Factors affecting N-acetyl-β-D-glucosaminidase as an indicator for mastitis detection in dairy sheep

The study of new indirect methods for mastitis detection is of great relevance both at the economic level of the farm and dairies, and in terms of consumer health, and animal welfare. These methods help us to monitor the disease and speed up the decision-making process on treatment of the affected animal and the destination of the milk. The main aim of this work was to study the effect of intramammary infection and other non-infectious factors on the activity of the enzyme N-acetyl-β-D-glucosaminidase (NAGase) in milk, in order to evaluate its use as an indicator for the early diagnosis of mastitis in sheep that could be less expensive, easier to measure and a better marker of inflammation or complementary to existing methods such as somatic cell count (SCC). Seven biweekly samplings were carried out, in which NAGase activity, SCC and milk were analyzed. Glands were classified according to their sanitary status based on the results of the SCC and bacteriological analysis. Non-infectious factors such as lactation stage, parity number and milking session had a statistically significant effect on NAGase values, finding the highest NAGase values at the onset and end of the study, in infectious mastitic glands of multiparous females and at morning milking. However, among the NAGase variation factors studied, the health status of the gland was the factor that caused the highest variation in enzyme levels, with infectious mastitic glands showing higher values than healthy glands. The predictive ability of NAGase was also studied by means of several logistic regression models, with the one that included NAGase together with lactation stage and parity obtaining the best results if sensitivity is to be prioritized, or the model that included NAGase, lactation stage, parity, milking and production if specificity is to be prioritized. From the results obtained, it can be concluded that the use of NAGase as an intramammary infection detection method in sheep can be useful when non-infectious factors that cause changes in the concentration of the enzyme are also considered.

Infrasound detection of approaching lahars

Infrasound may be used to detect the approach of hazardous volcanic mudflows, known as lahars, tens of minutes before their flow fronts arrive. We have analyzed signals from more than 20 secondary lahars caused by precipitation events at Fuego Volcano during Guatemala's rainy season in May through October of 2022. We are able to quantify the capabilities of infrasound monitoring through comparison with seismic data, time lapse camera imagery, and high-resolution video of a well-recorded event on August 17. We determine that infrasound sensors, deployed adjacent to the lahar path and in small-aperture (10 s of meters) arrays, are particularly sensitive to remote detection of lahars, including small-sized events, at distances of at least 5 km. At Fuego Volcano these detections could be used to provide timely alerts of up to 30 min before lahars arrive at a downstream monitoring site, such as in the frequently impacted Ceniza drainage. We propose that continuous infrasound monitoring, from locations adjacent to a drainage, may complement seismic monitoring and serve as a valuable tool to help identify approaching hazards. On the other hand, infrasound arrays located a kilometer or more from the lahar path can be effectively used to track a lahar's progression.

PACAP-PAC1R modulates fear extinction via the ventromedial hypothalamus

Exposure to traumatic stress can lead to fear dysregulation, which has been associated with posttraumatic stress disorder (PTSD). Previous work showed that a polymorphism in the PACAP-PAC1R (pituitary adenylate cyclase-activating polypeptide) system is associated with PTSD risk in women, and PACAP (ADCYAP1)-PAC1R (ADCYAP1R1) are highly expressed in the hypothalamus. Here, we show that female mice subjected to acute stress immobilization (IMO) have fear extinction impairments related to Adcyap1 and Adcyap1r1 mRNA upregulation in the hypothalamus, PACAP-c-Fos downregulation in the Medial Amygdala (MeA), and PACAP-FosB/ΔFosB upregulation in the Ventromedial Hypothalamus dorsomedial part (VMHdm). DREADD-mediated inhibition of MeA neurons projecting to the VMHdm during IMO rescues both PACAP upregulation in VMHdm and the fear extinction impairment. We also found that women with the risk genotype of ADCYAP1R1 rs2267735 polymorphism have impaired fear extinction.

Clozapine placental passage at delivery: an update

Introduction

Clozapine is an effective second-generation antipsychotic that is approved for treatment-resistant schizophrenia and risk reduction of recurrent suicidal behavior in schizophrenia or schizoaffective disorder. Its available pregnancy pharmacikinetics data remain limited, which presents a challenge for clinicians managing women taking clozapine during perinatal period .

Objectives

The aim of this study was to provide new data of clozapine and norclozapine placental passage and neonatal outcomes.

Methods

We retrospectively studied a consecutive case series of six pregnancies where there was clozapine exposure (5 in politherapy and 1 in monotherapy). Clozapine and norclozapine serum concentrations were determined in the mother-infant pairs on the day of delivery (intrapartum maternal blood and umbilical cord blood respectively) and measured using a validated high-performance liquid chromatography method. The within- and between-day precision expressed as the coefficient of variation (CV)% were both <10%. The limit of quantification (LoQ) was 5 ng/mL. Neonatal outcomes were reviewed from pediatric records.

Results

The mean infant-mother clozapine and norclozapine ratio at delivery were 0.44 (SD=0.13) and 0.28 (SD=0.05) respectively. There was a weak positive correlation between maternal and umbilical cord clozapine and norclozapine serum concentratios (Pearson correlation coefficient 0.183, p=0.769 and 0.827, p=0.084 respectively). The rate of neonatal complications was 16%. One neonate (16%) , whose mother had drug abuse history during pregnancy, presented with a generalized neurodevelopment delay and the consequent need for continuous intensive care.

Conclusions

In our study, placental passage of clozapine and norclozapine was partial during delivery. Statistical power was limited for examining te association between neonatal clozapine levels and neonatal outcomes.

Disclosure

No significant relationships.

Burden of disease from exposure to secondhand smoke in children in Europe

BACKGROUND

Secondhand smoke (SHS) exposure at home and fetal SHS exposure during pregnancy are a major cause of disease among children. The aim of this study is quantifying the burden of disease due to SHS exposure in children and in pregnancy in 2006-2017 for the 28 European Union (EU) countries.

METHODS

Exposure to SHS was estimated using a multiple imputation procedure based on the Eurobarometer surveys, and SHS exposure burden was estimated with the comparative risk assessment method using meta-analytical relative risks. Data on deaths and disability-adjusted life years (DALYs) were collected from National statistics and from the Global Burden of Disease Study.

