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Sbacco V, Petrucciani N, Lauteri G, Cossa A, Portinari M, Brescia A, Garulli G. Management of groin hernias in emergency setting: differences in indications and outcomes between laparoscopic and open approach. A single-center retrospective experience. Langenbecks Arch Surg 2024; 409:48. [PMID: 38277083 PMCID: PMC10817833 DOI: 10.1007/s00423-024-03238-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 01/16/2024] [Indexed: 01/27/2024]
Abstract
PURPOSE The use of minimally invasive groin hernia repair techniques in an emergency setting is still debated and its widespread is limited. The aim of this study is to evaluate the safety and efficacy of the laparoscopic transabdominal preperitoneal (TAPP) technique in the treatment of inguinal and femoral hernias in emergency setting based on our experience, comparing indications and outcomes with the open technique. METHODS A retrospective analysis was performed including all patients with incarcerated and/or strangulated groin hernia who underwent emergency surgery from November 2019 to September 2022. Perioperative variables and short- and long-term outcomes were examined. Statistical analysis was performed using chi-square test for nominal variables and Student's t test for continuous ones. A p value < 0.05 was considered statistically significant. RESULTS Sixty-six patients were included: 29 patients were treated with TAPP technique (Tapp group) and 37 with open technique plus diagnostic laparoscopy (Open group). Patients in the TAPP group were younger, had less severe clinical scenarios, and had a trend for lower Charlson Comorbidity Index, whereas ASA score and BMI were similar. The small bowel was more frequently herniated in the open group. Bilateral hernia repair was performed in 20.69% of patients in the Tapp group versus 0% in the Open group (p = 0.004). Bowel resection was more frequent in the open group (48.65% vs 0% of the Tapp group, p < 0.001) length of surgery was comparable in the two groups. In the Tapp group, the length of hospitalization was significantly shorter (2.59 ± 2.28 days vs. 9.08 ± 14.48 days; p = 0.023). Postoperative complications, according to Clavien-Dindo, were more severe in Open group where there were two deaths. There were no differences in the number of readmission and re-operations at 30 days and in the recurrence rate. CONCLUSIONS Emergency repair of inguinal and femoral hernias using TAPP is a valuable option, safe and feasible in selected patients. In this series, indications for TAPP were reserved to younger patients with less comorbidities and less severe clinical scenario. Future randomized studies are needed to compare TAPP with open emergency hernia surgery in all settings. Potential advantages of TAPP are the reduction of postoperative complications, earlier recovery, and the possibility of bilateral treatment.
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Affiliation(s)
- V Sbacco
- Department of Medical and Surgical Sciences and Translational Medicine, Unit of Colorectal Oncologic Surgery, "Sant'Andrea" University Hospital, Sapienza University of Rome, Rome, Italy
- Unit of General and Emergency Surgery, Infermi Hospital, Rimini, Italy
| | - N Petrucciani
- Department of Medical and Surgical Sciences and Translational Medicine, Unit of Colorectal Oncologic Surgery, "Sant'Andrea" University Hospital, Sapienza University of Rome, Rome, Italy.
| | - G Lauteri
- Department of Medical and Surgical Sciences and Translational Medicine, Unit of Colorectal Oncologic Surgery, "Sant'Andrea" University Hospital, Sapienza University of Rome, Rome, Italy
| | - A Cossa
- Department of Medical and Surgical Sciences and Translational Medicine, Unit of Colorectal Oncologic Surgery, "Sant'Andrea" University Hospital, Sapienza University of Rome, Rome, Italy
| | - M Portinari
- Unit of General and Emergency Surgery, Infermi Hospital, Rimini, Italy
| | - A Brescia
- Department of Medical and Surgical Sciences and Translational Medicine, Unit of Colorectal Oncologic Surgery, "Sant'Andrea" University Hospital, Sapienza University of Rome, Rome, Italy
| | - G Garulli
- Unit of General and Emergency Surgery, Infermi Hospital, Rimini, Italy
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Nag S, Larsen G, Szarvas J, Birkedahl LEK, Gulyás GM, Ciok WJ, Lagermann TM, Tafaj S, Bradbury S, Collignon P, Daley D, Dougnon V, Fabiyi K, Coulibaly B, Dembélé R, Nikiema G, Magloire N, Ouindgueta IJ, Hossain ZZ, Begum A, Donchev D, Diggle M, Turnbull L, Lévesque S, Berlinger L, Sogaard KK, Guevara PD, Valderrama CD, Maikanti P, Amlerova J, Drevinek P, Tkadlec J, Dilas M, Kaasch A, Westh HT, Bachtarzi MA, Amhis W, Salazar CES, Villacis J, Lúzon MAD, Palau DB, Duployez C, Paluche M, Asante-Sefa S, Moller M, Ip M, Mareković I, Pál-Sonnevend A, Cocuzza CE, Dambrauskiene A, Macanze A, Cossa A, Mandomando I, Nwajiobi-Princewill P, Okeke IN, Kehinde AO, Adebiyi I, Akintayo I, Popoola O, Onipede A, Blomfeldt A, Nyquist NE, Bocker K, Ussher J, Ali A, Ullah N, Khan H, Gustafson NW, Jarrar I, Al-Hamad A, Luvira V, Paveenkittiporn W, Baran I, Mwansa JCL, Sikakwa L, Yamba K, Hendriksen RS, Aarestrup FM. Whole genomes from bacteria collected at diagnostic units around the world 2020. Sci Data 2023; 10:628. [PMID: 37717051 PMCID: PMC10505216 DOI: 10.1038/s41597-023-02502-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 08/23/2023] [Indexed: 09/18/2023] Open
Abstract
The Two Weeks in the World research project has resulted in a dataset of 3087 clinically relevant bacterial genomes with pertaining metadata, collected from 59 diagnostic units in 35 countries around the world during 2020. A relational database is available with metadata and summary data from selected bioinformatic analysis, such as species prediction and identification of acquired resistance genes.
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Affiliation(s)
- Sidsel Nag
- National Food Institute, Technical University of Denmark, Kemitorvet, Kgs, Lyngby, 2800, Denmark.
| | - Gunhild Larsen
- National Food Institute, Technical University of Denmark, Kemitorvet, Kgs, Lyngby, 2800, Denmark
| | - Judit Szarvas
- National Food Institute, Technical University of Denmark, Kemitorvet, Kgs, Lyngby, 2800, Denmark
| | | | - Gábor Máté Gulyás
- National Food Institute, Technical University of Denmark, Kemitorvet, Kgs, Lyngby, 2800, Denmark
| | - Wojchiech Jakub Ciok
- National Food Institute, Technical University of Denmark, Kemitorvet, Kgs, Lyngby, 2800, Denmark
| | - Timmie Mikkel Lagermann
- National Food Institute, Technical University of Denmark, Kemitorvet, Kgs, Lyngby, 2800, Denmark
| | - Silva Tafaj
- Microbiology Department, University Hospital "Shefqet Ndroqi", Rruga Dr. Shefqet Ndroqi. Sauk, Tirana, 1044, Albania
| | - Susan Bradbury
- Microbiology Department, Canberra Hospital, Gilmore Cresent, Garran, 2605, Australian Capital Territory, Australia
| | - Peter Collignon
- Microbiology Department, Canberra Hospital, Gilmore Cresent, Garran, 2605, Australian Capital Territory, Australia
| | - Denise Daley
- Department of Microbiology, PathWest Laboratory Medicine, Fiona Stanley Hospital, 9 Robin Warren Drive, Murdoch, 6150, Western Australia, Australia
| | - Victorien Dougnon
- Research Unit in Applied Microbiology and Pharmacology of Natural Substances, Polytechnic School of Abomey-Calavi, University of Abomey-Calavi, 01 PO Box, Abomey-Calavi, 2009, Cotonou, Benin
| | - Kafayath Fabiyi
- Research Unit in Applied Microbiology and Pharmacology of Natural Substances, Polytechnic School of Abomey-Calavi, University of Abomey-Calavi, 01 PO Box, Abomey-Calavi, 2009, Cotonou, Benin
| | - Boubacar Coulibaly
- Department of Laboratory, Nouna Health Research Centre, Rue Namory Keita, Nouna, Burkina Faso
| | - René Dembélé
- Training and Research Unit in Applied Sciences and Technologies/Biochemistry-microbiology, University of Dedougou, Dedougou, 176, Boucle du Mouhoun, Burkina Faso
| | - Georgette Nikiema
- Training and Research Unit in Applied Sciences and Technologies/Biochemistry-microbiology, University of Dedougou, Dedougou, 176, Boucle du Mouhoun, Burkina Faso
| | - Natama Magloire
- Clinical Research Unit of Nanoro, National Institutes of Medical Research, Ouagadougou, 176, Burkina Faso
| | | | | | - Anowara Begum
- Department of Microbiology, University of Dhaka, Dhaka, 1000, Bangladesh
| | - Deyan Donchev
