Background: The Sepsis Prevention in Neonates in Zambia study is a prospective cohort study that ... more Background: The Sepsis Prevention in Neonates in Zambia study is a prospective cohort study that evaluated an infection prevention and control (IPC) bundle in the University Teaching Hospital neonatal intensive care unit (NICU) in Lusaka, Zambia. We present here the etiologies, antimicrobial resistance profiles, and associated mortality of bloodstream infections (BSI) in this cohort. Methods: Venous blood was collected from neonates with clinically suspected sepsis and cultured with an automated blood culture system. Organism identification and susceptibility testing were done using the Vitek II system. We used the CDC National Health Safety Network criteria to define pathogens and commensals. Results: There were 1120 blood cultures performed for 1060 neonates with suspected sepsis. Overall, 38% (424/1120) of cultures were positive of which 72% (306/424) grew pathogens. Blood cultures obtained after, as compared to before, 2 days of hospitalization were more likely to yield a pathog...
<p>TB prevalence in different patient groups stratified by HIV status (HIV status was avail... more <p>TB prevalence in different patient groups stratified by HIV status (HIV status was available for 858/900 study participants).</p
<p>Data are n TB positive/n tested (%) [95% CI], Odds Ratios (ORs) and associated confidenc... more <p>Data are n TB positive/n tested (%) [95% CI], Odds Ratios (ORs) and associated confidence intervals (CIs) from binary logistic regression analysis.</p>a<p>Multivariate analysis was controlled for the effects of Age and HIV.</p>b<p>Age was analysed as a continuous variable but is displayed as grouped to illustrate the distribution.</p>c<p>Three TB culture negative patients were represented in multiple NCD diagnosis categories.</p>d<p>Two TB culture negative patients were represented in multiple CD diagnosis categories.</p
Investment in Africa over the past year with regards to SARS-CoV-2 genotyping has led to a massiv... more Investment in Africa over the past year with regards to SARS-CoV-2 genotyping has led to a massive increase in the number of sequences, exceeding 100,000 genomes generated to track the pandemic on the continent. Our results show an increase in the number of African countries able to sequence within their own borders, coupled with a decrease in sequencing turnaround time. Findings from this genomic surveillance underscores the heterogeneous nature of the pandemic but we observe repeated dissemination of SARS-CoV-2 variants within the continent. Sustained investment for genomic surveillance in Africa is needed as the virus continues to evolve, particularly in the low vaccination landscape. These investments are very crucial for preparedness and response for future pathogen outbreaks.One-Sentence SummaryExpanding Africa SARS-CoV-2 sequencing capacity in a fast evolving pandemic.
Objectives : To conduct a diagnostic validation study of SARS-CoV-2 diagnostic kits. Methodology ... more Objectives : To conduct a diagnostic validation study of SARS-CoV-2 diagnostic kits. Methodology : We compared SARS-CoV-2 diagnostic test results from three RT-PCR assays used by the Zambian government between Nov 2020 to Feb 2021 (the Panther Fusion® assay, Da An Gene's 2019-nCoV RNA kit and Maccura's PCR Kit) with the Altona RealStar RT-PCR kit which served as the gold standard. We also evaluated results from rapid antigen testing, and whether co-morbidities were linked with increased odds of infection. Results : We recruited 244 participants, 61% (149/244) were positive by at least one PCR assay. Da An Gene, Maccura and Panther Fusion assays had sensitivities of 0.0% (95%CI 0-41%), 27.1% (95%CI 15-42%) and 76% (95%CI 65-85%) respectively but specificity was low (<85% for all three assays). HIV and TB were not associated with SARS-CoV-2, whereas female sex (OR 0.5 (0.3-0.9), p = 0.026) and Chronic Pulmonary Disease (0.1 (0.0-0.8), p = 0.031), were associated with lower odds of SARS-CoV-2 infection. 84% of 44 samples sequenced were Beta variant. Conclusions : The RT-PCR assays evaluated did not meet WHO recommended minimum sensitivity of 80%. Local diagnostic validation studies should be embedded within preparedness plans for future outbreaks to improve the public health response.
