Determinants of tuberculosis in Lambaréné and barriers towards successful antituberculous treatment

BACKGROUND: The epidemiology of tuberculosis in the central African country Gabon is characterized by an alarmingly high incidence rate and low treatment success rate. The aim of the study was to assess local TB determinants including treatment outcomes and to better understand the barriers towards successful treatment. METHODS: In a prospective observational cohort study TB patients were clinically and microbiologically monitored during the course of their treatment in Lambaréné, Gabon. TB treatment outcome was evaluated and risk factors for unfavorable treatment outcome were identified. RESULTS: Between 2012 and 2014, 201 adult and pediatric TB patients were enrolled and followed up. The HIV co-infection rate was 42% in adults; 4/91 (4.4%) and 4/13 (30.8%) on new and previously treated TB patients had multidrug-resistant TB (MDR-TB), respectively. Risk factors for adverse treatment outcome were far distance to treatment center and clinical diagnosis of TB. DISCUSSION: In Lambaréné, TB epidemiology is determined by a high rate of TB/HIV co-infection and a high rate of MDR-TB among re-treatment patients, as well as a low treament success rate. Prerequisites for an effective TB control in Gabon are the implementation of DOTS, the access to diagnostic capacity for MDR-TB and second-line TB drugs as well as improved integration of TB/HIV care.HINTERGRUND: Das zentralafrikanische Gabun weißt eine beunruhigend hohe Inzendenzrate von Tuberkulosefällen sowie eine geringe Erfolgsquote in der Tuberkulosetherapie auf. Ziel der Studie war die prospektive Erfassung lokaler Determinanten der Tuberkulose und das Aufzeigen von Hindernissen einer erfolgreichen Tuberkulosetherapie. METHODEN: In einer prospektiven Beobachtungsstudie wurden Tuberkulose Patienten während ihrer Behandung in Lambaréné, Gabun klinisch und mikrobiologisch nachverfolgt. Therapieerfolgsraten wurden ausgewertet und Risikofaktoren für ausbleibenden Therapieerfolg identifiziert. ERGEBNISSE: Zwischen 2012 und 2014 wurden 201 erwachsene und pädiatrische Tuberkulosepatienten eingeschlossen und nachverfolgt. 42% der Erwachsenen waren HIV-koinfiziert, der Anteil an multiresistenter Tuberkulose (MDR-TB) betrug 4/91 (4,4%) und 4/13 (30,8%) der Erst- und Rezidiv-Fälle. Die MDR-TB Patienten ausgenommen betrug die Therapieerfolgsquote 55%. Risikofaktoren für ausbleibenden Behandlungserfolg waren große Distanz zum Behandlungszentrum und klinisch diagnostizierte Tuberkulose. SCHLUSSFOLGERUNGEN: Die Epidemiologie der Tuberkulose in Lambaréné wird durch einen hohen Anteil an HIV-Koinfektionen und einen hohen Anteil an MDR-TB unter Rezidiv-Patienten sowie eine niedrige Therapieerfolgsquote bestimmt. Voraussetzungen für die effektive Tuberkulosebekämpfung in Gabun sind die Umsetzung der DOTS-Strategie (Directly Observed Therapy, short course), sowie der Zugang zu Diagnostik von MDR-TB und Zweitrang-Medikamenten und eine verbesserte Vernetzung zwischen Tuberkulose –und HIV Therapie

Neurological manifestations of COVID-19 in adults and children

Different neurological manifestations of coronavirus disease 2019 (COVID-19) in adults and children and their impact have not been well characterized. We aimed to determine the prevalence of neurological manifestations and in-hospital complications among hospitalized COVID-19 patients and ascertain differences between adults and children. We conducted a prospective multicentre observational study using the International Severe Acute Respiratory and emerging Infection Consortium (ISARIC) cohort across 1507 sites worldwide from 30 January 2020 to 25 May 2021. Analyses of neurological manifestations and neurological complications considered unadjusted prevalence estimates for predefined patient subgroups, and adjusted estimates as a function of patient age and time of hospitalization using generalized linear models. Overall, 161 239 patients (158 267 adults; 2972 children) hospitalized with COVID-19 and assessed for neurological manifestations and complications were included. In adults and children, the most frequent neurological manifestations at admission were fatigue (adults: 37.4%; children: 20.4%), altered consciousness (20.9%; 6.8%), myalgia (16.9%; 7.6%), dysgeusia (7.4%; 1.9%), anosmia (6.0%; 2.2%) and seizure (1.1%; 5.2%). In adults, the most frequent in-hospital neurological complications were stroke (1.5%), seizure (1%) and CNS infection (0.2%). Each occurred more frequently in intensive care unit (ICU) than in non-ICU patients. In children, seizure was the only neurological complication to occur more frequently in ICU versus non-ICU (7.1% versus 2.3%, P < 0.001). Stroke prevalence increased with increasing age, while CNS infection and seizure steadily decreased with age. There was a dramatic decrease in stroke over time during the pandemic. Hypertension, chronic neurological disease and the use of extracorporeal membrane oxygenation were associated with increased risk of stroke. Altered consciousness was associated with CNS infection, seizure and stroke. All in-hospital neurological complications were associated with increased odds of death. The likelihood of death rose with increasing age, especially after 25 years of age. In conclusion, adults and children have different neurological manifestations and in-hospital complications associated with COVID-19. Stroke risk increased with increasing age, while CNS infection and seizure risk decreased with age