- Clinical Laboratory of Microbiology and Virology, University Hospital "Lozenetz", Str. Kozyak 1, Sofia, 1407, Sofia, Bulgaria
| | | | | | - Simon Lévesque
- Service de microbiologie, Centre Integré Universitaire de Santé et de services sociaux de l'Estrie - Centre Hospitalier Universitaire de Sherbrooke, 3001 12è avenue Nord, Sherbrooke, J1H 5N4, Québec, Canada
| | | | - Kirstine Kobberoe Sogaard
- Division of Clinical Bacteriology and Mycology, University Hospital Basel, Petersgraben 4, Basel, 4031, Switzerland
| | - Paula Diaz Guevara
- Microbiology Group, Instituto Nacional de Salud, Avenida Calle 26·51-20 CAN, Bogotá, 111321, Colombia
| | | | - Panagiota Maikanti
- Charalampous, Microbiology Department, National Reference Laboratory for Antimicrobial Resistance Surveillance, Nicosia General Hospital, 215, Paleos Dromos Lefkosia-Lemesos str., Strovolos, 2029, Nicosia, Cyprus
| | - Jana Amlerova
- Department of Microbiology, University Hospital in Plzen, Edvarda Benese 1128/13, Plzen, 305 99, Czech Republic
| | - Pavel Drevinek
- Department of Medical Microbiology, Motol University Hospital, V Uvalu 84, Prague, 15006, Czech Republic
| | - Jan Tkadlec
- Department of Medical Microbiology, Motol University Hospital, V Uvalu 84, Prague, 15006, Czech Republic
| | - Milica Dilas
- Otto-von-Guericke University, Magdebourg, Germany
| | - Achim Kaasch
- Otto-von-Guericke University, Magdebourg, Germany
| | - Henrik Torkil Westh
- Klinisk Mikrobiologisk Afdeling, Hvidovre Hospital, Kettegårds Allé, Hvidovre, 2650, Denmark
| | - Mohamed Azzedine Bachtarzi
- Laboratoire de Microbiologie Clinique, Centre Hospitalo-universitaire, 1 place du 1er Mai 1945, Algiers, 16000, Algeria
| | - Wahiba Amhis
- Laboratoire de Microbiologie Clinique, Centre Hospitalo-universitaire, 1 place du 1er Mai 1945, Algiers, 16000, Algeria
| | - Carolina Elisabeth Satán Salazar
- National Reference Center for Antimicrobial Resistance, National Institute of Public Health Research "Dr. Leopoldo Izquieta Pérez", Iquique N14-285, Quito, 170403, Pichicha, Ecuador
| | - JoséEduardo Villacis
- Centro de Investigación para la Salud en América Latina (CISeAL), Pontificia Universidad Católica del Ecuador, Quinto, 1701-2184, Pichincha, Ecuador
| | | | | | - Claire Duployez
- Institute of Microbiology, Centre Hospitalier Universitaire de Lille, Rue du Pr. Jules Leclercq, Lille, 59037, France
| | - Maxime Paluche
- Bacteriology laboratory, Centre hospitalier de Valenciennes, Avenue Désandrouin, Valenciennes, 59300, France
| | - Solomon Asante-Sefa
- Sekondi Public Health Laboratory, Ghana Health Service, Effia Nkwanta Regional Hospital, Effia Nkwanta Regional Hospital, Takoradi, Ghana
| | - Mie Moller
- Dronning Ingrids Hospital, Nuuk, Greenland
| | - Margaret Ip
- Chinese University of Hong Kong, Shatin, Hong Kong
| | - Ivana Mareković
- Department of Clinical and Molecular Microbiology, University Hospital Centre Zagreb, Kišpatićeva 12, Zagreb, 10000, Croatia
| | - Agnes Pál-Sonnevend
- Medical Microbiology and Immunology, University of Pecs Medical School, Szigeti ut 12, Pecs, 7631, Hungary
| | | | - Asta Dambrauskiene
- Laboratory Medicine Department, Hospital of Lithuanian University of Health Sciences Kauno klinikos, Eiveniu Str. 2, Kaunas, 50161, Lithuania
| | | | - Anelsio Cossa
- Centro de Investigação em Saúde de Manhiça, Manhiça, Mozambique
| | | | | | - Iruka N Okeke
- Faculty of Pharmacy, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Aderemi O Kehinde
- College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
- University College of Ibadan, Ibadan, Oyo State, Nigeria
| | - Ini Adebiyi
- Faculty of Pharmacy, University of Ibadan, Ibadan, Oyo State, Nigeria
- University College of Ibadan, Ibadan, Oyo State, Nigeria
| | - Ifeoluwa Akintayo
- College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Oluwafemi Popoola
- College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
- University College of Ibadan, Ibadan, Oyo State, Nigeria
| | | | - Anita Blomfeldt
- Department of Microbiology and Infection Control, Akershus University Hospital, Sykehusveien 25, Lørenskog, 1478, Norway
| | - Nora Elisabeth Nyquist
- Department of Microbiology and Infection Control, Akershus University Hospital, Sykehusveien 25, Lørenskog, 1478, Norway
| | - Kiri Bocker
- Southern Community Laboratories, University of Otago, 472 George Street, Otago, 9016, Dunedin, New Zealand
| | - James Ussher
- Southern Community Laboratories, University of Otago, 472 George Street, Otago, 9016, Dunedin, New Zealand
| | - Amjad Ali
- Department of Industrial Biotechnology, Atta-ur-Rahman School of Applied Biosciences, National University of Sciences and Technology (NUST), H-12, Islamabad, 44000, Pakistan
| | - Nimat Ullah
- Department of Industrial Biotechnology, Atta-ur-Rahman School of Applied Biosciences, National University of Sciences and Technology (NUST), H-12, Islamabad, 44000, Pakistan
| | - Habibullah Khan
- Molecular Diagnostic Section, Khyber Teaching Hospital (KTH), University Road, Peshawar, 25120, Pakistan
| | - Natalie Weiler Gustafson
- Departamento de Bacteriologia, Laboratorio Central de Salud Publico, Avenida Venezuela y Tte Escurra, Asunción, CP, 1429, Paraguay
| | - Ikhlas Jarrar
- Basic Medical Sciences Department, Arab American University, AAUP st., Zababdeh, P240, Jenin, Palestine
| | - Arif Al-Hamad
- Division of Clinical Microbiology, Qatif Central Hospital, 3213 Dharan-Jubail Expressway, Al-Qatif, 32654-7376, Eastern Province, Saudi Arabia
| | - Viravarn Luvira
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Ratchawithi Road, Bangkok, 10400, Thailand
| | | | - Irmak Baran
- Medical Microbiology Department, Karadeniz Technical University Farabi Hospital, Farabi Hastanesi, Trabzon, 61080, Ortahisar, Turkey
| | | | | | | | - Rene Sjogren Hendriksen
- National Food Institute, Technical University of Denmark, Kemitorvet, Kgs, Lyngby, 2800, Denmark
| | - Frank Moller Aarestrup
- National Food Institute, Technical University of Denmark, Kemitorvet, Kgs, Lyngby, 2800, Denmark
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Grau-Pujol B, Gandasegui J, Escola V, Marti-Soler H, Cambra-Pellejà M, Demontis M, Brienen EAT, Jamine JC, Muchisse O, Cossa A, Sacoor C, Cano J, Van Lieshout L, Martinez-Valladares M, Muñoz J. Single-Nucleotide Polymorphisms in the Beta-Tubulin Gene and Its Relationship with Treatment Response to Albendazole in Human Soil-Transmitted Helminths in Southern Mozambique. Am J Trop Med Hyg 2022; 107:tpmd210948. [PMID: 35895348 PMCID: PMC9490645 DOI: 10.4269/ajtmh.21-0948] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 05/02/2022] [Indexed: 11/17/2022] Open
Abstract
Soil-transmitted helminth (STH) cornerstone control strategy is mass drug administration (MDA) with benzimidazoles. However, MDA might contribute to selection pressure for anthelmintic resistance, as occurred in livestock. The aim of this study is to evaluate the treatment response to albendazole and the relationship with the presence of putative benzimidazole resistance single-nucleotide polymorphisms (SNPs) in the β-tubulin gene of STH in Southern Mozambique. After screening 819 participants, we conducted a cohort study with 184 participants infected with STH in Manhiça district, Southern Mozambique. A pretreatment and a posttreatment stool samples were collected and the STH infection was identified by duplicate Kato-Katz and quantitative polymerase chain reaction (qPCR). Cure rate and egg reduction rates were calculated. Putative benzimidazole resistance SNPs (F167Y, F200T, and E198A) in Trichuris trichiura and Necator americanus were assessed by pyrosequencing. Cure rates by duplicate Kato-Katz and by qPCR were 95.8% and 93.6% for Ascaris lumbricoides, 28% and 7.8% for T. trichiura, and 88.9% and 56.7% for N. americanus. Egg reduction rate by duplicate Kato-Katz was 85.4% for A. lumbricoides, 34.9% for T. trichiura, and 40.5% for N. americanus. Putative benzimidazole resistance SNPs in the β-tubulin gene were detected in T. trichiura (23%) and N. americanus (21%) infected participants at pretreatment. No statistical difference was observed between pretreatment and posttreatment frequencies for none of the SNPs. Although treatment response to albendazole was low, particularly in T. trichiura, the putative benzimidazole resistance SNPs were not higher after treatment in the population studied. New insights are needed for a better understanding and monitoring of human anthelmintic resistance.