S OF PLENARY PRESENTATIONS A3 ABSTRACTS OF ORAL PRESENTATIONS A5S OF ORAL PRESENTATIONS A5 ABSTRA... more S OF PLENARY PRESENTATIONS A3 ABSTRACTS OF ORAL PRESENTATIONS A5S OF ORAL PRESENTATIONS A5 ABSTRACTS OF POSTER PRESENTATIONS A16S OF POSTER PRESENTATIONS A16
Introduction: Viruses from the family Filoviridae can cause viral haemorrhagic fevers (VHFs), inc... more Introduction: Viruses from the family Filoviridae can cause viral haemorrhagic fevers (VHFs), including Ebola virus disease (EVD) and Marburg virus disease (MVD). The 2014-16 outbreak of EVD in West Africa resulted in 11,308 deaths, representing a case fatality rate of 39.5%. During the outbreak, only 60% of patients were laboratory confirmed and global health authorities have identified the need for accurate and readily deployable molecular diagnostics as an important component of the ideal response to future outbreaks, to quickly identify and isolate patients. Areas covered: Following the outbreak in West Africa, various molecular diagnostic assays to detect EVD have been developed, to detect genes, proteins/antigens and antibodies associated with the infection. Currently PCR based techniques and rapid diagnostic tests (RDTs) that detect antigens specific to EVD infections dominate but recent advances in biosensor technologies have led to novel approaches for the development of EVD diagnostics. This review summarises the literature and available performance data of currently available molecular diagnostics for ebolavirus, identifies knowledge gaps and maps out future priorities for research in this field. Expert opinion: While there is now a plethora of diagnostic tests for EVD at various stages of development, there is an acute need for studies to compare the clinical performance of these EVD diagnostics. The sporadic nature of EVD outbreaks makes this extremely challenging, demanding pragmatic new modalities of research funding and ethical/institutional approval, to enable responsive research in outbreak settings. Retrospective head-to-head diagnostic comparisons could also be implemented using biobanked specimens, providing this can be done safely.
Background Sepsis is a leading cause of neonatal mortality in low-resource settings. As facility-... more Background Sepsis is a leading cause of neonatal mortality in low-resource settings. As facility-based births become more common, the proportion of neonatal deaths due to hospital-onset sepsis has increased. Methods We conducted a prospective cohort study in a neonatal intensive care unit in Zambia where we implemented a multifaceted infection prevention and control (IPC) bundle consisting of IPC training, text message reminders, alcohol hand rub, enhanced environmental cleaning, and weekly bathing of babies ≥1.5 kg with 2% chlorhexidine gluconate. Hospital-associated sepsis, bloodstream infection (BSI), and mortality (>3 days after admission) outcome data were collected for 6 months prior to and 11 months after bundle implementation. Results Most enrolled neonates had a birth weight ≥1.5 kg (2131/2669 [79.8%]). Hospital-associated mortality was lower during the intervention than baseline period (18.0% vs 23.6%, respectively). Total mortality was lower in the intervention than pr...
Human herpesvirus 6B (HHV-6B) is the causative agent of Roseola infantum, and has also been sugge... more Human herpesvirus 6B (HHV-6B) is the causative agent of Roseola infantum, and has also been suggested to play a role in the pathogenesis of febrile seizures in young children, a percentage of whom go on to develop febrile status epilepticus (FSE), but existing data is conflicting and inconclusive. HHV-6A is a distinct species, rarely detected in most parts of the world, but prior studies suggest a higher prevalence in febrile African children. We describe a case control study comparing the frequency of HHV-6A and/or HHV-6B infections in children with febrile seizures (including febrile status epilepticus) and a control group of febrile children without seizures. We recruited children aged 6-60 months admitted with a febrile illness with (cases) or without (controls) seizures presenting within 48 hours of commencement of fever. 3mls of whole blood was centrifuged and plasma stored at -80 C for pooled screening for HHV-6B and HHV-6A by Taqman Real Time PCR. 102 cases and 95 controls w...