RESULTS

Exposure to SHS and its attributable burden stalled in 2006-2017; in pregnant women, SHS exposure was 19.8% in 2006, 19.1% in 2010, and 21.0% in 2017; in children it was 10.1% in 2006, 9.6% in 2010, and 12.1% in 2017. In 2017, 35,633 DALYs among children were attributable to SHS exposure in the EU, mainly due to low birth weight.

CONCLUSIONS

Comprehensive smoking bans up to 2010 contributed to reduce SHS exposure and its burden in children immediately after their implementation; however, SHS exposure still occurs, and in 2017, its burden in children was still relevant.

IMPACT

Exposure to secondhand smoke at home and in pregnancy is a major cause of disease among children. Smoking legislation produced the adoption of voluntary smoking bans in homes; however, secondhand smoke exposure at home still occurs and its burden is substantial. In 2017, the number of deaths and disability-adjusted life years in children attributable to exposure to secondhand smoke in the European Union countries were, respectively, 335 and 35,633. Low birth weight caused by secondhand smoke exposure in pregnancy showed the largest burden. Eastern European Union countries showed the highest burden.

COVID-19 in transplant recipients: The Spanish experience

We report the nationwide experience with solid organ transplant (SOT) and hematopoietic stem cell transplant (HSCT) recipients diagnosed with coronavirus disease 2019 (COVID-19) in Spain until 13 July 2020. We compiled information for 778 (423 kidney, 113 HSCT, 110 liver, 69 heart, 54 lung, 8 pancreas, 1 multivisceral) recipients. Median age at diagnosis was 61 years (interquartile range [IQR]: 52-70), and 66% were male. The incidence of COVID-19 in SOT recipients was two-fold higher compared to the Spanish general population. The median interval from transplantation was 59 months (IQR: 18-131). Infection was hospital-acquired in 13% of cases. No donor-derived COVID-19 was suspected. Most patients (89%) were admitted to the hospital. Therapies included hydroxychloroquine (84%), azithromycin (53%), protease inhibitors (37%), and interferon-β (5%), whereas immunomodulation was based on corticosteroids (41%) and tocilizumab (21%). Adjustment of immunosuppression was performed in 85% of patients. At the time of analysis, complete follow-up was available from 652 patients. Acute respiratory distress syndrome occurred in 35% of patients. Ultimately, 174 (27%) patients died. In univariate analysis, risk factors for death were lung transplantation (odds ratio [OR]: 2.5; 95% CI: 1.4-4.6), age >60 years (OR: 3.7; 95% CI: 2.5-5.5), and hospital-acquired COVID-19 (OR: 3.0; 95% CI: 1.9-4.9).

Dissociative disorder following preeclampsia: A case report

Introduction

Preeclampsia is a new-onset hypertension with new-onset proteinuria after 20 weeks gestation. Scarce evidence regarding psychiatric effects of preeclampsia is available.

Objectives

To describe a case of a pregnant 24 year-old patient with a premature cesarean section in context of severe preeclampsia and dissociative symptoms.

Methods

Patient referred to a third-level hospital for cesarean section due to a severe preeclampsia at week 32, in whom magnesium sulfate, labetalol perfusion and betamethasone are started. In the puerperium period only labetalol up to 300 mg/6h is maintained.

Results

Due to the appearance of pulsating headache and photophobia, a computerized tomography is conducted, showing bilateral insular and occipital hypodensity related to vasogenic edema. High blood pressure is maintained (177/121 mmHg) despite antihypertensive treatment. A magnetic resonance imaging and an ophthalmologic exam do not show significant abnormalities and blood pressure is stabilized with treatment. However, the patient refers new-onset auditory imperative hallucinations and suicide thoughts, being referred to our Acute Psychiatric Ward for clinical assessment and intervention. Treatment with risperidone 2 mg is started. The day after her admission, she does not refer psychotic symptoms, explaining depersonalization symptoms in the previous 5 days, seeing herself having to choose a knife to commit suicide. After discharge, she maintains reiterative dreams in which she falls down from a building, not presenting dissociative symptoms during the day.

Conclusions

Further evidence regarding psychiatric effects of preeclampsia is needed in order to study the consequences of edema and pharmacological treatment. Blood pressure and psychiatric symptoms monitoring after preeclampsia should also be considered.

Disclosure

No significant relationships.

Neonatal and infant outcomes of clozapine exposure in pregnancy: A consecutive case series

Introduction

Clozapine is a second-generation antipsychotic agent approved for treatment-resistant schizophrenia and risk reduction of recurrent suicidal behavior in schizophrenia and schizoaffective disorder. Given the known negative consequences of relapse of severe mental disorders for both mother and infant, the maintenance of clozapine during pregnancy is recommended.¹ Studies of pregnancy regarding to clozapine have demonstrated a heterogenous range of neonatal and infant complications.²

Objectives

To evaluate neonatal and infants outcomes of clozapine exposure in pregnancy.

Methods

We report three cases of infants exposed to clozapine politherapy throughout pregnancy. The dose range for all women on clozapine was 200-600 mg/day. Infants were evaluated between 4-6 months of chronological age with the Bayley-III infant development scale (BSID-III)³ and with the Alarme Détresse Bébé Scale (ADBB)⁴ for the detection of early-signs of withdrawal.

Results

Women remained stable during pregnancy but presented obesity and gestational diabetes. Clozapine Newborn were born to term by caesarean section due to breech presentation (N=2) or instrumental delivery due to loss of fetal well-being (N=1). They presented normal weight (3500-3800 gr). Two presented Apgar_min1-5 9/10 and one Apgar_min1-5 6/8 which showed lethargy and low alertness during the first weeks of life. All showed normal capacity for sociability, reciprocity and development of language and communication. However, one baby had scores in the low normal zone for cognition and another for motor skills.

Conclusions

The infant’s risks of clozapine exposure during pregnancy should be discussed with women and weighed against those associated with other treatments and/or with untreated severe mental illness.

Unexplained Visual Loss After Silicone Oil Removal: A 7-Year Retrospective Study

Introduction

Unexplained visual loss after removal of silicone oil from the eye has been described. The purpose of this study is to determine the incidence of unexplained loss of visual acuity after SO removal and to provide possible explanations for this phenomenon.