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Affiliation(s)
- Berta Grau-Pujol
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic – University of Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- Mundo Sano Foundation, Buenos Aires, Argentina
| | - Javier Gandasegui
- Instituto de Ganadería de Montaña (CSIC-Universidad de León), Grulleros, León, Spain
- Departamento de Sanidad Animal, Facultad de Veterinaria, Universidad de León, Campus de Vegazana, León, Spain
| | - Valdemiro Escola
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Helena Marti-Soler
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic – University of Barcelona, Barcelona, Spain
| | - Maria Cambra-Pellejà
- Instituto de Ganadería de Montaña (CSIC-Universidad de León), Grulleros, León, Spain
- Departamento de Sanidad Animal, Facultad de Veterinaria, Universidad de León, Campus de Vegazana, León, Spain
| | - Maria Demontis
- Department of Parasitology, Centre of Infectious Diseases, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - Eric A. T. Brienen
- Department of Parasitology, Centre of Infectious Diseases, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | | | - Osvaldo Muchisse
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Anelsio Cossa
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Charfudin Sacoor
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Jorge Cano
- Expanded Special Project for Elimination of NTDs, World Health Organization Regional Office for Africa, Brazzaville, The Republic of the Congo
| | - Lisette Van Lieshout
- Department of Parasitology, Centre of Infectious Diseases, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - Maria Martinez-Valladares
- Instituto de Ganadería de Montaña (CSIC-Universidad de León), Grulleros, León, Spain
- Departamento de Sanidad Animal, Facultad de Veterinaria, Universidad de León, Campus de Vegazana, León, Spain
| | - Jose Muñoz
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic – University of Barcelona, Barcelona, Spain
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Grau-Pujol B, Martí-Soler H, Escola V, Demontis M, Jamine JC, Gandasegui J, Muchisse O, Cambra-Pellejà M, Cossa A, Martinez-Valladares M, Sacoor C, Van Lieshout L, Cano J, Giorgi E, Muñoz J. Towards soil-transmitted helminths transmission interruption: The impact of diagnostic tools on infection prediction in a low intensity setting in Southern Mozambique. PLoS Negl Trop Dis 2021; 15:e0009803. [PMID: 34695108 PMCID: PMC8568186 DOI: 10.1371/journal.pntd.0009803] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 11/04/2021] [Accepted: 09/09/2021] [Indexed: 11/19/2022] Open
Abstract
World Health Organization goals against soil-transmitted helminthiases (STH) are pointing towards seeking their elimination as a public health problem: reducing to less than 2% the proportion of moderate and heavy infections. Some regions are reaching WHO goals, but transmission could rebound if strategies are discontinued without an epidemiological evaluation. For that, sensitive diagnostic methods to detect low intensity infections and localization of ongoing transmission are crucial. In this work, we estimated and compared the STH infection as obtained by different diagnostic methods in a low intensity setting. We conducted a cross-sectional study enrolling 792 participants from a district in Mozambique. Two stool samples from two consecutive days were collected from each participant. Samples were analysed by Telemann, Kato-Katz and qPCR for STH detection. We evaluated diagnostic sensitivity using a composite reference standard. By geostatistical methods, we estimated neighbourhood prevalence of at least one STH infection for each diagnostic method. We used environmental, demographical and socioeconomical indicators to account for any existing spatial heterogeneity in infection. qPCR was the most sensitive technique compared to composite reference standard: 92% (CI: 83%- 97%) for A. lumbricoides, 95% (CI: 88%- 98%) for T. trichiura and 95% (CI: 91%- 97%) for hookworm. qPCR also estimated the highest neighbourhood prevalences for at least one STH infection in a low intensity setting. While 10% of the neighbourhoods showed a prevalence above 20% when estimating with single Kato-Katz from one stool and Telemann from one stool, 86% of the neighbourhoods had a prevalence above 20% when estimating with qPCR. In low intensity settings, STH estimated prevalence of infection may be underestimated if based on Kato-Katz. qPCR diagnosis outperformed the microscopy methods. Thus, implementation of qPCR based predictive maps at STH control and elimination programmes would disclose hidden transmission and facilitate targeted interventions for transmission interruption.
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Affiliation(s)
- Berta Grau-Pujol
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic—University of Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- Mundo Sano Foundation, Buenos Aires, Argentina
- * E-mail:
| | - Helena Martí-Soler
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic—University of Barcelona, Barcelona, Spain
| | - Valdemiro Escola
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Maria Demontis
- Department of Parasitology, Centre of Infectious Diseases, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | | | - Javier Gandasegui
- Instituto de Ganadería de Montaña (CSIC-Universidad de León), Grulleros, León, Spain
- Departamento de Sanidad Animal, Facultad de Veterinaria, Universidad de León, Campus de Vegazana, León, Spain
| | - Osvaldo Muchisse
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Maria Cambra-Pellejà
- Instituto de Ganadería de Montaña (CSIC-Universidad de León), Grulleros, León, Spain
- Departamento de Sanidad Animal, Facultad de Veterinaria, Universidad de León, Campus de Vegazana, León, Spain
| | - Anelsio Cossa
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Maria Martinez-Valladares
- Instituto de Ganadería de Montaña (CSIC-Universidad de León), Grulleros, León, Spain
- Departamento de Sanidad Animal, Facultad de Veterinaria, Universidad de León, Campus de Vegazana, León, Spain
| | - Charfudin Sacoor
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Lisette Van Lieshout
- Department of Parasitology, Centre of Infectious Diseases, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - Jorge Cano
- Expanded Special Project for Elimination of NTDs, World Health Organization Regional Office for Africa, Brazzaville, The Republic of the Congo
| | - Emanuele Giorgi
- Centre for Health Informatics, Computing and Statistics, Lancaster Medical School, Faculty of Health and Medicine, Lancaster University, United Kingdom
| | - Jose Muñoz
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic—University of Barcelona, Barcelona, Spain
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Saavedra B, Mambuque E, Gomes N, Nguenha D, Mabunda R, Faife L, Langa R, Munguambe S, Manjate F, Cossa A, Scott L, García-Basteiro AL. Diagnostic performance of the Abbott RealTime MTB assay for tuberculosis diagnosis in people living with HIV. Sci Rep 2021; 11:19271. [PMID: 34588508 PMCID: PMC8481474 DOI: 10.1038/s41598-021-96922-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 08/02/2021] [Indexed: 11/09/2022] Open
Abstract
Strengthening tuberculosis diagnosis is an international priority and the advocacy for multi-disease testing devices raises the possibility of improving laboratory efficiency. However, the advantages of centralized platforms might not translate into real improvements under operational conditions. This study aimed to evaluate the field use of the Abbott RealTime MTB (RT-MTB) and Xpert MTB/RIF assays, in a large cohort of HIV-positive and TB presumptive cases in Southern Mozambique. Over a 6-month period, 255 HIV-positive TB presumptive cases were consecutively recruited in the high TB/HIV burden district of Manhiça. The diagnostic performance of both assays was evaluated against two different reference standards: a microbiological gold standard (MGS) and a composite reference standard (CRS). Results from the primary analysis (MGS) showed improved sensitivity (Se) and reduced specificity (Sp) for the Abbott RT-MTB assay compared to the Xpert MTB/RIF (RT-MTB Se: 0.92 (95% CI: 0.75;0.99) vs Xpert Se: 0.73 (95% CI: 0.52;0.88) p value = 0.06; RT-MTB Sp: 0.80 (0.72;0.86) vs Xpert Sp: 0.96 (0.92;0.99) p value < 0.001). The lower specificity may be due to cross-reactivity with non-tuberculous mycobacteria (NTMs), the detection of non-viable MTBC, or the identification of true TB cases missed by the gold standard.
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Affiliation(s)
- Belén Saavedra
- PhD Program in Medicine and Translational Research, Universitat de Barcelona, Barcelona, Spain.
- Centro de Investigação Em Saude de Manhiça (CISM), Maputo, Mozambique.
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.
| | - Edson Mambuque
- Centro de Investigação Em Saude de Manhiça (CISM), Maputo, Mozambique
| | - Neide Gomes
- Centro de Investigação Em Saude de Manhiça (CISM), Maputo, Mozambique
| | - Dinis Nguenha
- Centro de Investigação Em Saude de Manhiça (CISM), Maputo, Mozambique
| | - Rita Mabunda
- Centro de Investigação Em Saude de Manhiça (CISM), Maputo, Mozambique
| | - Luis Faife
- Manhiça Health Research Hospital, Ministry of Health, National Tuberculosis Control Program, Maputo, Mozambique
| | - Ruben Langa
- Manhiça Health Research Hospital, Ministry of Health, National Tuberculosis Control Program, Maputo, Mozambique
| | - Shilzia Munguambe
- Centro de Investigação Em Saude de Manhiça (CISM), Maputo, Mozambique
| | - Filomena Manjate
- Centro de Investigação Em Saude de Manhiça (CISM), Maputo, Mozambique
| | - Anelsio Cossa
- Centro de Investigação Em Saude de Manhiça (CISM), Maputo, Mozambique
| | - Lesley Scott
- Department of Molecular Medicine and Haematology, School of Pathology, and iLEAD, Faculty of Health Sciences, Wits Health Consortium, University of the Witwatersrand, Johannesburg, South Africa
| | - Alberto L García-Basteiro
- Centro de Investigação Em Saude de Manhiça (CISM), Maputo, Mozambique
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
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6
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Gandasegui J, Grau-Pujol B, Cambra-Pelleja M, Escola V, Demontis MA, Cossa A, Jamine JC, Balaña-Fouce R, van Lieshout L, Muñoz J, Martínez-Valladares M. Improving stool sample processing and pyrosequencing for quantifying benzimidazole resistance alleles in Trichuris trichiura and Necator americanus pooled eggs. Parasit Vectors 2021; 14:490. [PMID: 34563247 PMCID: PMC8466976 DOI: 10.1186/s13071-021-04941-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 08/10/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is an urgent need for an extensive evaluation of benzimidazole efficacy in humans. In veterinary science, benzimidazole resistance has been mainly associated with three single-nucleotide polymorphisms (SNPs) in the isotype-1 β-tubulin gene. In this study, we optimized the stool sample processing methodology and resistance allele frequency assessment in Trichuris trichiura and Necator americanus anthelmintic-related SNPs by pyrosequencing, and standardized it for large-scale benzimidazole efficacy screening use. METHODS Three different protocols for stool sample processing were compared in 19 T. trichiura-positive samples: fresh stool, egg concentration using metallic sieves with decreasing pore size, and egg concentration followed by flotation with saturated salt solution. Yield of each protocol was assessed by estimating the load of parasite DNA by real-time PCR. Then, we sequenced a DNA fragment of the β-tubulin gene containing the putative benzimidazole resistance SNPs in T. trichiura and N. americanus. Afterwards, resistant and susceptible-type plasmids were produced and mixed at different proportions, simulating different resistance levels. These mixtures were used to compare previously described pyrosequencing assays with processes newly designed by our own group. Once the stool sample processing and the pyrosequencing methodology was defined, the utility of the protocols was assessed by measuring the frequencies of putative resistance SNPs in 15 T. trichiura- and 15 N. americanus-positive stool samples. RESULTS The highest DNA load was provided by egg concentration using metallic sieves with decreasing pore size. Sequencing information of the β-tubulin gene in Mozambican specimens was highly similar to the sequences previously reported, for T. trichiura and N. americanus, despite the origin of the sample. When we compared pyrosequencing assays using plasmids constructs, primers designed in this study provided the most accurate SNP frequencies. When pooled egg samples were analysed, none of resistant SNPs were observed in T. trichiura, whereas 17% of the resistant SNPs at codon 198 were found in one N. americanus sample. CONCLUSIONS We optimized the sample processing methodology and standardized pyrosequencing in soil-transmitted helminth (STH) pooled eggs. These protocols could be used in STH large-scale screenings or anthelmintic efficacy trials.
