counseling and antibody testing of pediatric inpatients can identify large numbers of HIV-seropositive children in high prevalence settings. The high rate of HIV infection in hospitalized infants and young children also underscores the urgent need for early infant diagnostic capacity in high prevalence settings.
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Heikens GT, Bunn J, Amadi B, Manary M, Chhagan M, Berkley JA, Rollins N, Kelly P, Adamczick C, Maitland K, Tomkins A. Case management of HIV-infected severely malnourished children: challenges in the area of highest prevalence. Lancet 2008; 371:1305-7. [PMID: 18406865 DOI: 10.1016/s0140-6736(08)60565-6] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Geert Tom Heikens
- Department of Paediatrics, College of Medicine, University of Malawi, Blantyre, Malawi
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Baccaglini L, Atkinson JC, Patton LL, Glick M, Ficarra G, Peterson DE. Management of oral lesions in HIV-positive patients. ACTA ACUST UNITED AC 2007; 103 Suppl:S50.e1-23. [PMID: 17379155 DOI: 10.1016/j.tripleo.2006.11.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2006] [Accepted: 11/01/2006] [Indexed: 11/24/2022]
Abstract
HIV/AIDS is currently the leading cause of death in Africa and the fourth leading cause of death worldwide. This systematic review of the literature was conducted to evaluate the evidence for treatment of the most common oral lesions associated with HIV: oral candidiasis with or without oropharyngeal involvement (OPC), oral hairy leukoplakia (OHL), recurrent aphthous-like ulcerations (RAU), oral Kaposi's sarcoma (OKS), orolabial herpes simplex infection (HSV), oral herpes zoster infection (VZV), intraoral or perioral warts (HPV), and HIV-associated periodontal diseases. Treatment of HIV-associated salivary gland disease is addressed in a different section of this World Workshop. We found the largest body of evidence for treatment of OPC in HIV patients. Future trials will be needed to test drugs currently in development for treatment of Candida strains that are resistant to existing therapies. There were no double blind, placebo-controlled randomized clinical trials (RCT) for topical treatment of OHL, and only one RCT for systemic treatment of the lesion with desciclovir. Systemic thalidomide was the only drug tested in RCT for treatment or prevention of RAU. Only 1 double-blind RCT comparing vinblastine and sodium tetradecyl sulfate was identified for localized treatment of OKS. Three drugs (famciclovir, acyclovir, and valaciclovir) were shown to be effective in randomized, double-blind trials for treatment or suppression of mucocutaneous HSV lesions in HIV patients. In all 3 trials, the effects of these medications on orolabial HSV lesions were not reported separately. There were no double-blind, placebo-controlled RCT testing topical treatments for orolabial HSV lesions in HIV patients. No trials testing treatments of oral VZV were identified. There were no double-blind, placebo-controlled RCT for treatment of HIV-associated intraoral or perioral warts or periodontal diseases. In conclusion, there is a need for well-designed RCTs to assess the safety and efficacy of topical and systemic treatments of most oral mucosal and perioral lesions in HIV patients. There is also a need to develop newer drugs for treatment of resistant fungal and viral microorganisms. Finally, standardized outcome measures should be developed for future clinical trials to allow comparisons of studies using different populations.
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Affiliation(s)
- Lorena Baccaglini
- Department of Community Dentistry and Behavioral Science, College of Dentistry, University of Florida, Gainesville, FL 32610-3628, USA.
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