Methods

This retrospective study included patients that underwent vitreoretinal surgery, at Centro Hospitalar São João, between January of 2012 and October of 2018. Inclusion criterion was vitreoretinal surgery in which the chosen endotamponade was SO, followed by removal of SO and exchange with balanced salt solution (BSS) or air. After SO removal, patients with documented loss of best corrected visual acuity (BCVA) on two or more Snellen lines were analyzed and patients in which the cause of the visual loss was identified, namely OHT (intraocular pressure > 21 mmHg), retinal re-detachment, glaucoma, retinal proliferative membrane formation, or corneal decompensation, were excluded. All patients with unexplained visual loss underwent spectral domain optical coherence tomography (SD-OCT) to exclude causes of visual reduction such as cystoid macular edema, epiretinal membrane, or ellipsoid/interdigitation zone disruption. A p value less than 0.05 was considered statistically significant.

Results

A total of 46 eyes underwent SO tamponade and SO removal during the study period. In 34.8% of the cases (n = 16) there was visual acuity loss in at least two Snellen lines. Of 46 eyes, 23.9% (n = 11) showed vision loss due to known secondary causes. Unexplained loss of visual acuity after SO removal occurred in 10.9% of cases. OHT during silicone endotamponade (p = 0.046) and silicone emulsification (p = 0.001) were identified as factors associated with unexplained visual loss after SO removal.

Conclusion

Unexplained loss of visual acuity after SO removal occurred in 10.9% of cases. OHT during silicone endotamponade and SO emulsification were identified as important factors in the ethology of this phenomenon.

Unravelling potential severe psychiatric repercussions on healthcare professionals during the COVID-19 crisis

The coronavirus disease 2019 (COVID-19) outbreak is putting healthcare professionals, especially those in the frontline, under extreme pressures, with a high risk of experiencing physical exhaustion, psychological disturbances, stigmatization, insomnia, depression and anxiety. We report the case of a general practitioner, without relevant somatic or psychiatric history that experienced a "brief reactive psychosis (298.8)" under stressful circumstances derived from COVID-19. She presented with delusional ideas of catastrophe regarding the current pandemic situation, delusions of self-reference, surveillance and persecution, with high affective and behavioural involvement. Physical examination and all further additional investigations did not reveal any secondary causes. She was administered olanzapine 10 mg with significant psychopathological improvement being later discharged with indications to maintain the treatment. To our knowledge this is the first reported case of severe mental illness in a healthcare professional without previous psychiatric history due to COVID-19 outbreak. Around 85% of patients presenting a brief psychotic disorder will develop a potentially disabling serious psychotic illness in the long-term. This case represents the potentially serious mental health consequences on healthcare professionals throughout the COVID-19 crisis and emphasizes the need to implement urgent measures to maintain staff mental health during the current pandemic.

The Working Life of People with Degenerative Cerebellar Ataxia

The aim of the present study was to characterize and analyze the most important individual and organizational variables associated with job accommodation in subjects with degenerative cerebellar ataxia by administering a series of international and validated work activity-related scales. Twenty-four workers (W) and 58 non-workers (NW) were recruited: 34 with autosomal dominant ataxia and 48 with autosomal recessive ataxia (27 with Friedreich ataxia and 21 with sporadic adult-onset ataxia of unknown etiology). The severity of ataxia was rated using the Scale for the Assessment and Rating of Ataxia. Our results showed that the ataxic W were predominantly middle-aged (41-50 years), high school graduate, and married men with a permanent work contract, who had been working for more than 7 years. The W with ataxia exhibited a good level of residual working capacity, irrespective of gender, age range, and duration of the disease, and they were observed to have a low or average-to-low job stress-related risk. Supporting patients with ataxia to find an appropriate job is an important priority because about 78% of NW search for a job and W and NW have the same potential work abilities (no relevant differences were found in terms of disease characteristics, gender, and work resilience). In this view, introducing NW to work-life may have a potential rehabilitative aspect. Findings of this study highlight that equal job opportunities for subjects affected by cerebellar ataxia are recommended.

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.

Maternal colonization with Staphylococcus aureus and Group B streptococcus is associated with colonization in newborns

OBJECTIVES

Although Staphylococcus aureus and Group B streptococcus (GBS) are major causes of neonatal sepsis in sub-Saharan Africa, it is unclear how these bacteria are transmitted to the neonate.

METHODS

In a cohort of 377 Gambian women and their newborns, nasopharyngeal swabs were collected at delivery (day 0), and 3, 6, 14 and 28 days later. Breast milk samples and vaginal swabs were collected from the mother. Staphylococcus aureus and GBS were isolated using conventional microbiological methods.

RESULTS

Most women were carriers of S. aureus (264 out of 361 with all samples collected, 73.1%) at some point during follow up and many were carriers of GBS (114 out of 361, 31.6%). Carriage of S. aureus was common in all three maternal sites and GBS was common in the vaginal tract and breast milk. Among newborns, carriage of S. aureus peaked at day 6 (238 out of 377, 63.1%) and GBS at day 3 (39 out of 377, 10.3%). Neonatal carriage of S. aureus at day 6 was associated with maternal carriage in the breast milk adjusted OR 2.54; 95% CI 1.45-4.45, vaginal tract (aOR 2.55; 95% CI 1.32-4.92) and nasopharynx (aOR 2.49; 95% CI 1.56-3.97). Neonatal carriage of GBS at day 6 was associated with maternal carriage in the breast milk (aOR 3.75; 95% CI 1.32-10.65) and vaginal tract (aOR 3.42; 95% CI 1.27-9.22).

CONCLUSIONS

Maternal colonization with S. aureus or GBS is a risk factor for bacterial colonization in newborns.