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Affiliation(s)
- Javier Gandasegui
- Instituto de Ganadería de Montaña (CSIC-Universidad de León), Grulleros, León, Spain.,Departamento de Sanidad Animal, Facultad de Veterinaria, Universidad de León, Campus de Vegazana, León, Spain
| | - Berta Grau-Pujol
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.,Centro de Investigação Em Saúde de Manhiça (CISM), Maputo, Mozambique.,Fundación Mundo Sano, Buenos Aires, Argentina
| | - María Cambra-Pelleja
- Instituto de Ganadería de Montaña (CSIC-Universidad de León), Grulleros, León, Spain.,Departamento de Sanidad Animal, Facultad de Veterinaria, Universidad de León, Campus de Vegazana, León, Spain
| | - Valdemiro Escola
- Centro de Investigação Em Saúde de Manhiça (CISM), Maputo, Mozambique
| | | | - Anelsio Cossa
- Centro de Investigação Em Saúde de Manhiça (CISM), Maputo, Mozambique
| | | | | | - Lisette van Lieshout
- Departement of Parasitology, Leiden University Medical Center, Leiden, The Netherlands
| | - José Muñoz
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - María Martínez-Valladares
- Instituto de Ganadería de Montaña (CSIC-Universidad de León), Grulleros, León, Spain. .,Departamento de Sanidad Animal, Facultad de Veterinaria, Universidad de León, Campus de Vegazana, León, Spain.
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7
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Grau-Pujol B, Cuamba I, Jairoce C, Cossa A, Da Silva J, Sacoor C, Dobaño C, Nhabomba A, Mejia R, Muñoz J. Molecular Detection of Soil-Transmitted Helminths and Enteric Protozoa Infection in Children and Its Association with Household Water and Sanitation in Manhiça District, Southern Mozambique. Pathogens 2021; 10:pathogens10070838. [PMID: 34357988 PMCID: PMC8308871 DOI: 10.3390/pathogens10070838] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 06/26/2021] [Accepted: 06/30/2021] [Indexed: 11/16/2022] Open
Abstract
Intestinal parasite infections can have detrimental health consequences in children. In Mozambique, soil-transmitted helminth (STH) infections are controlled through mass drug administration since 2011, but no specific control program exists for enteric protozoa. This study evaluates STH and protozoan infections in children attending healthcare in Manhiça district, Southern Mozambique, and its association with water and sanitation conditions. We conducted a cross-sectional study in children between 2 and 10 years old in two health centers (n = 405). A stool sample and metadata were collected from each child. Samples were analyzed by multi-parallel real-time quantitative PCR (qPCR). We fitted logistic regression-adjusted models to assess the association between STH or protozoan infection with household water and sanitation use. Nineteen percent were infected with at least one STH and 77.5% with at least one enteric protozoon. qPCR detected 18.8% of participants with intestinal polyparasitism. Protected or unprotected water well use showed a higher risk for at least one protozoan infection in children (OR: 2.59, CI: 1.01-6.65, p-value = 0.010; OR: 5.21, CI: 1.56-17.46, p-value = 0.010, respectively) compared to household piped water. A high proportion of children had enteric protozoan infections. Well consumable water displayed high risk for that.
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Affiliation(s)
- Berta Grau-Pujol
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic—University of Barcelona, 08036 Barcelona, Spain; (C.D.); (J.M.)
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo 1929, Mozambique; (I.C.); (C.J.); (A.C.); (C.S.); (A.N.)
- Mundo Sano Foundation, Buenos Aires 1535, Argentina
- Correspondence: ; Tel.: +34-9322-75400
| | - Inocencia Cuamba
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo 1929, Mozambique; (I.C.); (C.J.); (A.C.); (C.S.); (A.N.)
| | - Chenjerai Jairoce
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo 1929, Mozambique; (I.C.); (C.J.); (A.C.); (C.S.); (A.N.)
| | - Anelsio Cossa
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo 1929, Mozambique; (I.C.); (C.J.); (A.C.); (C.S.); (A.N.)
| | - Juliana Da Silva
- Department of Medicine, Baylor College of Medicine, Houston, TX 77030, USA;
| | - Charfudin Sacoor
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo 1929, Mozambique; (I.C.); (C.J.); (A.C.); (C.S.); (A.N.)
| | - Carlota Dobaño
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic—University of Barcelona, 08036 Barcelona, Spain; (C.D.); (J.M.)
| | - Augusto Nhabomba
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo 1929, Mozambique; (I.C.); (C.J.); (A.C.); (C.S.); (A.N.)
| | - Rojelio Mejia
- Department of Pediatrics, National School of Tropical Medicine, Baylor College of Medicine, Houston, TX 77030, USA;
| | - Jose Muñoz
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic—University of Barcelona, 08036 Barcelona, Spain; (C.D.); (J.M.)
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8
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Rakislova N, Jordao D, Ismail MR, Mayor A, Cisteró P, Marimon L, Ferrando M, Hurtado JC, Lovane L, Carrilho C, Lorenzoni C, Fernandes F, Nhampossa T, Cossa A, Mandomando I, Navarro M, Casas I, Munguambe K, Maixenchs M, Quintó L, Macete E, Martinez M, Snow RW, Bassat Q, Menéndez C, Ordi J. Accuracy of verbal autopsy, clinical data and minimally invasive autopsy in the evaluation of malaria-specific mortality: an observational study. BMJ Glob Health 2021; 6:bmjgh-2021-005218. [PMID: 34083241 PMCID: PMC8183227 DOI: 10.1136/bmjgh-2021-005218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 05/12/2021] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Global malaria mortality estimates are hindered by the low reliability of the verbal autopsy (VA) and the clinical records, the most common sources of information used to estimate malaria-specific mortality. We aimed to determine the accuracy of these tools, as well as of the minimally invasive autopsy (MIA), a needle-based postmortem sampling method, to identify malaria-specific mortality in a large series of deceased patients from Mozambique, using complete autopsy as the gold standard. METHODS Observational study that included 264 deaths, occurring at a tertiary level hospital in Mozambique, from 1 November 2013 to 31 March 2015 (17 months-long period). Clinical data were abstracted, a computer coded VA was completed using the clinical data as source of information, and an MIA followed by a complete autopsy were performed. Screening for malaria infection was conducted postmortem to all participants using molecular and histological techniques (PCR and immunohistochemistry). FINDINGS Malaria infection was considered the cause of death in 6/264 (2.3%) cases: 2/54 children (3.7%, both less than 5 years old) and 4/57 (7.0%) maternal deaths. The sensitivity and specificity of the VA, the clinical data and the MIA to identify malaria-specific deaths were 33.3% and 96.1%, 66.7% and 96.1%, and 100% and 100%, respectively. In addition, malaria was identified as a possible contributor in 14 additional patients who died of other diseases. These cases were also accurately identified by the MIA (sensitivity 82.4%, specificity 100%). INTERPRETATION The high sensitivity and specificity of the MIA in identifying malaria may help to improve current estimates of malaria-specific mortality in endemic areas.
