1
|
Pitt-Kendall R, Sun S, Hughes S, Merrick R, Donaldson H, Rayment M, Ivanov Z, Day M, Bari A, Rebec M, Callan E, Mohammed H, Sinka K, Cole M, Fifer H. Investigating the cause of increased tetracycline-resistant Neisseria gonorrhoeae in England, 2016-20. J Antimicrob Chemother 2024; 79:1060-1068. [PMID: 38517444 PMCID: PMC11062939 DOI: 10.1093/jac/dkae073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 02/29/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND Antimicrobial resistance in Neisseria gonorrhoeae is a global public health concern. Tetracycline resistance (TetR) increased from 39.4% to 75.2% between 2016 and 2021 in N. gonorrhoeae isolates collected through national surveillance in England, despite the absence of use of tetracyclines for the treatment of gonorrhoea. OBJECTIVES We investigated whether there was correlation between bacterial sexually transmitted infection (STI) tests performed and treatment with antimicrobials, with increased TetR in N. gonorrhoeae. METHODS We examined correlations between bacterial STI tests, antimicrobial treatment and TetR in N. gonorrhoeae, using national surveillance data from three large sexual health services (SHS) in London during 2016-20. Doxycycline prescribing data and antibiograms of a non-STI pathogen from distinct patient groups (sexual health, obstetric and paediatric), at a large London hospital, were analysed to identify if doxycycline use in SHS was associated with resistance in a non-STI organism. RESULTS A substantial increase in TetR was observed, particularly in isolates from gay, bisexual and other MSM (GBMSM). Strong positive correlations were observed exclusively in GBMSM between N. gonorrhoeae TetR and both bacterial STI tests (r = 0.97, P = 0.01) and antimicrobial treatment (r = 0.87, P = 0.05). Doxycycline prescribing increased dramatically during the study period in SHS. Prevalence of TetR in Staphylococcus aureus was higher in isolates sourced from SHS attendees than those from other settings. CONCLUSIONS Frequent screening of GBMSM at higher risk of STIs, such as those on pre-exposure prophylaxis (PrEP) leading to/and increased use of doxycycline for the treatment of diagnosed infections, may account for the increase in TetR in N. gonorrhoeae.
Collapse
Affiliation(s)
| | - Suzy Sun
- UK Health Security Agency, London, UK
| | | | | | | | - Michael Rayment
- Chelsea & Westminster NHS Foundation Trust, London, UK
- Imperial College London, London, UK
| | | | | | | | | | | | | | | | | | | |
Collapse
|
2
|
Merrick R, Pulford C, Rubeshkumar P, Seyan P, Fina L, Sawyer C, Pacchiarini N, Pollock C, Lighthill J, Potter T, Harvey N, Thomas K, Lloyd D, Gherman I, Mackintosh A, Lawes J, Snow L, Waldram A, Larkin L, Balasegaram S, Painset A, McCormick J, Elson R, Browning L, Williams C, Andrew R, Mably S, Thomas D. A genetically related cluster of Salmonella Typhimurium cases in humans associated with ruminant livestock and related food chains, United Kingdom, August 2021-December 2022. Epidemiol Infect 2024:1-22. [PMID: 38623863 DOI: 10.1017/s095026882400030x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2024] Open
|
3
|
Merrick R, McKerr C, Song J, Donnelly K, Gerrard R, Morgan M, Williams C, Craine N. Transferring inpatients between wards drives large nosocomial COVID-19 outbreaks, Wales, 2020-22: a matched case-control study using routine and enhanced surveillance data. J Hosp Infect 2024; 145:1-10. [PMID: 38081454 DOI: 10.1016/j.jhin.2023.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 11/27/2023] [Accepted: 11/28/2023] [Indexed: 01/19/2024]
Abstract
BACKGROUND The role of the hospital environment in the spread of COVID-19 is unclear. AIM To measure associations between ward characteristics and outbreak size to inform mitigations. METHODS Wards with large (case wards) and small (control wards) outbreaks in three acute hospitals were compared. Cases were healthcare-associated COVID-19 inpatients (positive polymerase chain reaction test ≥8 days post admission). Case wards were adult medical/surgical wards with ≥10 cases within rolling 14-day periods, between April 1st, 2020 and April 30th, 2022. Control wards were equivalents with 2-9 cases. Demographic and laboratory data were extracted from routine surveillance systems. Continuous data were aggregated fortnightly and analysed as binary variables according to median values. Each case ward was compared with two control wards matched on outbreak start date (±14 days) to calculate odds ratios (ORs) and 95% confidence intervals (95% CIs) using univariable and conditional multivariable logistic regression. FINDINGS From 170 outbreaks (median: 5 cases; interquartile range: 2-9), 35 case wards were identified. Community admissions were lower in case wards vs control wards (5 vs 10 median admissions; P<0.01, respectively), whereas transfers between wards within the same hospital were higher (58 vs 29 median transfers; P<0.01, respectively). Wards with more transfers in the preceding fortnight were significantly more likely to experience a large outbreak (≥35 vs <35 transfers; adjusted OR: 9.08; 95% CI: 2.5-33). CONCLUSION We recommend safely minimizing patient movements, such as by asking clinicians to record the rationale for transfer, to reduce the likelihood of disease transmission.
