85 research outputs found
Molecular Characterization of Community Acquired Staphylococcus aureus Bacteremia in Young Children in Southern Mozambique, 2001–2009
Background: The emergence of community-acquired Staphylococcus aureus infections is increasingly recognized as life threating problem worldwide. In Manhiça district, southern Mozambique, S. aureus is the leading cause of community-acquired bacteremia in neonates.Methods: Eighty-four S. aureus isolates from children less than 5 years admitted to Manhiça District Hospital from 2001 to 2009 were randomly selected and genetically characterized by DNA microarray and spa typing. Antimicrobial susceptibility was determined by VITEK 2.Results: Thirty-eight different spa types and 14 clonal complexes (CC) were identified. Spa-type t084 (n = 10; 12%) was the most predominant while CC8 (n = 18; 21%) and CC15 (n = 14; 16%) were the most frequent CCs. Mortality tended to be higher among children infected with CC45 (33.3%, 1/3) and CC8 (27.8%, 5/18). The majority of isolates possessed the accessory gene regulator I (45%) and belonged to either capsule type 8 (52%) or 5 (47%). Panton valentine leukocidin (PVL) encoding genes were detected in 30%. Antibiotic resistance was high for penicillin (89%), tetracycline (59%) and Trimethoprim Sulfamethoxazole (36%) while MRSA was uncommon (8%).Conclusions: Although MRSA were uncommon, we found high genetic diversity of methicillin susceptible S. aureus causing bacteremia in Mozambican children, associated with high resistance to the most available antibiotics in this community. Some CCs are likely to be more lethal indicating the need for prompt recognition and appropriate treatment
Low frequency of enterohemorrhagic, enteroinvasive and diffusely adherent Escherichia coli in children under 5 years in rural Mozambique: a case-control study
BACKGROUND NlmCategory: BACKGROUND content:
Diarrheagenic Escherichia coli (DEC) are among the leading
pathogens associated with endemic diarrhea in low income
countries. Yet, few epidemiological studies have focused the
contribution of enterohemorrhagic E. coli (EHEC), enteroinvasive
E. coli (EIEC) and diffusely adherent E. coli (DAEC). - Label:
METHODS NlmCategory: METHODS content: "We assessed the
contribution of EHEC, EIEC and DAEC isolated from stool samples
from a case-control study conducted in children aged
<\xE2\x80\x895\xE2\x80\x89years in Southern Mozambique
between December 2007 and November 2012. The isolates were
screened by conventional PCR targeting stx1 and stx2 (EHEC), ial
and ipaH (EIEC), and daaE (DAEC) genes." - Label: RESULTS
NlmCategory: RESULTS content: "We analyzed 297 samples from
cases with less-severe diarrhea (LSD) matched to 297 controls,
and 89 samples from cases with moderate-to-severe diarrhea (MSD)
matched to 222 controls, collected between November 3, 2011 and
November 2, 2012. DEC were more common among LSD cases (2.7%,
[8/297] of cases vs. 1.3% [4/297] of controls;
p\xC2\xA0=\xE2\x80\x890.243]) than in MSD cases (0%, [0/89] of
cases vs. 0.4%, [1/222]\xC2\xA0of controls;
p\xC2\xA0=\xE2\x80\x891.000). Detailed analysis revealed low
frequency of EHEC, DAEC or EIEC and no association with diarrhea
in all age strata. Although the low frequency, EIEC was
predominant in LSD cases aged 24-59\xE2\x80\x89months (4.1% for
cases vs. 0% for controls), followed by DAEC in similar
frequency for cases and controls in infants (1.9%) and lastly
EHEC from one control. Analysis of a subset of samples from
previous period (December 10, 2007 and October 31, 2011) showed
high frequency of DEC in controls compared to MSD cases (16.2%,
[25/154] vs. 11.9%, [14/118], p\xC2\xA0=\xE2\x80\x890.383,
respectively). Among these, DAEC predominated, being detected in
7.7% of cases vs. 17.6% of controls aged
24-59\xE2\x80\x89months, followed by EIEC in 7.7% of cases vs.
