84 research outputs found
Molecular Characterization of Community Acquired Staphylococcus aureus Bacteremia in Young Children in Southern Mozambique, 2001–2009
Background: The emergence of community-acquired Staphylococcus aureus infections is increasingly recognized as life threating problem worldwide. In Manhiça district, southern Mozambique, S. aureus is the leading cause of community-acquired bacteremia in neonates.Methods: Eighty-four S. aureus isolates from children less than 5 years admitted to Manhiça District Hospital from 2001 to 2009 were randomly selected and genetically characterized by DNA microarray and spa typing. Antimicrobial susceptibility was determined by VITEK 2.Results: Thirty-eight different spa types and 14 clonal complexes (CC) were identified. Spa-type t084 (n = 10; 12%) was the most predominant while CC8 (n = 18; 21%) and CC15 (n = 14; 16%) were the most frequent CCs. Mortality tended to be higher among children infected with CC45 (33.3%, 1/3) and CC8 (27.8%, 5/18). The majority of isolates possessed the accessory gene regulator I (45%) and belonged to either capsule type 8 (52%) or 5 (47%). Panton valentine leukocidin (PVL) encoding genes were detected in 30%. Antibiotic resistance was high for penicillin (89%), tetracycline (59%) and Trimethoprim Sulfamethoxazole (36%) while MRSA was uncommon (8%).Conclusions: Although MRSA were uncommon, we found high genetic diversity of methicillin susceptible S. aureus causing bacteremia in Mozambican children, associated with high resistance to the most available antibiotics in this community. Some CCs are likely to be more lethal indicating the need for prompt recognition and appropriate treatment
Hypoglycemia and Risk Factors for Death in 13 Years of Pediatric Admissions in Mozambique
Hypoglycemia is a life-threatening complication of several
diseases in childhood. We describe the prevalence and incidence
of hypoglycemia among admitted Mozambican children, establishing
its associated risk factors. We retrospectively reviewed
clinical data of 13 years collected through an ongoing
systematic morbidity surveillance in Manhica District Hospital
in rural Mozambique. Logistic regression was used to identify
risk factors for hypoglycemia and death. Minimum community-based
incidence rates (MCBIRs) for hypoglycemia were calculated using
data from the demographic surveillance system. Of 49,089
children < 15 years hospitalized in Manhica District
Hospital, 45,573 (92.8%) had a glycemia assessment on admission.
A total of 1,478 children (3.2%) presented hypoglycemia (< 3
mmol/L), of which about two-thirds (972) were with levels <
2.5 mmol/L. Independent risk factors for hypoglycemia on
admission and death among hypoglycemic children included
prostration, unconsciousness, edema, malnutrition, and
bacteremia. Hypoglycemic children were significantly more likely
to die (odds ratio [OR] = 7.11; P < 0.001), with an
associated case fatality rate (CFR) of 19.3% (245/1,267).
Overall MCBIR of hypoglycemia was 1.57 episodes/1,000 child
years at risk (CYAR), significantly decreasing throughout the
study period. Newborns showed the highest incidences (9.47
episodes/1,000 CYAR, P < 0.001). Hypoglycemia remains a
hazardous condition for African children. Symptoms and signs
associated to hypoglycemia should trigger the verification of
glycemia and the implementation of life-saving corrective
measures
Epidemiology and molecular characterization of multidrug-resistant Escherichia coli isolates harboring blaCTX-M group 1 extended-spectrum β-lactamases causing bacteremia and urinary tract infection in Manhiça, Mozambique
Background: The emergence and spread of extended-spectrum β-lactamases (ESBLs), especially CTX-M, is an important public health problem with serious implications for low-income countries where second-line treatment is often unavailable. Knowledge of the local prevalence of ESBL is critical to define appropriate empirical therapeutic strategies for multidrug-resistant (MDR) organisms. This study aimed to assess and characterize the presence of ESBL and especially CTX-M-producing Escherichia coli MDR isolates from patients with urinary tract infections (UTIs) and bacteremia in a rural hospital in Mozambique.
Materials and methods: One hundred and fifty-one E. coli isolates from bacteremia and UTI in children were screened for CTX-M, TEM, SHV and OXA β-lactamases by polymerase chain reaction and sequencing. Isolates carrying CTX-M group 1 β-lactamases were further studied. The resistance to other antibiotic families was determined by phenotypic and genotypic methods, the location of the blaCTX-M gene and the epidemiology of the isolates were studied, and extensive plasmid characterization was performed.
Results: Approximately 11% (17/151) of E. coli isolates causing bacteremia and UTI were ESBL producers. CTX-M-15 was the most frequently detected ESBL, accounting for 75% of the total isolates characterized. The blaCTX-M gene is located in different plasmids belonging to different incompatibility groups and can be found in non-epidemiologically related isolates, indicating the high capacity of this resistance determinant to spread widely.