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Affiliation(s)
- Natalia Rakislova
- ISGLOBAL, Hospital Clinic, University of Barcelona, Barcelona, Spain.,Department of Pathology, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Dercio Jordao
- Department of Pathology, Quelimane Central Hospital, Quelimane, Mozambique
| | - Mamudo R Ismail
- Department of Pathology, Maputo Central Hospital, Maputo, Mozambique.,Faculty of Medicine, University Eduardo Mondlane, Maputo, Mozambique
| | - Alfredo Mayor
- ISGLOBAL, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Pau Cisteró
- ISGLOBAL, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Lorena Marimon
- ISGLOBAL, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Melania Ferrando
- ISGLOBAL, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Juan Carlos Hurtado
- ISGLOBAL, Hospital Clinic, University of Barcelona, Barcelona, Spain.,Department of Microbiology, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Lucilia Lovane
- Department of Pathology, Maputo Central Hospital, Maputo, Mozambique
| | - Carla Carrilho
- Department of Pathology, Maputo Central Hospital, Maputo, Mozambique.,Faculty of Medicine, University Eduardo Mondlane, Maputo, Mozambique
| | | | - Fabiola Fernandes
- Department of Pathology, Maputo Central Hospital, Maputo, Mozambique
| | - Tacilta Nhampossa
- Centro de Investigação em Saúde de Manhiça, Manhica, Mozambique.,Department of Pediatrics, Maputo Central Hospital, Maputo, Mozambique
| | - Anelsio Cossa
- Centro de Investigação em Saúde de Manhiça, Manhica, Mozambique
| | | | - Mireia Navarro
- ISGLOBAL, Hospital Clinic, University of Barcelona, Barcelona, Spain.,Department of Microbiology, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Isaac Casas
- ISGLOBAL, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Khatia Munguambe
- Faculty of Medicine, University Eduardo Mondlane, Maputo, Mozambique.,Centro de Investigação em Saúde de Manhiça, Manhica, Mozambique
| | - Maria Maixenchs
- ISGLOBAL, Hospital Clinic, University of Barcelona, Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça, Manhica, Mozambique
| | - Llorenç Quintó
- ISGLOBAL, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Eusebio Macete
- Centro de Investigação em Saúde de Manhiça, Manhica, Mozambique
| | - Mikel Martinez
- ISGLOBAL, Hospital Clinic, University of Barcelona, Barcelona, Spain.,Department of Microbiology, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Robert W Snow
- Population and Health Unit, KEMRI - Wellcome Trust Research Programme, Nairobi, Kenya.,Centre for Tropical Medicine and Global Health, Nuttfield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Quique Bassat
- ISGLOBAL, Hospital Clinic, University of Barcelona, Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça, Manhica, Mozambique
| | - Clara Menéndez
- ISGLOBAL, Hospital Clinic, University of Barcelona, Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça, Manhica, Mozambique.,Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Jaume Ordi
- ISGLOBAL, Hospital Clinic, University of Barcelona, Barcelona, Spain .,Department of Pathology, Hospital Clínic, University of Barcelona, Barcelona, Spain
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9
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Garcia-Basteiro A, Hurtado JC, Castillo P, Fernandes F, Navarro M, Lovane L, Casas I, Quinto L, Jordao D, Ismail MR, Lorenzoni C, Carrilho C, Sanz A, Rakislova N, Mira A, Alvarez-Martínez M, Cossa A, Cobelens F, Mandomando I, Vila J, Bassat Q, Menéndez C, Ordi J, Martínez MJ. Unmasking the hidden tuberculosis mortality burden in a large postmortem study in Mozambique. Tuberculosis (Edinb) 2019. [DOI: 10.1183/13993003.congress-2019.pa5287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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10
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Ordi J, Castillo P, Garcia-Basteiro AL, Moraleda C, Fernandes F, Quintó L, Hurtado JC, Letang E, Lovane L, Jordao D, Navarro M, Bene R, Nhampossa T, Ismail MR, Lorenzoni C, Guisseve A, Rakislova N, Varo R, Marimon L, Sanz A, Cossa A, Mandomando I, Maixenchs M, Munguambe K, Vila J, Macete E, Alonso PL, Bassat Q, Martínez MJ, Carrilho C, Menéndez C. Clinico-pathological discrepancies in the diagnosis of causes of death in adults in Mozambique: A retrospective observational study. PLoS One 2019; 14:e0220657. [PMID: 31490955 PMCID: PMC6730941 DOI: 10.1371/journal.pone.0220657] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 07/20/2019] [Indexed: 11/18/2022] Open
Abstract
Background Clinico-pathological discrepancies are more frequent in settings in which limited diagnostic techniques are available, but there is little information on their actual impact. Aim We assessed the accuracy of the clinical diagnoses in a tertiary referral hospital in sub-Saharan Africa by comparison with post-mortem findings. We also identified potential risk factors for misdiagnoses. Methods One hundred and twelve complete autopsy procedures were performed at the Maputo Central Hospital (Mozambique), from November 2013 to March 2015. We reviewed the clinical records. Major clinico-pathological discrepancies were assessed using a modified version of the Goldman and Battle classification. Results Major diagnostic discrepancies were detected in 65/112 cases (58%) and were particularly frequent in infection-related deaths (56/80 [70%] major discrepancies). The sensitivity of the clinical diagnosis for toxoplasmosis was 0% (95% CI: 0–37), 18% (95% CI: 2–52) for invasive fungal infections, 25% (95% CI: 5–57) for bacterial sepsis, 34% (95% CI: 16–57), for tuberculosis, and 46% (95% CI: 19–75) for bacterial pneumonia. Major discrepancies were more frequent in HIV-positive than in HIV-negative patients (48/73 [66%] vs. 17/39 [44%]; p = 0.0236). Conclusions Major clinico-pathological discrepancies are still frequent in resource constrained settings. Increasing the level of suspicion for infectious diseases and expanding the availability of diagnostic tests could significantly improve the recognition of common life-threatening infections, and thereby reduce the mortality associated with these diseases. The high frequency of clinico-pathological discrepancies questions the validity of mortality reports based on clinical data or verbal autopsy.
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Affiliation(s)
- Jaume Ordi
- Department of Pathology, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
- * E-mail:
| | - Paola Castillo
- Department of Pathology, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Alberto L. Garcia-Basteiro
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- Amsterdam Institute for Global Health and Development (AIGHD), Academic Medical Center, Amsterdam, The Netherlands
| | - Cinta Moraleda
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Fabiola Fernandes
- Department of Pathology, Maputo Central Hospital, Maputo, Mozambique
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Llorenç Quintó
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Juan Carlos Hurtado
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
- Department of Microbiology, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Emili Letang
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- Service of Infectious Diseases, Hospital del Mar, Hospital del Mar Research Institute (IMIM), Barcelona, Spain
| | - Lucilia Lovane
- Department of Pathology, Maputo Central Hospital, Maputo, Mozambique
| | - Dercio Jordao
- Department of Pathology, Maputo Central Hospital, Maputo, Mozambique
| | - Mireia Navarro
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
- Department of Microbiology, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Rosa Bene
- Department of Medicine, Maputo Central Hospital, Maputo, Mozambique
| | - Tacilta Nhampossa
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Mamudo R. Ismail
- Department of Pathology, Maputo Central Hospital, Maputo, Mozambique
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Cesaltina Lorenzoni
- Department of Pathology, Maputo Central Hospital, Maputo, Mozambique
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Assucena Guisseve
- Department of Pathology, Maputo Central Hospital, Maputo, Mozambique
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Natalia Rakislova
- Department of Pathology, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Rosauro Varo
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Lorena Marimon
- Department of Pathology, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Ariadna Sanz
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Anelsio Cossa
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Inacio Mandomando
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Maria Maixenchs
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Khátia Munguambe
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Jordi Vila
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
- Department of Microbiology, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Eusebio Macete
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Pedro L. Alonso
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Quique Bassat
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- ICREA, Catalan Institution for Research and Advanced Studies, Barcelona, Spain
- Pediatric Infectious Diseases Unit, Pediatrics Department, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - Miguel J. Martínez
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Carla Carrilho
- Department of Pathology, Maputo Central Hospital, Maputo, Mozambique
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Clara Menéndez
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud, Madrid, Spain
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11
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Hurtado JC, Castillo P, Fernandes F, Navarro M, Lovane L, Casas I, Quintó L, Marco F, Jordao D, Ismail MR, Lorenzoni C, Martinez-Palhares AE, Ferreira L, Lacerda M, Monteiro W, Sanz A, Letang E, Marimon L, Jesri S, Cossa A, Mandomando I, Vila J, Bassat Q, Ordi J, Menéndez C, Carrilho C, Martínez MJ. Mortality due to Cryptococcus neoformans and Cryptococcus gattii in low-income settings: an autopsy study. Sci Rep 2019; 9:7493. [PMID: 31097746 PMCID: PMC6522501 DOI: 10.1038/s41598-019-43941-w] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 05/03/2019] [Indexed: 01/14/2023] Open
Abstract
Cryptococcosis is a major opportunistic infection and is one of the leading causes of death in adults living with HIV in sub-Saharan Africa. Recent estimates indicate that more than 130,000 people may die annually of cryptococcal meningitis in this region. Although complete diagnostic autopsy (CDA) is considered the gold standard for determining the cause of death, it is seldom performed in low income settings. In this study, a CDA was performed in 284 deceased patients from Mozambique (n = 223) and Brazil (n = 61). In depth histopathological and microbiological analyses were carried out in all cases dying of cryptococcosis. We determined the cryptococcal species, the molecular and sero-mating types and antifungal susceptibility. We also described the organs affected and reviewed the clinical presentation and patient management. Among the 284 cases included, 17 fatal cryptococcal infections were diagnosed. Cryptococcus was responsible for 16 deaths among the 163 HIV-positive patients (10%; 95%CI: 6-15%), including four maternal deaths. One third of the cases corresponded to C. gattii (VGI and VGIV molecular types, Bα and Cα strains) and the remaining infections typed were caused by C. neoformans var. Grubii (all VNI and Aα strains). The level of pre-mortem clinical suspicion was low (7/17, 41%), and 7/17 patients (41%) died within the first 72 hours of admission. Cryptococcosis was responsible for a significant proportion of AIDS-related mortality. The clinical diagnosis and patient management were inadequate, supporting the need for cryptococcal screening for early detection of the disease. This is the first report of the presence of C. gattii infection in Mozambique.