5.9% of controls for the same age category, although no
association was observed. EHEC was detected in one sample from
cases and two from controls." - Label: CONCLUSIONS NlmCategory:
CONCLUSIONS content: Our data suggests that although EHEC, DAEC
and EIEC are less frequent in endemic diarrhea in rural
Mozambique, attention should be given to their transmission
dynamics (e.g. the role on sporadic or epidemic diarrhea)
considering that the role of asymptomatic individuals as source
of dissemination remains unknown
Hypoxaemia in Mozambican children < 5 years of age admitted to hospital with clinical severe pneumonia: clinical features and performance of predictor models
OBJECTIVE: To determine the prevalence of hypoxaemia among
under-five children admitted to hospital with clinical severe
pneumonia, and to assess the performance to diagnose hypoxaemia
of models based on clinical signs. METHODS: We conducted a
hospital-based survey in a district hospital from Southern
Mozambique. RESULTS: A total of 825 children were recruited
after obtaining an informed consent. The prevalence of
hypoxaemia on admission was 27.9%, and 19.8% of these children
died (OR compared to non-hypoxaemic children 3.22, 95%CI 1.98 -
5.21, p<0.001). The model with larger area under the ROC
curve (AUC-ROC) to predict hypoxaemia included cyanosis or
thoracoabdominal breathing or respiratory rate >/= 70 breaths
per minute. None of the models performed well when tested in
different case scenarios of oxygen availability through
mathematical modelling, with over 50% of hypoxaemic children not
receiving oxygen even in favourable case scenarios. CONCLUSIONS:
Clinical signs alone or in combination are not suitable to
diagnose hypoxaemia. The use of pulse oximeters should be
strongly encouraged. This article is protected by copyright. All
rights reserved
Antibiotic resistance and molecular characterization of Shigella isolates recovered from children less than 5 years in Manhiça, Southern Mozambique
The objective of this study was to assess antibiotic resistance and the molecular epidemiology of shigella isolates from a case-control study of diarrhoea, conducted from 2007 to 2012 in children aged less than 5 years in Manhiça district, southern Mozambique. All isolates were tested for antimicrobial susceptibility using the disc diffusion method. Polymerase chain reaction was used to detect different molecular mechanisms of antibiotic resistance. Serotyping was performed using specific antisera. The clonal relationship of Shigella flexneri and Shigella sonnei was assessed by pulsed-field gel electrophoresis (PFGE). Of the 67 shigella isolates analysed, 59 were diarrhoeal cases and eight were controls. S. flexneri (70.1%; 47/67) was the most common species, followed by S. sonnei (23.9%; 16/67). The most prevalent S. flexneri serotypes were 2a (38.3%; 18/47), 6 (19.2%; 9/47) and 1b (14.9%; 7/47). High rates of antimicrobial resistance were observed for trimethoprim-sulfametoxazole (92.5%; 62/67), tetracycline (68.7%; 46/67), chloramphenicol (53.7%; 36/67) and ampicillin (50.7%; 34/67). Multi-drug resistance (MDR) was present in 55.2% (37/67) of the isolates and was associated with a case fatality rate of 8.1% (3/37). PFGE revealed 22 clones (16 S. flexneri and 6 S. sonnei), among which P1 (31.9%; 15/47), P9 (17%; 8/47) and P2 (10.6%; 5/47) were the most prevalent clones of S. flexneri. In conclusion, S. flexneri was the most prevalent species, with MDR isolates mainly belonging to three specific clones (P1, P9 and P2). The case fatality rate observed among MDR isolates is a matter of concern, indicating the need for appropriate treatment
Hypoglycemia and Risk Factors for Death in 13 Years of Pediatric Admissions in Mozambique
Hypoglycemia is a life-threatening complication of several
diseases in childhood. We describe the prevalence and incidence
of hypoglycemia among admitted Mozambican children, establishing
its associated risk factors. We retrospectively reviewed
clinical data of 13 years collected through an ongoing
systematic morbidity surveillance in Manhica District Hospital
in rural Mozambique. Logistic regression was used to identify
risk factors for hypoglycemia and death. Minimum community-based
incidence rates (MCBIRs) for hypoglycemia were calculated using
data from the demographic surveillance system. Of 49,089
children < 15 years hospitalized in Manhica District
Hospital, 45,573 (92.8%) had a glycemia assessment on admission.