Background: Autopsy studies are the gold standard for determining cause-of-death and can inform o... more Background: Autopsy studies are the gold standard for determining cause-of-death and can inform on improved diagnostic strategies and algorithms to improve patient care. We conducted a cross-sectional observational autopsy study to describe the burden of respiratory tract infections in inpatient children who died at the University Teaching Hospital in Lusaka, Zambia. Methods: Gross pathology was recorded and lung tissue was analysed by histopathology and molecular diagnostics. Recruitment bias was estimated by comparing recruited and non-recruited cases. Results: Of 121 children autopsied, 64 % were male, median age was 19 months (IQR, 12-45 months). HIV status was available for 97 children, of whom 34 % were HIV infected. Lung pathology was observed in 92 % of cases. Bacterial bronchopneumonia was the most common pathology (50 %) undiagnosed ante-mortem in 69 % of cases. Other pathologies included interstitial pneumonitis (17 %), tuberculosis (TB; 8 %), cytomegalovirus pneumonia (7 %) and pneumocystis Jirovecii pneumonia (5 %). Comorbidity between lung pathology and other communicable and non-communicable diseases was observed in 80 % of cases. Lung tissue from 70 % of TB cases was positive for Mycobacterium tuberculosis by molecular diagnostic tests. A total of 80 % of TB cases were comorbid with malnutrition and only 10 % of TB cases were on anti-TB therapy when they died. Conclusions: More proactive testing for bacterial pneumonia and TB in paediatric inpatient settings is needed.
Background: In sub-Saharan Africa, there is scanty data on the causes of neonatal sepsis and anti... more Background: In sub-Saharan Africa, there is scanty data on the causes of neonatal sepsis and antimicrobial resistance among common invasive pathogens that might guide policy and practice. Methods: A cross-sectional observational prevalence and etiology study of neonates with suspected sepsis admitted to the neonatal intensive care unit,
Background Patients with subclinical tuberculosis, smear-negative tuberculosis, extrapulmonary tu... more Background Patients with subclinical tuberculosis, smear-negative tuberculosis, extrapulmonary tuberculosis, multidrug-resistant tuberculosis, and asymptomatic tuberculosis are diffi cult to diagnose and may be missed at all points of health care. We did an autopsy study to ascertain the burden of tuberculosis at post mortem in medical inpatients at a tertiary care hospital in Lusaka, Zambia.
Background: A high burden of tuberculosis (TB) occurs in sub-Saharan African countries and many c... more Background: A high burden of tuberculosis (TB) occurs in sub-Saharan African countries and many cases of active TB and drug-resistant TB remain undiagnosed. Tertiary care hospitals provide an opportunity to study TB co-morbidity with noncommunicable and other communicable diseases (NCDs/CDs). We evaluated the burden of undiagnosed pulmonary TB and multi-drug resistant TB in adult inpatients, regardless of their primary admission diagnosis, in a tertiary referral centre.