Collapse
Affiliation(s)
- R Merrick
- UK Field Epidemiology Training Programme (UKFETP), UK Health Security Agency, UK; Public Health Wales, UK
| | | | | | | | | | - M Morgan
- UK Field Epidemiology Training Programme (UKFETP), UK Health Security Agency, UK; Public Health Wales, UK
| | | | | |
Collapse
|
4
|
Flannagan J, Chudasama DY, Hope R, Collin SM, Bhattacharya A, Merrick R, Aziz NA, Hopkins S, Dabrera G, Lamagni T. Attribution of nosocomial seeding to long-term care facility COVID-19 outbreaks. Epidemiol Infect 2023; 151:e191. [PMID: 37876042 PMCID: PMC10728972 DOI: 10.1017/s0950268823001565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 08/22/2023] [Accepted: 09/08/2023] [Indexed: 10/26/2023] Open
Abstract
Residents of long-term care facilities (LTCFs) were disproportionately affected by the COVID-19 pandemic. We assessed the extent to which hospital-associated infections contributed to COVID-19 LTCF outbreaks in England. We matched addresses of cases between March 2020 and June 2021 to reference databases to identify LTCF residents. Linkage to health service records identified hospital-associated infections, with the number of days spent in hospital before positive specimen date used to classify these as definite or probable. Of 149,129 cases in LTCF residents during the study period, 3,748 (2.5%) were definite or probable hospital-associated and discharged to an LTCF. Overall, 431 (0.3%) were identified as index cases of potentially nosocomial-seeded outbreaks (2.7% (431/15,797) of all identified LTCF outbreaks). These outbreaks involved 4,521 resident cases and 1,335 deaths, representing 3.0% and 3.6% of all cases and deaths in LTCF residents, respectively. The proportion of outbreaks that were potentially nosocomial-seeded peaked in late June 2020, early December 2020, mid-January 2021, and mid-April 2021. Nosocomial seeding contributed to COVID-19 LTCF outbreaks but is unlikely to have accounted for a substantial proportion. The continued identification of such outbreaks after the implementation of preventative policies highlights the challenges of preventing their occurrence.
