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Differences in diagnosis, management, and outcomes of acute febrile illness by health facility level in southern Ethiopia. Sci Rep 2022; 12:19166. [PMID: 36357441 PMCID: PMC9649757 DOI: 10.1038/s41598-022-23641-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 11/03/2022] [Indexed: 11/11/2022] Open
Abstract
We assessed the diagnosis, management and outcomes of acute febrile illness in a cohort of febrile children aged under 5 years presenting at one urban and two rural health centres and one tertiary hospital between 11 August 2019 and 01 November 2019. Pneumonia was diagnosed in 104 (30.8%) of 338 children at health centres and 128 (65.0%) of 197 at the hospital (p < 0.001). Malaria was detected in 33 (24.3%) of 136 children at the urban health centre, and in 55 (55.6%) of 99 and 7 (7.4%) of 95 children at the rural health centres compared to 11 (11.6%) of 95 at the hospital. Antibacterials were prescribed to 20 (11.5%) of 174 children without guidelines-specified indications (overprescribing) at health centres and in 7 (33.3%) of 21 children at the hospital (p = 0.013). Antimalarials were overprescribed to 13 (7.0%) of 185 children with negative malaria microscopy at the hospital. The fever resolved by day 7 in 326 (99.7%) of 327 children at health centres compared to 177 (93.2%) of 190 at the hospital (p < 0.001). These results suggest that additional guidance to health workers is needed to optimise the use of antimicrobials across all levels of health facilities.
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2
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Shimelis T, Vaz Nery S, Tadesse BT, Bartlett AW, Belay FW, Schierhout G, Dittrich S, Crump JA, Kaldor JM. Clinical management and outcomes of acute febrile illness in children attending a tertiary hospital in southern Ethiopia. BMC Infect Dis 2022; 22:434. [PMID: 35509024 PMCID: PMC9069758 DOI: 10.1186/s12879-022-07424-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 04/27/2022] [Indexed: 11/10/2022] Open
Abstract
Background The management of febrile illnesses is challenging in settings where diagnostic laboratory facilities are limited, and there are few published longitudinal data on children presenting with fever in such settings. We have previously conducted the first comprehensive study of infectious aetiologies of febrile children presenting to a tertiary care facility in Ethiopia. We now report on clinicians’ prescribing adherence with guidelines and outcomes of management in this cohort. Methods We consecutively enrolled febrile children aged 2 months and under 13 years, who were then managed by clinicians based on presentation and available laboratory and radiologic findings on day of enrolment. We prospectively collected outcome data on days 7 and 14, and retrospectively evaluated prescribing adherence with national clinical management guidelines. Results Of 433 children enrolled, the most common presenting syndromes were pneumonia and acute diarrhoea, diagnosed in 177 (40.9%) and 82 (18.9%), respectively. Antibacterial agents were prescribed to 360 (84.7%) of 425 children, including 36 (34.0%) of 106 children without an initial indication for antibacterials according to guidelines. Antimalarial drugs were prescribed to 47 (11.1%) of 425 children, including 30 (7.3%) of 411 children with negative malaria microscopy. Fever had resolved in 357 (89.7%) of 398 children assessed at day 7, and in-hospital death within 7 days occurred in 9 (5.9%) of 153 admitted patients. Among children with pneumonia, independent predictors of persisting fever or death by 7 days were young age and underweight for age. Antibacterial prescribing in the absence of a guideline-specified indication (overprescribing) was more likely among infants and those without tachypnea, while overprescribing antimalarials was associated with older age, anaemia, absence of cough, and higher fevers. Conclusion Our study underscores the need for improving diagnostic support to properly guide management decisions and enhance adherence by clinicians to treatment guidelines. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-022-07424-0.
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Affiliation(s)
- Techalew Shimelis
- Kirby Institute, University of New South Wales, Sydney, Australia. .,College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia.
| | - Susana Vaz Nery
- Kirby Institute, University of New South Wales, Sydney, Australia
| | | | - Adam W Bartlett
- Kirby Institute, University of New South Wales, Sydney, Australia
| | | | - Gill Schierhout
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Sabine Dittrich
- Foundation for Innovative New Diagnostics, Geneva, Switzerland.,Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - John A Crump
- Centre for International Health, University of Otago, Dunedin, New Zealand
| | - John M Kaldor
- Kirby Institute, University of New South Wales, Sydney, Australia
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3
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Ihling CM, Schnitzler P, Heinrich N, Mangu C, Sudi L, Souares A, Gies S, Sié A, Coulibaly B, Ouédraogo AT, Mordmüller B, Held J, Adegnika AA, Fernandes JF, Eckerle I, May J, Hogan B, Eibach D, Tabatabai J. Molecular epidemiology of respiratory syncytial virus in children in sub-Saharan Africa. Trop Med Int Health 2021; 26:810-822. [PMID: 33683751 DOI: 10.1111/tmi.13573] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES This study investigated the molecular epidemiology of respiratory syncytial virus (RSV) among febrile children with acute respiratory tract infection in Ghana, Gabon, Tanzania and Burkina Faso between 2014 and 2017 as well as the evolution and diversification of RSV strains from other sub-Saharan countries. METHODS Pharyngeal swabs were collected at four study sites (Agogo, Ghana: n = 490; Lambaréné, Gabon: n = 182; Mbeya, Tanzania: n = 293; Nouna, Burkina Faso: n = 115) and analysed for RSV and other respiratory viruses using rtPCR. For RSV-positive samples, sequence analysis of the second hypervariable region of the G gene was performed. A dataset of RSV strains from sub-Saharan Africa (2011-2017) currently available in GenBank was compiled. Phylogenetic analysis was conducted to identify the diversity of circulating RSV genotypes. RESULTS In total, 46 samples were tested RSV positive (Ghana n = 31 (6.3%), Gabon n = 4 (2.2%), Tanzania n = 9 (3.1%) and Burkina Faso n = 2 (1.7%)). The most common RSV co-infection was with rhinovirus. All RSV A strains clustered with genotype ON1 strains with a 72-nucleotide duplication and all RSV B strains belonged to genotype BAIX. Phylogenetic analysis of amino acid sequences from sub-Saharan Africa revealed the diversification into 11 different ON1 and 22 different BAIX lineages and differentiation of ON1 and BAIX strains into potential new sub-genotypes, provisionally named ON1-NGR, BAIX-KEN1, BAIX-KEN2 and BAIX-KEN3. CONCLUSION The study contributes to an improved understanding of the molecular epidemiology of RSV infection in sub-Saharan Africa. It provides the first phylogenetic data for RSV from Tanzania, Gabon and Burkina Faso and combines it with RSV strains from all other sub-Saharan countries currently available in GenBank.
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Affiliation(s)
- Clara Marlene Ihling
- Center of Infectious Diseases, Virology, Heidelberg University Hospital, Heidelberg, Germany.,German Center for Infection Research (DZIF), Heidelberg, Germany.,Dr. von Haunersches Kinderspital, University Hospital of the LMU Munich, Munich, Germany
| | - Paul Schnitzler
- Center of Infectious Diseases, Virology, Heidelberg University Hospital, Heidelberg, Germany
| | - Norbert Heinrich
- German Center for Infection Research (DZIF), Heidelberg, Germany.,Division for Infectious Diseases, University Hospital of the LMU Munich, Munich, Germany
| | - Chacha Mangu
- NIMR-Mbeya Medical Research Center, Mbeya, Tanzania
| | - Lwitiho Sudi
- NIMR-Mbeya Medical Research Center, Mbeya, Tanzania
| | - Aurélia Souares
- German Center for Infection Research (DZIF), Heidelberg, Germany.,Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany
| | - Sabine Gies
- German Center for Infection Research (DZIF), Heidelberg, Germany.,Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany
| | - Ali Sié
- Centre de Recherche en Santé de Nouna, Nouna, Burkina Faso
| | | | | | - Benjamin Mordmüller
- German Center for Infection Research (DZIF), Heidelberg, Germany.,Eberhard Karls University Tuebingen, Tübingen, Germany
| | - Jana Held
- German Center for Infection Research (DZIF), Heidelberg, Germany.,Eberhard Karls University Tuebingen, Tübingen, Germany
| | - Ayola Akim Adegnika
- German Center for Infection Research (DZIF), Heidelberg, Germany.,Eberhard Karls University Tuebingen, Tübingen, Germany.,Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
| | - José F Fernandes
- Eberhard Karls University Tuebingen, Tübingen, Germany.,Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
| | - Isabella Eckerle
- Institute of Virology, University of Bonn Medical Center, Bonn, Germany.,Faculty of Medicine, Geneva Center for Emerging Viral Diseases, University Hospitals of Geneva, University of Geneva, Geneva, Switzerland
| | - Juergen May
- German Center for Infection Research (DZIF), Heidelberg, Germany.,Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Benedikt Hogan
- German Center for Infection Research (DZIF), Heidelberg, Germany.,Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Daniel Eibach
- German Center for Infection Research (DZIF), Heidelberg, Germany.,Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Julia Tabatabai
- Center of Infectious Diseases, Virology, Heidelberg University Hospital, Heidelberg, Germany.,German Center for Infection Research (DZIF), Heidelberg, Germany.,Center for Pediatric and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany
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4
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Hin S, Lopez-Jimena B, Bakheit M, Klein V, Stack S, Fall C, Sall A, Enan K, Mustafa M, Gillies L, Rusu V, Goethel S, Paust N, Zengerle R, Frischmann S, Weidmann M, Mitsakakis K. Fully automated point-of-care differential diagnosis of acute febrile illness. PLoS Negl Trop Dis 2021; 15:e0009177. [PMID: 33630852 PMCID: PMC7906357 DOI: 10.1371/journal.pntd.0009177] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 01/26/2021] [Indexed: 12/13/2022] Open
Abstract
Background In this work, a platform was developed and tested to allow to detect a variety of candidate viral, bacterial and parasitic pathogens, for acute fever of unknown origin. The platform is based on a centrifugal microfluidic cartridge, the LabDisk (“FeverDisk” for the specific application), which integrates all necessary reagents for sample-to-answer analysis and is processed by a compact, point-of-care compatible device. Methodology/Principal findings A sample volume of 200 μL per FeverDisk was used. In situ extraction with pre-stored reagents was achieved by bind-wash-elute chemistry and magnetic particles. Enzymes for the loop-mediated isothermal amplification (LAMP) were pre-stored in lyopellet form providing stability and independence from the cold chain. The total time to result from sample inlet to read out was 2 h. The proof-of-principle was demonstrated in three small-scale feasibility studies: in Dakar, Senegal and Khartoum, Sudan we tested biobanked samples using 29 and 9 disks, respectively; in Reinfeld, Germany we tested spiked samples and analyzed the limit of detection using three bacteria simultaneously spiked in whole blood using 15 disks. Overall during the three studies, the FeverDisk detected dengue virus (different serotypes), chikungunya virus, Plasmodium falciparum, Salmonella enterica Typhi, Salmonella enterica Paratyphi A and Streptococcus pneumoniae. Conclusions/Significance The FeverDisk proved to be universally applicable as it successfully detected all different types of pathogens as single or co-infections, while it also managed to define the serotype of un-serotyped dengue samples. Thirty-eight FeverDisks at the two African sites provided 59 assay results, out of which 51 (86.4%) were confirmed with reference assay results. The results provide a promising outlook for future implementation of the platform in larger prospective clinical studies for defining its clinical sensitivity and specificity. The technology aims to provide multi-target diagnosis of the origins of fever, which will help fight lethal diseases and the incessant rise of antimicrobial resistance. Infectious diseases in tropical regions may have a variety of viral, bacterial or parasitic origins and a patient may suffer from several diseases simultaneously, each presenting with acute fever as a clinical symptom. This makes it difficult to determine the origin of the pathogen causing the disease(s). In addition to the endemic infectious diseases, outbreaks of epidemics frequently complicate diagnostic demands. Accurate diagnosis for proper patient management requires the utilization of highly sensitive and specific, rapid, easy-to-use diagnostic tools compatible with point-of-care settings. We describe the use of a disk-shaped microfluidic platform, the “FeverDisk”, for differential diagnosis of acute fever. Our FeverDisk platform demonstrated its capability to detect bacteria, viruses and parasites that are typical of tropical single and co-infections from biobanked samples within only 2 hours and in very good agreement with reference method results. This, in combination with its easy-to-use and point-of-care compatible nature, render our platform a promising candidate for detection of tropical diseases and precise identification of the cause of acute fever, in endemic and epidemic settings. Future work will involve extensive clinical characterization of the platform in prospective studies.
