Prevalence of Group A beta-haemolytic Streptococcus isolated from children with acute pharyngotonsillitis in Aden, Yemen.

OBJECTIVES: To estimate the prevalence of Group A beta-haemolytic streptococcus (GAS) and non-GAS infections among children with acute pharyngotonsillitis in Aden, Yemen, to evaluate the value of a rapid diagnostic test and the McIsaac score for patient management in this setting and to determine the occurrence of emm genotypes among a subset of GAS isolated from children with acute pharyngotonsillitis and a history of acute rheumatic fever (ARF) or rheumatic heart disease (RHD). METHODS: Group A beta-haemolytic streptococcus infections in school-aged children with acute pharyngotonsillitis in Aden, Yemen, were diagnosed by a rapid GAS antigen detection test (RADT) and/or GAS culture from a throat swab. The RADT value and the McIsaac screening score for patient management were evaluated. The emm genotype of a subset of GAS isolates was determined. RESULTS: Group A beta-haemolytic streptococcus pharyngotonsillitis was diagnosed in 287/691 (41.5%; 95% CI 37.8-45.3) children. Group B, Group C and Group G beta-haemolytic streptococci were isolated from 4.3% children. The RADT had a sensitivity of 238/258 (92.2%) and specificity of 404/423 (95.5%) against GAS culture. A McIsaac score of ≥4 had a sensitivity of 93% and a specificity of 82% for confirmed GAS infection. The emm genotypes in 21 GAS isolates from children with pharyngitis and a history of ARF and confirmed RHD were emm87 (11), emm12 (6), emm28 (3) and emm5 (1). CONCLUSION: This study demonstrates a very high prevalence of GAS infections in Yemeni children and the value of the RADT and the McIsaac score in this setting. More extensive emm genotyping is necessary to understand the local epidemiology of circulating strains

Are children with tuberculosis in Pakistan managed according to National programme policy guidelines? A study from 3 districts in Punjab

<p>Abstract</p> <p>Background</p> <p>The adherence to policies of National TB Control Programme (NTP) to manage a case of tuberculosis (TB) is a fundamental step to have a successful programme in any country. Childhood TB services faces an unmet challenge of case management due to difficulty with diagnosis and relatively new policies. For control of childhood TB in Pakistan, NTP developed and piloted its guidelines in 2006-2007. The objective of this study was to compare the documented case management practices of pediatricians and its impact on the outcome before and after introducing NTP policy guidelines.</p> <p>Findings</p> <p>An audit of case management practices of a historical cohort study was done in children below 15 years who were put on anti-tuberculosis treatment at all nine public hospitals in three districts in province of Punjab. The study period was two years pre-intervention (2004-05) and two years post-intervention (2006-07) after implementation of new NTP policy guidelines for childhood TB. There were 920 childhood TB cases registered during four years, 189 in pre-intervention period and 731 in post-intervention period. The practices changed significantly in post-intervention period for use of tuberculin skin test (63% of pulmonary cases, 19% of extrapulmonary cases and 67% for site unknown), and for the use of chest x-ray (69% of pulmonary cases, 16% of extrapulmonary cases and 74% for site unknown). Diagnostic scores were recorded for only a minority of cases (18%). The proportion of correct drugs pre- and post-intervention remained same. There were unknown treatment outcomes in 38 out of 141 cases (27%) in pre-intervention and in 483 out of 551 cases (87%) post-intervention, all among the 692 cases without documented treatment supporter.</p> <p>Conclusions</p> <p>The study has shown that pediatricians have started following parts of the national policy guidelines for management of childhood TB. The documented use of diagnostic tools is increased but record keeping of case management practices remained inadequate. This seems to increase case finding substantially but the treatment outcomes were poor mainly due to unknown outcomes. Development and implementation of standardized operational tools and regular monitoring system may improve the services.</p

Pulmonary disease in HIV-infected African children

Childhood human immunodeficiency virus (HIV) infection is common in most regions of sub-Saharan Africa. Acute and chronic respiratory diseases are major causes of morbidity and mortality in HIV-infected children. They represent a significant added burden in a region where diagnostic capabilities are limited and management decisions are often made on the basis of clinical guidelines alone. Pneumocystis carinii pneumonia is now recognised as an important cause of acute severe pneumonia and death in HIV-infected infants. However, there are few data on incidence and aetiology for more treatable conditions such as bacterial pneumonia. The association of pulmonary tuberculosis and HIV infection is uncertain, and the diagnosis is further confused by the presence of lymphoid interstitial pneumonitis and other chronic HIV-related pulmonary disease. This article reviews the literature and highlights the urgent need for further research in order to improve clinical management and appropriate interventions

Use of protective gear and the occurrence of occupational Marburg hemorrhagic fever in health workers from Watsa health zone, Democratic Republic of the Congo.