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Affiliation(s)
- Juan Carlos Hurtado
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.,Department of Microbiology, Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Paola Castillo
- Department of Microbiology, Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain.,Department of Pathology, Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Fabiola Fernandes
- Department of Pathology, Maputo Central Hospital, Maputo, Mozambique
| | - Mireia Navarro
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.,Department of Microbiology, Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Lucilia Lovane
- Department of Pathology, Maputo Central Hospital, Maputo, Mozambique
| | - Isaac Casas
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.,Department of Microbiology, Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Llorenç Quintó
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Francesc Marco
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.,Department of Microbiology, Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Dercio Jordao
- Department of Pathology, Maputo Central Hospital, Maputo, Mozambique
| | - Mamudo R Ismail
- Department of Pathology, Maputo Central Hospital, Maputo, Mozambique.,Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Cesaltina Lorenzoni
- Department of Pathology, Maputo Central Hospital, Maputo, Mozambique.,Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | | | - Luiz Ferreira
- Fundação de Medicina Tropical Doutor Heitor Viera Dourado, Manaus, Amazonas, Brazil
| | - Marcus Lacerda
- Fundação de Medicina Tropical Doutor Heitor Viera Dourado, Manaus, Amazonas, Brazil.,Instituto de Pesquisas Leônidas & Maria Deane, Fiocruz, Manaus, Brazil
| | - Wuelton Monteiro
- Fundação de Medicina Tropical Doutor Heitor Viera Dourado, Manaus, Amazonas, Brazil
| | - Ariadna Sanz
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Emilio Letang
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.,Hospital del Mar. Service of Infectious Diseases, Hospital del Mar, Hospital del Mar Research Institute (IMIM), Barcelona, Spain
| | - Lorena Marimon
- Department of Microbiology, Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain.,Department of Pathology, Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Susan Jesri
- Department of Microbiology, Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain.,Department of Pathology, Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Anelsio Cossa
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | | | - Jordi Vila
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.,Department of Microbiology, Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Quique Bassat
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique.,ICREA, Catalan Institution for Research and Advanced Studies, Pg. Lluís Companys 23, 08010, Barcelona, Spain.,Pediatric Infectious Diseases Unit, Pediatrics Department, Hospital Sant Joan de Déu (University of Barcelona), Barcelona, Spain
| | - Jaume Ordi
- Department of Microbiology, Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain.,Department of Pathology, Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Clara Menéndez
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique.,Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Carla Carrilho
- Department of Pathology, Maputo Central Hospital, Maputo, Mozambique.,Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Miguel J Martínez
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain. .,Department of Microbiology, Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain.
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12
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Varo R, Sitoe A, Cossa A, Ordi J, Rozman M, Bassat Q. Leukoerythroblastosis in a Young Child with Severe Malaria and Superimposed Gram Negative Infection. J Trop Pediatr 2018; 64:553-556. [PMID: 29272534 DOI: 10.1093/tropej/fmx101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Leukoerythroblastosis, a non-specific and often short-lasting response of the bone marrow to different diseases such as malignancies or infections, is characterized by the presence in the peripheral blood of immature red and white cells. METHODS We present a case of leukoerythoblastosis occurring in a 24 months old Mozambican girl, in the context of a severe malaria episode and an associated urinary tract infection. Peripheral blood smear was used for diagnosis of malaria and leukoerythroblastosis. Enterobacter cloacae isolation and antibiotic susceptibility testing were performed by conventional microbiology. RESULTS Peripheral blood smear was positive for Plasmodium falciparum and showed a leukoerythroblastosis with red cell anisopoikilocytosis and left shifted neutrophils. Urine culture confirmed the presence of a multi-resistant E. cloacae. Treatment of underlying conditions resolved the leukoerythroblastic reaction. CONCLUSIONS Leukoerythroblastosis may be related to different infectious diseases and may also appear in the context of severe malaria. Bacterial superinfection needs to be investigated.
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Affiliation(s)
- Rosauro Varo
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo 1929, Mozambique.,ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic - Universitat de Barcelona, Barcelona 08036, Spain
| | - Antonio Sitoe
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo 1929, Mozambique
| | - Anelsio Cossa
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo 1929, Mozambique
| | - Jaume Ordi
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic - Universitat de Barcelona, Barcelona 08036, Spain.,Department of Pathology, Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona 08036, Spain
| | - Maria Rozman
- Department of Pathology, Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona 08036, Spain
| | - Quique Bassat
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo 1929, Mozambique.,ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic - Universitat de Barcelona, Barcelona 08036, Spain.,ICREA, Pg. Lluís Companys 23, Barcelona 08010, Spain.,Pediatric Infectious Diseases Unit, Pediatrics Department, Hospital Sant Joan de Déu (University of Barcelona), Barcelona 08950, Spain.,Universidad Europea de Madrid, Madrid 28670, Spain
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13
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Fernandes F, Castillo P, Bassat Q, Quintó L, Hurtado JC, Martínez MJ, Lovane L, Jordao D, Bene R, Nhampossa T, Ritchie PS, Bandeira S, Sambo C, Chicamba V, Mocumbi S, Jaze Z, Mabota F, Ismail MR, Lorenzoni C, Sanz A, Rakislova N, Marimon L, Cossa A, Mandomando I, Vila J, Maixenchs M, Munguambe K, Macete E, Alonso P, Menéndez C, Ordi J, Carrilho C. Contribution of the clinical information to the accuracy of the minimally invasive and the complete diagnostic autopsy. Hum Pathol 2018; 85:184-193. [PMID: 30496801 PMCID: PMC6478426 DOI: 10.1016/j.humpath.2018.10.037] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 10/29/2018] [Accepted: 10/29/2018] [Indexed: 12/02/2022]
Abstract
Although autopsy diagnosis includes routinely, a thorough evaluation of all available pathological results and also of any available clinical data, the contribution of this clinical information to the diagnostic yield of the autopsy has not been analyzed. We aimed to determine to which degree the use of clinical data improves the diagnostic accuracy of the complete diagnostic autopsy (CDA) and the minimally invasive autopsy (MIA), a simplified pathological postmortem procedure designed for low-income sites. A total of 264 coupled MIA and CDA procedures (112 adults, 57 maternal deaths, 54 children, and 41 neonates) were performed at the Maputo Hospital, Mozambique. We compared the diagnoses obtained by the MIA blind to clinical data (MIAb), the MIA adding the clinical information (MIAc), and the CDA blind to clinical information (CDAb), with the results of the gold standard, the CDA with clinical data, by comparing the International Classification of Diseases, Tenth Revision codes and the main diagnostic classes obtained with each evaluation strategy (MIAb, MIAc, CDAb, CDAc). The clinical data increased diagnostic coincidence to the MIAb with the gold standard in 30 (11%) of 264 cases and modified the CDAb diagnosis in 20 (8%) of 264 cases. The increase in concordance between MIAb and MIAc with the gold standard was significant in neonatal deaths (κ increasing from 0.404 to 0.618, P = .0271), adult deaths (κ increasing from 0.732 to 0.813, P = .0221), and maternal deaths (κ increasing from 0.485 to 0.836, 0.;P < .0001). In conclusion, the use of clinical information increases the precision of MIA and CDA and may strengthen the performance of the MIA in resource-limited settings. The addition of clinical data increases the diagnostic accuracy of the minimally invasive autopsy (MIA) and complete diagnostic autopsy in 12% and 8% of the cases, respectively. The increase in concordance from MIA blind to clinical data to MIA enhanced with clinical data was significant in neonatal, adult, and maternal deaths and was also evident in children, although it did not reach statistical significance. The use of clinical data may improve the diagnostic precision of the MIA in resource-limited settings.
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Affiliation(s)
- Fabiola Fernandes
- Department of Pathology, Maputo Central Hospital, 1100 Maputo, Mozambique; Faculty of Medicine, Eduardo Mondlane University, 1100 Maputo, Mozambique
| | - Paola Castillo
- ISGlobal, Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain; Department of Pathology, Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain
| | - Quique Bassat
- ISGlobal, Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain; Centro de Investigação em Saúde de Manhiça, 1100 Maputo, Mozambique; ICREA, Catalan Institution for Research and Advanced Studies, Pg. Lluís Companys 23, 08010 Barcelona, Spain; Pediatric Infectious Diseases Unit, Pediatrics Department, Hospital Sant Joan de Déu, Universitat de Barcelona, 8950 Barcelona, Spain; Universidad Europea de Madrid, 28670 Madrid, Spain
| | - Llorenç Quintó
- ISGlobal, Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain
| | - Juan Carlos Hurtado
- ISGlobal, Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain; Department of Microbiology, Hospital Clinic of Barcelona, Universitat de Barcelona, 08036 Barcelona, Spain
| | - Miguel J Martínez
- ISGlobal, Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain; Department of Microbiology, Hospital Clinic of Barcelona, Universitat de Barcelona, 08036 Barcelona, Spain
| | - Lucilia Lovane
- Department of Pathology, Maputo Central Hospital, 1100 Maputo, Mozambique
| | - Dercio Jordao
- Department of Pathology, Maputo Central Hospital, 1100 Maputo, Mozambique
| | - Rosa Bene
- Department of Medicine, Maputo Central Hospital, 1100 Maputo, Mozambique
| | | | | | - Sónia Bandeira
- Department of Pediatrics, Maputo Central Hospital, 1100 Maputo, Mozambique
| | - Calvino Sambo
- Department of Pediatrics, Maputo Central Hospital, 1100 Maputo, Mozambique
| | - Valeria Chicamba
- Department of Pediatrics, Maputo Central Hospital, 1100 Maputo, Mozambique
| | - Sibone Mocumbi
- Department of Gynecology and Obstetrics, Maputo Central Hospital, 1100 Maputo, Mozambique
| | - Zara Jaze
- Department of Gynecology and Obstetrics, Maputo Central Hospital, 1100 Maputo, Mozambique
| | - Flora Mabota
- Department of Gynecology and Obstetrics, Maputo Central Hospital, 1100 Maputo, Mozambique
| | - Mamudo R Ismail
- Department of Pathology, Maputo Central Hospital, 1100 Maputo, Mozambique; Faculty of Medicine, Eduardo Mondlane University, 1100 Maputo, Mozambique
| | - Cesaltina Lorenzoni
- Department of Pathology, Maputo Central Hospital, 1100 Maputo, Mozambique; Faculty of Medicine, Eduardo Mondlane University, 1100 Maputo, Mozambique
| | - Ariadna Sanz
- ISGlobal, Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain
| | - Natalia Rakislova
- ISGlobal, Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain; Department of Pathology, Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain
| | - Lorena Marimon
- ISGlobal, Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain
| | - Anelsio Cossa
- Centro de Investigação em Saúde de Manhiça, 1100 Maputo, Mozambique
| | | | - Jordi Vila
- ISGlobal, Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain; Department of Microbiology, Hospital Clinic of Barcelona, Universitat de Barcelona, 08036 Barcelona, Spain
| | - Maria Maixenchs
- ISGlobal, Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain; Centro de Investigação em Saúde de Manhiça, 1100 Maputo, Mozambique
| | - Khátia Munguambe
- Centro de Investigação em Saúde de Manhiça, 1100 Maputo, Mozambique
| | - Eusebio Macete
- Centro de Investigação em Saúde de Manhiça, 1100 Maputo, Mozambique
| | - Pedro Alonso
- ISGlobal, Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain; Centro de Investigação em Saúde de Manhiça, 1100 Maputo, Mozambique
| | - Clara Menéndez
- ISGlobal, Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain; Centro de Investigação em Saúde de Manhiça, 1100 Maputo, Mozambique; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
| | - Jaume Ordi
- ISGlobal, Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain; Department of Pathology, Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain.