Diagnosis of tuberculosis in most countries where tuberculosis has a high endemicity relies heavi... more Diagnosis of tuberculosis in most countries where tuberculosis has a high endemicity relies heavily on smear microscopy, a century-old technology. Although it is simple and inexpensive, the specificity and sensitivity is poor, particularly in human immunodeficiency virus (HIV)-positive patients, as well as in children. Furthermore, it cannot differentiate between disease caused by drug-sensitive Mycobacterium tuberculosis (MTB) and disease caused by drug-resistant M. tuberculosis [1]. In sub-Saharan Africa, an average of only 56% of new cases of pulmonary tuberculosis were smear positive in 2010, with Zimbabwe, Swaziland, and Zambia having the lowest sputum smear-positive case detection rates, at 32%, 37%, and 38%, respectively [2], indicating that smear microscopy is suboptimal for use in Africa. Automated liquid culture, the recommended gold standard tuberculosis diagnostic test, is highly specific and sensitive for the detection of tuberculosis and drug-resistant tuberculosis, but it is labor-intensive, time-consuming (2-6 weeks from sample collection to availability of
Background: Human herpesvirus 6B (HHV-6B) is the causative agent of Roseola infantum, and has als... more Background: Human herpesvirus 6B (HHV-6B) is the causative agent of Roseola infantum, and has also been suggested to play a role in the pathogenesis of febrile seizures in young This article is protected by copyright. All rights reserved. Accepted Article children, a percentage of whom go on to develop febrile status epilepticus (FSE), but existing data is conflicting and inconclusive. HHV-6A is a distinct species, rarely detected in most parts of the world, but prior studies suggest a higher prevalence in febrile African children. We describe a case control study comparing the frequency of HHV-6A and/or HHV-6B infections in children with febrile seizures (including febrile status epilepticus) and a control group of febrile children without seizures. Methods We recruited children aged 6-60 months admitted with a febrile illness with (cases) or without (controls) seizures presenting within 48 hours of commencement of fever. 3mls of whole blood was centrifuged and plasma stored at-80 o C for pooled screening for HHV-6B and HHV-6A by Taqman Real Time PCR. Results 102 cases and 95 controls were recruited. The prevalence of HHV-6B DNA detection did not differ significantly between cases (5.8% (6/102)) and controls (10.5% (10/95)) but HHV-6B infection was associated with febrile status epilepticus (OR 15; 95% CI, [1.99-120]; p=0.009). HHV-6A was not detected. Conclusion Prevalence of HHV-6B was similar among cases and controls. Within the febrile seizure group, HHV-6B infection was associated with FSE, suggesting HHV-6B infections could play a role in pathogenesis of FSE.
Background. Betaherpesviruses are established causes of morbidity and mortality in immunosuppress... more Background. Betaherpesviruses are established causes of morbidity and mortality in immunosuppressed patient groups but have been little studied in sub-Saharan Africa, the epicenter of the human immunodeficiency virus (HIV) pandemic. In this region, primary infections with human cytomegalovirus (HCMV) and human herpesvirus type 6 (HHV-6) type 6 are endemic in infancy, but the clinical impact of these infections among pediatric inpatient groups is poorly characterized and assumptive, based largely on data from Western populations. Methods. We used TaqMan polymerase chain reaction to screen sera from a group of 303 pediatric inpatients aged between 3 weeks and 2 years, at the University Teaching Hospital in Lusaka, Zambia. We report the prevalence of DNAemia and viral loads within this patient group, and evaluate possible clinical associations/risk factors for betaherpesvirus infections in these hospitalized children. Results. We detected betaherpesvirus DNAemia in 59.1% (179/303) of children. HCMV was the most prevalent (41.3%), followed by HHV-6B (20.5%), HHV-7 (20.1%), and HHV-6A (0.3%). HIV infection (odds ratio [OR], 2.31; 95% confidence interval [CI], 1.37-3.90; P = .002), being underweight (OR, 1.82; 95% CI, 1.06-3.12; P = .03), and an admission diagnosis of suspected meningitis (OR, 5.72; 95% CI, 1.07-30.5; P = .041) were independently associated with an increased odds of HCMV DNAemia. Conversely, HHV-6B and HHV-7 DNAemia were not associated with HIV, underweight, or admission diagnosis. Median HCMV viral load was moderately but significantly higher in HIV-infected children. Conclusions. Highly prevalent HCMV DNAemia was independently associated with HIV infection and being underweight across all age groups, and was also associated with meningitis, with previously underappreciated implications for the health and development of African children.