Collapse
Affiliation(s)
| | | | - Russell Hope
- United Kingdom Health Security Agency, London, UK
| | | | | | | | | | | | | | | |
Collapse
|
5
|
Allen H, Merrick R, Ivanov Z, Pitt R, Mohammed H, Sinka K, Hughes G, Fifer H, Cole MJ. Is there an association between previous infection with Neisseria gonorrhoeae and gonococcal AMR? A cross-sectional analysis of national and sentinel surveillance data in England, 2015-2019. Sex Transm Infect 2023; 99:1-6. [PMID: 35246477 DOI: 10.1136/sextrans-2021-055298] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 02/06/2022] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVES Quarterly STI screening is recommended for high-risk gay, bisexual and other men who have sex with men (MSM) in the UK, but frequent antibiotic exposure could potentially increase the risk of antimicrobial resistance (AMR) developing in Neisseria gonorrhoeae. We investigated whether repeat diagnosis of gonorrhoea in those attending sexual health services (SHS) was associated with reduced antimicrobial susceptibility. METHODS Antimicrobial susceptibility data relating to the most recent gonorrhoea diagnosis for each individual included in the Gonococcal Resistance to Antimicrobials Surveillance Programme (2015-2019) were matched to their historical records in the national GUMCAD STI surveillance data set (2012-2019). The number of gonorrhoea diagnoses in the previous 3 years was calculated for each SHS attendee. Logistic regression was used to examine the associations between the number of diagnoses and reduced susceptibility to ceftriaxone (minimum inhibitory concentration (MIC) >0.03 mg/L), cefixime (MIC >0.06 mg/L) and azithromycin (MIC >0.25 mg/L) at the time of the latest diagnosis. RESULTS Of 6161 individuals included in the analysis, 3913 (63.5%) were MSM, 1220 (19.8%) were heterosexual men and 814 (13.2%) were women. Among MSM, 2476 (63.3%) had 1 past gonorrhoea diagnosis, 1295 (33.1%) had 2-4, 140 (3.6%) 5-9, and 2 (0.1%) ≥10. Most women and heterosexual men (91.7%) had one past gonorrhoea diagnosis; none had more than four. Reduced ceftriaxone and cefixime susceptibility was more common among MSM with two to four gonorrhoea diagnoses (3.8% and 5.8%, respectively) compared with those with one (2.2% and 3.9%, respectively). After adjusting for potential confounding, this association remained (adjusted OR: 1.59, 95% CI 1.07 to 2.37, p=0.02; adjusted OR: 1.54, 95% CI 1.11 to 2.14, p=0.01). No evidence was found for any other associations. CONCLUSIONS Among MSM, repeat diagnosis of gonorrhoea may be associated with reduced ceftriaxone and cefixime susceptibility. As these are last-line therapies for gonorrhoea, further research is needed to assess the impact of intensive STI screening on AMR.
Collapse
Affiliation(s)
- Hester Allen
- Blood Safety, Hepatitis, Sexually Transmitted Infections (STI) and HIV Division, UK Health Security Agency, London, UK
| | - Rachel Merrick
- Blood Safety, Hepatitis, Sexually Transmitted Infections (STI) and HIV Division, UK Health Security Agency, London, UK
| | - Zdravko Ivanov
- Antimicrobial Resistance and Healthcare Associated Infections Reference Laboratory, UK Health Security Agency, London, UK
| | - Rachel Pitt
- Antimicrobial Resistance and Healthcare Associated Infections Reference Laboratory, UK Health Security Agency, London, UK
| | - Hamish Mohammed
- Blood Safety, Hepatitis, Sexually Transmitted Infections (STI) and HIV Division, UK Health Security Agency, London, UK
| | - Katy Sinka
- Blood Safety, Hepatitis, Sexually Transmitted Infections (STI) and HIV Division, UK Health Security Agency, London, UK
| | - Gwenda Hughes
- UK Public Health Rapid Support Team, London School of Hygiene and Tropical Medicine, London, UK
| | - Helen Fifer
- Blood Safety, Hepatitis, Sexually Transmitted Infections (STI) and HIV Division, UK Health Security Agency, London, UK
| | - Michelle Jayne Cole
- Antimicrobial Resistance and Healthcare Associated Infections Reference Laboratory, UK Health Security Agency, London, UK
| |
Collapse
|
6
|
Merrick R, Chudasama D, Flannagan J, Campos-Matos I, Howard A, Bindra R, Gill ON, Dabrera G, Lamagni T. Differential impact of quarantine policies for recovered COVID-19 cases in England: a case cohort study of surveillance data, June to December 2020. BMC Public Health 2022; 22:1915. [PMID: 36241977 PMCID: PMC9562076 DOI: 10.1186/s12889-022-14254-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 08/24/2022] [Accepted: 09/02/2022] [Indexed: 11/30/2022] Open
Abstract