BACKGROUND: Occupational transmission to health workers (HWs) has been a typical feature of Marburg hemorrhagic fever (MHF) outbreaks. The goal of this study was to identify cases of occupational MHF in HWs from Durba and Watsa, Democratic Republic of the Congo; to assess levels of exposure and protection; and to explore reasons for inconsistent use of protective gear. METHODS: A serosurvey of 48 HWs who cared for patients with MHF was performed. In addition, HWs were given a questionnaire on types of exposure, use of protective gear, and symptoms after contact. Informal and in-depth interviews with HWs were also performed. RESULTS: We found 1 HW who was seropositive for MHF, in addition to 5 cases of occupational MHF known beforehand; 4 infections had occurred after the introduction of infection control. HWs protected themselves better during invasive procedures (injections, venipuncture, and surgery) than during noninvasive procedures, but the overall level of protection in the hospital remained insufficient, particularly outside of isolation wards. The reasons for inconsistent use of protective gear included insufficient availability of the gear, adherence to traditional explanatory models of the origin of disease, and peer bonding with sick colleagues. CONCLUSIONS: Infection control must not focus too exclusively on the establishment of isolation wards but should aim at improving overall hospital hygiene. Training of HWs should allow them to voice and discuss their doubts and prepare them for the peculiarities of caring for ill colleagues

Qualidade parasitológica e condições higiênico-sanitárias de hortaliças comercializadas na cidade de Florianópolis, Santa Catarina, Brasil Parasitological quality and hygienic-sanitary conditions of vegetables sold in the city of Florianópolis, Santa Catarina, Brazil

Embora as hortaliças sejam amplamente comercializadas e consumidas no Brasil, o consumo de verduras cruas constitui importante meio de transmissão de parasitas intestinais. Neste estudo, avaliou-se a presença de formas transmissíveis de três tipos de hortaliças (rúcula, agrião e alface-crespa) comercializadas em cinco principais pontos de venda aos consumidores (dois supermercados, dois "sacolões" e em uma feira livre), na cidade de Florianópolis, Santa Catarina, Brasil, no período de junho 2003 a maio 2004. As hortaliças in natura foram lavadas com água e esta foi submetida ao método de sedimentação, durante um período de 24 horas. Concomitante à pesquisa laboratorial, foram avaliadas as condições de cultivo e manipulação de diferentes produtores agrícolas, os quais forneciam as hortaliças que eram posteriormente comercializadas em Florianópolis. A análise parasitológica mostrou alta freqüência de parasitas intestinais na maioria das amostras analisadas (40% a 76%). Entre os fatores envolvidos na contaminação das verduras, destacaram-se a origem das águas de irrigação, o acondicionamento, o transporte e a manipulação destas durante a coleta. Conclui-se que as hortaliças comercializadas nesta região têm relevante papel na transmissão de enfermidades intestinais, havendo necessidade de medidas específicas que evitem a contaminação desses vegetais.<br>Although vegetables are widely sold and consumed in Brazil, the ingestion of raw vegetables is an important way of transmission of intestinal parasites. In this study, the presence of transmissible forms of intestinal parasites in three vegetable species commercially available in five very busy locations (two supermarkets, two "kilo markets" and a street market) located in the city of Florianópolis, Santa Catarina, Brazil, within the period between June 2003 and May 2004 was evaluated. The in natura vegetables were washed with water and the washing water was submitted to the spontaneous sedimentation method for a period of 24 hours. Concomitantly to the laboratory research, the conditions of cultivation and manipulation of the producers of the vegetables sold in Florianópolis were evaluated. The parasitologic analysis confirmed the presence of intestinal parasites in most of the vegetables analyzed (40% to 76%). Among the factors involved in the contamination of vegetables, the origin of the water used for irrigation, storage and transportation of vegetables and the degree of manipulation during the sampling process can be included. From the results, it can be concluded that vegetables sold in the investigated region play an important role in the transmission of intestinal diseases, and, therefore, specific measures should to be taken in order to avoid the contamination of these vegetables