Background: The Sepsis Prevention in Neonates in Zambia study is a prospective cohort study that ... more Background: The Sepsis Prevention in Neonates in Zambia study is a prospective cohort study that evaluated an infection prevention and control (IPC) bundle in the University Teaching Hospital neonatal intensive care unit (NICU) in Lusaka, Zambia. We present here the etiologies, antimicrobial resistance profiles, and associated mortality of bloodstream infections (BSI) in this cohort. Methods: Venous blood was collected from neonates with clinically suspected sepsis and cultured with an automated blood culture system. Organism identification and susceptibility testing were done using the Vitek II system. We used the CDC National Health Safety Network criteria to define pathogens and commensals. Results: There were 1120 blood cultures performed for 1060 neonates with suspected sepsis. Overall, 38% (424/1120) of cultures were positive of which 72% (306/424) grew pathogens. Blood cultures obtained after, as compared to before, 2 days of hospitalization were more likely to yield a pathog...
<p>TB prevalence in different patient groups stratified by HIV status (HIV status was avail... more <p>TB prevalence in different patient groups stratified by HIV status (HIV status was available for 858/900 study participants).</p
<p>Data are n TB positive/n tested (%) [95% CI], Odds Ratios (ORs) and associated confidenc... more <p>Data are n TB positive/n tested (%) [95% CI], Odds Ratios (ORs) and associated confidence intervals (CIs) from binary logistic regression analysis.</p>a<p>Multivariate analysis was controlled for the effects of Age and HIV.</p>b<p>Age was analysed as a continuous variable but is displayed as grouped to illustrate the distribution.</p>c<p>Three TB culture negative patients were represented in multiple NCD diagnosis categories.</p>d<p>Two TB culture negative patients were represented in multiple CD diagnosis categories.</p
Investment in Africa over the past year with regards to SARS-CoV-2 genotyping has led to a massiv... more Investment in Africa over the past year with regards to SARS-CoV-2 genotyping has led to a massive increase in the number of sequences, exceeding 100,000 genomes generated to track the pandemic on the continent. Our results show an increase in the number of African countries able to sequence within their own borders, coupled with a decrease in sequencing turnaround time. Findings from this genomic surveillance underscores the heterogeneous nature of the pandemic but we observe repeated dissemination of SARS-CoV-2 variants within the continent. Sustained investment for genomic surveillance in Africa is needed as the virus continues to evolve, particularly in the low vaccination landscape. These investments are very crucial for preparedness and response for future pathogen outbreaks.One-Sentence SummaryExpanding Africa SARS-CoV-2 sequencing capacity in a fast evolving pandemic.
Objectives : To conduct a diagnostic validation study of SARS-CoV-2 diagnostic kits. Methodology ... more Objectives : To conduct a diagnostic validation study of SARS-CoV-2 diagnostic kits. Methodology : We compared SARS-CoV-2 diagnostic test results from three RT-PCR assays used by the Zambian government between Nov 2020 to Feb 2021 (the Panther Fusion® assay, Da An Gene's 2019-nCoV RNA kit and Maccura's PCR Kit) with the Altona RealStar RT-PCR kit which served as the gold standard. We also evaluated results from rapid antigen testing, and whether co-morbidities were linked with increased odds of infection. Results : We recruited 244 participants, 61% (149/244) were positive by at least one PCR assay. Da An Gene, Maccura and Panther Fusion assays had sensitivities of 0.0% (95%CI 0-41%), 27.1% (95%CI 15-42%) and 76% (95%CI 65-85%) respectively but specificity was low (<85% for all three assays). HIV and TB were not associated with SARS-CoV-2, whereas female sex (OR 0.5 (0.3-0.9), p = 0.026) and Chronic Pulmonary Disease (0.1 (0.0-0.8), p = 0.031), were associated with lower odds of SARS-CoV-2 infection. 84% of 44 samples sequenced were Beta variant. Conclusions : The RT-PCR assays evaluated did not meet WHO recommended minimum sensitivity of 80%. Local diagnostic validation studies should be embedded within preparedness plans for future outbreaks to improve the public health response.