A total of 1,478 children (3.2%) presented hypoglycemia (< 3
mmol/L), of which about two-thirds (972) were with levels <
2.5 mmol/L. Independent risk factors for hypoglycemia on
admission and death among hypoglycemic children included
prostration, unconsciousness, edema, malnutrition, and
bacteremia. Hypoglycemic children were significantly more likely
to die (odds ratio [OR] = 7.11; P < 0.001), with an
associated case fatality rate (CFR) of 19.3% (245/1,267).
Overall MCBIR of hypoglycemia was 1.57 episodes/1,000 child
years at risk (CYAR), significantly decreasing throughout the
study period. Newborns showed the highest incidences (9.47
episodes/1,000 CYAR, P < 0.001). Hypoglycemia remains a
hazardous condition for African children. Symptoms and signs
associated to hypoglycemia should trigger the verification of
glycemia and the implementation of life-saving corrective
measures
Diarrhoeal disease and subsequent risk of death in infants and children residing in low-income and middle-income countries: Analysis of the gems case-control study and 12-month gems-1a follow-on study
Background: The Global Enteric Multicenter Study (GEMS) was a 3-year case-control study that measured the burden, aetiology, and consequences of moderate-to-severe diarrhoea (MSD) in children aged 0-59 months. GEMS-1A, a 12-month follow-on study, comprised two parallel case-control studies, one assessing MSD and the other less-severe diarrhoea (LSD). In this report, we analyse the risk of death with each diarrhoea type and the specific pathogens associated with fatal outcomes.Methods: GEMS was a prospective, age-stratified, matched case-control study done at seven sites in Africa and Asia. Children aged 0-59 months with MSD seeking care at sentinel health centres were recruited along with one to three randomly selected matched community control children without diarrhoea. In the 12-month GEMS-1A follow-on study, children with LSD and matched controls, in addition to children with MSD and matched controls, were recruited at six of the seven sites; only cases of MSD and controls were enrolled at the seventh site. We compared risk of death during the period between enrolment and one follow-up household visit done about 60 days later (range 50-90 days) in children with MSD and LSD and in their respective controls. Approximately 50 pathogens were detected using, as appropriate, classic bacteriology, immunoassays, gel-based PCR and reverse transcriptase PCR, and quantitative real-time PCR (qPCR). Specimens from a subset of GEMS cases and controls were also tested by a TaqMan Array Card that compartmentalised probe-based qPCR for 32 enteropathogens.Findings: 223 (2·0%) of 11 108 children with MSD and 43 (0·3%) of 16 369 matched controls died between study enrolment and the follow-up visit at about 60 days (hazard ratio [HR] 8·16, 95% CI 5·69-11·68, p\u3c0·0001). 12 (0·4%) of 2962 children with LSD and seven (0·2%) of 4074 matched controls died during the follow-up period (HR 2·78, 95% CI 0·95-8·11, p=0·061). Risk of death was lower in children with dysenteric MSD than in children with non-dysenteric MSD (HR 0·20, 95% CI 0·05-0·87, p=0·032), and lower in children with LSD than in those with non-dysenteric MSD (HR 0·29, 0·14-0·59, p=0·0006). In children younger than 24 months with MSD, infection with typical enteropathogenic Escherichia coli, enterotoxigenic E coli encoding heat-stable toxin, enteroaggregative E coli, Shigella spp (non-dysentery cases), Aeromonas spp, Cryptosporidium spp, and Entamoeba histolytica increased risk of death. Of 61 deaths in children aged 12-59 months with non-dysenteric MSD, 31 occurred among 942 children qPCR-positive for Shigella spp and 30 deaths occurred in 1384 qPCR-negative children (HR 2·2, 95% CI 1·2-3·9, p=0·0090), showing that Shigella was strongly associated with increased risk of death.Interpretation: Risk of death is increased following MSD and, to a lesser extent, LSD. Considering there are approximately three times more cases of LSD than MSD in the population, more deaths are expected among children with LSD than in those with MSD. Because the major attributable LSD-associated and MSD-associated pathogens are the same, implementing vaccines and rapid diagnosis and treatment interventions against these major pathogens are rational investments.Funding: Bill & Melinda Gates Foundation