Relationship of mammary gland health status and other noninfectious factors with electrical conductivity of milk in Manchega ewes

Measuring the electrical conductivity (EC) of milk during milking has been extensively studied in cattle as a low-cost mastitis detection method that can be easily automated. The aim of this work was to study the effect of the health status of the glands and several noninfectious factors (lactation stage, milking session, and lactation number) that affect the use of EC measurement of milk to detect mastitis in dairy sheep livestock. Likewise, we studied the relation between EC and milk composition (macrocomposition and mineral content) and between EC and somatic cell count (SCC). Finally, we evaluated the use of EC thresholds as a mastitis detection method. To this end, we monitored the glandular milk EC throughout 2 consecutive lactations, during which 42 and 40 ewes were controlled, respectively. We carried out 7 biweekly checks, analyzing the EC, SCC, composition, and mineral content of glandular milk at morning and evening milkings. Before the morning milking, samples were aseptically collected for bacteriological analysis, and the results along with the SCC were used to classify the glands according to their sanitary status (healthy, latently infected, or infected). Lactation stage, parity, milking (morning or evening), health status, and the interactions of parity with health status, lactation stage with health status, and parity with lactation stage all had a significant effect on SCC and EC of the milk. The correlation between EC and SCC was only significant when all the data were analyzed jointly (r = 0.33) and for SCC ≥ 600.000 cells/mL (r = 0.25). The changes in milk composition, mainly in fat content, largely explained the variation in EC (R² = 0.69). For the same EC threshold, the specificity and sensitivity varied depending on the parity or the milking, with the negative predictive value obtained being higher than the positive predictive value at all times. We concluded that developing methods of detecting mastitis in sheep by milk EC readings would require consideration of noninfectious factors that also affect the gauging of EC. One option to consider would be individualized daily monitoring of the glands, as demonstrated in other species such as cattle and goat.

Barcodes of marine invertebrates from north Iberian ports: Native diversity and resistance to biological invasions

Ports are gateways for many marine organisms transported by ships worldwide, especially non-indigenous species (NIS). In this study carried out in North Iberian ports (Cantabrian Sea, Bay of Biscay) we have observed 38% of exotic macroinvertebrates. Four species, namely the barnacle Austrominius modestus, the tubeworm Ficopomatus enigmaticus, the Pacific oyster Crassostrea gigas and the pygmy mussel Xenostrobus securis, exhibited clear signs of invasiveness. A total of 671 barcode (cytochrome oxidase subunit I or 18S rRNA) genes were obtained and confirmed the species status of some cryptic NIS. Negative and significant correlation between diversity estimators of native biota and proportion of NIS suggests biotic resistance in ports. This could be applied to management of port biota for contributing to prevent the settlement of biopollutants in these areas which are very sensitive to biological invasions.

Oral azithromycin given during labour decreases bacterial carriage in the mothers and their offspring: a double-blind randomized trial

Bacterial sepsis remains a leading cause of death among neonates with Staphylococcus aureus, group B streptococcus (GBS) and Streptococcus pneumoniae identified as the most common causative pathogens in Africa. Asymptomatic bacterial colonization is an intermediate step towards sepsis. We conducted a phase III, double-blind, placebo-controlled randomized trial to determine the impact of giving one oral dose of azithromycin to Gambian women in labour on the nasopharyngeal carriage of S. aureus, GBS or S. pneumoniae in the newborn at day 6 postpartum. Study participants were recruited in a health facility in western Gambia. They were followed for 8 weeks and samples were collected during the first 4 weeks. Between April 2013 and April 2014 we recruited 829 women who delivered 843 babies, including 13 stillbirths. Sixteen babies died during the follow-up period. No maternal deaths were observed. No serious adverse events related to the intervention were reported. According to the intent-to-treat analysis, prevalence of nasopharyngeal carriage of the bacteria of interest in the newborns at day 6 was lower in the intervention arm (28.3% versus 65.1% prevalence ratio 0.43; 95% CI 0.36–0.52, p <0.001). At the same time-point, prevalence of any bacteria in the mother was also lower in the azithromycin group (nasopharynx, 9.3% versus 40.0%, p <0.001; breast milk, 7.9% versus 21.6%, p <0.001; and the vaginal tract, 13.2% versus 24.2%, p <0.001). Differences between arms lasted for at least 4 weeks. Oral azithromycin given to women in labour decreased the carriage of bacteria of interest in mothers and newborns and may lower the risk of neonatal sepsis.

Trial registrationClinicalTrials.gov Identifier NCT01800942.

Nasopharyngeal colonization of Gambian infants by Staphylococcus aureus and Streptococcus pneumoniae before the introduction of pneumococcal conjugate vaccines

Staphylococcus aureus and Streptococcus pneumoniae commonly colonize the upper respiratory tract and can cause invasive disease. Several studies suggest an inverse relationship between these two bacteria in the nasopharynx. This association is of particular concern as the introduction of pneumococcal conjugate vaccines (PCVs) that affect pneumococcal nasopharyngeal carriage become widespread. A cohort of children in rural Gambia were recruited at birth and followed for 1 year, before the introduction of PCV into the routine immunization program. Nasopharyngeal swabs were taken immediately after birth, every 2 weeks for the first 6 months and then every other month. The presence of S. aureus and S. pneumoniae was determined using conventional microbiologic methods. Prevalence of S. aureus carriage was 71.6% at birth, decreasing with age to reach a plateau at approximately 20% between 10 to 20 weeks of age. Carriage with any S. pneumoniae increased during the first 10 weeks of life to peak at approximately 90%, mostly of PCV13 serotypes. Although in the crude analysis S. aureus carriage was inversely associated with carriage of any S. pneumoniae and PCV13 serotypes, after adjusting by age and season, there was a positive association with any carriage (odds ratio 1.32; 95% confidence interval 1.07-1.64; p 0.009) and no association with carriage of PCV13 serotypes (odds ratio 0.99; 95% confidence interval 0.70-1.41; p 0.973). Among Gambian infants, S. aureus and S. pneumoniae are not inversely associated in nasopharyngeal carriage after adjustment for age. Further carriage studies following the introduction of PCV are needed to better understand the relationship between the two bacteria.