Background From 12th March 2020, individuals in England were advised to quarantine in their home if a household member tested positive for SARS-CoV-2. A mandatory isolation period of 10 days was introduced on 28th September 2020 and applied to all individuals with COVID-19. We assessed the frequency, timing, and characteristics of recovered COVID-19 cases requiring subsequent quarantine episodes due to household re-exposure. Methods In this case cohort study, all laboratory-confirmed COVID-19 cases notified in England (29th June to 28th December 2020) were analysed to identify consecutive household case(s). Multivariable logistic regression was used to determine associations between case characteristics and need to quarantine following recent infection (within 28 days of diagnosis). Results Among 1,651,550 cases resident in private dwellings and Houses of Multiple Occupancy (HMOs), 744,548 (45.1%) were the only case in their home and 56,179 (3.4%) were succeeded by further household cases diagnosed within 11–28 days of their diagnosis. Of 1,641,412 cases arising in private homes, the likelihood of further household cases was highest for Bangladeshi (aOR = 2.20, 95% CI = 2.10–2.31) and Pakistani (aOR = 2.15, 95% CI = 2.08–2.22) individuals compared to White British, as well as among young people (17-24y vs. 25-64y; aOR = 1.19, 95% CI = 1.16–1.22), men (vs. women; aOR = 1.06, 95% CI = 1.04–1.08), London residents (vs. Yorkshire and Humber; aOR = 1.57, 95% CI = 1.52–1.63) and areas of high deprivation (IMD 1 vs. 10; aOR = 1.13, 95% CI = 1.09–1.19). Conclusion Policies requiring quarantine on re-exposure differentially impact some of the most disadvantaged populations. Quarantine exemption for recently recovered individuals could mitigate the socioeconomic impact of responses to COVID-19 or similar infectious disease outbreaks.
Collapse
Affiliation(s)
- Rachel Merrick
- COVID-19 National Epidemiology Cell, UK Health Security Agency, London, UK.
| | - Dimple Chudasama
- COVID-19 National Epidemiology Cell, UK Health Security Agency, London, UK
| | - Joe Flannagan
- COVID-19 National Epidemiology Cell, UK Health Security Agency, London, UK
| | - Ines Campos-Matos
- COVID-19 National Epidemiology Cell, UK Health Security Agency, London, UK
| | - Annabelle Howard
- COVID-19 International Cell, UK Health Security Agency, London, UK
| | - Renu Bindra
- COVID-19 National Guidance Cell, UK Health Security Agency, London, UK
| | - O Noël Gill
- COVID-19 National Guidance Cell, UK Health Security Agency, London, UK
| | - Gavin Dabrera
- COVID-19 National Epidemiology Cell, UK Health Security Agency, London, UK
| | - Theresa Lamagni
- COVID-19 National Epidemiology Cell, UK Health Security Agency, London, UK
| |
Collapse
|
7
|
Merrick R, Cole M, Pitt R, Enayat Q, Ivanov Z, Day M, Sun S, Sinka K, Woodford N, Mohammed H, Fifer H. Antimicrobial-resistant gonorrhoea: the national public health response, England, 2013 to 2020. Euro Surveill 2022; 27. [PMID: 36205171 PMCID: PMC9540523 DOI: 10.2807/1560-7917.es.2022.27.40.2200057] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Neisseria gonorrhoeae has developed resistance to all antimicrobials used to treat gonorrhoea, and the emergence of ceftriaxone-resistant strains threatens the last-line option for empirical treatment. The 2013 Gonococcal Resistance to Antimicrobials Surveillance Programme (GRASP) Action Plan recommended measures to delay the spread of antimicrobial resistance (AMR) in N. gonorrhoeae in England. We reviewed trends in gonococcal AMR since then and the experience of implementing the Action Plan’s recommendations to respond to incidents of resistant N. gonorrhoeae. Between 2013 and 2019, diagnoses of gonorrhoea in England rose by 128% to 70,922, the largest annual number ever reported. Over this period, N. gonorrhoeae isolates have become less susceptible to azithromycin (minimum inhibitory concentration > 0.5 mg/L), increasing from 4.7% in 2016 to 8.7% in 2020; this led to a change in first-line treatment for gonorrhoea in the United Kingdom (UK) from dual therapy (ceftriaxone/azithromycin) to ceftriaxone monotherapy in 2019. We also detected the first global treatment failure for pharyngeal gonorrhoea with a dual-therapy regimen (ceftriaxone/azithromycin), followed by an additional six ceftriaxone-resistant strains. Continued engagement of sexual health clinicians and laboratories with the UK Health Security Agency (UKHSA) is essential for the timely detection of N. gonorrhoeae strains with ceftriaxone resistance and to rapidly contain transmission of these strains within England.