Detection of Streptococcus pneumoniae and Haemophilus influenzae type B by real-time PCR from dried blood spot samples among children with pneumonia: a useful approach for developing countries
Correction https://doi.org/10.1371/journal.pone.0147678Background: Dried blood spot (DBS) is a reliable blood collection method for storing samples at room temperature and easily transporting them. We have previously validated a Real-Time PCR for detection of Streptococcus pneumoniae in DBS. The objective of this study was to apply this methodology for the diagnosis of S. pneumoniae and Haemophilus influenzae b (Hib) in DBS samples of children with pneumonia admitted to two hospitals in Mozambique and Morocco. Methods: Ply and wzg genes of S. pneumoniae and bexA gene of Hib, were used as targets of Real-Time PCR. 329 DBS samples of children hospitalized with clinical diagnosis of pneumonia were tested. Results: Real-Time PCR in DBS allowed for a significant increase in microbiological diagnosis of S. pneumoniae and Hib. When performing blood bacterial culture, only ten isolates of S. pneumoniae and none of Hib were detected (3·0% positivity rate, IC95% 1·4-5·5%). Real-Time PCR from DBS samples increased the detection yield by 4x fold, as 30 S. pneumoniae and 11 Hib cases were detected (12·4% positivity rate, IC95% 9·0-16·5%; P<0·001). Conclusion: Real-Time PCR applied in DBS may be a valuable tool for improving diagnosis and surveillance of pneumonia caused by S. pneumoniae or Hib in developing countries
Risk factors for death among children 0–59 months of age with moderate-to-severe diarrhea in Manhiça district, southern Mozambique
Background: Despite major improvements in child survival rates, the number of deaths due to diarrhea remains
unacceptably high. We aimed to describe diarrhea-associated mortality and evaluate risk factors for death among
Mozambican children with moderate-to-severe diarrhea (MSD).
Methods: Between December 2007 and November 2012, children under-five with MSD were enrolled in Manhiça
district, as part of the Global Enteric Multicenter study (GEMS). Clinical, epidemiological, and socio-demographic
characteristics were collected. Anthropometric measurements were performed and stool samples collected upon
recruitment. A follow-up visit ~ 60 days post-enrolment was conducted and verbal autopsies performed in all death
cases.
Results: Of the 916 MSD-cases analyzed; 90% (821/916) completed 60 days follow-up and 69 patients died. The
case fatality rate at follow-up was 8% (69/821), and the mortality rate 10.2 (95%CI: 7.75–13.59) deaths per 1000
persons-week at risk. Nearly half of the deaths 48% (33/69) among study participants clustered within 2 weeks of
the onset of diarrhea.
Typical enteropathogenic Escherichia coli (typical EPEC) and Cryptosporidium were the two pathogens associated to
an increased risk of death in the univariate analysis with (HR = 4.16, p = 0.0461) and (H = 2.84, p = 0.0001)
respectively. Conversely, Rotavirus infection was associated to a decreased risk of death (HR = 0.52, p = 0.0198).
According to the multivariate analysis, risk factors for death included co-morbidities such as malnutrition (HR = 4.13,
p < 0.0001), pneumonia/lower respiratory infection (HR = 3.51, p < 0.0001) or invasive bacterial disease (IBD) (HR = 6.
80, p = 0.0009), presenting on arrival with lethargy or overt unconsciousness (HR = 1.73, p = 0.0302) or wrinkled skin
(HR = 1.71, p = 0.0393), and cryptosporidium infection (HR = 2.14, p = 0.0038).