High prevalence of Pneumocystis jirovecii pneumonia among Mozambican children <5 years of age admitted to hospital with clinical severe pneumonia

We aimed to describe Pneumocystis jirovecii pneumonia (PCP) prevalence and features in children from sub-Saharan Africa and to investigate PCP-associated risk factors. During 2006-2007 we used molecular methods to test children younger than 5 years old admitted with severe pneumonia to a hospital in southern Mozambique for Pneumocystis infection. We recruited 834 children. PCP prevalence was 6.8% and HIV prevalence was 25.7%. The in-hospital and delayed mortality were significantly higher among children with PCP (20.8% vs. 10.2%, p 0.021, and 11.5% vs. 3.6%, p 0.044, respectively). Clinical features were mostly overlapping between the two groups. Independent risk factors for PCP were age less than a year (odds ratio (OR) 6.34, 95% confidence interval (CI) 1.86-21.65), HIV infection (OR 2.99, 95% CI 1.16-7.70), grunting (OR 2.64, 95% CI 1.04-6.73) and digital clubbing (OR 10.75, 95% CI 1.21-95.56). PCP is a common and life-threatening cause of severe pneumonia in Mozambican children. Mother-to-child HIV transmission prevention should be strengthened. Better diagnostic tools are needed.

Within-day variation and effect of acute stress on plasma and milk cortisol in lactating goats

An experiment was carried out to study the effect of acute stress on cortisol concentration in goat milk (milk cortisol; MC) and its suitability for stress assessment. Additional variables studied were plasma cortisol (PC), blood glucose (BG), and somatic cell count (SCC). Ten goats free of mastitis at 2 mo of lactation were divided into 2 groups. One group of animals was exposed to acute stress (visual and auditory, but not physical, contact with a barking dog for 3 min) immediately before the 1000 h sampling (STR), and the other group was considered as the control group, not exposed to acute stress (CON). The animals were gradually accustomed to the sampling schedule for 1 wk before the stress treatment (pre-experimental period). The variables PC, MC, BG, SCC, and milk composition (fat, lactose, whey protein, true protein, and casein) were recorded at 0600, 1000, 1130, 1400, 1800, 2200, and 0200 h. Milk variables were recorded in both glands separately. The right gland (n=10) was completely milked and the left gland (n=10) was milked to 30 mL at every sampling except at 1000 h, when complete milking was carried out on both glands. Variables were analyzed by using a linear mixed model. Both PC and MC concentrations varied throughout the day, with values being highest in the morning. Higher PC levels were recorded in the STR group immediately after treatment compared with CON (36.9 vs 16.3 ng/mL). For MC, differences between treatments were noted 1.5h after STR treatment (1.27 vs 0.25 ng/mL). Blood glucose increased immediately after treatment in STR animals, being different from CON until 1.5h after treatment sampling (101 vs. 58 mg/dL). The SCC was not increased by STR treatment, showing higher values in the morning and afternoon compared with evening and night (5.6±0.13 to 5.87±0.13 log10 SCC). The STR treatment had no significant effect on milk composition, and overall milk yield of a complete day after stress stimulus of both groups was similar (STR: 2,067±280 g/d; CON: 2,134±427 g/d). We conclude that plasma and milk cortisol concentrations in control dairy goats varied throughout the day; MC showed significant differences in the STR group if samples were taken 1.5h after the stressing stimulus, whereas PC showed significant differences in samples taken immediately after the stressing stimulus. Additionally, MC sampling has the advantage of being noninvasive compared with blood sampling.

Short communication: effects of milk removal on teat tissue and recovery in Murciano-Granadina goats

The aim of this work was to study how machine milking (MM) carried out in appropriate conditions affects teat wall thickness and canal length and their return after milking to premilking conditions compared with other milk removal methods considered biological referents: kid suckling (KS), catheter removal (CATH), and hand milking (HM). Three Latin square experiments were designed, each divided into 2 periods. In the first period, the left glands of each animal were machine milked and the KS, CATH, and HM treatments were applied to the right glands in experiments 1, 2, and 3, respectively. Subsequently, in the second period, the removal methods were interchanged. Teat wall thickness, teat wall area, teat end wall area, and teat canal length were measured from the ultrasound images. Milk removal using the reference methods (KS, CATH, and HM) and by MM caused increases in teat wall thickness and teat canal length, which were greater with MM. The time needed for the teat walls and canal to return to their physiological conditions before milk removal was greater than 10h in the reference methods and following machine milking.

Unplanned pregnancy and discontinuation of SSRIs in pregnant women with previously treated affective disorder

OBJECTIVE

To identify the factors associated with discontinuation of selective serotonin reuptake inhibitors (SSRIs) in pregnant women and to determine the rates of SSRI reintroduction during pregnancy.

METHOD

A prospective study was conducted in the Perinatal Psychiatry Service of the Hospital Clínic in Barcelona. The total sample comprised 132 consecutive pregnant women with depressive or anxiety disorder (DSM-IV criteria), seen between January 2005 and December 2008 and who were receiving SSRIs at the time of conception. Clinical, psychometric and socio-demographic variables were collected at the first visit. All women were assessed during treatment with the Edinburgh Perinatal Depression Scale (EPDS) and the Spielberger State-Trait Anxiety Inventory (STAI). Dose and type of antidepressant were recorded at each visit during pregnancy.

RESULTS

Seventy women (53%) discontinued SSRI treatment upon confirmation of pregnancy. Socio-demographic, obstetric and psychiatric variables did not differ significantly between women who maintained and women who discontinued treatment. Only unplanned pregnancy was associated with a greater risk of discontinuation (OR=2.7, 95% CI=1.34-5.52). Women who discontinued treatment also had higher EPDS and STAI scores in the first visit and prenatal visit (34-36 weeks) (p<.05). Of the 70 women who discontinued treatment, 57.1% (N=40) reintroduced treatment, almost half of these in the first trimester of pregnancy.

CONCLUSIONS

Unplanned pregnancy was a risk factor for abrupt discontinuation of SSRIs upon confirmation of pregnancy in women with depressive or anxiety disorder. More than half the pregnant women who discontinued SSRIs reintroduced antidepressant therapy during pregnancy.

Interspecific introgression and changes in population structure in a flatfish species complex after the Prestige accident

Oil spills cause aggressive impacts on marine ecosystems affecting immense areas and the species inhabiting them. If wastes are not cleaned up properly, the remnants may affect local populations for a long time. This work focuses on the long-term impacts of the Prestige spillage that occurred off Galician coast (Spain) in November 2002. Model species were two sympatric flatfish, the megrims Lepidorhombus whiffiagonis and Lepidorhombus boscii. Samples obtained before and nine years after the Prestige accident from affected and unaffected areas were genotyped for six hypervariable nuclear markers and for the mitochondrial D-loop sequence. The results revealed a high proportion of post-F1 interspecific hybrids in the area affected, and also increased intraspecific population differentiation likely due to such localized introgression of foreign genes. These changes suggest the appearance of a hybrid zone following the accident and emphasize the need of paying special attention to potential evolutionary impacts of oil spills.