Conclusion: Our data suggest the presence of a co-selection of third-generation cephalosporin-resistant determinants in the study area despite limited access to these antibiotics. This highlights the importance of continuous surveillance of antimicrobial resistance of both genetic elements of resistance and resistant isolates in order to monitor the emergence and trends of ESBL-producing isolates to promote adequate therapeutic strategies for the management of MDR bacterial infections
Under treatment of pneumonia among children under 5 years of age in a malaria-endemic area: population-based surveillance study conducted in Manhica district- rural, Mozambique
BACKGROUND: Integrated Management of Childhood Illness (IMCI)
guidelines were developed to decrease morbidity and mortality,
yet implementation varies across settings. Factors associated
with poor adherence are not well understood. METHODS: We used
data from Manhica District Hospital outpatient department and
five peripheral health centers to examine pneumonia management
for children <5 years old from January 2008 to June 2011.
Episodes of IMCI-defined pneumonia (cough or difficult breathing
plus tachypnea), severe pneumonia (pneumonia plus chest wall
in-drawing), and/or clinician-diagnosed pneumonia (based on
discharge diagnosis) were included. RESULTS: Among severe
pneumonia episodes, 96.2% (2,918/3,032) attended in the
outpatient department and 70.0% (291/416) attended in health
centers were appropriately referred to the emergency department.
Age<1 year, malnutrition and various physical exam findings
were associated with referral. For non-severe pneumonia
episodes, antibiotics were prescribed in 45.7% (16,094/35,224).
Factors associated with antibiotic prescription included age
<1 year, abnormal auscultatory findings, and clinical
diagnosis of pneumonia; diagnosis of malaria or gastroenteritis
and pallor were negatively associated with antibiotic
prescription. CONCLUSION: Adherence to recommended management of
severe pneumonia was high in a hospital outpatient department,
but suboptimal in health centers. Antibiotics were prescribed in
fewer than half of non-severe pneumonia episodes, and diagnosis
of malaria was the strongest risk factor for incorrect
management
Malaria in rural Mozambique. Part II: children admitted to hospital
This is an Open Access article distributed under the terms of the Creative Commons Attribution Licens
Infant mortality and morbidity associated with preterm and small-for-gestational-age births in Southern Mozambique: A retrospective cohort study
BACKGROUND: Preterm and small for gestational age (SGA) births
have been associated with adverse outcomes during the first
stages of life. We evaluated the morbidity and mortality
associated with preterm and SGA births during the first year of
life in a rural area of Southern Mozambique. METHODS: This is a
retrospective cohort study using previously collected data from
children born at the Manhica District Hospital in two different
periods (2003-2005 and 2010-2012). Newborns were classified as
being preterm and/or SGA or as babies not fulfilling any of the
previous conditions (term non-SGA). All children were followed
up for a year for morbidity and mortality outcomes. RESULTS: A
total of 5574 live babies were included in the analysis. The
prevalence of preterm delivery was 6.2% (345/5574); the
prevalence of SGA was 14.0% (776/5542) and 2.2% (114/5542) of
the children presented both conditions. During the neonatal
period, preterm delivery and SGA were associated with 13 (HR:
13.0, 95% CI 4.0-42.2) and 5 times (HR: 4.5, 95% CI: 1.6-12.6)
higher mortality compared to term non SGA babies. Risk of
hospitalization was only increased when both conditions were
present (IRR: 3.5, 95%CI: 1.5-8.1). Mortality is also increased
during the entire first year, although at a lower rate.
CONCLUSIONS: Neonatal and infant mortality rates are remarkably
high among preterm and SGA babies in southern Mozambique. These
increased rates are concentrated within the neonatal period.
Prompt identification of these conditions is needed to implement
interventions aimed at increasing survival of these high-risk
newborns
Characterisation of extended-spectrum b-lactamases among Klebsiella pneumoniae isolates causing bacteraemia and urinary tract infection in Mozambique
The aim of this study was to determine the prevalence of extended-spectrum β-lactamase (ESBL)-producing Klebsiella pneumoniae isolated from urinary tract and bloodstream infections in a rural hospital in Manhiça, Mozambique. ESBLs were investigated among ceftriaxone-non-susceptible K. pneumoniae clinical isolates recovered between 2004 and 2009. Characterisation of blaCTX-M, blaSHV, blaOXA and blaTEM genes was performed by PCR and sequencing. Epidemiological relationships were established by phylogenetic analysis, repetitive extragenic palindromic PCR (REP-PCR), pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST), whilst plasmid transferability was evaluated by conjugation. In addition, the presence of class 1 and 2 integrons was studied. A total of 19 K. pneumoniae were analysed. The blaCTX-M-15 gene was found in all strains. Other ESBL genes were found concomitantly, including blaSHV-5, blaSHV-2, blaSHV-2A, blaSHV-12 and blaSHV-38. In addition, other β-lactamases such as blaTEM-1 and blaOXA-30 were also detected. REP-PCR identified 15 different epidemiological profiles. MLST analysis also showed great variability of sequence types. The blaCTX-M-15 gene showed a high transfer capacity. The presence of class 1 integrons was high. High levels of multidrug resistance were also found. In conclusion, these data show the dominance of the CTX-M-type ESBL, particularly CTX-M-15, supporting its worldwide dissemination, including in areas with limited access to third-generation cephalosporins. This finding is a matter of concern for clinical management as third-generation cephalosporins are an alternative for treating severe cases of multidrug-resistant infections in this community
Invasive bacterial disease trends and characterization of group B streptococcal isolates among young infants in southern Mozambique, 2001-2015
BACKGROUND: Maternal group B streptococcal (GBS) vaccines under
development hold promise to prevent GBS disease in young
infants. Sub-Saharan Africa has the highest estimated disease
burden, although data on incidence and circulating strains are
limited. We described invasive bacterial disease (IBD) trends
among infants <90 days in rural Mozambique during 2001-2015,
with a focus on GBS epidemiology and strain characteristics.