A case series of children and young people admitted to a tertiary care hospital in Germany with COVID-19

Background!#!While our knowledge about COVID-19 in adults has rapidly increased, data on the course of disease and outcome in children with different comorbidities is still limited.!##!Methods!#!Prospective, observational study at a tertiary care children's hospital in southern Germany. Clinical and virology data from all paediatric patients admitted with SARS-CoV-2 infection at our hospital were prospectively assessed.!##!Results!#!Between March and November 2020, 14 patients were admitted with COVID-19. One patient was admitted a second time with COVID-19 6 months after initial disease. Among seven patients with severe underlying comorbidities, three developed multisystem inflammatory syndrome (MIS-C), two were admitted to the paediatric intensive care unit. One patient needed invasive ventilation. Another patient died shortly after discharge of COVID-19-related complications.!##!Conclusions!#!While COVID-19 generally causes mild disease in children, severe respiratory illness and MIS-C occur, in some cases with fatal outcome. Children with underlying diseases might be at special risk for severe disease

Encephalitis Unraveled: The Unlikely Encounter of Sickle Cell Disease and Cerebral Malaria in a Teenager

Sickle-cell disease (SCD) is a group of inherited blood disorders in which a mutation in the β-globin (HBB) gene causes red blood cells to produce abnormal hemoglobin, known as Hb S. SCD is characterized by an autosomal-recessive pattern of inheritance, implying that for a child to manifest the condition, they must inherit an Hb S allele from both parents (HbSS) or one Hb S allele and another β-globin variant, such as Hb C or β-thalassemia (HbSC, HbS/β-thal). It has been observed that (heterozygote) carriers of one copy of the sickle-cell trait (HbAS) are typically healthy and can even gain partial protection from severe malaria. The term “severe and complicated malaria” is delineated based on specific clinical and laboratory characteristics in the presence of Plasmodium falciparum parasitemia. The prevalent forms of severe malaria among African children include cerebral malaria, respiratory distress, and severe malaria anemia. Cerebral malaria is a rare complication of malaria infection and is associated with a high mortality rate

Infection Control and Management of COVID-19: Challenges for Paediatric Tertiary Care Hospitals

Abstract PURPOSE: To describe infection control measures and patient management at a tertiary children’s hospital in southern Germany during the COVID-19 pandemic.METHODS: Prospective, observational study of infection control measures, patient management, clinical and virologic data of paediatric patients treated at our hospital during the COVID-19 pandemic from February to May 2020. Infection control measures were documented beginning with preparation for the pandemic. All paediatric patients with suspected SARS-CoV-2 infection were prospectively included in the study.RESULTS: With local triage, restraint of patient admission and testing strategies implemented, healthcare capacity remained adequate and no healthcare-associated infections occurred. Workload in the paediatric emergency department significantly decreased following the lockdown of schools and kindergartens. 7 of 174 (4%) children with and 2 of 208 (1%) children without typical symptoms, respectively, were diagnosed with COVID-19 by PCR. Six out of nine inpatients treated for COVID-19 had underlying comorbidities, two were admitted to the intensive care unit. One patient died shortly after discharge.CONCLUSIONS: While COVID-19 generally causes mild disease in children, severe illness and fatal cases may occur, particularly among children with underlying diseases. Tertiary children’s hospitals may face challenges with treating potential high-risk patients during the pandemic. Thus, timely establishment of effective testing and triage strategies is crucial.</jats:p

A case series of children and young people admitted to a tertiary care hospital in Germany with COVID-19

Abstract Background While our knowledge about COVID-19 in adults has rapidly increased, data on the course of disease and outcome in children with different comorbidities is still limited. Methods Prospective, observational study at a tertiary care children’s hospital in southern Germany. Clinical and virology data from all paediatric patients admitted with SARS-CoV-2 infection at our hospital were prospectively assessed. Results Between March and November 2020, 14 patients were admitted with COVID-19. One patient was admitted a second time with COVID-19 6 months after initial disease. Among seven patients with severe underlying comorbidities, three developed multisystem inflammatory syndrome (MIS-C), two were admitted to the paediatric intensive care unit. One patient needed invasive ventilation. Another patient died shortly after discharge of COVID-19-related complications. Conclusions While COVID-19 generally causes mild disease in children, severe respiratory illness and MIS-C occur, in some cases with fatal outcome. Children with underlying diseases might be at special risk for severe disease. </jats:sec