Stool Xpert® MTB/RIF test for the diagnosis of childhood pulmonary tuberculosis at primary clinics in Zimbabwe.

OBJECTIVE: To evaluate the diagnostic performance of Xpert® MTB/RIF on stool samples from children with clinical suspicion of pulmonary tuberculosis (PTB) at primary care clinics. DESIGN: A cross-sectional diagnostic evaluation enrolling 5-16 year olds from whom one induced sputum (IS) sample was tested for microbiological TB confirmation. Results of a single stool sample tested using Xpert were compared against microbiologically confirmed TB, defined as a positive result on sputum microscopy and/or culture and/or IS Xpert. RESULTS: Of 222 children enrolled, 218 had complete microbiological results. The median age was 10.6 years (interquartile range 8-13). TB was microbiologically confirmed in 19/218 (8.7%) children. Of these, respectively 5 (26%), 9 (47%) and 15 (79%) were smear-, culture- and IS Xpert-positive. Stool Xpert was positive in 13/19 (68%) microbiologically confirmed cases and 4/199 (2%) microbiologically negative cases. Stool Xpert detected 76.9% (10/13) of human immunodeficiency virus (HIV) infected and 50% (3/6) of non-HIV-infected children with microbiologically confirmed TB (P = 0.241). CONCLUSION: Stool Xpert is a potential alternative screening test for children with suspected TB if sputum is unavailable. Strategies to optimise the diagnostic yield of stool Xpert assay need further study

In vitro antifungal susceptibility profiles of Cryptococcus species isolated from HIV-associated cryptococcal meningitis patients in Zimbabwe.

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Severe malaria in Parirenyatwa Hospital, Harare Intensive Care Unit: a case record review of 16 cases

Background: Zimbabwe has reported a decrease in malaria admissions and mortality rates by 64% and 71% respectively between 2003 and 2012, suggesting the country is on track to achieve a decrease in admission rates by 50-75% and mortality rates by >75% by 2015. The aim of this study is to review the Intensive Care Unit (ICU) outcomes of the malaria patients admitted into Parirenyatwa Group of Hospitals (PGHs) adult  ICU and to determine whether the Multiple Organ Dysfunction Score can be applied to a small set of patients with severe malaria in our unit.Materials and Methods: A retrospective case record review of patients admitted in ICU with a diagnosis of malaria at PGH general adult ICU. Demographic data, clinical data, laboratory data and data on interventions in ICU were collected. Multiple Organ Dysfunction Score (MODS), Malaria Prediction Score (MPS) and Malaria Score for Adults (MSA) were applied for all patients.Results: Sixteen (16) malaria patients were included in the study and all were adults with an age range of 18-68 and 10 (62.5%) were female. Parasitaemia on admission was quantified in 8/16 (50%) patients were 2 patients had parasitaemia greater than 5% and 6 had parasitaemia less than 5%. The complications included unarousable coma 12 (75%), persistent seizures 6 (37.5%), circulation collapse 3 (18.8%), Moderate to severe ARDS 4 (25%), renal impairment 7 (44%), severe metabolic acidosis 8 (50%), severe anaemia 8 (50%), severe thrombocytopaenia 4 (25%), hyperbilirubinaemia 9 (56%) and hypoglycaemia 2 (12.5%). The case fatality rate was 50%. Death was associated with a shorter duration of ICU stay and higher MODS scores.Conclusion: Although antimalarial therapies are the mainstay of malaria treatment, ICU admission and interventions remain pivotal in reducing morbidity and mortality in severe malaria. The MODS score is a good predictor of mortality in a small number of malaria patients; however specific scores should be studied

Cryptococcus neoformans population diversity and clinical outcomes of HIV-associated cryptococcal meningitis patients in Zimbabwe.

&lt;p&gt;HIV and cryptococcal meningitis co-infection is a major public health problem in most developing countries. Cryptococcus neoformans sensu stricto is responsible for the majority of HIV-associated cryptococcosis cases in sub-Saharan Africa. Despite the available information, little is known about cryptococcal population diversity and its association with clinical outcomes in patients with HIV-associated cryptococcal meningitis in sub-Saharan Africa. In a prospective cohort, we investigated the prevalence and clinical outcome of Cryptococcusneoformans sensu stricto meningitis among HIV-infected patients in Harare, Zimbabwe, and compared the genotypic diversity of the isolates with those collected from other parts of Africa. Molecular typing was done using amplified fragment length polymorphism genotyping and microsatellite typing. The majority of patients with HIV-associated Cryptococcusneoformans sensu stricto meningitis in this cohort were males (n=33/55; 60.0&amp;thinsp;%). The predominant Cryptococcus neoformans sensu stricto genotype among the Zimbabwean isolates was genotype AFLP1/VNI (n=40; 72.7&amp;thinsp;%), followed by AFLP1A/VNB/VNII (n=8; 14.6&amp;thinsp;%), and AFLP1B/VNII was the least isolated (n=7; 12.7&amp;thinsp;%). Most of the isolates were mating-type &amp;alpha; (n=51; 92.7&amp;thinsp;%), and only four (7.3&amp;thinsp;%) were mating-type a. Overall in-hospital mortality was 55.6&amp;thinsp;% (n=30), and no difference between infecting genotype and clinical outcome of patient (P=0.73) or CD4+ counts (P=0.79) was observed. Zimbabwean Cryptococcusneoformans sensu stricto genotypes demonstrated a high level of genetic diversity by microsatellite typing, and 51 genotypes within the main molecular types AFLP1/VNI, AFLP1A/VNB/VNII and AFLP1B/VNII were identified. This study demonstrates that Cryptococcusneoformans sensu stricto in Zimbabwe has a high level of genetic diversity when compared to other regional isolates.&lt;/p&gt;</p