Collapse
Affiliation(s)
- Rachel Merrick
- United Kingdom Health Security Agency, London, United Kingdom
| | - Michelle Cole
- United Kingdom Health Security Agency, London, United Kingdom
| | - Rachel Pitt
- United Kingdom Health Security Agency, London, United Kingdom
| | - Qudsia Enayat
- United Kingdom Health Security Agency, London, United Kingdom
| | - Zdravko Ivanov
- United Kingdom Health Security Agency, London, United Kingdom
| | - Michaela Day
- United Kingdom Health Security Agency, London, United Kingdom
| | - Suzy Sun
- United Kingdom Health Security Agency, London, United Kingdom
| | - Katy Sinka
- United Kingdom Health Security Agency, London, United Kingdom
| | - Neil Woodford
- United Kingdom Health Security Agency, London, United Kingdom
| | - Hamish Mohammed
- United Kingdom Health Security Agency, London, United Kingdom
| | - Helen Fifer
- United Kingdom Health Security Agency, London, United Kingdom
| |
Collapse
|
8
|
Jayes D, Merrick R, Pulford C, Buitendam E, Mohammed H, Saunders J. What is the role of sexual health services in the delivery of primary prevention of sexually transmitted infections? A narrative review. Sex Health 2022; 19:319-328. [PMID: 35922117 DOI: 10.1071/sh22047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 07/07/2022] [Indexed: 11/23/2022]
Abstract
Sexually transmitted infections (STIs) affect hundreds of millions of people globally. The resulting impact on quality of life and the economy for health systems is huge. Specialist sexual health services (SHS) play a key role in the provision of primary prevention interventions targeted against STIs. We conducted a narrative review to explore the role of SHSs in delivering primary prevention interventions for STIs. Established interventions include education and awareness building, condom promotion, and the provision of vaccines. Nascent interventions such as the use of antibiotics as pre- and post-exposure prophylaxis are not currently recommended, but have already been adopted by some key population groups. The shift to delivering SHS through digital health technologies may help to reduce barriers to access for some individuals, but creates challenges for the delivery of primary prevention and may inadvertently increase health inequities. Intervention development will need to consider carefully these shifting models of service delivery so that existing primary prevention options are not side-lined and that new interventions reach those who can benefit most.
Collapse
Affiliation(s)
- Danielle Jayes
- Office for Health Improvement and Disparities, Department for Health and Social Care, London, UK
| | - Rachel Merrick
- Blood Safety, Hepatitis, STIs and HIV Division, UK Health Security Agency, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Caisey Pulford
- Blood Safety, Hepatitis, STIs and HIV Division, UK Health Security Agency, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Erna Buitendam
- Blood Safety, Hepatitis, STIs and HIV Division, UK Health Security Agency, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Hamish Mohammed
- Blood Safety, Hepatitis, STIs and HIV Division, UK Health Security Agency, 61 Colindale Avenue, London NW9 5EQ, UK; and Institute for Global Health, University College London, London, UK
| | - John Saunders
- Blood Safety, Hepatitis, STIs and HIV Division, UK Health Security Agency, 61 Colindale Avenue, London NW9 5EQ, UK; and Institute for Global Health, University College London, London, UK
| |
Collapse
|
9
|
Fifer H, Merrick R, Pitt R, Yung M, Allen H, Day M, Sinka K, Woodford N, Mohammed H, Brown CS, Hughes G, Cole M. Frequency and Correlates of Mycoplasma genitalium Antimicrobial Resistance Mutations and Their Association With Treatment Outcomes: Findings From a National Sentinel Surveillance Pilot in England. Sex Transm Dis 2021; 48:951-954. [PMID: 34108410 DOI: 10.1097/olq.0000000000001493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Mycoplasma genitalium infection is a public health concern due to extensive antimicrobial resistance. Using data from a pilot of M. genitalium antimicrobial resistance surveillance, we determined the prevalence and risk factors for resistance among specimens from sexual health clinic attendees and assessed treatment outcomes. METHODS Seventeen sexual health