| | - Carla Carrilho
- Department of Pathology, Maputo Central Hospital, 1100 Maputo, Mozambique; Faculty of Medicine, Eduardo Mondlane University, 1100 Maputo, Mozambique
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14
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Hurtado JC, Quintó L, Castillo P, Carrilho C, Fernandes F, Jordao D, Lovane L, Navarro M, Casas I, Bene R, Nhampossa T, Santos Ritchie P, Bandeira S, Sambo C, Chicamba V, Mocumbi S, Jaze Z, Mabota F, Ismail MR, Lorenzoni C, Guisseve A, Rakislova N, Marimon L, Castrejon N, Sanz A, Cossa A, Mandomando I, Munguambe K, Maixenchs M, Muñoz-Almagro C, Macete E, Alonso P, Vila J, Bassat Q, Menéndez C, Martínez MJ, Ordi J. Postmortem Interval and Diagnostic Performance of the Autopsy Methods. Sci Rep 2018; 8:16112. [PMID: 30382145 PMCID: PMC6208334 DOI: 10.1038/s41598-018-34436-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 10/10/2018] [Indexed: 11/09/2022] Open
Abstract
Postmortem studies, including the complete diagnostic autopsy (CDA) and the minimally invasive autopsy (MIA), an innovative approach to post-mortem sampling and cause of death investigation, are commonly performed within 24 hours after death because the quality of the tissues deteriorates over time. This short timeframe may hamper the feasibility of the procedure. In this study, we compared the diagnostic performance of the two postmortem procedures when carried out earlier and later than 24 hours after death, as well as the impact of increasing postmortem intervals (PMIs) on the results of the microbiological tests in a series of 282 coupled MIA/CDA procedures performed at the Maputo Central Hospital in Mozambique between 2013 and 2015. 214 procedures were conducted within 24 hours of death (early autopsies), and 68 after 24 hours of death (late autopsies). No significant differences were observed in the number of non-conclusive diagnoses (2/214 [1%] vs. 1/68 [1%] p = 0.5645 for the CDA; 27/214 [13%] vs. 5/68 [7%] p = 0.2332 for the MIA). However, increasing PMIs were associated with a raise in the number of bacteria identified (rate: 1.014 per hour [95%CI: 1.002–1.026]; p = 0.0228). This increase was mainly due to rising numbers of bacteria of the Enterobacteriaceae family and Pseudomonas genus strains. Thus, performing MIA or CDA more than 24 hours after death can still render reliable diagnostic results, not only for non-infectious conditions but also for many infectious diseases, although, the contribution of Enterobacteriaceae and Pseudomonas spp. as etiological agents of infections leading to death may be overestimated.
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Affiliation(s)
- Juan Carlos Hurtado
- ISGlobal, Hospital Clinic - Universitat de Barcelona, Barcelona, Spain.,Department of Microbiology, Hospital Clinic - Universitat de Barcelona, Barcelona, Spain
| | - Llorenç Quintó
- ISGlobal, Hospital Clinic - Universitat de Barcelona, Barcelona, Spain
| | - Paola Castillo
- ISGlobal, Hospital Clinic - Universitat de Barcelona, Barcelona, Spain.,Department of Pathology, Hospital Clinic - Universitat de Barcelona, Barcelona, Spain
| | - Carla Carrilho
- Department of Pathology, Maputo Central Hospital, Maputo, Mozambique.,Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Fabiola Fernandes
- Department of Pathology, Maputo Central Hospital, Maputo, Mozambique.,Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Dercio Jordao
- Department of Pathology, Maputo Central Hospital, Maputo, Mozambique
| | - Lucilia Lovane
- Department of Pathology, Maputo Central Hospital, Maputo, Mozambique
| | - Mireia Navarro
- ISGlobal, Hospital Clinic - Universitat de Barcelona, Barcelona, Spain.,Department of Microbiology, Hospital Clinic - Universitat de Barcelona, Barcelona, Spain
| | - Isaac Casas
- ISGlobal, Hospital Clinic - Universitat de Barcelona, Barcelona, Spain.,Department of Microbiology, Hospital Clinic - Universitat de Barcelona, Barcelona, Spain
| | - Rosa Bene
- Department of Medicine, Maputo Central Hospital, Maputo, Mozambique
| | | | | | - Sónia Bandeira
- Department of Pediatrics, Maputo Central Hospital, Maputo, Mozambique
| | - Calvino Sambo
- Department of Pediatrics, Maputo Central Hospital, Maputo, Mozambique
| | - Valeria Chicamba
- Department of Pediatrics, Maputo Central Hospital, Maputo, Mozambique
| | - Sibone Mocumbi
- Department of Gynecology and Obstetrics, Maputo Central Hospital, Maputo, Mozambique
| | - Zara Jaze
- Department of Gynecology and Obstetrics, Maputo Central Hospital, Maputo, Mozambique
| | - Flora Mabota
- Department of Gynecology and Obstetrics, Maputo Central Hospital, Maputo, Mozambique
| | - Mamudo R Ismail
- Department of Pathology, Maputo Central Hospital, Maputo, Mozambique.,Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Cesaltina Lorenzoni
- Department of Pathology, Maputo Central Hospital, Maputo, Mozambique.,Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Assucena Guisseve
- Department of Pathology, Maputo Central Hospital, Maputo, Mozambique.,Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Natalia Rakislova
- ISGlobal, Hospital Clinic - Universitat de Barcelona, Barcelona, Spain.,Department of Pathology, Hospital Clinic - Universitat de Barcelona, Barcelona, Spain
| | - Lorena Marimon
- ISGlobal, Hospital Clinic - Universitat de Barcelona, Barcelona, Spain.,Department of Pathology, Hospital Clinic - Universitat de Barcelona, Barcelona, Spain
| | - Natalia Castrejon
- Department of Pathology, Hospital Clinic - Universitat de Barcelona, Barcelona, Spain
| | - Ariadna Sanz
- Department of Microbiology, Hospital Clinic - Universitat de Barcelona, Barcelona, Spain
| | - Anelsio Cossa
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | | | - Khátia Munguambe
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique.,Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | - Maria Maixenchs
- ISGlobal, Hospital Clinic - Universitat de Barcelona, Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | - Carmen Muñoz-Almagro
- Department of Molecular Microbiology, University Hospital Sant Joan de Déu (University of Barcelona), Barcelona, Spain.,Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Faculty of Medicine, Univesitat Internacional de Catalunya, Barcelona, Spain
| | - Eusebio Macete
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | - Pedro Alonso
- ISGlobal, Hospital Clinic - Universitat de Barcelona, Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | - Jordi Vila
- ISGlobal, Hospital Clinic - Universitat de Barcelona, Barcelona, Spain.,Department of Microbiology, Hospital Clinic - Universitat de Barcelona, Barcelona, Spain
| | - Quique Bassat
- ISGlobal, Hospital Clinic - Universitat de Barcelona, Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique.,ICREA, Catalan Institution for Research and Advanced Studies, Pg. Lluís Companys 23, 08010, Barcelona, Spain.,Pediatric Infectious Diseases Unit, Pediatrics Department, Hospital Sant Joan de Déu (University of Barcelona), Barcelona, Spain
| | - Clara Menéndez
- ISGlobal, Hospital Clinic - Universitat de Barcelona, Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique.,Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Miguel J Martínez
- ISGlobal, Hospital Clinic - Universitat de Barcelona, Barcelona, Spain.,Department of Microbiology, Hospital Clinic - Universitat de Barcelona, Barcelona, Spain
| | - Jaume Ordi
- ISGlobal, Hospital Clinic - Universitat de Barcelona, Barcelona, Spain. .,Department of Pathology, Hospital Clinic - Universitat de Barcelona, Barcelona, Spain.
