Malaria diagnostic testing and treatment practices in three different Plasmodium falciparum transmission settings in Tanzania: before and after a government policy change

BACKGROUND: Patterns of decreasing malaria transmission intensity make presumptive treatment of malaria an unjustifiable approach in many African settings. The controlled use of anti-malarials after laboratory confirmed diagnosis is preferable in low endemic areas. Diagnosis may be facilitated by malaria rapid diagnostic tests (RDTs). In this study, the impact of a government policy change, comprising the provision of RDTs and advice to restrict anti-malarial treatment to RDT-positive individuals, was assessed by describing diagnostic behaviour and treatment decision-making in febrile outpatients <10 years of age in three hospitals in the Kagera and Mwanza Region in northern Tanzania. METHODS: Prospective data from Biharamulo and Rubya Designated District Hospital (DDH) were collected before and after policy change, in Sumve DDH no new policy was implemented. Diagnosis of malaria was confirmed by RDT; transmission intensity was evaluated by a serological marker of malaria exposure in hospital attendees. RESULTS: Prior to policy change, there was no evident association between the actual level of transmission intensity and drug-prescribing behaviour. After policy change, there was a substantial decrease in anti-malarial prescription and an increase in prescription of antibiotics. The proportion of parasite-negative individuals who received anti-malarials decreased from 89.1% (244/274) to 38.7% (46/119) in Biharamulo and from 76.9% (190/247) to 10.0% (48/479) in Rubya after policy change. CONCLUSION: This study shows that an official policy change, where RDTs were provided and healthcare providers were advised to adhere to RDT results in prescribing drugs can be followed by more rational drug-prescribing behaviour. The current findings are promising for improving treatment policy in Tanzanian hospitals

Nasopharyngeal carriage of Streptococcus pneumonia in pneumonia-prone age groups in Semarang, Java Island, Indonesia

Introduction: Streptococcus pneumoniae is a worldwide occurring pathogen Nasopharyngeal carriage of Streptococcus pneumoniae precedes pneumonia and other pneumococcal diseases in the community. Little is known about S. pneumoniae carriage in Indonesia, complicating strategies to control pneumococcal diseases. We investigated nasopharyngeal carriage of S. pneumoniae in Semarang, Indonesia. Methods: A population-based survey was performed in Semarang, Indonesia. Nasopharyngeal swabs and questionnaires were taken from 496 healthy young (6-60 month-old) children and 45-70 year-old adults. Results: Forty-three percent of children aged 6-60 months and 11% of adults aged 45-75 years carried S. pneumoniae. Determinants of carriage were being a child (OR 7.7; 95

Patterns of Proinflammatory Cytokines and Inhibitors during Typhoid Fever

Cytokines and inhibitors in plasma were measured in 44 patients with typhoid fever. Ex vivo production of the cytokines was analyzed in a whole blood culture system with and without lipopolysaccharide (LPS). Acute phase circulating concentrations of cytokines (±SD) were as follows: interleukin (IL)-Iβ, <140 pg/mL; tumor necrosis factor-α (TNFa), 130 ± 50 pg/mL; IL-6, 96 ± 131 pg/mL; and IL-8, 278 ± 293 pg/mL. Circulating inhibitors were elevated in the acute phase: IL-1 receptor antagonist (IL-1RA) was 2304 ± 1427 pg/mL and soluble TNF receptors 55 and 75 were 4973 ± 2644 pg/mL and 22,865 ± 15,143 pg/mL, respectively. LPS-stimulated production of cytokines was lower during the acute phase than during convalescence (mean values: IL-Iβ, 2547 vs. 6576 pg/mL; TNFα, 2609 vs. 6338 pg/mL; IL-6, 2416 vs. 7713 pg/mL), LPS-stimulated production of IL-1RA was higher in the acute than during the convalescent phase (5608 vs. 3977 pg/mL). Inhibited production of cytokines during the acute phase may bedue to a switch from a proinflammatory to an antiinflammatory mod

Circulating Lipoproteins Are a Crucial Component of Host Defense against Invasive Salmonella typhimurium Infection

Contains fulltext : 79883.pdf (Publisher’s version ) (Open Access)BACKGROUND: Circulating lipoproteins improve the outcome of severe Gram-negative infections through neutralizing lipopolysaccharides (LPS), thus inhibiting the release of proinflammatory cytokines. METHODS/PRINCIPAL FINDINGS: Low density lipoprotein receptor deficient (LDLR-/-) mice, with a 7-fold increase in LDL, are resistant against infection with Salmonella typhimurium (survival 100% vs 5%, p<0.001), and 100 to 1000-fold lower bacterial burden in the organs, compared with LDLR+/+ mice. Protection was not due to differences in cytokine production, phagocytosis, and killing of Salmonella organisms. The differences were caused by the excess of lipoproteins, as hyperlipoproteinemic ApoE-/- mice were also highly resistant to Salmonella infection. Lipoproteins protect against infection by interfering with the binding of Salmonella to host cells, and preventing organ invasion. This leads to an altered biodistribution of the microorganisms during the first hours of infection: after intravenous injection of Salmonella into LDLR+/+ mice, the bacteria invaded the liver and spleen within 30 minutes of infection. In contrast, in LDLR-/- mice, Salmonella remained constrained to the circulation from where they were efficiently cleared, with decreased organ invasion. CONCLUSIONS: plasma lipoproteins are a potent host defense mechanism against invasive Salmonella infection, by blocking adhesion of Salmonella to the host cells and subsequent tissue invasion

