4 research outputs found

    First case report of a successfully managed severe COVID-19 infection in Malawi

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    The coronavirus disease 2019 (COVID-19) pandemic is now established on the African continent, with cases rapidly increasing in Malawi (1742 confirmed cases and 19 deaths as of 5 July 20201). Clinicians require guidelines, deliverable in the Malawi context, to effectively and safely treat patients for the best possible outcome. In Malawi, key public messages around social distancing, hand washing and shielding for at-risk individuals have been widely distributed by the Ministry of Health. However, it has not been possible to implement strict lockdown measures in Malawi due to the risk of widespread economic disruption, hunger, worsened food insecurity, risk of violence and mass political rallies. Testing rates are low such that the number of confirmed cases in Malawi is likely to significantly under-represent the actual number of cases. As the epidemic unfolds, it is vital that doctors implement standardised case management guidelines to improve survival for patients who require hospital admission. The majority of patients hospitalised with COVID-19 require medical-ward level care, including provision of adequate oxygen3. Increased oxygen provision has been a major focus of COVID-19 preparedness activities in Malawi

    Distinct clinical and immunological profiles of patients with evidence of SARS-CoV-2 infection in sub-Saharan Africa

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    Although the COVID-19 pandemic has left no country untouched there has been limited research to understand clinical and immunological responses in African populations. Here we characterise patients hospitalised with suspected (PCR-negative/IgG-positive) or confirmed (PCR-positive) COVID-19, and healthy community controls (PCR-negative/IgG-negative). PCR-positive COVID-19 participants were more likely to receive dexamethasone and a beta-lactam antibiotic, and survive to hospital discharge than PCR-negative/IgG-positive and PCR-negative/IgG-negative participants. PCR-negative/IgG-positive participants exhibited a nasal and systemic cytokine signature analogous to PCR-positive COVID-19 participants, predominated by chemokines and neutrophils and distinct from PCR-negative/IgG-negative participants. PCR-negative/IgG-positive participants had increased propensity for Staphylococcus aureus and Streptococcus pneumoniae colonisation. PCR-negative/IgG-positive individuals with high COVID-19 clinical suspicion had inflammatory profiles analogous to PCR-confirmed disease and potentially represent a target population for COVID-19 treatment strategies

    First case report of a successfully managed severe COVID-19 infection in Malawi

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    The coronavirus disease 2019 (COVID-19) pandemic is now established on the African continent, with cases rapidly increasing in Malawi (1742 confirmed cases and 19 deaths as of 5 July 20201). Clinicians require guidelines, deliverable in the Malawi context, to effectively and safely treat patients for the best possible outcome. In Malawi, key public messages around social distancing, hand washing and shielding for at-risk individuals have been widely distributed by the Ministry of Health. However, it has not been possible to implement strict lockdown measures in Malawi due to the risk of widespread economic disruption, hunger, worsened food insecurity, risk of violence and mass political rallies. Testing rates are low such that the number of confirmed cases in Malawi is likely to significantly under-represent the actual number of cases. As the epidemic unfolds, it is vital that doctors implement standardised case management guidelines to improve survival for patients who require hospital admission. The majority of patients hospitalised with COVID-19 require medical-ward level care, including provision of adequate oxygen3. Increased oxygen provision has been a major focus of COVID-19 preparedness activities in Malawi

    Examination of ELISA against PCR for assessing treatment efficacy against Cryptosporidium in a clinical trial context

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    Background: Cryptosporidium is a gastrointestinal pathogen that presents a serious opportunistic infection in immunocompromised individuals including those living with human immunodeficiency syndrome. The CRYPTOFAZ trial, previously published, was conducted in Malawi to evaluate the efficacy of clofazimine in response to an unmet need for drugs to treat cryptosporidiosis in HIV populations. A combination of rapid diagnostic tests, ELISA, qPCR, and conventional sequencing were employed to detect Cryptosporidium in 586 individuals during pre-screening and monitor oocyst shedding and identify enteric co-pathogens in 22 enrolled/randomized participants during the in-patient period and follow-up visits. Methodology: Oocyst shedding as measured by qPCR was used to determine primary trial outcomes, however pathogen was detected even at trial days 41–55 in individuals randomized to either clofazimine or placebo arms of the study. Therefore, in this work we re-examine the trial outcomes and conclusions in light of data from the other diagnostics, particularly ELISA. ELISA data was normalized between experiments prior to comparison to qPCR. The amount of all identified enteric pathogens was examined to determine if co-pathogens other than Cryptosporidium were major causative agents to a participant’s diarrhea. Conclusion: ELISA had higher sample-to-sample variability and proved to be equally or less sensitive than qPCR in detecting Cryptosporidium positive samples. Compared to qPCR, ELISA had equal or greater specificity in detecting Cryptosporidium negative samples. Sequencing identified several Cryptosporidium species including viatorum which has never been identified in Malawi and Southern Africa. In addition to Cryptosporidium, enterotoxigenic E. coli was also identified as a pathogen in diarrheagenic amounts in 4 out of 22 participants
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