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15
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Castillo P, Hurtado JC, Martínez MJ, Jordao D, Lovane L, Ismail MR, Carrilho C, Lorenzoni C, Fernandes F, Mocumbi S, Jaze ZO, Mabota F, Cossa A, Mandomando I, Cisteró P, Mayor A, Navarro M, Casas I, Vila J, Maixenchs M, Munguambe K, Sanz A, Quintó L, Macete E, Alonso P, Bassat Q, Ordi J, Menéndez C. Validity of a minimally invasive autopsy for cause of death determination in maternal deaths in Mozambique: An observational study. PLoS Med 2017; 14:e1002431. [PMID: 29117196 PMCID: PMC5695595 DOI: 10.1371/journal.pmed.1002431] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 10/06/2017] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Despite global health efforts to reduce maternal mortality, rates continue to be unacceptably high in large parts of the world. Feasible, acceptable, and accurate postmortem sampling methods could provide the necessary evidence to improve the understanding of the real causes of maternal mortality, guiding the design of interventions to reduce this burden. METHODS AND FINDINGS The validity of a minimally invasive autopsy (MIA) method in determining the cause of death was assessed in an observational study in 57 maternal deaths by comparing the results of the MIA with those of the gold standard (complete diagnostic autopsy [CDA], which includes any available clinical information). Concordance between the MIA and the gold standard diagnostic categories was assessed by the kappa statistic, and the sensitivity, specificity, positive and negative predictive values and their 95% confidence intervals (95% CI) to identify the categories of diagnoses were estimated. The main limitation of the study is that both the MIA and the CDA include some degree of subjective interpretation in the attribution of cause of death. A cause of death was identified in the CDA in 98% (56/57) of cases, with indirect obstetric conditions accounting for 32 (56%) deaths and direct obstetric complications for 24 (42%) deaths. Nonobstetric infectious diseases (22/32, 69%) and obstetric hemorrhage (13/24, 54%) were the most common causes of death among indirect and direct obstetric conditions, respectively. Thirty-six (63%) women were HIV positive, and HIV-related conditions accounted for 16 (28%) of all deaths. Cerebral malaria caused 4 (7%) deaths. The MIA identified a cause of death in 86% of women. The overall concordance of the MIA with the CDA was moderate (kappa = 0.48, 95% CI: 0.31-0.66). Both methods agreed in 68% of the diagnostic categories and the agreement was higher for indirect (91%) than for direct obstetric causes (38%). All HIV infections and cerebral malaria cases were identified in the MIA. The main limitation of the technique is its relatively low performance for identifying obstetric causes of death in the absence of clinical information. CONCLUSIONS The MIA procedure could be a valuable tool to determine the causes of maternal death, especially for indirect obstetric conditions, most of which are infectious diseases. The information provided by the MIA could help to prioritize interventions to reduce maternal mortality and to monitor progress towards achieving global health targets.
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Affiliation(s)
- Paola Castillo
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain
- Department of Pathology, Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Juan Carlos Hurtado
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain
- Department of Microbiology, Hospital Clinic of Barcelona, Universitat de Barcelona, Spain
| | - Miguel J. Martínez
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain
- Department of Microbiology, Hospital Clinic of Barcelona, Universitat de Barcelona, Spain
| | - Dercio Jordao
- Department of Pathology, Maputo Central Hospital, Maputo, Mozambique
| | - Lucilia Lovane
- Department of Pathology, Maputo Central Hospital, Maputo, Mozambique
| | - Mamudo R. Ismail
- Department of Pathology, Maputo Central Hospital, Maputo, Mozambique
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Carla Carrilho
- Department of Pathology, Maputo Central Hospital, Maputo, Mozambique
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Cesaltina Lorenzoni
- Department of Pathology, Maputo Central Hospital, Maputo, Mozambique
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Fabiola Fernandes
- Department of Pathology, Maputo Central Hospital, Maputo, Mozambique
| | - Sibone Mocumbi
- Department of Gynecology and Obstetrics, Maputo Central Hospital, Maputo, Mozambique
| | - Zara Onila Jaze
- Department of Gynecology and Obstetrics, Maputo Central Hospital, Maputo, Mozambique
| | - Flora Mabota
- Department of Gynecology and Obstetrics, Maputo Central Hospital, Maputo, Mozambique
| | - Anelsio Cossa
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | | | - Pau Cisteró
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Alfredo Mayor
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | - Mireia Navarro
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain
- Department of Microbiology, Hospital Clinic of Barcelona, Universitat de Barcelona, Spain
| | - Isaac Casas
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain
- Department of Microbiology, Hospital Clinic of Barcelona, Universitat de Barcelona, Spain
| | - Jordi Vila
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain
- Department of Microbiology, Hospital Clinic of Barcelona, Universitat de Barcelona, Spain
| | - Maria Maixenchs
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | - Khátia Munguambe
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | - Ariadna Sanz
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Llorenç Quintó
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Eusebio Macete
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | - Pedro Alonso
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | - Quique Bassat
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
- ICREA, Catalan Institution for Research and Advanced Studies, Pg. Lluís Companys, Barcelona, Spain
| | - Jaume Ordi
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain
- Department of Pathology, Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Clara Menéndez
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- * E-mail:
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Rovira G, Cooke EF, Mucavele H, Sitoe A, Madrid L, Nhampossa T, Garrine M, Massora S, Cossa A, Mandomando I, Bassat Q. The Challenge of Diagnosing and Treating Staphylococcus aureus Invasive Infections in a Resource-limited Sub-Saharan Africa Setting: A Case Report. J Trop Pediatr 2015; 61:397-402. [PMID: 26187541 DOI: 10.1093/tropej/fmv045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Community-acquired methicillin-sensitive Staphylococcus aureus (CA-MSSA) is responsible for the majority of skin and soft-tissue infections. CA-MSSA can also cause life-threatening infections, possibly in relation to particular virulence factors, including Panton-Valentine leukocidin (PVL). METHODS We describe a severe CA-MSSA necrotizing pneumonia complicated with multifocal osteomyelitis, pericardial effusion and endocarditis in a 6-year-old boy admitted to a Mozambican hospital. Staphylococcus aureus isolation and antibiotic susceptibility testing were performed by conventional microbiology. Additionally, microarray assay was used for molecular characterization. RESULTS Blood culture confirmed the presence of S. aureus susceptible to most antimicrobial agents, including methicillin. Molecular characterization confirmed the presence of PVL, together with alpha and beta haemolysin genes. CONCLUSIONS To our knowledge, this is the first reported case of disseminated CA-MSSA disease with confirmed PVL exotoxin in sub-Saharan Africa. PVL-positive CA-MSSA should be considered in the differential diagnosis of community-acquired pneumonia, making laboratory testing a higher priority.
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Affiliation(s)
- Gemma Rovira
- EAP Sardenya-Hospital de la Santa Creu i Sant Pau, Barcelona, 08025, Spain
| | - Elisa F Cooke
- Unidad de Enfermedades Infecciosas, Servicio de Pediatría, Hospital 12 de Octubre, Madrid, 28041, Spain
| | - Helio Mucavele
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique, CP1929
| | - Antonio Sitoe
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique, CP1929
| | - Lola Madrid
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique, CP1929 ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic - Universitat de Barcelona, Barcelona, 08036, Spain
| | - Tacilta Nhampossa
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique, CP1929 Instituto Nacional de Saúde, Ministério de Saúde, Maputo, Mozambique, CP264
| | - Marcelino Garrine
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique, CP1929
| | - Sergio Massora
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique, CP1929
| | - Anelsio Cossa
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique, CP1929
| | - Inacio Mandomando
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique, CP1929 Instituto Nacional de Saúde, Ministério de Saúde, Maputo, Mozambique, CP264
| | - Quique Bassat
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique, CP1929 ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic - Universitat de Barcelona, Barcelona, 08036, Spain
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Cossa A. Ein Chromtiirmalin aus den Chromeisenlagern des Urals. Z KRIST-CRYST MATER 2015. [DOI: 10.1524/zkri.1883.7.1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Mavale-Manuel S, Joaquim O, Nunes E, Pedro A, Bandeira S, Eduardo E, Macome C, Almeida L, Cossa A, Malichocho J, Maciel L, Constance E, Marques S, Tembe A, de Blic J, Annesi-Maesano I. Prevalence of asthma-like symptoms by ISAAC video questionnaire in Mozambican schoolchildren. Monaldi Arch Chest Dis 2007; 65:189-95. [PMID: 17393663 DOI: 10.4081/monaldi.2006.548] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The International Study of Asthma and Allergies in Childhood (ISAAC) video questionnaire was developed to overcome the language and cultural differences in the assessment of asthma-like symptoms. METHODS 27 schools were included in the Maputo Asthma and Allergies in childhood Study (MAPAAS) using ISAAC methods, and a video questionnaire (VQ) was administered to 1614 adolescents 13-14 years old of 20 schools located in urban, suburban and semi-rural areas of Maputo (Mozambique). Simultaneously, they also replied to the ISAAC written questionnaire (WQ). RESULTS According to the video questionnaire, the prevalence of current asthma was 11.9% (compared with 13.3% using the written questionnaire). Wheezing after exercise in the last year was reported by about 21%. Females reported more frequent wheezing after exercise than males (p < .001). The prevalence of nocturnal cough in the last year was 24.7%, and was more frequent in the suburban area (p < .001). "Severe attacks of asthma" was reported by 11.9% of the individuals. Teenagers instructed in the suburban schools reported more severe asthma-like symptoms than others (p < .05). There was a poor correlation between the WQ and the AVQ3.0 (kappa coefficients varied from 0.09 to 0.24). The lowest agreement was observed for the question regarding severe attacks of asthma. Agreement was better in terms of specificity than in terms of sensitivity. CONCLUSIONS In spite of the poor agreement between the written and the video questionnaires, the prevalence of asthma symptoms estimated using the video questionnaire confirms that asthma is an important public health problem in Maputo.
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Affiliation(s)
- S Mavale-Manuel
- Maputo Central Hospital--Department of Paediatrics, Mozambique
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