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Affiliation(s)
- Sebastian Hin
- Laboratory for MEMS Applications, IMTEK – Department of Microsystems Engineering, University of Freiburg, Freiburg, Germany
| | - Benjamin Lopez-Jimena
- Institute of Aquaculture, University of Stirling, Scotland, United Kingdom
- Mast Group Ltd, Mast House, Bootle, Liverpool, United Kingdom
| | | | - Vanessa Klein
- Laboratory for MEMS Applications, IMTEK – Department of Microsystems Engineering, University of Freiburg, Freiburg, Germany
| | - Seamus Stack
- Mast Group Ltd, Mast House, Bootle, Liverpool, United Kingdom
| | - Cheikh Fall
- Arbovirus and viral haemorrhagic fever unit, Institut Pasteur de Dakar, Dakar, Senegal
| | - Amadou Sall
- Arbovirus and viral haemorrhagic fever unit, Institut Pasteur de Dakar, Dakar, Senegal
| | - Khalid Enan
- Department of Virology, Central Laboratory-The Ministry of Higher Education and Scientific Research, Khartoum, Sudan
| | - Mohamed Mustafa
- Department of Virology, Central Laboratory-The Ministry of Higher Education and Scientific Research, Khartoum, Sudan
| | - Liz Gillies
- Mast Group Ltd, Mast House, Bootle, Liverpool, United Kingdom
| | - Viorel Rusu
- MagnaMedics Diagnostics BV, Geleen, The Netherlands
| | - Sven Goethel
- MagnaMedics Diagnostics BV, Geleen, The Netherlands
| | - Nils Paust
- Laboratory for MEMS Applications, IMTEK – Department of Microsystems Engineering, University of Freiburg, Freiburg, Germany
- Hahn-Schickard, Freiburg, Germany
| | - Roland Zengerle
- Laboratory for MEMS Applications, IMTEK – Department of Microsystems Engineering, University of Freiburg, Freiburg, Germany
- Hahn-Schickard, Freiburg, Germany
| | | | - Manfred Weidmann
- Institute of Aquaculture, University of Stirling, Scotland, United Kingdom
| | - Konstantinos Mitsakakis
- Laboratory for MEMS Applications, IMTEK – Department of Microsystems Engineering, University of Freiburg, Freiburg, Germany
- Hahn-Schickard, Freiburg, Germany
- * E-mail:
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5
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Gildas Boris H, Idrissa D, Marie Louise S, Cheikh T, Aliou BM, Fatoumata DS, Rebecca G, Raymond B, Diamilatou T, Vincent R, Oumar F, Abdoulaye S, Muriel V. Identification of Pathogens Potentially Associated with Non-Malarial Fever in Children: A Pilot Study in Peri-Urban Dakar, Senegal. Am J Trop Med Hyg 2021; 104:1335-1341. [PMID: 33556036 DOI: 10.4269/ajtmh.19-0963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 12/07/2020] [Indexed: 12/15/2022] Open
Abstract
Fever is one of the most common reasons for pediatric consultation in Africa. Malaria incidence has now dropped considerably, yet etiologies of non-malarial febrile diseases are poorly documented. This pilot study aimed to 1) identify pathogens potentially associated with non-malarial fever in children younger than 10 years in the suburbs of Dakar and 2) describe the epidemiological characteristics of these patients. During the study period, all eligible children (< 10 years of age, body temperature ≥ 38°C, negative result for the malaria rapid diagnostic test, living in Guediawaye/Pikine for the previous four calendar months, not receiving any anti-infectious treatment since the onset of fever, and with parent's consent to participate) presenting to the health post in Medina Gounass located in Guediawaye on Mondays and Fridays were included. In total, 106 children participated in the study, and PCR from nasopharyngeal swabs, hemoculture, C-reactive protein, blood cell counts, and quantitative buffy coat from blood samples and coproculture from stool samples were performed. In 70 (66%) children, at least one pathogen was isolated. Viruses were identified in 55 children, most commonly enteroviruses, rhinoviruses, and adenoviruses, and dengue virus was identified in three children. Only five children had bacterial infections, and 10 had bacterial and viral coinfections. Ninety-seven children (92%) received prescription for antibiotics. Many strains of bacteria were found to be resistant to several antibiotics. Despite limitations, this pilot study showed that pathogens potentially associated with non-malarial fever in children younger than 10 years near Dakar were predominantly viruses, most commonly upper respiratory infections, although bacteria accounted for a small proportion.
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Affiliation(s)
- Hedible Gildas Boris
- 1Unité d'Epidémiologie des Maladies Infectieuses, Institut Pasteur, Dakar, Senegal
| | - Dieng Idrissa
- 2Pôle de Virologie, Institut Pasteur, Dakar, Senegal
| | - Senghor Marie Louise
- 1Unité d'Epidémiologie des Maladies Infectieuses, Institut Pasteur, Dakar, Senegal
| | - Talla Cheikh
- 1Unité d'Epidémiologie des Maladies Infectieuses, Institut Pasteur, Dakar, Senegal
| | - Barry Mamadou Aliou
- 1Unité d'Epidémiologie des Maladies Infectieuses, Institut Pasteur, Dakar, Senegal
| | - Diène Sarr Fatoumata
- 1Unité d'Epidémiologie des Maladies Infectieuses, Institut Pasteur, Dakar, Senegal
| | - Grant Rebecca
- 3Unité d'épidémiologie des Maladies émergentes, Institut Pasteur, Paris, France
| | - Bercion Raymond
- 4Laboratoire de Biologie Médicale, Institut Pasteur, Dakar, Senegal
| | - Thiam Diamilatou
- 1Unité d'Epidémiologie des Maladies Infectieuses, Institut Pasteur, Dakar, Senegal
| | | | - Faye Oumar
- 2Pôle de Virologie, Institut Pasteur, Dakar, Senegal
| | - Seck Abdoulaye
- 4Laboratoire de Biologie Médicale, Institut Pasteur, Dakar, Senegal.,6Faculté de Médecine, de Pharmacie et d'Odontologie, UCAD, Dakar, Senegal
| | - Vray Muriel
- 1Unité d'Epidémiologie des Maladies Infectieuses, Institut Pasteur, Dakar, Senegal.,3Unité d'épidémiologie des Maladies émergentes, Institut Pasteur, Paris, France.,7INSERM, France
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6
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Shimelis T, Tadesse BT, W/Gebriel F, Crump JA, Schierhout G, Dittrich S, Kaldor JM, Vaz Nery S. Aetiology of acute febrile illness among children attending a tertiary hospital in southern Ethiopia. BMC Infect Dis 2020; 20:903. [PMID: 33256629 PMCID: PMC7706267 DOI: 10.1186/s12879-020-05635-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 11/19/2020] [Indexed: 12/23/2022] Open
Abstract
Background The diagnosis of non-malarial aetiologies, which now represent the majority of febrile illnesses, has remained problematic in settings with limited laboratory capacity. We aimed to describe common aetiologies of acute febrile illness among children in a setting where malaria transmission has declined. Methods A prospective cross-sectional study was conducted among children aged at least 2 months and under 13 years presenting with fever (temperature of ≥37.5 °C or a history of fever in the past 48 h) to Hawassa Comprehensive Specialized Hospital, southern Ethiopia, from May 2018 through February 2019. Clinical and demographic data were gathered for consecutive participants, and malaria microscopy, HIV testing, and blood and urine cultures were performed regardless of clinical presentation. Additionally, stool analyses (culture and rotavirus/adenovirus RDT) and throat swab for group A Streptococcus (GAS) and urine Streptococcus pneumoniae were performed by RDTs for children with specific conditions. The antimicrobial susceptibility of bacterial isolates was determined using disc diffusion method. Results During the study period 433 children were recruited, median age 20 months (range, 2 months – 12 years) and 178 (41.1%) female. Malaria was diagnosed in 14 (3.2%) of 431 children, and 3 (0.7%) had HIV infection. Bacteraemia or fungaemia was detected in 27 (6.4%) of 421 blood cultures, with Staphylococcus aureus isolated in 16 (3.8%). Urinary tract infections (UTIs) were detected in 74 (18.4%) of 402, with Escherichia coli isolated in 37 (9.2%). Among 56 children whose stool specimens were tested, 14 (25%) were positive for rotavirus, 1 (1.8%) for Salmonella Paratyphi A, and 1 (1.8%) for Shigella dysenteriae. Among those with respiratory symptoms, a throat swab test for GAS and urine test for S. pneumoniae were positive in 28 (15.8%) of 177 and 31 (17.0%) of 182, respectively. No test was positive for a pathogen in 266 (61.4%) of 433 participants. Bacterial isolates were frequently resistant to ampicillin, trimethoprim-sulfamethoxazole, tetracycline, and amoxicillin and clavulanic acid. Conclusion Our results showed low proportions of malaria and bacteraemia among febrile children. In contrast, the frequent detection of UTI emphasize the need to support enhanced diagnostic capacity to ensure appropriate antimicrobial intervention. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-020-05635-x.
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Affiliation(s)
- Techalew Shimelis
- Kirby Institute, University of New South Wales, Sydney, Australia. .,College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia.
| | | | - Fitsum W/Gebriel
- College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - John A Crump
- Centre for International Health, University of Otago, Dunedin, New Zealand
| | | | - Sabine Dittrich
- Foundation for Innovative New Diagnostics, Geneva, Switzerland.,Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - John M Kaldor
- Kirby Institute, University of New South Wales, Sydney, Australia
| | - Susana Vaz Nery
- Kirby Institute, University of New South Wales, Sydney, Australia
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7
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Kapito-Tembo A, Mathanga D, Bauleni A, Nyirenda O, Pensulo P, Ali D, Valim C, Taylor TE, Laufer MK. Prevalence and Clinical Management of Non-malarial Febrile Illnesses among Outpatients in the Era of Universal Malaria Testing in Malawi. Am J Trop Med Hyg 2020; 103:887-893. [PMID: 32588795 DOI: 10.4269/ajtmh.18-0800] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Increasing access to rapid diagnostic tests for malaria (mRDTs) has raised awareness of the challenges healthcare workers face in managing non-malarial febrile illnesses (NMFIs). We examined NMFI prevalence, clinical diagnoses, and prescribing practices in outpatient clinics across different malaria transmission settings in Malawi. Standardized facility-based malaria surveillance was conducted at three facilities one of every 4 weeks over 2 years. Information on demographics, presenting symptoms, temperature, clinical diagnosis, and treatment were collected from outpatients presenting with malaria-like symptoms. Of the 25,486 patients with fever, 69% had NMFI. Non-malarial febrile illness prevalence was lower in 5- to 15-year-old patients (55%) than in children < 5 years (72%) and adults > 15 years of age (77%). The most common clinical diagnoses among febrile patients with negative mRDTs in all age-groups and settings were respiratory infections (46%), sepsis (29%), gastroenteritis (13%), musculoskeletal pain (9%), and malaria (5%). Antibiotic prescribing was high in all age-groups and settings. Trimethoprim-sulfamethoxazole (40%) and amoxicillin (29%) were the most commonly prescribed antibiotics and were used for nearly all clinical diagnoses. In these settings with minimal access to diagnostic tools, patients with fever and a negative mRDT received a limited number of clinical diagnoses. Many were likely to be inaccurate and were associated with the inappropriate use of the limited range of available antibiotics. Prescription and diagnostic practices for NMFIs in the facilities require research and policy input. Resource-limited malaria-endemic countries urgently need more point-of-care diagnostic tools and evidence-based diagnosis and treatment algorithms to provide effective and cost-efficient care.
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Affiliation(s)
- Atupele Kapito-Tembo
- Malaria Alert Center, University of Malawi College of Medicine, Blantyre, Malawi
| | - Don Mathanga
- Malaria Alert Center, University of Malawi College of Medicine, Blantyre, Malawi
| | - Andrew Bauleni
- Malaria Alert Center, University of Malawi College of Medicine, Blantyre, Malawi
| | - Osward Nyirenda
- Blantyre Malaria Project, University of Malawi College of Medicine, Blantyre, Malawi
| | - Paul Pensulo
- Blantyre Malaria Project, University of Malawi College of Medicine, Blantyre, Malawi
| | - Doreen Ali
- Malawi National Malaria Control Program, Lilongwe, Malawi
| | - Clarissa Valim
- Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, Massachusetts
| | - Terrie E Taylor
- College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan.,Blantyre Malaria Project, University of Malawi College of Medicine, Blantyre, Malawi
| | - Miriam K Laufer
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland
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8
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Kaboré B, Post A, Lompo P, Bognini JD, Diallo S, Kam BTD, Rahamat-Langendoen J, Wertheim HFL, van Opzeeland F, Langereis JD, de Jonge MI, Tinto H, Jacobs J, van der Ven AJ, de Mast Q. Aetiology of acute febrile illness in children in a high malaria transmission area in West Africa. Clin Microbiol Infect 2020; 27:590-596. [PMID: 32505586 DOI: 10.1016/j.cmi.2020.05.029] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 05/19/2020] [Accepted: 05/25/2020] [Indexed: 01/12/2023]
Abstract
OBJECTIVES Areas with declining malaria transmission in sub-Saharan Africa have recently witnessed important changes in the aetiology of childhood acute febrile illness (AFI). We describe the aetiology of AFI in a high malaria transmission area in rural Burkina Faso. METHODS In a prospective hospital-based diagnostic study, children aged 3 months to 15 years with AFI were recruited and assessed using a systematic diagnostic protocol, including blood cultures, whole blood PCR on a selection of bacterial pathogens, malaria diagnostics and a multiplex PCR on nasopharyngeal swabs targeting 21 viral and 4 bacterial respiratory pathogens. RESULTS A total of 589 children with AFI were enrolled from whom an infectious disease was considered in 575 cases. Acute respiratory tract infections, malaria and invasive bacterial infections (IBI) accounted for 179 (31.1%), 175 (30.4%) and 75 (13%) of AFI cases respectively; 16 (21.3%) of IBI cases also had malarial parasitaemia. A viral pathogen was demonstrated from the nasopharynx in 157 children (90.7%) with respiratory tract symptoms. Of all children with viral respiratory tract infections, 154 (92.4% received antibiotics, whereas no antibiotic was provided in 13 (17%) of IBI cases. CONCLUSIONS Viral respiratory infections are a common cause of childhood AFI in high malaria transmission areas, next to malaria and IBI. These findings highlight the importance of interventions to improve targeted treatment with antimicrobials. Most patients with viral infections received antibiotics unnecessarily, while a considerable number with IBI did not receive antibiotics.