Effect of age and vaccination with a pneumococcal conjugate vaccine on the density of pneumococcal nasopharyngeal carriage

This study evaluated the impact of age and pneumococcal vaccination on the density of pneumococcal nasopharyngeal carriage. Among colonized individuals, density decreased with increasing age. Time-trends analysis revealed that pneumococcal vaccination appeared to lower the density of nasopharyngeal carriage.

Background. This study evaluated the impact of age and pneumococcal vaccination on the density of pneumococcal nasopharyngeal carriage.

Methods. A cluster-randomized trial was conducted in rural Gambia. In 11 villages (the vaccine group), all residents received 7-valent pneumococcal conjugate vaccine (PCV-7), while in another 10 villages (the control group), only children <30 months old or born during the study period received PCV-7. Cross-sectional surveys (CSSs) were conducted to collect nasopharyngeal swabs before vaccination (baseline CSS) and 4, 12, and 22 months after vaccination. Pneumococcal density was defined using a semiquantitative classification (range, 1–4) among colonized individuals. An age-trend analysis of density was conducted using data from the baseline CSS. Mean pneumococcal density was compared in CSSs conducted before and after vaccination.

Results. Mean bacterial density among colonized individuals in the baseline CSS was 2.57 for vaccine-type (VT) and non–vaccine-type (NVT) pneumococci; it decreased with age (P < .001 for VT and NVT). There was a decrease in the density of VT carriage following vaccination in individuals older than 5 years (from 2.44 to 1.88; P = .001) and in younger individuals (from 2.57 to 2.11; P = .070) in the vaccinated villages. Similar decreases in density were observed with NVT within vaccinated and control villages. No significant differences were found between vaccinated and control villages in the postvaccination comparisons for either VT or NVT.

Conclusions. A high density of carriage among young subjects might partly explain why children are more efficient than adults in pneumococcal transmission. PCV-7 vaccination lowered the density of VT and of NVT pneumococcal carriage in the before-after vaccination analysis.

Clinical Trials Registration. ISRCTN51695599.

Obstetrical and neonatal outcomes after prenatal exposure to selective serotonin reuptake inhibitors: the relevance of dose

OBJECTIVE

The purpose of this study was to evaluate the effects of prenatal exposure to selective serotonin reuptake inhibitors (SSRIs) on obstetrical and neonatal outcomes.

METHOD

A case-control study was conducted to compare perinatal outcomes among pregnant women with affective disorder (DSM-IV criteria) and who received SSRIs during pregnancy with those of women without an active psychiatric disorder during pregnancy who were non-exposed to antidepressants during pregnancy. Each case was matched to two controls for maternal age (± 2 years) and parity.

RESULTS

A total of 252 women were enrolled in the study, 84 exposed and 168 non-exposed. Demographic and clinical characteristics did not differ significantly between the groups. The rates of prelabor rupture of membranes, induction of labor and cesarean delivery were slightly higher but not statistically significant in the exposed group. The mean gestational age at birth was 38.8 (± 1.86) weeks for the exposed group and 39.4 (± 1.52) weeks for the non-exposed group (p=.005). Rates for preterm birth were higher in the exposed group (OR=3.44, 95% CI=1.30-9.11). After stratification for dose, it was found that exposure to a high-dose was associated with lower gestational age (p=.009) and higher rates of prematurity (OR=5.07, 95% CI=1.34-19.23). The differences remained significant after controlling for maternal status and the length of exposure.

CONCLUSION

Women treated with SSRIs during pregnancy, mainly at high-dose, had an increased risk of preterm birth compared to healthy women of similar age and parity who were not exposed to SSRI during pregnancy.

Serum biomarkers for the diagnosis of malaria, bacterial and viral infections in children living in malaria-endemic areas

This review assesses current knowledge on the use of serum biomarkers for the diagnosis of malaria, bacterial and viral infections in sick children living in malaria-endemic areas. Reducing pediatric morbidity and mortality remains an essential challenge in these areas, where malaria and bacterial infections are the leading cause of death. In such settings, diagnostic tools that aid to overcome this problem are scarce and diagnosis relies mainly on clinical observations that can lead to incorrect treatment prescriptions. Currently, only malaria RDTs (rapid diagnostic tests) fulfill the criteria for a wide implementation under the operational conditions of resource-limited settings. New, affordable, simple and rapid diagnostic tools for bacterial diagnosis are crucial to guarantee adequate management of antibiotics. Serum biomarkers such as C-reactive protein or procalcitonin, used in developed countries, could form the basis for these tools. Few studies have, however, assessed their validity in malaria-endemic areas and data remain inconclusive. Viral diagnosis is not of highest priority in places where no specific etiological treatment is available and the presence of a virus cannot exclude bacterial/malarial coinfections. Although future studies may elucidate the diagnostic role of certain biomarkers in malaria-endemic areas, understanding the operational and sociological conditions of these settings will remain essential for the successful implementation of current and new diagnostic tools.

Estimating the vaccine-preventable burden of hospitalized pneumonia among young Mozambican children

Polysaccharide-protein conjugate vaccines against Haemophilus influenzae type b (Hib) and Streptococcus pneumoniae have proven efficacy against radiologically confirmed pneumonia. Measurement of pneumonia incidence provides a platform to estimate of the vaccine-preventable burden. Over 24 months, we conducted surveillance for radiologically confirmed severe pneumonia episodes among children <2 years of age admitted to a rural hospital in Manhiça, southern Mozambique. Study children were tested for HIV during the second year of surveillance. Severe pneumonia accounted for 15% of 5132 hospital admissions and 32% of in-hospital mortality among children <2 years of age. Also, 43% of chest radiographs were interpreted as radiologically confirmed pneumonia. HIV-infection was associated with 81% of fatal pneumonia episodes among children tested for HIV. The minimum incidence rate of radiologically confirmed pneumonia requiring hospitalization was 19 episodes/1000 child-years. Incidence rates among HIV-infected children were 9.3-19.0-fold higher than HIV-uninfected. Introduction of Hib and pneumococcal conjugate vaccines would have a substantial impact on pneumonia hospitalizations among African children if vaccine effects are similar to those observed in clinical trials.

