Showing papers by "Tacilta Nhampossa published in 2009"

Severe malaria and concomitant bacteraemia in children admitted to a rural Mozambican hospital.

Abstract: OBJECTIVES To describe the prevalence, aetiology and prognostic implications of coexisting invasive bacterial disease in children admitted with severe malaria in a rural Mozambican Hospital. METHODS Retrospective study of data systematically collected from June 2003 to May 2007 in a rural Mozambican hospital, from all children younger than 5 years admitted with severe malaria. RESULTS Seven thousand and forty-three children were admitted with a diagnosis of malaria. 25.2% fulfilled the criteria for severe malaria. 5.4% of the children with severe malaria and valid blood culture results had a concomitant bacteraemia. Case fatality rates of severe malaria cases rose steeply when bacteraemia was also present (from 4.0% to 22.0%, P < 0.0001), and bacteraemia was an independent risk factor for death among severe malaria patients (adjusted OR 6.2, 95% CI 2.8-13.7, P = 0.0001). Streptococcus pneumoniae, Gram-negative bacteria, Staphilococcus aureus and non-typhoid Salmonella (NTS) were the most frequently isolated microorganisms among severe malaria cases. Their frequency and associated case fatality rates (CFR) varied according to age and to syndromic presentation. Streptococcus pneumoniae had a relatively low CFR, but was consistently associated with severe malaria syndromes, or anaemia severity groups. No clear-cut relationship between malarial anaemia and NTS bacteraemia was found. CONCLUSIONS The coexistence of malaria and invasive bacterial infections is a frequent and life-threatening condition in many endemic African settings. In Mozambique, S. pneumoniae is the leading pathogen in this interaction, possibly as a consequence of the high HIV prevalence in the area. Measures directed at reducing the burden of both those infections are urgently needed to reduce child mortality in Africa.

A 10 year study of the cause of death in children under 15 years in Manhiça, Mozambique

Abstract: Background Approximately 46 million of the estimated 60 million deaths that occur in the world each year take place in developing countries. Further, this mortality is highest in Sub-Saharan Africa, although causes of mortality in this region are not well documented. The objective of this study is to describe the most frequent causes of mortality in children under 15 years of age in the demographic surveillance area of the Manhica Health Research Centre, between 1997 and 2006, using the verbal autopsy tool.

Predictors of Immune Reconstitution Inflammatory Syndrome-Associated With Kaposi Sarcoma in Mozambique: A Prospective Study

Abstract: Background The impact and relevance of immune reconstitution inflammatory syndrome-associated with Kaposi sarcoma (IRIS-KS) has not been assessed in sub-Saharan African countries, where the bulk of HIV-1 and KS-associated herpesvirus (KSHV) coinfection occurs. Understanding the risk factors for developing IRIS-KS would aid in the identification and in the improvement of clinical management for high-risk patients. Methods Sixty-nine consecutive HIV-1 and KSHV coinfected Mozambican adults initiating cART were prospectively followed for development of IRIS-KS over 10 months as part of a larger prospective observational study. Plasma HIV RNA, CD4 counts, anti-KSHV lytic antibodies, and plasma KSHV DNA viral load were assessed at the pre-cART visit and at 4 and 10 months after cART initiation. A survival analysis was performed to assess potential risk factors for developing IRIS-KS. Results During the first 10 months of combined antiretroviral therapy (cART), 8 patients (8/69, 11.6%) experienced IRIS-KS at a median time of 13.8 weeks after cART initiation. Multivariate analysis identified 4 independent IRIS-KS predictors: clinical pretreatment KS [hazard ratio (HR) 91.7], detectable plasma KSHV DNA (HR 24.4), hematocrit Conclusions This study identified 4 independent predictors of IRIS-KS, which may help to develop screening tools aiding in the identification of patients at high risk of IRIS-KS for whom close clinical supervision is warranted.

Invasive non-typhoidal Salmonella in Mozambican children.