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Affiliation(s)
- B Kaboré
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands; IRSS/Clinical Research Unit of Nanoro (CRUN), Nanoro, Burkina Faso
| | - A Post
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - P Lompo
- IRSS/Clinical Research Unit of Nanoro (CRUN), Nanoro, Burkina Faso
| | - J D Bognini
- IRSS/Clinical Research Unit of Nanoro (CRUN), Nanoro, Burkina Faso
| | - S Diallo
- IRSS/Clinical Research Unit of Nanoro (CRUN), Nanoro, Burkina Faso
| | - B T D Kam
- IRSS/Clinical Research Unit of Nanoro (CRUN), Nanoro, Burkina Faso
| | - J Rahamat-Langendoen
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, the Netherlands; Radboudumc Center for Infectious Diseases (RCI), the Netherlands
| | - H F L Wertheim
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, the Netherlands; Radboudumc Center for Infectious Diseases (RCI), the Netherlands
| | - F van Opzeeland
- Section of Paediatric Infectious Diseases, Laboratory of Medical Immunology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - J D Langereis
- Radboudumc Center for Infectious Diseases (RCI), the Netherlands; Section of Paediatric Infectious Diseases, Laboratory of Medical Immunology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - M I de Jonge
- Radboudumc Center for Infectious Diseases (RCI), the Netherlands; Section of Paediatric Infectious Diseases, Laboratory of Medical Immunology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - H Tinto
- IRSS/Clinical Research Unit of Nanoro (CRUN), Nanoro, Burkina Faso; Centre Muraz, Bobo-Dioulasso, Burkina Faso
| | - J Jacobs
- Department of Clinical Sciences, Institute of Tropical Medicine (ITM), Antwerp, Belgium; Department of Microbiology, Immunology and Transplantation, University of Leuven (KU Leuven), Leuven, Belgium
| | - A J van der Ven
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands; Radboudumc Center for Infectious Diseases (RCI), the Netherlands
| | - Q de Mast
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands; Radboudumc Center for Infectious Diseases (RCI), the Netherlands.
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9
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Chipwaza B, Sumaye RD. High malaria parasitemia among outpatient febrile children in low endemic area, East-Central Tanzania in 2013. BMC Res Notes 2020; 13:251. [PMID: 32448376 PMCID: PMC7247273 DOI: 10.1186/s13104-020-05092-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 05/16/2020] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE This study investigated the prevalence and distribution patterns of malaria in Kilosa district as part of non-malaria causes of febrile illnesses in children study. We enrolled febrile patients aged 2-13 years presenting at the outpatient department during the rainy and dry seasons, in 2013. For each participant, we tested for malaria parasites and identified parasite species using microscopy. We then calculated parasite density and estimated geometric mean parasite density. RESULTS The overall malaria prevalence in febrile children was 23.7% (n = 609). Plasmodium falciparum accounted for 98.6% of malaria positives. There was a heterogeneous distribution of malaria cases among the 17 wards constituting the catchment area. A high proportion (69.4%, n = 144) of malaria positive individuals had high parasite densities. Individuals who were enrolled in the rainy season had higher geometric mean parasite density (15415.1 parasites/µl, 95% CI 10735.3-22134.9) compared to the dry season (6115.3 parasites/µl, 95% CI 4237.8-8824.6). The relatively high malaria prevalence recorded in Kilosa, an area considered low endemicity, calls for concerted effort in documenting malaria burden at fine geographical scales and tailor preventive and control strategies that target hotspots of high malaria transmission.
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Affiliation(s)
- Beatrice Chipwaza
- St Francis University College of Health and Allied Sciences, P.O. Box 175, Ifakara, Tanzania.
- Ifakara Health Institute, Ifakara, P.O. Box 53, Ifakara, Tanzania.
| | - Robert D Sumaye
- Ifakara Health Institute, Ifakara, P.O. Box 53, Ifakara, Tanzania
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10
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Hogan B, Eibach D, Krumkamp R, Sarpong N, Dekker D, Kreuels B, Maiga-Ascofaré O, Gyau Boahen K, Wiafe Akenten C, Adu-Sarkodie Y, Owusu-Dabo E, May J. Malaria Coinfections in Febrile Pediatric Inpatients: A Hospital-Based Study From Ghana. Clin Infect Dis 2019; 66:1838-1845. [PMID: 29408951 PMCID: PMC5982794 DOI: 10.1093/cid/cix1120] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 01/06/2018] [Indexed: 11/12/2022] Open
Abstract
Background The epidemiology of pediatric febrile illness is shifting in sub-Saharan Africa, but malaria remains a major cause of childhood morbidity and mortality. The present study describes causes of febrile illness in hospitalized children in Ghana and aims to determine the burden of malaria coinfections and their association with parasite densities. Methods In a prospective study, children (aged ≥30 days and ≤15 years) with fever ≥38.0°C were recruited after admission to the pediatric ward of a primary hospital in Ghana. Malaria parasitemia was determined and blood, stool, urine, respiratory, and cerebrospinal fluid specimens were screened for parasitic, bacterial, and viral pathogens. Associations of Plasmodium densities with other pathogens were calculated. Results From November 2013 to April 2015, 1238 children were enrolled from 4169 admissions. A clinical/microbiological diagnosis could be made in 1109/1238 (90%) patients, with Plasmodium parasitemia (n = 728/1238 [59%]) being predominant. This was followed by lower respiratory tract infections/pneumonia (n = 411/1238 [34%]; among detected pathogens most frequently Streptococcus pneumoniae, n = 192/299 [64%]), urinary tract infections (n = 218/1238 [18%]; Escherichia coli, n = 21/32 [66%]), gastrointestinal infections (n = 210 [17%]; rotavirus, n = 32/97 [33%]), and invasive bloodstream infections (n = 62 [5%]; Salmonella species, n = 47 [76%]). In Plasmodium-infected children the frequency of lower respiratory tract, gastrointestinal, and bloodstream infections increased with decreasing parasite densities. Conclusions In a hospital setting, the likelihood of comorbidity with a nonmalarial disease is inversely correlated with increasing blood levels of malaria parasites. Hence, parasite densities provide important information as an indicator for the probability of coinfection, in particular to guide antimicrobial medication.
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Affiliation(s)
- Benedikt Hogan
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine Hamburg, Germany.,German Center for Infection Research, Hamburg-Borstel-Lübeck, Germany
| | - Daniel Eibach
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine Hamburg, Germany
| | - Ralf Krumkamp
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine Hamburg, Germany.,German Center for Infection Research, Hamburg-Borstel-Lübeck, Germany
| | - Nimako Sarpong
- German Center for Infection Research, Hamburg-Borstel-Lübeck, Germany.,Kumasi Centre for Collaborative Research in Tropical Medicine, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Denise Dekker
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine Hamburg, Germany.,German Center for Infection Research, Hamburg-Borstel-Lübeck, Germany
| | - Benno Kreuels
- German Center for Infection Research, Hamburg-Borstel-Lübeck, Germany.,Division of Tropical Medicine, I. Department of Internal Medicine, University Medical Centre Hamburg Eppendorf, Germany
| | - Oumou Maiga-Ascofaré
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine Hamburg, Germany.,German Center for Infection Research, Hamburg-Borstel-Lübeck, Germany.,Kumasi Centre for Collaborative Research in Tropical Medicine, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Kennedy Gyau Boahen
- German Center for Infection Research, Hamburg-Borstel-Lübeck, Germany.,Kumasi Centre for Collaborative Research in Tropical Medicine, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Charity Wiafe Akenten
- German Center for Infection Research, Hamburg-Borstel-Lübeck, Germany.,Kumasi Centre for Collaborative Research in Tropical Medicine, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Yaw Adu-Sarkodie
- Department of Clinical Microbiology, School of Public Health, College of Health Sciences, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
| | - Ellis Owusu-Dabo
- Kumasi Centre for Collaborative Research in Tropical Medicine, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.,Department of Global Health, School of Public Health, College of Health Sciences, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
| | - Jürgen May
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine Hamburg, Germany.,German Center for Infection Research, Hamburg-Borstel-Lübeck, Germany
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11
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Abdul-Mumin A, Ervin S, Halvorson EE. Clinical characteristics associated with increased resource utilization of hospitalized children under 5 years with acute gastroenteritis at a tertiary hospital in the northern region of Ghana: a retrospective study. Pan Afr Med J 2019; 33:186. [PMID: 31565146 PMCID: PMC6756856 DOI: 10.11604/pamj.2019.33.186.13133] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 02/08/2019] [Indexed: 12/19/2022] Open
Abstract
Introduction Acute gastroenteritis (AGE) is a leading cause of mortality in children in developing countries. Management of AGE consumes medical resources, including antibiotics and intra-venous fluids, but factors affecting resource utilization in the management of AGE are under-studied. We hope to identify clinical predictors of resource utilization in AGE. Methods We performed a retrospective chart review of patients 1-60 months of age admitted to a tertiary hospital in Northern Ghana between January 2013 and December 2014 with an admitting diagnosis of AGE. We collected data on patient demographics, presenting symptoms, and subsequent management. Our primary outcome was prolonged hospital length of stay, defined as >4 days. Secondary outcomes included other measures of resource utilization, such as use of antibiotics, antimalarials and intravenous fluids. Demographic and clinical characteristics were compared between groups with Pearson chi square test for categorical variables and ANOVA for continuous variables. Multivariable logistic regression modeling for each outcome included all variables found to be significant in the bivariate analysis. Results We reviewed charts for 473 patients admitted for AGE during this timeframe. 264 (56%) were male, median age was 12 months. 448 (95%) received antibiotics, 396 (84%) received antimalarials and 365 (77.2%) received intravenous fluids. 167 (35.3%) had prolonged LOS >4 days. Following multiple logistic regression analysis, clinical features associated with prolonged LOS included fever duration (OR 2.87, 95% CI 2.28-3.61 per 1-day increase), mild (OR 2.39, 95% CI 1.12-5.08) or moderate (OR 3.13, 95% CI 1.57-6.21) dehydration (compared to none) and symptom duration (OR 1.13, 95% CI 1.01-1.27 per 1-day increase). Conclusion Dehydration and duration of symptoms prior to presentation predict prolonged hospital LOS in young children with AGE in Northern Ghana.
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Affiliation(s)
- Alhassan Abdul-Mumin
- Department of Pediatrics and Child Health, University for Development Studies, School of Medicine and Health Sciences and Tamale Teaching Hospital, Tamale, Northern Region, Ghana
| | - Sean Ervin
- Department of Pediatrics, Wake Forest Baptist Medical Center, Medical Center Boulevard, Winston Salem, NC 27157 USA
| | - Elizabeth Eby Halvorson
- Department of Pediatrics, Wake Forest Baptist Medical Center, Medical Center Boulevard, Winston Salem, NC 27157 USA
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12
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Hercik C, Cosmas L, Mogeni OD, Kohi W, Mfinanga S, Loffredo C, Montgomery JM. Health Beliefs and Patient Perspectives of Febrile Illness in Kilombero, Tanzania. Am J Trop Med Hyg 2019; 101:263-270. [PMID: 31115309 PMCID: PMC6609178 DOI: 10.4269/ajtmh.17-0862] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Accepted: 03/16/2019] [Indexed: 01/18/2023] Open
Abstract
This qualitative study assessed the knowledge and beliefs surrounding fever syndrome among adult febrile patients seeking health care in Kilombero, Tanzania. From June 11 to July 13, 2014, 10% of all adult (≥ 15 years) febrile patients enrolled in the larger syndromic study, who presented with an axillary temperature ≥ 37.5°C and symptom onset ≤ 5 days prior, were randomly selected to participate in an in-depth physician-patient interview, informed by Health Belief Model constructs. Interviews were audio recorded, translated, and transcribed. Transcripts were coded using NVivo Version 11.1, and the thematic content was analyzed by two separate researchers. Blood and nasopharyngeal/oralpharyngeal specimens were collected and analyzed using both acute febrile illness and respiratory TaqMan Array Cards for multipathogen detection of 56 potential causative agents. A total of 18 participants provided 188 discrete comments. When asked to speculate the causative agent of febrile illness, 33.3% cited malaria and the other 66.6% offered nonbiomedical responses, such as "mosquitoes" and "weather." Major themes emerging related to severity and susceptibility to health hazards included lack of bed net use, misconceptions about bed nets, and mosquito infestation. Certain barriers to treatment were cited, including dependence on traditional healers, high cost of drugs, and poor dispensary services. Overall, we demonstrate low concurrence in speculations of fever etiology according to patients, clinicians, and laboratory testing. Our findings contribute to the important, yet limited, base of knowledge surrounding patient risk perceptions of febrile illness and underscore the potential utility of community-based participatory research to inform disease control programs.