clinics in England sent consecutive M. genitalium-positive specimens to the national reference laboratory from January to March 2019. Regions of the 23S rRNA, parC, and gyrA genes associated with macrolide and fluoroquinolone resistance, respectively, were amplified and sequenced where appropriate. Fisher exact tests, and univariate and multivariable logistic regression models were used to determine associations between demographic, clinical, and behavioral factors and resistance-associated mutations. RESULTS More than two-thirds (173 of 249 [69%]) of M. genitalium specimens had mutations associated with macrolide resistance, whereas predicted fluoroquinolone (21 of 251 [8%]) and dual-drug (12 of 237 [5%]) resistance were less prevalent. No specimens had both gyrA and parC resistance-associated mutations. Macrolide resistance was more common in specimens from men who have sex with men compared with heterosexual men (adjusted odds ratio, 2.64; 95% confidence interval, 1.09-6.38; P = 0.03). There was an association between both macrolide and fluoroquinolone resistance and having a previous sexually transmitted infection (P = 0.06).Only 19% of individuals returned for a test of cure. Of those infected with a macrolide-resistant genotype who were given azithromycin, 57 of 78 (73%) were known or assumed to be clinically cured; however, 43 of these 57 (75%) also received doxycycline. Of the 21 with a macrolide-resistant genotype who failed treatment, 18 of 21 (86%) also received doxycycline. CONCLUSIONS Although macrolide resistance was widespread, particularly among specimens from men who have sex with men and those with a previous sexually transmitted infection diagnosis in the past year, resistance-associated mutations in M. genitalium did not seem to be unequivocally predictive of treatment failure.
Collapse
Affiliation(s)
- Helen Fifer
- From the National Infection Service, Public Health England, London, United Kingdom
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Affiliation(s)
- R Merrick
- Institute of Public Health, University of Cambridge, Cambridge, UK.
| | - S Walsh
- Institute of Public Health, University of Cambridge, Cambridge, UK
| | - J Ford
- Institute of Public Health, University of Cambridge, Cambridge, UK
| | | | | |
Collapse
|
11
|
|
12
|
Mukiibi JM, Mtimavalye LA, Broadhead R, Mzula E, Dzinyemba WE, Merrick R, Khoromana CO, Ching'ani GW. Some haematological parameters in Malawian neonates. East Afr Med J 1995; 72:10-4. [PMID: 7781547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Studies of haematological parameters were performed on 366 (177 male and 189 female) normal Malawian neonates with mean +/- s.d. birthweight of 2.99 +/- 0.37 (range 2.1-4.0) kg using a Nova Cell Track, Model Nova CT11. Cord anaemia (Cord Hb < 13.5g dl-1) was detected in 100 (27.3%) of the neonates. It was also shown that although the male babies had a significantly higher erythrocyte protoporphyrin level (p < 0.001) than the females, there were no significant differences (p > 0.05) in the red cell, white cell and platelet indices between the two sexes. When the haematological parameters of the 266 (72.7%) non-anaemic (Cord Hb > 13.5g dl-1) neonates were analysed, the mean +/- s.d. values which may serve as local reference standards were: Hb 16.0 +/- 1.7 (range 13.5-21.3) g dl-1, Hct 47.0 +/- 6.0 (range 36.5-67.5) percent, MCV 112.6 +/- 8.9 (range 72.2-131.0) fl, MCH 31.9 +/- 5.5 (range 24.4-48.5) pg, MCHC 33.5 +/- 2.8 (range 29.1-48.9) g dl-1 reticulocyte count 6.9 +/- 3.6 (range 1.2-25.0) percent, free erythrocyte protoporphyrin 3.3 +/- 0.9 (range 1.9-7.7) mgs ZPP gm-1 Hb, platelet count 269.9 +/- 57.7 (range 134.0-454.0) x 10(9) l-1 and total leucocyte count 12.3 +/- 4.8 (range 5.5-35.3) x 10(9) l-1. Further analysis of the differential wbc count disclosed normal levels of eosinophils and neutrophils similar to those given in standard haematology textbooks for Caucasian neonates; thus strengthening the belief that eosinophilia and relative neutropenia previously reported in adult Africans is not of genetic origin, but rather an acquired phenomena.
Collapse
Affiliation(s)
- J M Mukiibi
- Department of Haematology, College of Medicine, University of Malawi, Chichiri, Blantyre
| | | | | | | | | | | | | | | |
Collapse
|
13
|
|
14
|
|