Abstract: Summary Objective To describe the epidemiology and clinical presentation of invasive non-typhoidal Salmonella (NTS) in Mozambique. Methodology We analysed the epidemiology, clinical presentation and serotype distribution of invasive NTS among Mozambican children admitted to the Manhica District Hospital between May 2001 and April 2006. Results A total of 401 NTS cases were analysed; the median age was 16 months [interquartile range (IQR): 10–24]. Fever, cough and increased respiratory rate were the most common symptoms reported, while diarrhoea was present in only 29%. In the univariate analysis, invasive NTS was associated with age, fever, diarrhoea, increased respiratory rate, splenomegaly, hepatomegaly, severe malnutrition, and severe anaemia. Young age, severe malnutrition, diarrhoea and pneumonia were independent risk factors of death. S. typhimurium (66%), and S. enteritidis (25%) were the most frequent serotypes, with incidence rates of 240.4 and 108.6 per 100 000 child years among infants for S. typhimurium and S. enteritidis, respectively; and no significant differences were found regarding their clinical presentation. Resistance to ampicillin, chloramphenicol and trimethoprim-sulfamethoxazole was high for both S. typhimurium and S. enteritidis. Conclusions Clinical presentation of invasive NTS was non-specific and similar to that of other infections, with some factors being associated with NTS. Antibiotic resistance was very common to currently recommended and available antibiotics for suspected sepsis. Salmonella invasif non typhoidique chez les enfants Mozambicains Objectif: Decrire l’epidemiologie et la presentation clinique de Salmonella invasive non typhoidique (NTS) au Mozambique. Methodologie: Nous avons analyse l’epidemiologie, la presentation clinique et la distribution des serotypes du NTS invasif chez les enfants mozambicains admis a l’hopital de district de Manhica entre mai 2001 et avril 2006. Resultats: 401 cas de NTS ont ete analyses, l’âge median etait de 16 mois [gamme interquartile (IQR): 10 - 24]. Fievre, toux et une augmentation du rythme respiratoire etaient les symptomes les plus couramment signales, tandis que la diarrhee etait presente chez seulement 29%. Dans l’analyse univariee, le NTS invasif a ete associee avec l’âge, la fievre, la diarrhee, une augmentation du rythme respiratoire, une splenomegalie, une hepatomegalie, une malnutrition severe et une anemie severe. Le jeune âge, la malnutrition severe, la diarrhee et la pneumonie etaient des facteurs de risque independants de deces. S. typhimurium (66%), et S. enteritidis (25%) etaient les serotypes les plus frequents, avec des taux d’incidence de 240,4 et 108,6 par 100.000 enfants annee chez les nourrissons pour S. typhimurium et S. enteritidis, respectivement et aucune difference significative n’a ete trouvee selon leur presentation clinique. La resistance a l’ampicilline, au chloramphenicol et au trimethoprime-sulfamethoxazole etait elevee a la fois pour S. typhimurium et S. enteritidis. Conclusions: La presentation clinique du NTS invasif etait non specifique et similaire a celle d’autres infections, certains facteurs etant associes au NTS. La resistance aux antibiotiques etait tres frequente pour les antibiotiques actuellement recommandes et disponibles pour les suspects de sepsi. Salmonella no typhi invasiva en ninos de Mozambique Objetivo: Describir la epidemiologia y la presentacion clinica de Salmonella no typhi (SNT) invasiva en Mozambique. Metodologia: Hemos analizado la epidemiologia, la presentacion clinica y la distribucion de serotipos de SNT invasiva en ninos Mozambiquenos admitidos al Hospital Distrital de Manhica entre Mayo 2001 y Abril 2006. Resultados: Se analizaron 401 casos de SNT; la edad media era de 16 meses [rango intercuartil (IQR): 10 – 24]. La fiebre, la tos y una tasa respiratoria aumentada fueron los sintomas mas comunmente reportados, mientras que la diarrea estaba presente en solo un 29%. En el analisis univariado, la SNT invasiva estaba asociada con la edad, fiebre, diarrea, tasa respiratoria aumentada, esplenomegalia, hepatomegalia, desnutricion severa y anemia severa. Una edad temprana, desnutricion severa, diarrea y neumonia eran factores de riesgo independientes de muerte. Los serotipos mas frecuentes eran S. typhimurium (66%), y S. enteritidis (25%), con tasas de incidencia entre bebes de 240.4 y 108.6 por 100,000 ninos ano, para S. typhimurium y S. enteritidis, respectivamente. No se encontraron diferencias significativas con respecto a su presentacion clinica. La resistencia a ampicilina, cloranfenicol y trimetoprima-sulfametoxazol era alta tanto para S. typhimurium como para S. enteritidis. Conclusiones: La presentacion clinica de SNT invasiva era no especifica y similar a la de otras infecciones, con algunos factores asociados a SNT. La resistencia a antibioticos era muy comun frente a los antibioticos recetados ante la sospecha de sepsis y actualmente disponibles.