S OF PLENARY PRESENTATIONS A3 ABSTRACTS OF ORAL PRESENTATIONS A5S OF ORAL PRESENTATIONS A5 ABSTRA... more S OF PLENARY PRESENTATIONS A3 ABSTRACTS OF ORAL PRESENTATIONS A5S OF ORAL PRESENTATIONS A5 ABSTRACTS OF POSTER PRESENTATIONS A16S OF POSTER PRESENTATIONS A16
Introduction: Viruses from the family Filoviridae can cause viral haemorrhagic fevers (VHFs), inc... more Introduction: Viruses from the family Filoviridae can cause viral haemorrhagic fevers (VHFs), including Ebola virus disease (EVD) and Marburg virus disease (MVD). The 2014-16 outbreak of EVD in West Africa resulted in 11,308 deaths, representing a case fatality rate of 39.5%. During the outbreak, only 60% of patients were laboratory confirmed and global health authorities have identified the need for accurate and readily deployable molecular diagnostics as an important component of the ideal response to future outbreaks, to quickly identify and isolate patients. Areas covered: Following the outbreak in West Africa, various molecular diagnostic assays to detect EVD have been developed, to detect genes, proteins/antigens and antibodies associated with the infection. Currently PCR based techniques and rapid diagnostic tests (RDTs) that detect antigens specific to EVD infections dominate but recent advances in biosensor technologies have led to novel approaches for the development of EVD diagnostics. This review summarises the literature and available performance data of currently available molecular diagnostics for ebolavirus, identifies knowledge gaps and maps out future priorities for research in this field. Expert opinion: While there is now a plethora of diagnostic tests for EVD at various stages of development, there is an acute need for studies to compare the clinical performance of these EVD diagnostics. The sporadic nature of EVD outbreaks makes this extremely challenging, demanding pragmatic new modalities of research funding and ethical/institutional approval, to enable responsive research in outbreak settings. Retrospective head-to-head diagnostic comparisons could also be implemented using biobanked specimens, providing this can be done safely.
Background Sepsis is a leading cause of neonatal mortality in low-resource settings. As facility-... more Background Sepsis is a leading cause of neonatal mortality in low-resource settings. As facility-based births become more common, the proportion of neonatal deaths due to hospital-onset sepsis has increased. Methods We conducted a prospective cohort study in a neonatal intensive care unit in Zambia where we implemented a multifaceted infection prevention and control (IPC) bundle consisting of IPC training, text message reminders, alcohol hand rub, enhanced environmental cleaning, and weekly bathing of babies ≥1.5 kg with 2% chlorhexidine gluconate. Hospital-associated sepsis, bloodstream infection (BSI), and mortality (>3 days after admission) outcome data were collected for 6 months prior to and 11 months after bundle implementation. Results Most enrolled neonates had a birth weight ≥1.5 kg (2131/2669 [79.8%]). Hospital-associated mortality was lower during the intervention than baseline period (18.0% vs 23.6%, respectively). Total mortality was lower in the intervention than pr...
Human herpesvirus 6B (HHV-6B) is the causative agent of Roseola infantum, and has also been sugge... more Human herpesvirus 6B (HHV-6B) is the causative agent of Roseola infantum, and has also been suggested to play a role in the pathogenesis of febrile seizures in young children, a percentage of whom go on to develop febrile status epilepticus (FSE), but existing data is conflicting and inconclusive. HHV-6A is a distinct species, rarely detected in most parts of the world, but prior studies suggest a higher prevalence in febrile African children. We describe a case control study comparing the frequency of HHV-6A and/or HHV-6B infections in children with febrile seizures (including febrile status epilepticus) and a control group of febrile children without seizures. We recruited children aged 6-60 months admitted with a febrile illness with (cases) or without (controls) seizures presenting within 48 hours of commencement of fever. 3mls of whole blood was centrifuged and plasma stored at -80 C for pooled screening for HHV-6B and HHV-6A by Taqman Real Time PCR. 102 cases and 95 controls w...
