Bacteremia in Childhood Life-Threatening Infections in Urban Gambia: EUCLIDS in West Africa

Background

The limited availability of microbiology services in sub-Saharan Africa impedes accurate diagnosis of bacterial pathogens and understanding of trends in prevalence and antibiotic sensitivities. We aimed to characterize bacteremia among hospitalized children in The Gambia and to identify factors associated with bacteremia and mortality.

Methods

We prospectively studied children presenting with suspected severe infection to 2 urban hospitals in The Gambia, between January 2013 and September 2015. Demographic and anthropometric data, clinical features, management, and blood culture results were documented. Urine screens for antibiotic activity were performed in a subset of participants.

Results

Of 411 children enrolled (median age, 29 months; interquartile range, 11–82), 79.5% (325 of 409) reported prehospital antibiotic use. Antimicrobial activity by urinary screen for antibiotic activity was detected in 70.8% (n = 80 of 113). Sixty-six bacterial pathogens were identified in 65 (15.8%) participants and Staphylococcus aureus predominated. Gram-positive organisms were more commonly identified than Gram-negative (P < .01). Antibiotic resistance against first-line antimicrobials (ampicillin and gentamicin) was common among Gram-negative bacteria (39%; range, 25%–100%). Factors significantly associated with bacteremia included the following: gender, hydration status, musculoskeletal examination findings, admission to the Medical Research Council The Gambia at London School of Hygiene & Tropical Medicine hospital, and meeting sepsis criteria. Those associated with increased mortality were presence of a comorbidity, clinical pallor, tachypnea, and altered consciousness. Tachycardia was associated with reduced mortality.

Conclusions

The bacteremia rate in children with suspected childhood life-threatening infectious diseases in The Gambia is high. The pattern of pathogen prevalence and antimicrobial resistance has changed over time compared with previous studies illustrating the importance of robust bacterial surveillance programs in resource-limited settings.

[A young child with acute abdomen and iron deficiency anemia]

The case of a 20 month-old girl that was admitted to the emergency ward because of worsening of her general condition in the setting of acute non-bloody gastroenteritis is reported. The clinical examination revealed signs of severe dehydration and a prominent tender abdomen. Laboratory evaluation showed leucocytosis, elevated C-reactive protein and severe hypochromic microcytic anemia. Abdominal X-ray revealed diffuse meteorism. The child underwent laparascopic evaluation. A perforated Meckel's diverticulum was found. Perforation and anemia due to occult bleeding are unusual presentations of Meckel's diverticulum. The differential diagnosis of children presenting with an acute abdomen with special focus on Meckel's diverticulum is discussed.

Study of adsorption and viscoelastic properties of proteins with a quartz crystal microbalance by measuring the oscillation amplitude

The adsorption kinetics of protein A, BSA, IgG, and fibronectin has been investigated using a homemade quartz crystal microbalance. Information about the energy losses appearing in the system is measured by the maximal oscillation amplitude and the dissipation factor. Only the maximal oscillation amplitude allows us to distinguish the different contributions of liquid and mass to the total frequency shift. The adsorption of proteins has been performed on Ti and Au surfaces at different concentrations. The amount of irreversible adsorbed protein A and IgG increases with increasing bulk concentrations. On Au more proteins adsorb, but their biological activity is reduced in comparison to Ti. Protein A forms a first monolayer in a few seconds, which shows practically no energy losses, and following this a second monolayer is formed. The adsorption rate for the second monolayer is much smaller and energy losses are present. Fibronectin is forming a very viscoelastic system, whose mechanical properties are affected by immersion in different buffer solutions.

Simultaneous measurement of the maximum oscillation amplitude and the transient decay time constant of the QCM reveals stiffness changes of the adlayer

Interpretation of adsorption kinetics measured with a quartz crystal microbalance (QCM) can be difficult for adlayers undergoing modification of their mechanical properties. We have studied the behavior of the oscillation amplitude, A(0), and the decay time constant, tau, of quartz during adsorption of proteins and cells, by use of a home-made QCM. We are able to measure simultaneously the frequency, f, the dissipation factor, D, the maximum amplitude, A(0), and the transient decay time constant, tau, every 300 ms in liquid, gaseous, or vacuum environments. This analysis enables adsorption and modification of liquid/mass properties to be distinguished. Moreover the surface coverage and the stiffness of the adlayer can be estimated. These improvements promise to increase the appeal of QCM methodology for any applications measuring intimate contact of a dynamic material with a solid surface.

Electronic structure of the YH3 phase from angle-resolved photoemission spectroscopy

Yttrium can be loaded with hydrogen up to high concentrations causing dramatic structural and electronic changes of the host lattice. We report on angle-resolved photoemission experiments of the Y trihydride phase. Most importantly, we find the absence of metal d bands at the Fermi level and a set of flat, H-induced bands located at much higher binding energy than predicted, indicating an increased electron affinity at H sites.

Hydrogen-storage materials for mobile applications

Mobility--the transport of people and goods - is a socioeconomic reality that will surely increase in the coming years. It should be safe, economic and reasonably clean. Little energy needs to be expended to overcome potential energy changes, but a great deal is lost through friction (for cars about 10 kWh per 100 km) and low-efficiency energy conversion. Vehicles can be run either by connecting them to a continuous supply of energy or by storing energy on board. Hydrogen would be ideal as a synthetic fuel because it is lightweight, highly abundant and its oxidation product (water) is environmentally benign, but storage remains a problem. Here we present recent developments in the search for innovative materials with high hydrogen-storage capacity.