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Affiliation(s)
| | - Leonard Cosmas
- Division of Global Health Protection, Center for Global Health, US Centers for Disease Control and Prevention (US CDC), Nairobi, Kenya
| | - Ondari D. Mogeni
- Centre for Global Health Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Wanze Kohi
- Muhimbili Research Centre, National Institute of Medical Research, Dar es Salaam, Tanzania
| | - Sayoki Mfinanga
- Muhimbili Research Centre, National Institute of Medical Research, Dar es Salaam, Tanzania
- Muhimbili University of Health and Allied Science, Dar es Salaam, Tanzania
| | - Christopher Loffredo
- Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, Washington, District of Columbia
| | - Joel M. Montgomery
- Division of Global Health Protection, Center for Global Health, US Centers for Disease Control and Prevention (US CDC), Nairobi, Kenya
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13
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Berger Y, Adler A, Ariel T, Rokney A, Averbuch D, Grisaru‐Soen G. Paediatric community-acquired bacteraemia, pneumococcal invasive disease and antibiotic resistance fell after the pneumococcal conjugate vaccine was introduced. Acta Paediatr 2019; 108:1321-1328. [PMID: 30506762 DOI: 10.1111/apa.14670] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Revised: 10/26/2018] [Accepted: 11/27/2018] [Indexed: 12/29/2022]
Abstract
AIM This study examined the impact of the routine pneumococcal conjugate vaccination (PCV) on childhood community-acquired bacteraemia (CAB) and antibiotic resistance patterns in Israeli children. METHODS Israel added the PCV vaccine to its national immunisation programme in July 2009. We retrospectively analysed the medical records of all patients with CAB under 18 years at three children's hospitals in Tel Aviv and Jerusalem from 2007 to 2015. The microbiological data, clinical presentation, pneumococcal serotype distribution, antibiotic susceptibility and outcomes of infections were compared before and after the vaccine was introduced. RESULTS There were 511 904 emergency department visits and 125 922 children were hospitalised. Of those, 238 had CAB before vaccination was introduced (mean age 17 months) and 316 had CAB after the introduction (mean age 21 months). Emergency department presentations for CAB fell from 141.8 to 91.8 per 100 000 visits: a relative risk reduction (RRR) of 35%. Hospitalisations for CAB decreased from 430 to 337 per 100 000 admissions: an RRR of 22%. Hospitalisations due to Staphylococcus aureus increased significantly and penicillin nonsusceptible blood Streptococcus pneumoniae isolates decreased significantly. CONCLUSION Introducing national pneumococcal conjugate vaccination significantly changed the epidemiology of CAB, with reduced antibiotic-resistant Streptococcus pneumoniae and increased hospitalisation rates for Staphylococcus aureus infections.
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Affiliation(s)
- Yael Berger
- Hadassah Hebrew University Medical Centre Tel Aviv Israel
| | - Amos Adler
- Microbiology Laboratory Tel Aviv Sourasky Medical Centre Tel Aviv Israel
- The Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Tenenbaum Ariel
- Pediatric Department MS Pediatric Division Hadassah Hebrew University Medical Jerusalem Israel
| | - Assaf Rokney
- Government Central Laboratories Ministry of Health Jerusalem Israel
| | - Diana Averbuch
- Pediatric Infectious Diseases Pediatric Division Hadassah Hebrew University Medical Centre Tel Aviv Israel
| | - Galia Grisaru‐Soen
- The Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
- Pediatric Infectious Disease Unit of Dana Children's Hospital Tel Aviv Sourasky Medical Centre Tel Aviv Israel
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14
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Lamorde M, Mpimbaza A, Walwema R, Kamya M, Kapisi J, Kajumbula H, Sserwanga A, Namuganga JF, Kusemererwa A, Tasimwa H, Makumbi I, Kayiwa J, Lutwama J, Behumbiize P, Tagoola A, Nanteza JF, Aniku G, Workneh M, Manabe Y, Borchert JN, Brown V, Appiah GD, Mintz ED, Homsy J, Odongo GS, Ransom RL, Freeman MM, Stoddard RA, Galloway R, Mikoleit M, Kato C, Rosenberg R, Mossel EC, Mead PS, Kugeler KJ. A Cross-Cutting Approach to Surveillance and Laboratory Capacity as a Platform to Improve Health Security in Uganda. Health Secur 2019; 16:S76-S86. [PMID: 30480504 DOI: 10.1089/hs.2018.0051] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Global health security depends on effective surveillance for infectious diseases. In Uganda, resources are inadequate to support collection and reporting of data necessary for an effective and responsive surveillance system. We used a cross-cutting approach to improve surveillance and laboratory capacity in Uganda by leveraging an existing pediatric inpatient malaria sentinel surveillance system to collect data on expanded causes of illness, facilitate development of real-time surveillance, and provide data on antimicrobial resistance. Capacity for blood culture collection was established, along with options for serologic testing for select zoonotic conditions, including arboviral infection, brucellosis, and leptospirosis. Detailed demographic, clinical, and laboratory data for all admissions were captured through a web-based system accessible at participating hospitals, laboratories, and the Uganda Public Health Emergency Operations Center. Between July 2016 and December 2017, the expanded system was activated in pediatric wards of 6 regional government hospitals. During that time, patient data were collected from 30,500 pediatric admissions, half of whom were febrile but lacked evidence of malaria. More than 5,000 blood cultures were performed; 4% yielded bacterial pathogens, and another 4% yielded likely contaminants. Several WHO antimicrobial resistance priority pathogens were identified, some with multidrug-resistant phenotypes, including Acinetobacter spp., Citrobacter spp., Escherichia coli, Staphylococcus aureus, and typhoidal and nontyphoidal Salmonella spp. Leptospirosis and arboviral infections (alphaviruses and flaviviruses) were documented. The lessons learned and early results from the development of this multisectoral surveillance system provide the knowledge, infrastructure, and workforce capacity to serve as a foundation to enhance the capacity to detect, report, and rapidly respond to wide-ranging public health concerns in Uganda.
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Affiliation(s)
- Mohammed Lamorde
- Mohammed Lamorde, PhD, FRCP, is Head of the Department of Prevention, Care and Treatment, Infectious Diseases Institute, Kampala, Uganda. Co-senior author
| | - Arthur Mpimbaza
- Arthur Mpimbaza, MBChB, MMed, MSc, is Project Coordinator, Infectious Diseases Research Collaboration, Kampala, and Lecturer, Child Health and Development Centre, College of Health Sciences, Makerere University, Kampala. Co-senior author
| | - Richard Walwema
- Richard Walwema, MBA, is with the Infectious Diseases Institute, Kampala
| | - Moses Kamya
- Moses Kamya, MBChB, MMed, MPH, PhD, is Professor and Chair, Makerere University School of Medicine, Kampala. Dr. Kamya is also with the Infectious Diseases Research Collaboration, Kampala
| | - James Kapisi
- James Kapisi, MBChB, MMed, MSc Epid, Infectious Diseases Research Collaboration, Kampala
| | - Henry Kajumbula
- Henry Kajumbula, MBChB, MMed, Department of Medical Microbiology, Makerere University School of Medicine, Kampala
| | - Asadu Sserwanga
- Asadu Sserwanga, MBChB, MPH, Infectious Diseases Research Collaboration, Kampala
| | | | - Abel Kusemererwa
- Abel Kusemererwa, Infectious Diseases Research Collaboration, Kampala
| | - Hannington Tasimwa
- Hannington Tasimwa, Department of Medical Microbiology, Makerere University School of Medicine, Kampala
| | - Issa Makumbi
- Issa Makumbi, MBChB, is with the Uganda Ministry of Health Public Health Emergency Operations Centre, Kampala
| | - John Kayiwa
- John Kayiwa, Uganda Virus Research Institute, Entebbe, Wakiso, Uganda
| | - Julius Lutwama
- Julius Lutwama, PhD, Uganda Virus Research Institute, Entebbe, Wakiso, Uganda
| | - Prosper Behumbiize
- Prosper Behumbiize is with the Health Information Systems Program, Kampala
| | - Abner Tagoola
- Abner Tagoola, MBChB, MMed, MSc, is with the Jinja Regional Referral Hospital Republic of Uganda Ministry of Health, Jinja, Uganda
| | - Jane Frances Nanteza
- Jane Frances Nanteza, MBChB, MMed, is with the Mubende Regional Referral Hospital, Republic of Uganda Ministry of Health, Mubende, Uganda
| | - Gilbert Aniku
- Gilbert Aniku, MBChB, MMed, is with Arua Regional Referral Hospital, Republic of Uganda Ministry of Health, Arua, Uganda
| | - Meklit Workneh
- Meklit Workneh, MD, MPH, is a Medical Microbiology Fellow, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Yukari Manabe
- Yukari Manabe, MD, is Associate Director of Global Health Research and Innovation, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Jeff N Borchert
- Jeff N. Borchert, MS, is a Public Health Analyst, Centers for Disease Control and Prevention, Division of Vector-Borne Diseases, Fort Collins, Colorado
| | - Vance Brown
- Vance Brown, MA, is Deputy Program Director, Centers for Disease Control and Prevention, Division of Global Health Protection, Kampala, Uganda
| | - Grace D Appiah
- Grace D. Appiah, MD, MS, is a Medical Epidemiologist, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Eric D Mintz
- Eric D. Mintz, MD, MPH, is a Medical Epidemiologist, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jaco Homsy
- Jaco Homsy, MD, MPH, is Program Director, Centers for Disease Control and Prevention, Division of Global Health Protection, Kampala, Uganda
| | - George S Odongo
- George S. Odongo, MPH, is a Public Health Informatics Fellow, Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Raymond L Ransom
- Raymond L. Ransom is Associate Director for Informatics, Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Molly M Freeman
- Molly M. Freeman, PhD, is a Microbiologist, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Robyn A Stoddard
- Robyn A. Stoddard, DVM, PhD, Microbiologists, Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Renee Galloway
- Renee Galloway, MLS, MPH, Microbiologists, Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Matthew Mikoleit
- Matthew Mikoleit, MS, is a Microbiologist, Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Cecilia Kato
- Cecilia Kato, PhD, is a Biologist, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ronald Rosenberg
- Ronald Rosenberg, ScD, is Associate Director for Science, Centers for Disease Control and Prevention, Division of Vector-Borne Diseases, Fort Collins, Colorado
| | - Eric C Mossel
- Eric C. Mossel, PhD, is a Microbiologist, Centers for Disease Control and Prevention, Division of Vector-Borne Diseases, Fort Collins, Colorado
| | - Paul S Mead
- Paul S. Mead, MD, MPH, is a Medical Officer, Centers for Disease Control and Prevention, Division of Vector-Borne Diseases, Fort Collins, Colorado
| | - Kiersten J Kugeler
- Kiersten Kugeler, PhD, MPH, is an Epidemiologist, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, CO
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15
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Martin T, Eliades MJ, Wun J, Burnett SM, Alombah F, Ntumy R, Gondwe M, Onyando B, Onditi S, Guindo B, Hamilton P. Effect of Supportive Supervision on Competency of Febrile Clinical Case Management in Sub-Saharan Africa. Am J Trop Med Hyg 2019; 100:882-888. [PMID: 30793696 PMCID: PMC6447112 DOI: 10.4269/ajtmh.18-0365] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 12/18/2018] [Indexed: 01/22/2023] Open
Abstract
Since 2010, the WHO has recommended that clinical decision-making for malaria case management be performed based on the results of a parasitological test result. Between 2015 and 2017, the U.S. President's Malaria Initiative-funded MalariaCare project supported the implementation of this practice in eight sub-Saharan African countries through 5,382 outreach training and supportive supervision visits to 3,563 health facilities. During these visits, trained government supervisors used a 25-point checklist to observe clinicians' performance in outpatient departments, and then provided structured mentoring and action planning. At baseline, more than 90% of facilities demonstrated a good understanding of WHO recommendations-when tests should be ordered, using test results to develop an accurate final diagnosis, severity assessment, and providing the correct prescription. However, significant deficits were found in history taking, conducting a physical examination, and communicating with patients and their caregivers. After three visits, worker performance demonstrated steady improvement-in particular, with checking for factors associated with increased morbidity and mortality: one sign of severe malaria (72.9-85.5%), pregnancy (81.1-87.4%), and anemia (77.2-86.4%). A regression analysis predicted an overall improvement in clinical performance of 6.3% (P < 0.001) by the third visit. These findings indicate that in most health facilities, there is good baseline knowledge on the processes of quality clinical management, but further training and on-site mentoring are needed to improve the clinical interaction that focuses on second-order decision-making, such as severity of illness, management of non-malarial fever, and completing the patient-provider communication loop.