Penurunan Penggunaan Antibiotik pada Pasien Anak dengan Demam

Latar belakang. Resistensi antibiotik saat ini menjadi problem dunia yang mencemaskan. Penggunaan antibotik secara berlebihan dan tidak rasional merupakan kontributor utama terjadinya resistensi antibiotik. Upaya mengubah pola peresepan antibiotik menjadi lebih rasional merupakan hal yang tidak mudah. Tujuan. Memperbaiki kuantitas dan kualitas penggunaan antibiotik pada pasien yang dirawat dengan demam, serta mengevaluasi dampak terhadap morbiditas dan mortalitas. Metoda. Penelitian prospektif intervensi di bangsal anak RS Dr Kariadi, Juli 2003 - Desember 2004, dibagi menjadi 4 periode yaitu periode awal, penyusunan pedoman, pelatihan, dan umpan balik. Pada periode awal dilakukan pengambilan data dasar. Pada periode penyusunan pedoman dilakukan konsensus untuk menyusun pedoman penggunaan antibiotik pada anak dengan demam. Periode pelatihan adalah sosialisasi dan pelatihan kepada dokter. Pada periode pascapelatihan dilakukan umpan balik terhadap peserta pelatihan. Subyek penelitian adalah semua pasien usia >1 bulan yang dirawat dengan demam> 38ºC (rektal) dalam 24 jam pertama perawatan, kecuali yang diketahui menderita HIV/AIDS atau neutropeni karena kemoterapi. Data penggunaan antibiotik diambil dari catatan medik, diamati selama 6 hari pertama perawatan. Data morbiditas dan mortalitas diamati sampai pasien keluar dari rumah sakit. Uji statistik menggunakan X 2 dan Anova. Hasil. Terdapat penurunan kuantitas penggunaan antibiotik dan peningkatan kualitas penggunaan antibiotik secara bermakna (p=0.000 dan p=0,000). Penurunan kuantitas antibiotiok terutama disebabkan pengurangan penggunaan antibiotik yang tidak diperlukan. Tidak terdapat perbedaan lama rawat dan lama demam (p=0.96 dan p=0.32) dan tidak terdapat perbedaan kematian selama periode pengamatan. Kesimpulan. Dengan pedoman yang baik, penggunaan jumlah antibiotik dapat diturunkan tanpa meningkatkan risiko morbiditas dan mortalitas

Persistence of Salmonellae in Blood and Bone Marrow: Randomized Controlled Trial Comparing Ciprofloxacin and Chloramphenicol Treatments against Enteric Fever

We performed a randomized controlled trial involving 55 adult patients with enteric fever to compare ciprofloxacin and chloramphenicol. Blood and bone marrow cultures and cytokine profiles during therapy were done to compare the clinical and bacteriological efficacies of these drugs. All patients were randomly assigned to receive chloramphenicol (500 mg four times a day orally) for 14 days or ciprofloxacin (500 mg twice a day orally) for 7 days. In each treatment group, patients were subsequently randomized to have blood and bone marrow cultured after either 3 or 5 days of treatment. Twenty-seven patients received chloramphenicol, and 28 received ciprofloxacin. The two groups were similar in terms of baseline characteristics. No significant differences in clinical cure and time to defervescence were found. All strains isolated were susceptible to both antibiotics. Although ciprofloxacin was more effective in the elimination of Salmonella enterica serovars Typhi and Paratyphi A from bone marrow than chloramphenicol, there was still an impressive persistence of Salmonella in the bone marrow culture (67%). In the ciprofloxacin-treated patients the suppressed cytokine production capacity showed a trend to normalize earlier than in patients treated with chloramphenicol

Nasopharyngeal Carriage of Streptococcus pneumonia in Pneumonia-Prone Age Groups in Semarang, Java Island, Indonesia

Introduction: Streptococcus pneumoniae is a worldwide occurring pathogen Nasopharyngeal carriage of Streptococcus pneumoniae precedes pneumonia and other pneumococcal diseases in the community. Little is known about S. pneumoniae carriage in Indonesia, complicating strategies to control pneumococcal diseases. We investigated nasopharyngeal carriage of S. pneumoniae in Semarang, Indonesia. Methods: A population-based survey was performed in Semarang, Indonesia. Nasopharyngeal swabs and questionnaire