Formation of a stable decagonal quasicrystalline Al-Pd-Mn surface layer

We report the in situ formation of an ordered equilibrium decagonal Al-Pd-Mn quasicrystal overlayer on the fivefold symmetric surface of an icosahedral Al-Pd-Mn monograin. The decagonal structure of the epilayer is evidenced by x-ray photoelectron diffraction, low-energy electron diffraction, and electron backscatter diffraction. This overlayer is also characterized by a reduced density of states near the Fermi edge as expected for quasicrystals. This is the first time that a millimeter-size surface of the stable decagonal Al-Pd-Mn is obtained, studied, and compared to its icosahedral counterpart.

Chemical nucleation for CVD diamond growth

A new nucleation method to form diamond by chemically pretreating silicon (111) surfaces is reported. The nucleation consists of binding covalently 2,2-divinyladamantane molecules on the silicon substrate. Then low-pressure diamond growth was performed for 2 h via microwave plasma CVD in a tubular deposition system. The resulting diamond layers presented a good cristallinity and the Raman spectra showed a single very sharp peak at 1331 cm(-1), indicating high-quality diamonds.

Adsorption and Bioactivity of Protein A on Silicon Surfaces Studied by AFM and XPS

The adsorption of protein A on silicon surfaces was studied by atomic force microscopy (AFM) and X-ray photoelectron spectroscopy. The deposition was made statically from various concentrations of protein A in water solution. The biological activity was checked by the immobilization of rabbit immunoglobulin G. The protein adsorption occurs in least two different phases and leads to a multilayer film. The first monolayer of proteins is rapidly adsorbed on the surface. The adsorption of the second layer of proteins occurs much more slowly (a thousand times slower) and also involves the third monolayer. The protein A of the first monolayer is denaturated and biologically inactive. On the contrary, the proteins of the second monolayer keep their natural diameter and remain biologically active. AFM artifacts such as the convolution with small objects and the resulting estimation of the coverage ratio are discussed. Copyright 2001 Academic Press.

Evaluating mechanical adhesion of sol-gel titanium dioxide coatings containing calcium phosphate for metal implant application

The adhesion of thin (< 10 microm) sol-gel calcium phosphate-titanium dioxide films bonded to a titanium substrate was studied using two different tests: a rotating-bending test and a tensile bond test. The former evaluates the impact of both the coating procedure and the surface pre-treatment on the resistance to fatigue of the substrate as well as the adhesion of the coating; the latter measures the tensile adhesion strength of the coating. Both tests gave similar results. A reduction of the thickness of the coating or an increase of the roughness of the substrate improves the quality of the interface. A comparison of the adhesion of the calcium phosphate-titanium dioxide film with that of a pure calcium phosphate coating obtained by a similar route suggests the involvement of a chemical component in the binding.

Hydrogen atoms cause long-range electronic effects on graphite

We report on long-range electronic effects caused by hydrogen-carbon interaction at the graphite surface. Two types of defects could be distinguished with a combined mode of scanning tunneling microscopy and atomic force microscopy: chemisorption of hydrogen on the basal plane of graphite and atomic vacancy formation. Both types show a (sqrt[3]xsqrt[3])R30 degrees superlattice in the local density of states but have a different topographic structure. The range of modifications in the electronic structure, of fundamental importance for electronic devices based on carbon nanostructures, has been found to be of the order of 20-25 lattice constants.

Surface and friction characterization by thermoelectric measurements during ultrasonic friction processes

Even though friction is one of the oldest problems in physics many aspects of friction processes are not clear today. We present an experimental setup, which permits the study of tribological systems by measuring the dissipated heat at the interface of two surfaces during a friction process with a time resolution of 1 ms. The apparatus is based on a standard ultrasonic wire-bond machine used in semiconductor industries to connect the internal semiconductor die to the external leads, but the standard bond wire is replaced by a thermocouple. To demonstrate the ability of the apparatus it will be shown that bond substrates used in semiconductor industries can be unequivocally characterized.

Thin films of calcium phosphate and titanium dioxide by a sol-gel route: a new method for coating medical implants

Titanium is a commonly used biomaterial for dental and orthopaedic applications. To increase its ability to bond with bone, some attempts were made to coat its surface with calcium phosphate (CaP). This paper describes a new type of coating. Instead of a pure CaP layer, a mixing of titanium dioxide (TIO2) and CaP is fabricated and deposited as a coating. These layers are deposited by a sol-gel route on pure titanium substrates using various pre-treatments. The method consists of mixing a solution of tetrabutyl ortho-titanate or a sol of titanium dioxide with a solution of calcium nitrate and phosphorous esters. This composite is deposited on to commercially pure titanium plates, mechanically polished or blasted with pure crystalline aluminum oxide, using the spin-coating technique. These coatings are then fired at 650 or 850 degrees C for various times. The samples are characterized by X-ray diffraction for their crystallinity, X-ray photoelectron spectroscopy for their surface chemical composition and scanning electron microscopy for their topography. Samples treated at 850 degrees C present a well-pronounced crystallinity, and a high chemical purity at the surface. The topography is strongly related to the viscosity of the precursor and the substrate pre-treatment. Possibilities to structure the outermost layer are presented.