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Affiliation(s)
- Troy Martin
- President’s Malaria Initiative (PMI) MalariaCare Project, PATH, Washington, District of Columbia
| | - M. James Eliades
- President’s Malaria Initiative (PMI) MalariaCare Project, PATH, Washington, District of Columbia
- Malaria, Asia; Population Services International, Yangon, Myanmar
- Population and Family Health, Mailman School of Public Health, Columbia University, New York, New York
| | - Jolene Wun
- President’s Malaria Initiative (PMI) MalariaCare Project, PATH, Washington, District of Columbia
| | - Sarah M. Burnett
- President’s Malaria Initiative (PMI) MalariaCare Project, PATH, Washington, District of Columbia
| | - Fozo Alombah
- President’s Malaria Initiative (PMI) MalariaCare Project, PATH, Washington, District of Columbia
| | - Raphael Ntumy
- President’s Malaria Initiative (PMI) MalariaCare Project, PATH, Accra, Ghana
| | - McPherson Gondwe
- President’s Malaria Initiative (PMI) MalariaCare Project, PATH, Lilongwe, Malawi
| | - Beatrice Onyando
- President’s Malaria Initiative (PMI) MalariaCare Project, PATH, Kisumu, Kenya
| | - Samwel Onditi
- President’s Malaria Initiative (PMI) MalariaCare Project, PATH, Kisumu, Kenya
| | - Boubacar Guindo
- President’s Malaria Initiative (PMI) MalariaCare Project, Population Services International, Bamako, Mali
| | - Paul Hamilton
- President’s Malaria Initiative (PMI) MalariaCare Project, PATH, Washington, District of Columbia
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16
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Msemo OA, Mbwana J, Mahende C, Malabeja A, Gesase S, Crump JA, Dekker D, Lusingu JPA. Epidemiology and Antimicrobial Susceptibility of Salmonella enterica Bloodstream Isolates Among Febrile Children in a Rural District in Northeastern Tanzania: A Cross-sectional Study. Clin Infect Dis 2019; 68:S177-S182. [PMID: 30845323 PMCID: PMC6405276 DOI: 10.1093/cid/ciy1126] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Salmonella enterica including Salmonella Typhi and nontyphoidal Salmonella (NTS) are the predominant cause of community-acquired bloodstream infections in sub-Saharan Africa (sSA). Multiple-drug resistance and emerging fluoroquinolone resistance are of concern. Data on the age distribution of typhoid fever in sSA are scarce but essential for typhoid conjugate vaccine policy. We sought to describe Salmonella bloodstream infections, antimicrobial resistance, and age distribution at a rural district hospital in northeastern Tanzania. METHODS From 2008 to 2016, febrile children or children with a history of fever aged 1 month to 5 years admitted to Korogwe District Hospital were enrolled. Demographic, clinical data and blood cultures were collected. Organisms were identified by conventional microbiological methods, and antimicrobial susceptibility test was done by disc diffusion. RESULTS Of 4176 participants receiving blood cultures, 383 (9.2 %) yielded pathogens. Of pathogens, 171 (44.6%) were Salmonella enterica of which 129 (75.4%) were Salmonella Typhi, and 42 (24.6%) were NTS. The median (interquartile range age of participants was 13.1 (6.3-28.0) months for those with Salmonella Typhi and 11.5 (8.5-23.4) months for NTS. Of 129 Salmonella Typhi, 89 (89.9%) were resistant to amoxicillin, 85 (81.0%) to chloramphenicol, and 93 (92.1%) to trimethoprim-sulfamethoxazole compared with 22 (62.9%), 15 (39.4%), and 27 (79.4%), respectively, for NTS. Multidrug resistance was present in 68 (81.0%) of Salmonella Typhi and 12 (41.4%) of NTS. CONCLUSION Salmonella Typhi was the leading cause of bloodstream infection among infants and young children <2 years of age admitted to Korogwe District Hospital. Multidrug resistance was common, highlighting a role for typhoid conjugate vaccine into routine infant vaccine schedules.
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Affiliation(s)
- Omari A Msemo
- National Institute for Medical Research, Tanga Center, Tanzania
| | - Joyce Mbwana
- National Institute for Medical Research, Tanga Center, Tanzania
| | - Coline Mahende
- National Institute for Medical Research, Tanga Center, Tanzania
| | | | - Samwel Gesase
- National Institute for Medical Research, Tanga Center, Tanzania
| | - John A Crump
- Centre for International Health, University of Otago, Dunedin, New Zealand
| | - Denise Dekker
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
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Ngocho JS, de Jonge MI, Minja L, Olomi GA, Mahande MJ, Msuya SE, Mmbaga BT. Modifiable risk factors for community-acquired pneumonia in children under 5 years of age in resource-poor settings: a case-control study. Trop Med Int Health 2019; 24:484-492. [PMID: 30702791 DOI: 10.1111/tmi.13211] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Despite the availability of vaccines and antibiotics, pneumonia remains the leading cause of mortality among children under 5 years of age. The objective of this study was to identify modifiable risk factors for community-acquired pneumonia (CAP) in children under 5 years of age in a vaccinated population. METHODS A case-control study was conducted between January and December 2017. The cases included children aged 2-59 months with X-ray-confirmed pneumonia, whereas the controls were children from the community with no history of respiratory infection. A multivariable logistic regression model was used to determine the modifiable risk factors for CAP. RESULTS A total of 113 children with X-ray-confirmed pneumonia and 350 healthy children were enrolled in this study. The median ages for the cases and controls were 13.7 (IQR = 7.2-25.3) and 13.4 (IQR = 6.0-24.8) months respectively. One (0.9%) child died after the enrolment. The independent predictors of CAP included a lack of exclusive breastfeeding for 6 months (aOR = 1.7, 95% CI = 1.0-2.9), underweight (aOR = 2.1, 95% CI = 1.0-4.5), unclean cooking fuel (aOR = 1.8, 95% CI = 1.0-3.3) and low income (aOR = 2.9, 95% CI = 1.6-5.4). No association was found between vaccination status and CAP. CONCLUSION In addition to a lack of exclusive breastfeeding, children from families of low-economic status were at risk of contracting CAP. Since the risk factors are complex, the study results call for more concerted efforts by and collaboration among the health, agriculture and development sectors to address mortality caused by CAP.
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Affiliation(s)
- James Samwel Ngocho
- Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Marien Isaäk de Jonge
- Section of Pediatric Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Linda Minja
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | | | - Michael Johnson Mahande
- Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Sia Emmanueli Msuya
- Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania.,Community Health Department, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
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Bonko MDA, Kiemde F, Tahita MC, Lompo P, Some AM, Tinto H, van Hensbroek MB, Mens PF, Schallig HDFH. The effect of malaria rapid diagnostic tests results on antimicrobial prescription practices of health care workers in Burkina Faso. Ann Clin Microbiol Antimicrob 2019; 18:5. [PMID: 30691506 PMCID: PMC6348635 DOI: 10.1186/s12941-019-0304-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 01/20/2019] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Malaria rapid diagnostic tests (RDT) are widely used in endemic areas in order to comply with the recommendation that malaria treatment should only be given after the clinical diagnosis has been confirmed by RDT or microscopy. However, the overestimation of malaria infection with the use of PfHRP2 based RDT, makes the management of febrile illnesses more challenging. This study aimed to assess the effect of the use of malaria RDT on antimicrobial prescription practices. METHODS A prospective study was conducted among febrile children under-5 years of age attending four health facilities and the referral hospital in the Nanoro Health District (Burkina Faso). To assess the effect of malaria RDT testing on the prescriptions of antimicrobials in febrile children, the initial diagnosis and antimicrobial prescriptions following a malaria RDT testing were recorded. The necessity of these prescriptions was subsequently checked by assessing the actual cause of fever by expert malaria microscopy and a microbiology analysis of blood, urine, stool and nasopharynx swabs that were collected from febrile cases to determine the actual cause of the fever episode. RESULTS Malaria was diagnosed by nurses, who are the primary health care providers, with a malaria RDT in 72.7% (798/1098) of febrile children, but only 53.7% (589/1097) cases could be confirmed by expert microscopy. Health care workers were likely to prescribe antimalarials to malaria positive RDT compared to malaria negative RDT (RR = 7.74, p = 0.00001). Malaria negative RDT result had a significant influence on the antibiotic prescriptions (RR = 3.57, p = 0.0001). The risk of prescribing antimicrobials was higher in health facility level compared to referral hospital. By cross-checking of laboratory findings to antimicrobial prescriptions, an important part of children with positive bacterial infection have received antibiotic prescriptions although the majority without any infection have also received antibiotics. CONCLUSION Despite the good attitude of health care workers to adhere to diagnostic test results, antimalarials and antibiotics remain inappropriate prescribed to febrile children. The low specificity of malaria RDT used could be an important cause of these practices.
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Affiliation(s)
- Massa dit Achille Bonko
- Institut de Recherche en Science de la Sante-Unite de Recherche Clinique de Nanoro, Nanoro, Burkina Faso
- Parasitology Unit, Department of Medical Microbiology, Amsterdam University Medical Centers, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Francois Kiemde
- Institut de Recherche en Science de la Sante-Unite de Recherche Clinique de Nanoro, Nanoro, Burkina Faso
- Parasitology Unit, Department of Medical Microbiology, Amsterdam University Medical Centers, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Global Child Health Group, Amsterdam University Medical Centers, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Marc Christian Tahita
- Institut de Recherche en Science de la Sante-Unite de Recherche Clinique de Nanoro, Nanoro, Burkina Faso
| | - Palpouguini Lompo
- Institut de Recherche en Science de la Sante-Unite de Recherche Clinique de Nanoro, Nanoro, Burkina Faso
| | - Athanase M. Some
- Institut de Recherche en Science de la Sante-Unite de Recherche Clinique de Nanoro, Nanoro, Burkina Faso
| | - Halidou Tinto
- Institut de Recherche en Science de la Sante-Unite de Recherche Clinique de Nanoro, Nanoro, Burkina Faso
| | - Michael Boele van Hensbroek
- Global Child Health Group, Amsterdam University Medical Centers, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Petra F. Mens
- Parasitology Unit, Department of Medical Microbiology, Amsterdam University Medical Centers, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Henk D. F. H. Schallig
- Parasitology Unit, Department of Medical Microbiology, Amsterdam University Medical Centers, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
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Mitsakakis K, D'Acremont V, Hin S, von Stetten F, Zengerle R. Diagnostic tools for tackling febrile illness and enhancing patient management. MICROELECTRONIC ENGINEERING 2018; 201:26-59. [PMID: 32287568 PMCID: PMC7114275 DOI: 10.1016/j.mee.2018.10.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Most patients with acute infectious diseases develop fever, which is frequently a reason to visit health facilities in resource-limited settings. The symptomatic overlap between febrile diseases impedes their diagnosis on clinical grounds. Therefore, the World Health Organization promotes an integrated management of febrile illness. Along this line, we present an overview of endemic and epidemic etiologies of fever and state-of-the-art diagnostic tools used in the field. It becomes evident that there is an urgent need for the development of novel technologies to fulfill end-users' requirements. This need can be met with point-of-care and near-patient diagnostic platforms, as well as e-Health clinical algorithms, which co-assess test results with key clinical elements and biosensors, assisting clinicians in patient triage and management, thus enhancing disease surveillance and outbreak alerts. This review gives an overview of diagnostic technologies featuring a platform based approach: (i) assay (nucleic acid amplification technologies are examined); (ii) cartridge (microfluidic technologies are presented); (iii) instrument (various detection technologies are discussed); and at the end proposes a way that such technologies can be interfaced with electronic clinical decision-making algorithms towards a broad and complete diagnostic ecosystem.
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Affiliation(s)
- Konstantinos Mitsakakis
- Hahn-Schickard, Georges-Koehler-Allee 103, 79110 Freiburg, Germany
- Laboratory for MEMS Applications, IMTEK – Department of Microsystems Engineering, University of Freiburg, Georges-Koehler-Allee 103, 79110 Freiburg, Germany
- Corresponding author.
| | - Valérie D'Acremont
- Swiss Tropical and Public Health Institute, University of Basel, Socinstrasse 57, 4002 Basel, Switzerland
- Department of Ambulatory Care and Community Medicine, University of Lausanne, Bugnon 44, 1011 Lausanne, Switzerland
| | - Sebastian Hin
- Hahn-Schickard, Georges-Koehler-Allee 103, 79110 Freiburg, Germany
| | - Felix von Stetten
- Hahn-Schickard, Georges-Koehler-Allee 103, 79110 Freiburg, Germany
- Laboratory for MEMS Applications, IMTEK – Department of Microsystems Engineering, University of Freiburg, Georges-Koehler-Allee 103, 79110 Freiburg, Germany
| | - Roland Zengerle
- Hahn-Schickard, Georges-Koehler-Allee 103, 79110 Freiburg, Germany
- Laboratory for MEMS Applications, IMTEK – Department of Microsystems Engineering, University of Freiburg, Georges-Koehler-Allee 103, 79110 Freiburg, Germany
- BIOSS – Centre for Biological Signalling Studies, University of Freiburg, Schaenzlestr. 18, 79104 Freiburg, Germany
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20
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Tine RC, Ndiaye LA, Niang MN, Kiori DE, Dia N, Gaye O, Broutin H. Upper respiratory infections in a rural area with reduced malaria transmission in Senegal: a pathogens community study. BMC Infect Dis 2018; 18:459. [PMID: 30200897 PMCID: PMC6131886 DOI: 10.1186/s12879-018-3362-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 08/24/2018] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Acute Respiratory Infections (ARI) are common causes of febrile illnesses in many settings in Senegal. These infections are usually managed presumptively due to lack of appropriate diagnostic tools. This situation, can lead to poor management of febrile illness or antibiotic misuse. In addition, there are limited data on the spectrum of pathogens commonly responsible for these ARI. This study was conducted to explore the pathogens community among patients with acute respiratory infection in a rural area in Senegal. METHODS A cross sectional study was conducted from August to December 2015. Children and adult patients attending Keur Socé health post for signs suggestive of acute respiratory infection were enrolled after providing inform consent. Eligible participants were recruited using a consecutive sampling method. Paired nose and throat swabs were collected for pathogen detection. Samples were processed using a multiplex PCR designed to identify 21 pathogens including both virus and bacteria. RESULTS Two hundred and fifty patients participated in the study. Samples positivity rate was evaluated at 95.2% (238/250). Streptococcus pneumoniae was the predominant pathogen (74%) and was present in all months and all age-groups, followed by Staphylococcus aureus (28,8%) and rhinovirus (28,4%). Respiratory syncytial virus (RSV) was detected only among children under 5 years old in August and September while coronavirus was present in all age groups, during the months of October and December. CONCLUSION This pilot study revealed a diversity of pathogens over the time and across all age groups, highlighting the need for further exploration. A pathogen community approach including both virus and bacteria at a larger scale becomes crucial for a better understanding of transmission dynamics at population level in order to help shape ARI control strategies.