METHODS: Community-level birth and mortality data were obtained
from Manhica's demographic surveillance system. IBD cases were
captured through ongoing surveillance at Manhica district
hospital. Stored GBS isolates from cases underwent serotyping by
multiplex PCR, antimicrobial susceptibility testing, and whole
genome sequencing. RESULTS: There were 437 IBD cases, including
57 GBS cases. Significant declines in overall IBD, neonatal
mortality, and stillbirth rates were observed (P<0.0001), but
not for GBS (P = 0.17). In 2015, GBS was the leading cause of
young infant IBD (2.7 per 1,000 live births). Among 35 GBS
isolates available for testing, 31 (88.6%) were highly related
serotype III isolates within multilocus sequence types (STs) 17
(68.6%) or 109 (20.0%). All seven ST109 isolates (21.9%) had
elevated minimum inhibitory concentration (MIC) to penicillin
(>/=0.12 mug/mL) associated with penicillin-binding protein
(PBP) 2x substitution G398A. Epidemiologic and molecular data
suggest this is a well-established clone. CONCLUSION: A notable
young infant GBS disease burden persisted despite improvements
in overall maternal and neonatal health. We report an
established strain with pbp2x point mutation, a first-step
mutation associated with reduced penicillin susceptibility
within a well-known virulent lineage in rural Mozambique. Our
findings further underscores the need for non-antibiotic GBS
prevention strategies
Host age and expression of genes involved in red blood cell invasion in Plasmodium falciparum field isolates
Plasmodium falciparum proteins involved in erythrocyte invasion
are main targets of acquired immunity and important vaccine
candidates. We hypothesized that anti-parasite immunity acquired
upon exposure would limit invasion-related gene (IRG) expression
and affect the clinical impact of the infection. 11 IRG
transcript levels were measured in P. falciparum isolates by
RT-PCR, and IgG/IgM against invasion ligands by Luminex(R), in
50 Mozambican adults, 25 children with severe malaria (SM) and
25 with uncomplicated malaria (UM). IRG expression differences
among groups and associations between IRG expression and
clinical/immunologic parameters were assessed. IRG expression
diversity was higher in parasites infecting children than adults
(p = 0.022). eba140 and ptramp expression decreased with age (p
= 0.003 and 0.007, respectively) whereas p41 expression
increased (p = 0.022). pfrh5 reduction in expression was abrupt
early in life. Parasite density decreased with increasing pfrh5
expression (p < 0.001) and, only in children, parasite
density increased with p41 expression (p = 0.007), and decreased
with eba175 (p = 0.013). Antibody responses and IRG expression
were not associated. In conclusion, IRG expression is associated
with age and parasite density, but not with specific antibody
responses in the acute phase of infection. Our results confirm
the importance of multi-antigen vaccines development to avoid
parasite immune escape when tested in malaria-exposed
individuals
Postdischarge Mortality Prediction in Sub-Saharan Africa.
BACKGROUND: Although the burden of postdischarge mortality (PDM) in low-income settings appears to be significant, no clear recommendations have been proposed in relation to follow-up care after hospitalization. We aimed to determine the burden of pediatric PDM and develop predictive models to identify children who are at risk for dying after discharge. METHODS: Deaths after hospital discharge among children aged <15 years in the last 17 years were reviewed in an area under demographic and morbidity surveillance in Southern Mozambique. We determined PDM over time (up to 90 days) and derived predictive models of PDM using easily collected variables on admission. RESULTS: Overall PDM was high (3.6%), with half of the deaths occurring in the first 30 days. One primary predictive model for all ages included young age, moderate or severe malnutrition, a history of diarrhea, clinical pneumonia symptoms, prostration, bacteremia, having a positive HIV status, the rainy season, and transfer or absconding, with an area under the curve of 0.79 (0.75-0.82) at day 90 after discharge. Alternative models for all ages including simplified clinical predictors had a similar performance. A model specific to infants <3 months old was used to identify as predictors being a neonate, having a low weight-for-age z score, having breathing difficulties, having hypothermia or fever, having oral candidiasis, and having a history of absconding or transfer to another hospital, with an area under the curve of 0.76 (0.72-0.91) at day 90 of follow-up. CONCLUSIONS: Death after discharge is an important although poorly recognized contributor to child mortality. A simple predictive algorithm based on easily recognizable variables could readily be used to identify most infants and children who are at a high risk of dying after discharge
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