When restricting the analysis to those with available HIV results (n = 191, 22% of the total study sample), HIV was
shown to be a significant risk factor for death (HR = 5.05, p = 0.0009).
Verbal autopsies were conducted in 100% of study deaths, and highlighted diarrhea as the main underlying cause
of death 39%, (27/69); followed by HIV/AIDS related deaths 29.0% (20/69) and sepsis 11.6% (8/69).Conclusion: Preventive strategies targeting Cryptosporidium, malnutrition and early identification and treatment of
associated co-morbidities could contribute to the prevention of the majority of diarrhea associated deaths in
Mozambican children
Under treatment of pneumonia among children under 5 years of age in a malaria-endemic area: population-based surveillance study conducted in Manhica district- rural, Mozambique
BACKGROUND: Integrated Management of Childhood Illness (IMCI)
guidelines were developed to decrease morbidity and mortality,
yet implementation varies across settings. Factors associated
with poor adherence are not well understood. METHODS: We used
data from Manhica District Hospital outpatient department and
five peripheral health centers to examine pneumonia management
for children <5 years old from January 2008 to June 2011.
Episodes of IMCI-defined pneumonia (cough or difficult breathing
plus tachypnea), severe pneumonia (pneumonia plus chest wall
in-drawing), and/or clinician-diagnosed pneumonia (based on
discharge diagnosis) were included. RESULTS: Among severe
pneumonia episodes, 96.2% (2,918/3,032) attended in the
outpatient department and 70.0% (291/416) attended in health
centers were appropriately referred to the emergency department.
Age<1 year, malnutrition and various physical exam findings
were associated with referral. For non-severe pneumonia
episodes, antibiotics were prescribed in 45.7% (16,094/35,224).
Factors associated with antibiotic prescription included age
<1 year, abnormal auscultatory findings, and clinical
diagnosis of pneumonia; diagnosis of malaria or gastroenteritis
and pallor were negatively associated with antibiotic
prescription. CONCLUSION: Adherence to recommended management of
severe pneumonia was high in a hospital outpatient department,
but suboptimal in health centers. Antibiotics were prescribed in
fewer than half of non-severe pneumonia episodes, and diagnosis
of malaria was the strongest risk factor for incorrect
management
Clinical features, risk factors, and impact of antibiotic treatment of diarrhea caused by Shigella in children less than 5 years in Manhiça District, rural Mozambique
Objectives: During the period from December 2007 to November 2012, the epidemiology of diarrhea caused by Shigella was studied among children <5 years of age residing in Manhiça District, Southern Mozambique.
Materials and methods: Children from 0 to 5 years with moderate-to-severe diarrhea (MSD) and less severe diarrhea (LSD) were enrolled along with matched controls (by age, gender, and neighborhood). Age-stratified logistic regression analyses were conducted to identify clinical features and risk factors associated with Shigella positivity in cases of diarrhea. The impact of antibiotic treatment was assessed for patients with known outcome.
Results: A total of 916 cases of MSD and 1979 matched controls, and 431 cases of LSD with equal number of controls were enrolled. Shigella was identified as significant pathogen in both cases of MSD and LSD compared to their respective controls. Shigella was detected in 3.9% (17/431) of LSD compared to 0.5% (2/431) in controls (P=0.001) and in 6.1% (56/916) of MSD cases compared to 0.2% (4/1979) in controls (P<0.0001), with an attributable fraction of 8.55% (95% CI: 7.86–9.24) among children aged 12–23 months. Clinical symptoms associated to Shigella among MSD cases included dysentery, fever, and rectal prolapse. Water availability, giving stored water to child, washing hands before preparing baby’s food, and mother as caretaker were the protective factors against acquiring diarrhea caused by Shigella. Antibiotic treatment on admission was associated with a positive children outcome.
Conclusion: Shigella remains a common pathogen associated with childhood diarrhea in Mozambique, with dysentery being a significant clinical feature of shigellosis. Adherence to the basic hygiene rules and the use of antibiotic treatment could contribute to the prevention of most of diarrhea due to Shigella
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