Genetic and structural analysis of MBL2 and MASP2 polymorphisms in south-eastern African children

The mannose-binding lectin (MBL) pathway of complement system is activated when carbohydrate-bound MBL forms complexes with different serine proteases (MASP-1, MASP-2 and MASP-3), among which MASP-2 has a predominant functional role. Polymorphisms impairing the quantity and/or the functional activity of proteins encoded by the MBL2 and MASP2 genes have been reported in all human populations showing different allelic frequency and distribution. This likely reflects the existence of environmental influences on MBL2 and MASP2 genetic evolution. Herewith, we conducted a study in a children population from Mozambique to analyse the genetic diversity of sequences corresponding to the promoter and collagen-like region (exon 1) of MBL2 and to the CUB-1 and epidermal growth factor domain (exon 3) of MASP2, which are critical regions for the formation of functional MBL/MASP-2 complexes. Our results show a high prevalence of MBL-intermediate/low genotypes (43.5%); the description of new alleles and a high level of sequence polymorphism at both MBL2 and MASP2, with no statistical evidence for positive or balancing selection. Furthermore, Biacore analyses performed to explore the functional relevance of the MASP2 variants found [T73M (2.9%), R84Q (12.7%) and P111L (25.4%)] were compared with those of two previously reported variants (R103C and D105G). None of the analysed MASP2 variants, with the exception of D105G, interfered with interactions with either MBL or ficolins (H and L).

[Prophylactic thyroidectomy in multiple endocrine neoplasia syndrome]

Multiple endocrine neoplasia (MEN) 2a consists on medullary thyroid carcinoma, pheochromocytoma and hyperparathyroidism. The identification of the RET proto-oncogene in 1993 has changed the prognosis of the disease. We have retrospectively studied the patients diagnosed of MEN 2a in our centre for the last 7 years in order to establish the most adequate age to undergo surgery. We present ten patients diagnosed with MEN 2a, whose ages ranged from 1.5 to 11 years old. Mean age at time of operation: 6,4 years An ultrasound study, calcitonin determinations and cathecholamines and urinary metanephrine levels were obtained before surgery. The surgical treatment is based on total total thyroidectomy, in selected cases lymph node resection in the central zone lf the neck. The most frequent RET mutation is the one affecting codon 634 (exon 10), which was found in children. Both of them had an alteration in codon 611 (exon11). No complications appeared after surgery and hospital discharge took place in the 2nd-4th day after surgery. Pathological findings were medullary thyroid microcarcinoma (MTMC) in 3 out of 10 patients, calcitonin preoperative tests were high in one of them. No tumoral cells were found in the lymph nodes. During the follow up period, 9 out of 10 from the operated patients, maintained normal calcitonin, CEA, PTH, calcium, cathecholamines and urinary metanephrine levels. Since there are 3 cases of MTC in patients between 3 and 6 years old, and diagnostic test data are not conclusive, we thoroughly recommend prophyilactic thyroidectomy at early ages, from 3 to 4 years old.

Surveillance of acute bacterial meningitis among children admitted to a district hospital in rural Mozambique

BACKGROUND

Acute bacterial meningitis (ABM) remains an important cause of mortality among African children. Epidemiologic data with regard to ABM infection are necessary for prioritizing public health interventions.

METHODS

We strengthened hospital-based surveillance of ABM among children admitted to Manhiça District Hospital (Maputo, Mozambique). Cerebrospinal fluid (CSF) samples were collected from children admitted to the hospital who met clinical criteria of ABM. Laboratory determinations were performed. Clinical information and outcome of cases were recorded.

RESULTS

During the first 12 months of surveillance, which began in January 2006, CSF samples were collected from 642 children <15 years of age with suspected meningitis (18% of all pediatric patients admitted to the hospital during that time). ABM was confirmed in 43 (7%) of the 642 cases. Haemophilus influenzae type b (Hib) (14 cases), pneumococcus (9 cases), and meningococcus (7 cases) represented approximately 70% of confirmed cases. Four of the 9 pneumococci were serotypes covered by the 7-valent pneumococcal conjugate vaccine. The case fatality rate among patients with ABM was 24% (8 of 33 with known outcome); an additional 8 patients left the hospital before discharge. The incidence of ABM was 85 per 100,000 population, which peaked at 2-12 months of age at 1078 cases per 100,000 population. All 9 pneumococci isolates were susceptible to chloramphenicol, and 8 were susceptible to penicillin (the additional 1 had intermediate resistance). For the 10 Hib isolates tested, only 1 was susceptible to chloramphenicol, and 5 were susceptible to ampicillin.

CONCLUSION

These data reinforce the importance of ABM as a cause of hospital admission and death in rural sub-Saharan Africa. Most observed ABM cases could have been prevented by current pneumococcal and Hib conjugate vaccines.

Acute bacterial meningitis among children, in Manhiça, a rural area in Southern Mozambique

INTRODUCTION

Acute bacterial meningitis (ABM) is one of the most severe diseases in Sub-Saharan Africa. Although data for the continent is very limited, more than one million cases are estimated per year, with mortality and life-long sequelae occurring in 50% of these cases.

METHODS

As part of the clinical management of children admitted to the Manhiça District Hospital, information on cases of ABM was recorded. We analysed data from June 1998 to November 2003.

RESULTS

During the study period, 475 cerebrospinal-fluid (CSF) samples were collected from 20,173 children <15 years of age admitted to hospital. Culture results confirmed 71 (15%) cases of ABM. The most prevalent bacterial aetiologies were Streptotoccus pneumoniae (pneumococcus, n=31), Haemophilus influenzae (n=13) and Neisseria meningitis (n=8). Other important bacteria were Streptococcus sp. (n=7), Salmonella sp. (n=4) and Staphylococcus aureus (n=3). Crude incidence rates of ABM and pneumococcal meningitis were 20/100,000 and 10/100,000 children-year-at-risk, respectively. Incidences were more than three times higher in the <1 year age group. Overall case fatality rate was 36%, and was highest for H. influenzae and pneumococcal meningitis (55% and 45%, respectively, p=0.044). Pneumococcal susceptibility was 81% for oxacillin and 93% for chloramphenicol. For H. influenzae isolates, susceptibility was 54% for ampicillin and 62% for chloramphenicol.