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Affiliation(s)
- Roger C Tine
- Service de Parasitologie, Faculté de Médecine, Université Cheikh Anta Diop de Dakar (UCAD), BP5005, Dakar-Fann, Senegal.
| | - Léon A Ndiaye
- Service de Parasitologie, Faculté de Médecine, Université Cheikh Anta Diop de Dakar (UCAD), BP5005, Dakar-Fann, Senegal
| | - Mbayame N Niang
- Laboratoire des Virus respiratoires, Institut Pasteur de Dakar, Dakar, Senegal
| | - Davy E Kiori
- Laboratoire des Virus respiratoires, Institut Pasteur de Dakar, Dakar, Senegal
| | - Ndongo Dia
- Laboratoire des Virus respiratoires, Institut Pasteur de Dakar, Dakar, Senegal
| | - Oumar Gaye
- Service de Parasitologie, Faculté de Médecine, Université Cheikh Anta Diop de Dakar (UCAD), BP5005, Dakar-Fann, Senegal
| | - Hélène Broutin
- Service de Parasitologie, Faculté de Médecine, Université Cheikh Anta Diop de Dakar (UCAD), BP5005, Dakar-Fann, Senegal.,MIVEGEC, UMR CNRS -IRD -University of Montpellier - 911, Avenue Agropolis BP 64501, Cédex 5 34394, Montpellier, France
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Rauf A, Singhi S, Nallasamy K, Walia M, Ray P. Non-Respiratory and Non-Diarrheal Causes of Acute Febrile Illnesses in Children Requiring Hospitalization in a Tertiary Care Hospital in North India: A Prospective Study. Am J Trop Med Hyg 2018; 99:783-788. [PMID: 29988003 PMCID: PMC6169172 DOI: 10.4269/ajtmh.18-0056] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Accepted: 06/04/2018] [Indexed: 02/04/2023] Open
Abstract
Acute febrile illnesses (AFIs) in children from the developing world can have varying etiologies. Awareness of local epidemiology helps in prioritizing investigations and empiric treatment. This prospective study was carried out in a tertiary care center in North India, aiming to determine the burden, etiology, and outcome of AFI other than pneumonia and diarrhea in hospitalized children. A total of 613 consecutive children aged 3 months to 12 years with febrile illness of < 7 days during four selected months of 2014 representing different seasons were screened for eligibility. Those with acute respiratory diseases (N = 175, 28.5%) and diarrheal illness (N = 46, 7.5%) were excluded and 217 children were enrolled. Mean (standard deviation) age was 4.8 (3.4) years. Nearly half (N = 91, 41.9%) presented in post-monsoon season. Diagnosis could be established in 187 (86.2%) children. Acute central nervous system infections were the most common (N = 54, 24.8%). Among specific infections, scrub typhus was the most frequent (N = 23, 10.5%) followed by malaria (N = 14, 6.4%), typhoid (N = 14, 6.5%), and viral hepatitis (N = 13, 6.0%). Blood culture had a low (6.5%) yield; Salmonella typhi (N = 6) and Staphylococcus aureus (N = 5) were the common isolates. Serological tests were helpful in 50 (23%) cases. In multivariate analysis, hepatomegaly and/or splenomegaly independently predicted scrub typhus. Mortality rate was 10.1%. We conclude that AFI other than pneumonia and diarrhea are a significant burden and follow a seasonal trend. Scrub typhus has emerged as an important etiology of childhood AFIs in northern India. Periodic review of regional epidemiology will help in understanding the changing pattern of infectious diseases.
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Affiliation(s)
- Abdul Rauf
- Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sunit Singhi
- Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Karthi Nallasamy
- Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Mandeep Walia
- Department of Pediatrics, Maulana Azad Medical College, New Delhi, India
| | - Pallab Ray
- Department of Microbiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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22
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Sonda T, Kumburu H, van Zwetselaar M, Alifrangis M, Mmbaga BT, Aarestrup FM, Kibiki G, Lund O. Whole genome sequencing reveals high clonal diversity of Escherichia coli isolated from patients in a tertiary care hospital in Moshi, Tanzania. Antimicrob Resist Infect Control 2018; 7:72. [PMID: 29977533 PMCID: PMC5992844 DOI: 10.1186/s13756-018-0361-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 05/22/2018] [Indexed: 01/06/2023] Open
Abstract
Background Limited information regarding the clonality of circulating E. coli strains in tertiary care hospitals in low and middle-income countries is available. The purpose of this study was to determine the serotypes, antimicrobial resistance and virulence genes. Further, we carried out a phylogenetic tree reconstruction to determine relatedness of E. coli isolated from patients in a tertiary care hospital in Tanzania. Methods E. coli isolates from inpatients admitted at Kilimanjaro Christian Medical Centre between August 2013 and August 2015 were fully genome-sequenced at KCMC hospital. Sequence analysis was done for identification of resistance genes, Multi-Locus Sequence Typing, serotyping, and virulence genes. Phylogeny reconstruction using CSI Phylogeny was done to ascertain E. coli relatedness. Stata 13 (College Station, Texas 77,845 USA) was used to determine Cohen's kappa coefficient of agreement between the phenotypically tested and whole genome sequence predicted antimicrobial resistance. Results Out of 38 E. coli isolates, 21 different sequence types (ST) were observed. Eight (21.1%) isolates belonged to ST131; of which 7 (87.5.%) were serotype O25:H4. Ten (18.4%) isolates belonged to ST10 clonal complex; of these, four (40.0%) were ST617 with serotype O89:H10. Twenty-eight (73.7%) isolates carried genes encoding beta-lactam resistance enzymes. On average, agreement across all drugs tested was 83.9%. Trimethoprim/sulphamethoxazole (co-trimoxazole) showed moderate agreement: 45.8%, kappa =15% and p = 0.08. Amoxicillin-clavulanate showed strongest agreement: 87.5%, kappa = 74% and p = 0.0001. Twenty-two (57.9%) isolates carried virulence factors for host cells adherence and 25 (65.7%) for factors that promote E. coli immune evasion by increasing survival in serum. The phylogeny analysis showed that ST131 clustering close together whereas ST10 clonal complex had a very clear segregation of the ST617 and a mix of the rest STs. Conclusion There is a high diversity of E. coli isolated from patients admitted to a tertiary care hospital in Tanzania. This underscores the necessity to routinely screen all bacterial isolates of clinical importance in tertiary health care facilities. WGS use for laboratory-based surveillance can be an effective early warning system for emerging pathogens and resistance mechanisms in LMICs.
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Affiliation(s)
- Tolbert Sonda
- 1Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical Centre, Moshi, Tanzania.,2Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Happiness Kumburu
- 1Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical Centre, Moshi, Tanzania.,2Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Marco van Zwetselaar
- 1Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Michael Alifrangis
- Centre for Medical Parasitology, Department of Immunology and Microbiology, University of Copenhagen and Department of Infectious Diseases, Copenhagen University Hospital, Copenhagen, Denmark
| | - Blandina T Mmbaga
- 1Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical Centre, Moshi, Tanzania.,2Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | | | - Gibson Kibiki
- 2Kilimanjaro Christian Medical University College, Moshi, Tanzania.,East African Health Research Commission, Bujumbura, Burundi
| | - Ole Lund
- 5Centre for Biological Sequence Analysis, Technical University of Denmark, Copenhagen, Denmark
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Kiemde F, Tahita MC, Lompo P, Rouamba T, Some AM, Tinto H, Mens PF, Schallig HDFH, van Hensbroek MB. Treatable causes of fever among children under five years in a seasonal malaria transmission area in Burkina Faso. Infect Dis Poverty 2018; 7:60. [PMID: 29891004 PMCID: PMC5994647 DOI: 10.1186/s40249-018-0442-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 05/17/2018] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Fever remains a major public health problem. In Burkina Faso, more than half of febrile children are considered not to be infected by malaria. This study prospectively assessed probable (treatable) causes of fever in Burkinabe children. METHODS A prospective study was conducted among febrile children (≥37.5 °C) under 5 years of age presenting at four health facilities and one referral hospital in rural Burkina Faso. From each participant, blood was collected for malaria microscopy and culture, urine for dipstick testing and culturing if tested positive for leucocytes and nitrite, stool for rotavirus/adenovirus testing, culture and parasitology, and a nasopharyngeal swab for culture. RESULTS In total 684 febrile children were included in the study. Plasmodium falciparum malaria was found in 49.7% (340/684) of the participants and non-malaria infections in 49.1% (336/684) of children. The non-nalaria infections included gastro-intestinal infections (37.0%), common bacterial pathogens of nasopharynx (24.3%), bacterial bloodstream infections (6.0%) and urinary tract infections (1.8%). Nearly 45% (154/340) of the malaria infected children were co-infected with non-nalaria infections, but only 3.2% (11/340) of these co-infections could be considered as a possible alternative cause of fever. In contrast, in the malaria microscopy negative children 18.0% (62/344) of the infections could be the probable cause of the fever. Pathogens were not isolated from 23.7% (162/684) of the febrile cases. CONCLUSIONS Malaria remains the most common pathogen found in febrile children in Burkina Faso. However, a relative high number of febrile children had non-malaria infections. The correct diagnosis of these non-malaria fevers is a major concern, and there is an urgent need to develop more point-of-care diagnostic tests and capacities to identify and treat the causes of these fevers.
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Affiliation(s)
- Francois Kiemde
- Institut de Recherche en Science de la Sante-Unite de Recherche Clinique de Nanoro, Nanoro, Burkina Faso. .,Academic Medical Centre, Department of Medical Microbiology, Parasitology Unit, Amsterdam, The Netherlands. .,Global Child Health Group, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
| | - Marc Christian Tahita
- Institut de Recherche en Science de la Sante-Unite de Recherche Clinique de Nanoro, Nanoro, Burkina Faso
| | - Palpouguini Lompo
- Institut de Recherche en Science de la Sante-Unite de Recherche Clinique de Nanoro, Nanoro, Burkina Faso
| | - Toussaint Rouamba
- Institut de Recherche en Science de la Sante-Unite de Recherche Clinique de Nanoro, Nanoro, Burkina Faso
| | - Athanase M Some
- Institut de Recherche en Science de la Sante-Unite de Recherche Clinique de Nanoro, Nanoro, Burkina Faso
| | - Halidou Tinto
- Institut de Recherche en Science de la Sante-Unite de Recherche Clinique de Nanoro, Nanoro, Burkina Faso
| | - Petra F Mens
- Academic Medical Centre, Department of Medical Microbiology, Parasitology Unit, Amsterdam, The Netherlands
| | - Henk D F H Schallig
- Academic Medical Centre, Department of Medical Microbiology, Parasitology Unit, Amsterdam, The Netherlands
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Hercik C, Cosmas L, Mogeni OD, Wamola N, Kohi W, Houpt E, Liu J, Ochieng C, Onyango C, Fields B, Mfinanga S, Montgomery JM. A Combined Syndromic Approach to Examine Viral, Bacterial, and Parasitic Agents among Febrile Patients: A Pilot Study in Kilombero, Tanzania. Am J Trop Med Hyg 2017; 98:625-632. [PMID: 29280432 PMCID: PMC5929188 DOI: 10.4269/ajtmh.17-0421] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
The use of fever syndromic surveillance in sub-Saharan Africa is an effective approach to determine the prevalence of both malarial and nonmalarial infectious agents. We collected both blood and naso/oro-pharyngeal (NP/OP) swabs from consecutive consenting patients ≥ 1 year of age, with an axillary temperature ≥ 37.5°C, and symptom onset of ≤ 5 days. Specimens were analyzed using both acute febrile illness (AFI) and respiratory TaqMan array cards (Resp TAC) for multiagent detection of 56 different bloodstream and respiratory agents. In addition, we collected epidemiologic data to further characterize our patient population. We enrolled 205 febrile patients, including 70 children (1 < 15 years of age; 34%) and 135 adults (≥ 15 years of age; 66%). AFI TAC and Resp TAC were performed on 191 whole blood specimens and 115 NP/OP specimens, respectively. We detected nucleic acid for Plasmodium (57%), Leptospira (2%), and dengue virus (1%) among blood specimens. In addition, we detected 17 different respiratory agents, most notably, Haemophilus influenzae (64%), Streptococcus pneumonia (56%), Moraxella catarrhalis (39%), and respiratory syncytial virus (11%) among NP/OP specimens. Overall median cycle threshold was measured at 26.5. This study provides a proof-of-concept for the use of a multiagent diagnostic approach for exploratory research on febrile illness and underscores the utility of quantitative molecular diagnostics in complex epidemiologic settings of sub-Saharan Africa.
