Malaria among children under 10 years in 4 endemic health areas in Kisantu Health Zone: epidemiology and transmission

BACKGROUND

The Democratic Republic of the Congo (DRC) is the second most malaria-affected country in the world with 21,608,681 cases reported in 2019. The Kongo Central (KC) Province has a malaria annual incidence of 163 cases/per 1000 inhabitants which are close to the national average of 153.4/1000. However, the malaria prevalence varies both between and within health zones in this province. The main objective of this study was to describe the epidemiology and transmission of malaria among children aged 0 to 10 years in the 4 highest endemic health areas in Kisantu Health Zone (HZ) of KC in DRC.

METHODS

A community-based cross-sectional study was conducted from October to November 2017 using multi-stage sampling. A total of 30 villages in 4 health areas in Kisantu HZ were randomly selected. The prevalence of malaria was measured using a thick blood smear (TBS) and known predictors and associated outcomes were assessed. Data are described and association determinants of malaria infection were analysed.

RESULTS

A total of 1790 children between 0 and 10 years were included in 30 villages in 4 health areas of Kisantu HZ. The overall prevalence in the study area according to the TBS was 14.8% (95% CI: 13.8-16.6; range: 0-53). The mean sporozoite rate in the study area was 4.3% (95% CI: 2.6-6.6). The determination of kdr-west resistance alleles showed the presence of both L1014S and L1014F with 14.6% heterozygous L1014S/L1014F, 84.4% homozygous 1014F, and 1% homozygous 1014S. The risk factors associated with malaria infection were ground or wooden floors aOR: 15.8 (95% CI: 8.6-29.2), a moderate or severe underweight: 1.5 (1.1-2.3) and to be overweight: 1.9 (95% CI: 1.3-2.7).

CONCLUSION

Malaria prevalence differed between villages and health areas within the same health zone. The control strategy activities must be oriented by the variety in the prevalence and transmission of malaria in different areas. The policy against malaria regarding long-lasting insecticidal nets should be based on the evidence of metabolic resistance.

[Are mydriatic eyedrops dangerous for pre-term infants?]

The funduscopic examination is essential in neonatology to screen for retinopathy in the pre-term infant. Mydriatic eyedrops, which are used for this examination, are known to induce digestive side effects. We present a case of necrotizing enterocolitis developing in a pre-term infant as a complication of mydriatics. This infant was a girl born at 28 weeks gestation and 5 days, with Down's syndrome, who died on the 44th day of life, due to necrotizing enterocolitis, after instillation of 1 drop of atropine 0.3% in each eye. The chronology of events, the application method, and the clinical symptoms of atropine impregnation argue in favor of a causal relationship between atropine and necrotizing enterocolitis. The review of the literature made on the basis of this observation shows that side effects of mydriatic eyedrops are frequent in pre-term infants and raise the question of atropine hypersensitivity in pre-term infants with Down's syndrome.

[Candidemia original diagnosis]

We reported here a case of fungemia, which was diagnosed by a globular numeration: peripheral blood smears showed yeast cells, especially in the cytoplasm of neutrophils, with characteristic images of fungal phagocytosis. This test induced a prompt diagnosis of fungal septicaemia and the prescription of adapted treatment, which probably permitted to rescue the patient from a high mortality pathology.

[Advantages and limits of the surveillance of nosocomial infections from the microbiology laboratory: experience of Meaux hospital]

To estimate the incidence of nosocomial infections (NI) in our hospital and to increase healthcare professionals' awareness of hygiene, a prospective study was performed between January and December 2002 from the microbiology laboratory data. On 1334 suspicions of NI, corresponding to 1062 patients, sent to the hygiene correspondents in each medical care unit, the infection control team received 853 answers (64% of sendings) with 430 NI validated. The incidence rate of NI validated was 1.7 NI/1000 days of hospitalisation and 1.6 NI/100 inpatients. The NI were predominantly related to urinary tract (47%), bloodstream (14%), and lower respiratory tract (12%). Transmission of these informations to medical information department permitted a valorisation of additional 16,000 ISA points. This prospective study permitted to develop a network of hygiene correspondents in every medical care units. None of the medical care units was unharmed by NI but the exhaustive declaration of NI seems difficult to realise. This study permitted to point out some dysfunctionments in the management of invasive procedures and to improve these practices.

[Update on the susceptibility of streptococci to antibiotics (enterococci and Streptococcus pneumoniae excluded)]

Over the last years, the emergence of resistance to antibiotics has complicated the management of streptococcal infections. The resistance of streptococci to antibiotics is increasing and seems to be linked to the consumption of antibiotics. Resistances to antibiotics have been noted in all species of streptococci and no family of antibiotics is unaffected by resistances. The incidence of resistance to antibiotics varies from one species to another and according to countries. Presently, even though no Streptococcus pyogenes has shown diminished susceptibility to betalactams, this phenomenon has been reported for some strains in the B, C, and G groups, and for up to 56 % of oral streptococci. As for the resistance to macrolides, it reaches as many as 41 % of Streptococcus pyogenes, 46 % of group B streptococci, and 63 % of oral streptococci responsible for severe infections. This evolution is worrying for all streptococci but particularly for oral streptococci which represent a potential reservoir of virulence genes, notably towards Streptococcus pneumoniae. New families of antibiotics as the ketolides or the oxazolidinones appear to be effective in the treatment of streptococcal infections, but it seems that only a policy of control of the consumption of antibiotics could globally decrease the occurrence of resistance.

Comparison of four commercialized biochemical systems for clinical yeast identification by colour-producing reactions

We compared the ability of four commercially available yeast identification systems for routine laboratory hospital use: Auxacolor (AUX) (Sanofi Diagnostics Pasteur, Marne-la-Coquette), Fungichrom I (FUC) and Fungifast I Twin (FUF) (International Microbio, Toulon), Api Candida (API) (bioMérieux, Lyon). These systems are based on obtaining a biochemical profile easily defined by colorimetric reactions. We tested 202 yeasts belonging to 19 species which were included or were not included in the manufacturer's data base of the identification systems. Without extra tests, for all the organisms tested, after 24 h of incubation, the percentage of organisms correctly identified was 48% for AUX, 75% for FUC, 77% for FUF and 81% for API. However, if we consider the ratio of the number of correct identifications without extra tests with the number of yeasts included in the manufacturers' data bases (sensitivity) the results increased to 61% for AUX, 81% for FUC, 91% for FUF and 83% for API. These systems are particularly well adapted to medical use, they are simple to set up, interpret, and have very good efficiency for the yeasts most commonly isolated in clinical specimens. The findings reported here indicate that the most favourable results were obtained with FUF and API systems.