CONCLUSIONS

S. pneumoniae and H. influenzae are the main aetiologies responsible for the high burden of morbidity and mortality associated with ABM in rural Mozambique. These findings are important to evaluate treatment guidelines and potential impact of control measures.

Validating a MCNPX model of Mg(Ar) and TE(TE) ionisation chambers exposed to 60CO gamma rays

For an accurate determination of the absorbed doses in complex radiation fields (e.g. mixed neutron-gamma fields), a better interpretation of the response of ionisation chambers is required. This study investigates a model of the ionisation chambers using a different approach, analysing the collected charge per minute as a response of the detector instead of the dose. The MCNPX Monte Carlo code is used. In this paper, the model is validated using a well-known irradiation field only: a (60)Co source. The detailed MCNPX models of a Mg(Ar) and TE(TE) ionisation chamber is investigated comparing the measured charge per minute obtained free-in-air and in a water phantom with the simulated results. The difference between the calculations and the measurements for the TE(TE) chamber is within +/-2% whereas for the Mg(Ar) chamber is around +7%. The systematic discrepancy in the case of Mg(Ar) chamber is expected to be caused by an overestimation of the sensitive volume.

Set-up and calibration of a triple ionization chamber system for dosimetry in mixed neutron/photon fields

The aim of this study is to introduce a triple ionization chamber system to separate dose components of mixed neutron/photon fields. Fast and thermal neutron dose components have a different biological effectiveness than gamma dose components. If boron neutron capture is used to enhance the dose in certain areas of a patient, the precise knowledge of the thermal neutron flux is essential. A tissue equivalent and two magnesium ionization chambers have been prepared for use in a triple chamber system for this purpose. One of the magnesium chambers is coated with (10)B on the inside to enhance its response to thermal neutrons. All three chambers have been calibrated at a cobalt source, medical linear accelerators and several neutron sources. The chambers have been studied in Monte Carlo simulations and the results are compared with measurements.

Identification and physical mapping of induced translocation breakpoints involving chromosome 1R in rye

To obtain translocations involving specific chromosomes in rye, pollen of a line in which chromosome 1R has large C-bands on its two telomeres, but which lacks C-bands (or has very small ones) on the telomeres of the remaining chromosomes, was X-irradiated. All translocations involving the labelled chromosome (1R) could be easily recognized in C-banded mitotic metaphases. The non-labelled chromosome involved in each translocation was identified either from mitotic C-banding analysis or from the meiotic configurations observed in some specific progenies. A physical map including 40 translocation breakpoints has been developed by means of synaptonemal complex (SC) analysis of well-paired pachytene quadrivalents. The results agree with the hypothesis of chromosomes 2R to 7R having similar probabilities of participating in translocations with chromosome 1R. However, the locations of the breakpoints are not entirely random: an excess of translocation breakpoints located on the short arm of chromosome 1R was obtained, and the two acentric translocated segments of each translocation show a trend towards having similar sizes. The possible reasons for these two non-random situations are discussed.

Invasive pneumococcal disease in children<5 years of age in rural Mozambique

OBJECTIVES

To estimate the incidence and epidemiological characteristics of invasive pneumococcal disease (IPD) in children<5 years of age living in a rural area of southern Mozambique.

METHODS

As part of the clinical management of children admitted to Manhiça District Hospital, prospective surveillance for invasive bacterial disease was conducted from June 2001 to May 2003. The level of antibiotic resistance of the isolates was also analysed.

RESULTS

Pneumococcus was the most commonly isolated bacterium, accounting for 212 episodes. The estimated crude incidence rate of IPD in the study area among children<5 years of age was 416/100,000 per child-year at risk. The youngest age group (<3 months) had the highest incidence (779/100,000). Cases were detected during both rainy and dry seasons. The most common clinical diagnosis was pneumonia, made in 146/212 (69%) of the episodes of IPD. The overall case fatality rate was 10%, being highest among children with pneumococcal meningitis (5/9=56%). Pneumococcal isolates were highly susceptible to penicillin (86% susceptible and 14% with intermediate resistance) and chloramphenicol (98% susceptible). In contrast, up to 37% of the isolates tested were non-susceptible to cotrimoxazole.

CONCLUSIONS

Incidence rates of IPD and associated mortality shown in this study highlight the need for pneumococcal vaccines in rural Africa, which must be effective in infants and young children.

Community incidences of respiratory infections in an actively followed cohort of children <1 year of age in Manhiça, a rural area of southern Mozambique

OBJECTIVE

To estimate the community incidence-rates of respiratory infections among infants in Manhiça, southern Mozambique, and to determine risk factors associated with these infections.

METHODS

A cohort of children <1 year of age were visited at home every week until they turned one. During the visits, field workers recorded signs/symptoms of respiratory infections and tested the children for malaria parasites when they had fever.

RESULTS

Between 1 July 1998 and 30 June 1999, 1,044 children contributed with 23,726 weeks at risk. Children met the criteria for acute respiratory infection in 19.2% of the visits, for lower respiratory infection in 0.9% and for severe lower respiratory infection in 0.2%. The crude incidence rate measured for acute respiratory infections was 23.0, that for lower respiratory infection was 0.9 and that for severe lower respiratory infection was 0.2 per 100-person-week-at-risk. The risk of acute and lower respiratory infection was inversely related to age. Females were at significantly lower risk for all three conditions than males. A trend of increased risk of severe lower respiratory infection was noted among children born during the rainy season (adjusted rate ratio = 1.95, P = 0.122 in only 47 episodes). Malaria was strongly associated with an increased risk of all three respiratory infections [rate ratio of 2.35, 10.90 and 13.82 (P < 0.001) in the adjusted analysis, respectively]. Thirty-five children died during the follow-up period; 20% of them from lower respiratory infection. Conclusions Respiratory infections are a major cause of morbidity and mortality among infants in rural Mozambique. Our study provides a better understanding of the associated determinants.