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Affiliation(s)
| | - Leonard Cosmas
- Global Disease Detection Branch, Division of Global Health Protection, Center for Global Health, US Centers for Disease Control and Prevention (CDC), Nairobi, Kenya
| | - Ondari D Mogeni
- Kenya Medical Research Institute-Centre for Global Health Research (KEMRI-CGHR), Nairobi, Kenya
| | - Newton Wamola
- Kenya Medical Research Institute-Centre for Global Health Research (KEMRI-CGHR), Nairobi, Kenya
| | - Wanze Kohi
- National Institute of Medical Research (NIMR), Muhimbili Research Centre, Salaam, Tanzania
| | - Eric Houpt
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia
| | - Jie Liu
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia
| | - Caroline Ochieng
- Kenya Medical Research Institute-Centre for Global Health Research (KEMRI-CGHR), Nairobi, Kenya
| | - Clayton Onyango
- Global Disease Detection Branch, Division of Global Health Protection, Center for Global Health, US Centers for Disease Control and Prevention (CDC), Nairobi, Kenya
| | - Barry Fields
- Global Disease Detection Branch, Division of Global Health Protection, Center for Global Health, US Centers for Disease Control and Prevention (CDC), Nairobi, Kenya
| | - Sayoki Mfinanga
- National Institute of Medical Research (NIMR), Muhimbili Research Centre, Salaam, Tanzania
| | - Joel M Montgomery
- Global Disease Detection Branch, Division of Global Health Protection, Center for Global Health, US Centers for Disease Control and Prevention (CDC), Nairobi, Kenya
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Hooft AM, Ripp K, Ndenga B, Mutuku F, Vu D, Baltzell K, Masese LN, Vulule J, Mukoko D, LaBeaud AD. Principles, practices and knowledge of clinicians when assessing febrile children: a qualitative study in Kenya. Malar J 2017; 16:381. [PMID: 28931399 PMCID: PMC5607512 DOI: 10.1186/s12936-017-2021-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Accepted: 09/07/2017] [Indexed: 11/10/2022] Open
Abstract
Background Clinicians in low resource settings in malaria endemic regions face many challenges in diagnosing and treating febrile illnesses in children. Given the change in WHO guidelines in 2010 that recommend malaria testing prior to treatment, clinicians are now required to expand the differential when malaria testing is negative. Prior studies have indicated that resource availability, need for additional training in differentiating non-malarial illnesses, and lack of understanding within the community of when to seek care play a role in effective diagnosis and treatment. The objective of this study was to examine the various factors that influence clinician behavior in diagnosing and managing children presenting with fever to health centres in Kenya. Methods A total of 20 clinicians (2 paediatricians, 1 medical officer, 2 nurses, and 15 clinical officers) were interviewed, working at 5 different government-sponsored public clinic sites in two areas of Kenya where malaria is prevalent. Clinicians were interviewed one-on-one using a structured interview technique. Interviews were then analysed qualitatively for themes. Results The following five themes were identified: (1) Strong familiarity with diagnosis of malaria and testing for malaria; (2) Clinician concerns about community understanding of febrile illness, use of traditional medicine, delay in seeking care, and compliance; (3) Reliance on clinical guidelines, history, and physical examination to diagnose febrile illness and recognize danger signs; (4) Clinician discomfort with diagnosis of primary viral illness leading to increased use of empiric antibiotics; and (5) Lack of resources including diagnostic testing, necessary medications, and training modalities contributes to the difficulty clinicians face in assessing and treating febrile illness in children. These themes persisted across all sites, despite variation in levels of medical care. Within these themes, clinicians consistently expressed a need for reliable basic testing, especially haemograms and bacterial cultures. Clinicians discussed the use of counseling and education to improve community understanding of febrile illness in order to decrease preventable deaths in children. Conclusion Results of this study suggest that since malarial testing has become more widespread, clinicians working in resource-poor environments still face difficulty when evaluating a child with fever, especially when malaria testing is negative. Improving access to additional diagnostics, continuing medical education, and ongoing evaluation and revision of clinical guidelines may lead to more consistent management of febrile illness by providers, and may potentially decrease prescription of unnecessary antibiotics. Additional interventions at the community level may also have an important role in managing febrile illness, however, more studies are needed to identify targets for intervention at both the clinic and community levels. Electronic supplementary material The online version of this article (doi:10.1186/s12936-017-2021-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anneka M Hooft
- UCSF Benioff Children's Hospital Oakland, 747 52nd St, Oakland, CA, 94609, USA.
| | - Kelsey Ripp
- Department of Medicine, Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA, 19104, USA.,Department of Pediatrics, Children's Hospital of Philadelphia, 3400 Spruce St, Philadelphia, PA, 19104, USA
| | - Bryson Ndenga
- Kenya Medical Research Institute, P.O. Box 1578, Kisumu, 40100, Kenya
| | - Francis Mutuku
- Department of Environment and Health Sciences, Technical University of Mombasa, P.O. Box 90420 - 80100 G.P.O, Mombasa, Kenya
| | - David Vu
- Stanford University, 300 Pasteur Drive, G312C, Stanford, CA, 94305-5208, USA
| | - Kimberly Baltzell
- University of Washington, HMC Box 359909, 325 9th Avenue, Seattle, WA, 98104-2499, USA
| | - Linnet N Masese
- Vector-Borne Diseases Unit, P. O. Box 20750 - 00202, Nairobi, Kenya
| | - John Vulule
- Kenya Medical Research Institute, P.O. Box 1578, Kisumu, 40100, Kenya
| | - Dunstan Mukoko
- UCSF School of Nursing Center for Global Health, Center for Global Health, Box 0606, San Francisco, CA, 94143-0602, USA
| | - A Desiree LaBeaud
- Stanford University, 300 Pasteur Drive, G312C, Stanford, CA, 94305-5208, USA
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Mahende C, Ngasala B, Lusingu J, Mårtensson T, Lushino P, Lemnge M, Mmbando B, Premji Z. Profile of C-reactive protein, white cells and neutrophil populations in febrile children from rural north-eastern Tanzania. Pan Afr Med J 2017; 26:51. [PMID: 28451028 PMCID: PMC5398868 DOI: 10.11604/pamj.2017.26.51.10264] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 11/16/2016] [Indexed: 12/04/2022] Open
Abstract
Introduction C-reactive protein (CRP), white blood cell (WBC) and absolute neutrophil counts (ANC) are important inflammatory biomarkers in the early diagnosis of infections. However, little is known on their profile and usefulness in fever case management in children attending outpatient clinic in rural north-eastern Tanzania. Methods Patients aged between 2 and 59 months presenting with fever at Korogwe District Hospital were enrolled. Venous blood was collected for evaluation of serum CRP, WBC and ANC. Individual patient diagnosis was based on integrated management of childhood illness (IMCI) guidelines and laboratory investigations (blood and urine cultures). Results A total of 867 patients were enrolled, out of which 691 (79.7%) had complete clinical and laboratory data available for analysis. Acute upper respiratory tract infection 284 (41.1%), acute gastroenteritis 127 (18.4%) and pneumonia 100 (14.5%) were the most frequent diagnoses. The geometric mean levels of serum CRP, WBC and ANC were 10.4 (95% CI: 9.2 - 11.8), 11.5 (95% CI: 11.1 - 11.9) and 5.5 (95% CI: 5.2 - 5.8), respectively. CRP≤20, WBC≤15 (103cells/µL) and ANC≤10 103cells/µL) were observed in the majority of the patients with upper respiratory tract infection, pneumonia, acute gastroenteritis and non-specific febrile illness. Only serum CRP levels were positively correlated with positive blood cultures at a calculated cut-off value of 37.3 mg/L, giving a specificity of 77.8% and sensitivity of 74.2%. Conclusion CRP assessment together with IMCI guidelines may be useful in assisting the diagnosis and management of paediatric febrile infections in Tanzania.
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Affiliation(s)
- Coline Mahende
- Korogwe Research Station, Tanga Centre, National Institute for Medical Research, P. O. Box 5004, Tanga, Tanzania.,Department of Medical Entomology and Parasitology, School of Public Health, Muhimbili University of Health and Allied Sciences, P. O. Box 65001, Dar es Salaam, Tanzania
| | - Billy Ngasala
- Department of Medical Entomology and Parasitology, School of Public Health, Muhimbili University of Health and Allied Sciences, P. O. Box 65001, Dar es Salaam, Tanzania
| | - John Lusingu
- Korogwe Research Station, Tanga Centre, National Institute for Medical Research, P. O. Box 5004, Tanga, Tanzania.,Department of International Health, Microbiology and Immunology, University of Copenhagen, Denmark
| | - Thomas Mårtensson
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - Paminus Lushino
- Korogwe Research Station, Tanga Centre, National Institute for Medical Research, P. O. Box 5004, Tanga, Tanzania
| | - Martha Lemnge
- Korogwe Research Station, Tanga Centre, National Institute for Medical Research, P. O. Box 5004, Tanga, Tanzania
| | - Bruno Mmbando
- Korogwe Research Station, Tanga Centre, National Institute for Medical Research, P. O. Box 5004, Tanga, Tanzania
| | - Zul Premji
- Department of Medical Entomology and Parasitology, School of Public Health, Muhimbili University of Health and Allied Sciences, P. O. Box 65001, Dar es Salaam, Tanzania
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Uche IV, MacLennan CA, Saul A. A Systematic Review of the Incidence, Risk Factors and Case Fatality Rates of Invasive Nontyphoidal Salmonella (iNTS) Disease in Africa (1966 to 2014). PLoS Negl Trop Dis 2017; 11:e0005118. [PMID: 28056035 PMCID: PMC5215826 DOI: 10.1371/journal.pntd.0005118] [Citation(s) in RCA: 132] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Accepted: 10/19/2016] [Indexed: 11/19/2022] Open
Abstract
This study systematically reviews the literature on the occurrence, incidence and case fatality rate (CFR) of invasive nontyphoidal Salmonella (iNTS) disease in Africa from 1966 to 2014. Data on the burden of iNTS disease in Africa are sparse and generally have not been aggregated, making it difficult to describe the epidemiology that is needed to inform the development and implementation of effective prevention and control policies. This study involved a comprehensive search of PubMed and Embase databases. It documents the geographical spread of iNTS disease over time in Africa, and describes its reported incidence, risk factors and CFR. We found that Nontyphoidal Salmonella (NTS) have been reported as a cause of bacteraemia in 33 out of 54 African countries, spanning the five geographical regions of Africa, and especially in sub-Saharan Africa since 1966. Our review indicates that NTS have been responsible for up to 39% of community acquired blood stream infections in sub-Saharan Africa with an average CFR of 19%. Salmonella Typhimurium and Enteritidis are the major serovars implicated and together have been responsible for 91%% of the cases of iNTS disease, (where serotype was determined), reported in Africa. The study confirms that iNTS disease is more prevalent amongst Human Immunodeficiency Virus (HIV)-infected individuals, infants, and young children with malaria, anaemia and malnutrition. In conclusion, iNTS disease is a substantial cause of community-acquired bacteraemia in Africa. Given the high morbidity and mortality of iNTS disease in Africa, it is important to develop effective prevention and control strategies including vaccination.
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Affiliation(s)
| | | | - Allan Saul
- Novartis Vaccines Institute for Global Health, Siena, Italy
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28
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Kazaura M, Lugangira K, Kalokola F. Prescription practices for non-malaria febrile illnesses among under-fives in the Lake Zone, Tanzania. ASIAN PACIFIC JOURNAL OF TROPICAL DISEASE 2016. [DOI: 10.1016/s2222-1808(16)61125-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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29
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Kiemde F, Spijker R, Mens PF, Tinto H, Boele M, Schallig HDFH. Aetiologies of non-malaria febrile episodes in children under 5 years in sub-Saharan Africa. Trop Med Int Health 2016; 21:943-955. [PMID: 27159214 DOI: 10.1111/tmi.12722] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To provide an overview of the most frequent aetiologies found in febrile episodes of children under 5 years from sub-Saharan Africa. METHODS MEDLINE and EMBASE were searched for publications in English and French on non-malaria fever episodes in African children under 5 years of age, which were published between January 1990 and July 2015. Case reports and conference abstracts were excluded. RESULTS In total, 3851 titles and abstracts were reviewed, and 153 were selected for full screening of which 18 were included in the present review. Bloodstream infection (BSI) was most commonly investigated (nine of 18) followed by urinary tract infection (UTI) (four of 18) and respiratory tract infection (RTI) (two of 18). Few studies investigated BSI and UTI in the same children (two of 18), or BSI and gastrointestinal infection (GII) (one of 18). As for BSI, the most frequently isolated bacteria were E. coli (four of 12), Streptococcus pneumonia (four of 12), Salmonella spp (three of 12) and Staphylococcus aureus (two of 12) with a positive identification rate of 19.7-33.3%, 5.2-27.6%, 11.7-65.4% and 23.5-42.0%, respectively. As for UTI, the main bacteria isolated were E. coli (six of six) and Klebsiella spp (six of six) with a positive rate of 20.0-72.3% and 10.0-28.5%, respectively. No bacterium was isolated in RTI group, but Human influenzae A and B were frequently found, with the highest positive identification rate in Tanzania (75.3%). Dengue virus (two of 12) was the most frequently reported viral infection with a positive identification rate of 16.7-30.8%. Finally, only rotavirus/adenovirus (69.2% positive identification rate) was found in GII and no bacterium was isolated in this group. CONCLUSIONS The high prevalence of treatable causes of non-malaria fever episodes requires a proper diagnosis of the origin of fever followed by an appropriate treatment, thereby reducing the under-5 mortality in sub-Saharan Africa and preventing the overprescription of antibiotics and thus circumventing the rise of antibiotic resistance.
