Asymptomatic Bacteremia in Children Infected with Human Immunodeficiency Virus in Calabar, South-South, Nigeria

Background: Asymptomatic Human Immunodeficiency Virus (HIV) infected children are prone to serious bacterial infection as a result of poor immunity.Objective: This was to determine the common pathogenic organisms responsible for bacteremia among asymptomatic HIV infected children attending the outpatient clinics at the University of Calabar Teaching Hospital, Nigeria.Subjects and Methods: This prospective non randomized cross-sectional study was conducted over 6months from January 1st to 30th June 2014 among cohorts of HIV infected Anti-retroviral (ARV) naive and experienced children attending the clinic. Ethical approval was obtained from the ethical committee of the institution. Blood culture specimens were collected from all HIV infected patients who met the criteria for enrollment. All specimens with isolated bacteria organisms were treated with antibiotics according to the sensitivity pattern, in addition to administered Anti-retroviral drugs.Results: Out of the total of 109 patients recruited, 38(34.9%) had bacteremia. There were more males (57.9%), and most of them (63.2%) had Highly Active Anti-Retroviral Therapy (HAART) for more than 24weeks. Bacteremia was inversely proportional to the CD4 count. The commonest organism isolated was unclassified Coliforms (47.3%) followed by Staphyloccocus aureus (39.5%).Conclusions: HIV infected children are prone to bacteremia especially among those with low CD4 count. Coliform was the commonest organism isolated. We recommend that HIV infected children be routinely investigated for bacteremia

Identifying the research, advocacy, policy and implementation needs for the prevention and management of respiratory syncytial virus lower respiratory tract infection in low- and middle-income countries

Introduction: The high burden of respiratory syncytial virus (RSV) infection in young children disproportionately occurs in low- and middle-income countries (LMICs). The PROUD (Preventing RespiratOry syncytial virUs in unDerdeveloped countries) Taskforce of 24 RSV worldwide experts assessed key needs for RSV prevention in LMICs, including vaccine and newer preventive measures. Methods: A global, survey-based study was undertaken in 2021. An online questionnaire was developed following three meetings of the Taskforce panellists wherein factors related to RSV infection, its prevention and management were identified using iterative questioning. Each factor was scored, by non-panellists interested in RSV, on a scale of zero (very-low-relevance) to 100 (very-high-relevance) within two scenarios: (1) Current and (2) Future expectations for RSV management. Results: Ninety questionnaires were completed: 70 by respondents (71.4% physicians; 27.1% researchers/scientists) from 16 LMICs and 20 from nine high-income (HI) countries (90.0% physicians; 5.0% researchers/scientists), as a reference group. Within LMICs, RSV awareness was perceived to be low, and management was not prioritised. Of the 100 factors scored, those related to improved diagnosis particularly access to affordable point-of-care diagnostics, disease burden data generation, clinical and general education, prompt access to new interventions, and engagement with policymakers/payers were identified of paramount importance. There was a strong need for clinical education and local data generation in the lowest economies, whereas upper-middle income countries were more closely aligned with HI countries in terms of current RSV service provision. Conclusion: Seven key actions for improving RSV prevention and management in LMICs are proposed

Evaluation of pulmonary tuberculosis case detection improvement with the deployment of XpertMTB/Rif in the tuberculosis control program of cross River State, Nigeria

Objective/Background: Global indices show that Nigeria has the highest tuberculosis (TB)-related mortality rate. Overdependence on Ziehl–Neelsen (ZN) smear microscopy for diagnosis and human immunodeficiency virus (HIV)/AIDS has limited control efforts. The new polymerase chain reaction-based XpertMTB/Rif (Cepheid Inc., CA, USA), which detects Mycobacterium tuberculosis and rifampicin resistance, was introduced in Cross River State in 2014. We evaluated the increment in pulmonary TB case detection following introduction of XpertMTB/Rif into the Cross River State TB control program. Materials and Methods: Data from three XpertMTB/Rif centers in Cross River were prospectively collected from June 2014 to December 2015. One spot specimen and one early morning sputum specimen were collected from each patient and tested using microscopy while one specimen was used for XpertMTB/Rif. Results: A total of 2326 patients comprising 47.4.0% (1103) males and 52.6% (1223) females were evaluated. Their mean age was 38.8 years (range 4–89 years); 42.6% (991) were HIV positive and 50.9% (1183) HIV negative, and for 6.5% (158) HIV status was unknown. XpertMTB/Rif detected M. tuberculosis in 22.9% (534) of patients, while 16.8% (391) were ZN smear positive. Smear microscopy missed 24.5% (131/534) of cases (P < 0.0001). When patients where categorized according to HIV status, XpertMTB/Rif detected 23.7% (280/1183) and ZN smear microscopy detected 18.5% (219/1183) of HIV-negative patients. XpertMTB/Rif detected 21.5% (213/991) and ZN smear 14.1% (140/991) of HIV-positive patients. TB case detection was significantly higher in HIV-negative patients than in HIV-positive patients when either XpertMTB/Rif and/or ZN was used (P = 0.018 and 0.012, respectively). Conclusion: The use of XpertMTB/Rif has significantly increased TB case detection and data in Cross River State. Scale-up of additional strategies such as culture is still required to improve TB detection in HIV patients