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Affiliation(s)
- Francois Kiemde
- Institut de Recherche en Science de la Santé, Nanaro, Burkina Faso.,Parasitology Unit, Royal Tropical Institute, Amsterdam, The Netherlands
| | - René Spijker
- Medical Library, University of Amsterdam, Amsterdam, The Netherlands.,Cochrane Netherlands, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Petra F Mens
- Parasitology Unit, Royal Tropical Institute, Amsterdam, The Netherlands.,Centre of Tropical Medicine and Travel Medicine, University of Amsterdam, Amsterdam, The Netherlands
| | - Halidou Tinto
- Institut de Recherche en Science de la Santé, Nanaro, Burkina Faso
| | - Michael Boele
- Global Child Health Group, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
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DeAntonio R, Yarzabal JP, Cruz JP, Schmidt JE, Kleijnen J. Epidemiology of community-acquired pneumonia and implications for vaccination of children living in developing and newly industrialized countries: A systematic literature review. Hum Vaccin Immunother 2016; 12:2422-40. [PMID: 27269963 PMCID: PMC5027706 DOI: 10.1080/21645515.2016.1174356] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
This systematic review evaluated the epidemiology of community-acquired pneumonia in children <6 y of age within 90 developing and newly industrialized countries. Literature searches (1990–2011), based on MEDLINE, EMBASE, Cochrane, CAB Global Health, WHO, UNICEF, country-specific websites, conferences, health-technology-assessment agencies, and the reference lists of included studies, yielded 8,734 records; 62 of 340 studies were included in this review. The highest incidence rate among included studies was 0.51 episodes/child-year, for children <5 y of age in Bangladesh. The highest prevalence was in Chinese children <6 months of age (37.88%). The main bacterial pathogens were Streptococcus pneumoniae, Haemophilus influenzae and Mycoplasma pneumoniae and the main viral pathogens were respiratory syncytial virus, adenovirus and rhinovirus. Community-acquired pneumonia remains associated with high rates of morbidity and mortality. Improved and efficient surveillance and documentation of the epidemiology and burden of community-acquired pneumonia across various geographical regions is warranted.
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Affiliation(s)
| | | | | | | | - Jos Kleijnen
- d School for Public Health and Primary Care (CAPHRI), Maastricht University , Maastricht , The Netherlands.,e Kleijnen Systematic Reviews Ltd , York , United Kingdom
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Masakhwe C, Ochanda H, Nyakoe N, Ochiel D, Waitumbi J. Frequency of Epstein - Barr Virus in Patients Presenting with Acute Febrile Illness in Kenya. PLoS One 2016; 11:e0155308. [PMID: 27163791 PMCID: PMC4862666 DOI: 10.1371/journal.pone.0155308] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 04/27/2016] [Indexed: 01/20/2023] Open
Abstract
Background Most acute febrile illnesses (AFI) are usually not associated with a specific diagnosis because of limitations of available diagnostics. This study reports on the frequency of EBV viremia and viral load in children and adults presenting with febrile illness in hospitals in Kenya. Methodology/Principal Findings A pathogen surveillance study was conducted on patients presenting with AFI (N = 796) at outpatient departments in 8 hospitals located in diverse regions of Kenya. Enrollment criterion to the study was fever without a readily diagnosable infection. All the patients had AFI not attributable to the common causes of fever in Kenyan hospitals, such as malaria or rickettsiae, leptospira, brucella and salmonella and they were hence categorized as having AFI of unknown etiology. EBV was detected in blood using quantitative TaqMan-based qPCR targeting a highly conserved BALF5 gene. The overall frequency of EBV viremia in this population was 29.2%, with significantly higher proportion in younger children of <5years (33.8%, p = 0.039) compared to patients aged ≥5 years (26.3% for 5–15 years or 18.8% for >15 years). With respect to geographical localities, the frequency of EBV viremia was higher in the Lake Victoria region (36.4%), compared to Kisii highland (24.6%), Coastal region (22.2%) and Semi-Arid region (25%). Furthermore, patients from the malaria endemic coastal region and the Lake Victoria region presented with significantly higher viremia than individuals from other regions of Kenya. Conclusions/Significance This study provides profiles of EBV in patients with AFI from diverse eco-regions of Kenya. Of significant interest is the high frequency of EBV viremia in younger children. The observed high frequencies of EBV viremia and elevated viral loads in residents of high malaria transmission areas are probably related to malaria induced immune activation and resultant expansion of EBV infected B-cells.
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Affiliation(s)
- Clement Masakhwe
- School of Biological Sciences, University of Nairobi, Nairobi, Kenya
- Walter Reed Project/Kenya Medical Research Institute, Kisumu, Kenya
| | - Horace Ochanda
- School of Biological Sciences, University of Nairobi, Nairobi, Kenya
| | - Nancy Nyakoe
- Walter Reed Project/Kenya Medical Research Institute, Kisumu, Kenya
| | - Daniel Ochiel
- Walter Reed Project/Kenya Medical Research Institute, Kisumu, Kenya
| | - John Waitumbi
- Walter Reed Project/Kenya Medical Research Institute, Kisumu, Kenya
- * E-mail:
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32
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Elfving K, Shakely D, Andersson M, Baltzell K, Ali AS, Bachelard M, Falk KI, Ljung A, Msellem MI, Omar RS, Parola P, Xu W, Petzold M, Trollfors B, Björkman A, Lindh M, Mårtensson A. Acute Uncomplicated Febrile Illness in Children Aged 2-59 months in Zanzibar - Aetiologies, Antibiotic Treatment and Outcome. PLoS One 2016; 11:e0146054. [PMID: 26821179 PMCID: PMC4731140 DOI: 10.1371/journal.pone.0146054] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 12/11/2015] [Indexed: 12/29/2022] Open
Abstract
Background Despite the fact that a large proportion of children with fever in Africa present at primary health care facilities, few studies have been designed to specifically study the causes of uncomplicated childhood febrile illness at this level of care, especially in areas like Zanzibar that has recently undergone a dramatic change from high to low malaria transmission. Methods We prospectively studied the aetiology of febrile illness in 677 children aged 2–59 months with acute uncomplicated fever managed by IMCI (Integrated Management of Childhood Illness) guidelines in Zanzibar, using point-of-care tests, urine culture, blood-PCR, chest X-ray (CXR) of IMCI-pneumonia classified patients, and multiple quantitative (q)PCR investigations of nasopharyngeal (NPH) (all patients) and rectal (GE) swabs (diarrhoea patients). For comparison, we also performed NPH and GE qPCR analyses in 167 healthy community controls. Final fever diagnoses were retrospectively established based on all clinical and laboratory data. Clinical outcome was assessed during a 14-day follow-up. The utility of IMCI for identifying infections presumed to require antibiotics was evaluated. Findings NPH-qPCR and GE-qPCR detected ≥1 pathogen in 657/672 (98%) and 153/164 (93%) of patients and 158/166 (95%) and 144/165 (87%) of controls, respectively. Overall, 57% (387/677) had IMCI-pneumonia, but only 12% (42/342) had CXR-confirmed pneumonia. Two patients were positive for Plasmodium falciparum. Respiratory syncytial virus (24.5%), influenza A/B (22.3%), rhinovirus (10.5%) and group-A streptococci (6.4%), CXR-confirmed pneumonia (6.2%), Shigella (4.3%) were the most common viral and bacterial fever diagnoses, respectively. Blood-PCR conducted in a sub-group of patients (n = 83) without defined fever diagnosis was negative for rickettsiae, chikungunya, dengue, Rift Valley fever and West Nile viruses. Antibiotics were prescribed to 500 (74%) patients, but only 152 (22%) had an infection retrospectively considered to require antibiotics. Clinical outcome was generally good. However, two children died. Only 68 (11%) patients remained febrile on day 3 and three of them had verified fever on day 14. An additional 29 (4.5%) children had fever relapse on day 14. Regression analysis determined C-reactive Protein (CRP) as the only independent variable significantly associated with CXR-confirmed pneumonia. Conclusions This is the first study on uncomplicated febrile illness in African children that both applied a comprehensive laboratory panel and a healthy control group. A majority of patients had viral respiratory tract infection. Pathogens were frequently detected by qPCR also in asymptomatic children, demonstrating the importance of incorporating controls in fever aetiology studies. The precision of IMCI for identifying infections requiring antibiotics was low.
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Affiliation(s)
- Kristina Elfving
- Department of Infectious Diseases, University of Gothenburg, Gothenburg, Sweden
- Department of Paediatrics, University of Gothenburg, Gothenburg, Sweden
- * E-mail:
| | - Deler Shakely
- Malaria Research, Department of Microbiology, Tumour and Cell biology, Karolinska Institutet, Stockholm, Sweden
- Department of Medicine, Kungälv Hospital, Kungälv, Sweden
| | - Maria Andersson
- Department of Infectious Diseases, University of Gothenburg, Gothenburg, Sweden
| | - Kimberly Baltzell
- Department of Family Health Care Nursing, University of California San Francisco, San Francisco, United States of America
| | - Abdullah S. Ali
- Zanzibar Malaria Elimination Programme, Ministry of Health, Zanzibar, Tanzania
| | - Marc Bachelard
- Department of Paediatrics, University of Gothenburg, Gothenburg, Sweden
| | - Kerstin I. Falk
- Department of Microbiology, Tumor and Cell biology, Karolinska Institutet, Stockholm, Sweden
| | - Annika Ljung
- Department of Infectious Diseases, University of Gothenburg, Gothenburg, Sweden
| | - Mwinyi I. Msellem
- Zanzibar Malaria Elimination Programme, Ministry of Health, Zanzibar, Tanzania
| | - Rahila S. Omar
- Zanzibar Malaria Elimination Programme, Ministry of Health, Zanzibar, Tanzania
| | - Philippe Parola
- Aix Marseille University, UM63, WHO collaborative centre for rickettsioses and other arthropod borne bacterial diseases, Faculté de Médecine, Marseille, France
| | - Weiping Xu
- Malaria Research, Department of Microbiology, Tumour and Cell biology, Karolinska Institutet, Stockholm, Sweden
| | - Max Petzold
- Akademistatistik, Centre for Applied Biostatistics, Occupational and Environmental Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Birger Trollfors
- Department of Paediatrics, University of Gothenburg, Gothenburg, Sweden
| | - Anders Björkman
- Malaria Research, Department of Microbiology, Tumour and Cell biology, Karolinska Institutet, Stockholm, Sweden
| | - Magnus Lindh
- Department of Infectious Diseases, University of Gothenburg, Gothenburg, Sweden
| | - Andreas Mårtensson
- Malaria Research, Department of Microbiology, Tumour and Cell biology, Karolinska Institutet, Stockholm, Sweden
- Centre for Clinical Research Sörmland, Uppsala University, Uppsala, Sweden
- Department of Women’s and Children’s Health, International Maternal and Child Health Unit (IMCH), Uppsala University, Uppsala, Sweden
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Hildenwall H, Amos B, Mtove G, Muro F, Cederlund K, Reyburn H. Causes of non-malarial febrile illness in outpatients in Tanzania. Trop Med Int Health 2015; 21:149-156. [PMID: 26544671 PMCID: PMC4738434 DOI: 10.1111/tmi.12635] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Objective In sub‐Saharan Africa, the use of malaria rapid diagnostic tests (mRDT) has raised awareness of alternative fever causes in children but few studies have included adults. To address this gap, we conducted a study of mRDT‐negative fever aetiologies among children and adults in Tanzania. Methods A total of 1028 patients aged 3 months to 50 years with a febrile illness and negative mRDT were enrolled from a Tanzanian hospital outpatient department. All had a physical examination and cultures from blood, nasopharynx/throat and urine. Patients were followed on Days 7 and 14 and children meeting WHO criteria for pneumonia were followed on Day 2 with chest radiology. Results Respiratory symptoms were the most frequent presenting complaint, reported by 20.3% of adults and 64.0% (339/530) of children. Of 38 X‐rayed children meeting WHO pneumonia criteria, 47.4% had a normal X‐ray. Overall, only 1.3% of 1028 blood cultures were positive. Salmonella typhi was the most prevalent pathogen isolated (7/13, 53.8%) and S. typhi patients reported fever for a median of 7 days (range 2–14). Children with bacteraemia did not present with WHO symptoms requiring antibiotic treatment. Young children and adults had similar prevalences of positive urine cultures (24/428 and 29/498, respectively). Conclusion Few outpatient fevers are caused by blood stream bacterial infection, and most adult bacteraemia would be identified by current clinical guidelines although paediatric bacteraemia may be more difficult to diagnose. While pneumonia may be overdiagnosed, urinary tract infection was relatively common. Our results emphasise the difficulty in identifying African children in need of antibiotics among the majority who do not.
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Affiliation(s)
- Helena Hildenwall
- Global Health - Health Systems and Policy, Karolinska Institutet, Stockholm, Sweden.,Joint Malaria Programme, St Augustine's Hospital, Muheza, Tanzania
| | - Ben Amos
- Joint Malaria Programme, St Augustine's Hospital, Muheza, Tanzania
| | - George Mtove
- Joint Malaria Programme, St Augustine's Hospital, Muheza, Tanzania.,National Institute for Medical Research, Amani Centre, Muheza, Tanga, Tanzania
| | - Florida Muro
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Kerstin Cederlund
- Department of Radiology, Karolinska University Hospital, Huddinge, Sweden.,Department of Clinical Science, Karolinska Institutet, Stockholm, Sweden
| | - Hugh Reyburn
- London School of Hygiene and Tropical Medicine, London, United Kingdom
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