Background: Autopsy studies are the gold standard for determining cause-of-death and can inform o... more Background: Autopsy studies are the gold standard for determining cause-of-death and can inform on improved diagnostic strategies and algorithms to improve patient care. We conducted a cross-sectional observational autopsy study to describe the burden of respiratory tract infections in inpatient children who died at the University Teaching Hospital in Lusaka, Zambia. Methods: Gross pathology was recorded and lung tissue was analysed by histopathology and molecular diagnostics. Recruitment bias was estimated by comparing recruited and non-recruited cases. Results: Of 121 children autopsied, 64 % were male, median age was 19 months (IQR, 12-45 months). HIV status was available for 97 children, of whom 34 % were HIV infected. Lung pathology was observed in 92 % of cases. Bacterial bronchopneumonia was the most common pathology (50 %) undiagnosed ante-mortem in 69 % of cases. Other pathologies included interstitial pneumonitis (17 %), tuberculosis (TB; 8 %), cytomegalovirus pneumonia (7 %) and pneumocystis Jirovecii pneumonia (5 %). Comorbidity between lung pathology and other communicable and non-communicable diseases was observed in 80 % of cases. Lung tissue from 70 % of TB cases was positive for Mycobacterium tuberculosis by molecular diagnostic tests. A total of 80 % of TB cases were comorbid with malnutrition and only 10 % of TB cases were on anti-TB therapy when they died. Conclusions: More proactive testing for bacterial pneumonia and TB in paediatric inpatient settings is needed.
Background: In sub-Saharan Africa, there is scanty data on the causes of neonatal sepsis and anti... more Background: In sub-Saharan Africa, there is scanty data on the causes of neonatal sepsis and antimicrobial resistance among common invasive pathogens that might guide policy and practice. Methods: A cross-sectional observational prevalence and etiology study of neonates with suspected sepsis admitted to the neonatal intensive care unit,
Background Patients with subclinical tuberculosis, smear-negative tuberculosis, extrapulmonary tu... more Background Patients with subclinical tuberculosis, smear-negative tuberculosis, extrapulmonary tuberculosis, multidrug-resistant tuberculosis, and asymptomatic tuberculosis are diffi cult to diagnose and may be missed at all points of health care. We did an autopsy study to ascertain the burden of tuberculosis at post mortem in medical inpatients at a tertiary care hospital in Lusaka, Zambia.
Background: A high burden of tuberculosis (TB) occurs in sub-Saharan African countries and many c... more Background: A high burden of tuberculosis (TB) occurs in sub-Saharan African countries and many cases of active TB and drug-resistant TB remain undiagnosed. Tertiary care hospitals provide an opportunity to study TB co-morbidity with noncommunicable and other communicable diseases (NCDs/CDs). We evaluated the burden of undiagnosed pulmonary TB and multi-drug resistant TB in adult inpatients, regardless of their primary admission diagnosis, in a tertiary referral centre.
Diagnosis of tuberculosis in most countries where tuberculosis has a high endemicity relies heavi... more Diagnosis of tuberculosis in most countries where tuberculosis has a high endemicity relies heavily on smear microscopy, a century-old technology. Although it is simple and inexpensive, the specificity and sensitivity is poor, particularly in human immunodeficiency virus (HIV)-positive patients, as well as in children. Furthermore, it cannot differentiate between disease caused by drug-sensitive Mycobacterium tuberculosis (MTB) and disease caused by drug-resistant M. tuberculosis [1]. In sub-Saharan Africa, an average of only 56% of new cases of pulmonary tuberculosis were smear positive in 2010, with Zimbabwe, Swaziland, and Zambia having the lowest sputum smear-positive case detection rates, at 32%, 37%, and 38%, respectively [2], indicating that smear microscopy is suboptimal for use in Africa. Automated liquid culture, the recommended gold standard tuberculosis diagnostic test, is highly specific and sensitive for the detection of tuberculosis and drug-resistant tuberculosis, but it is labor-intensive, time-consuming (2-6 weeks from sample collection to availability of
Background: Human herpesvirus 6B (HHV-6B) is the causative agent of Roseola infantum, and has als... more Background: Human herpesvirus 6B (HHV-6B) is the causative agent of Roseola infantum, and has also been suggested to play a role in the pathogenesis of febrile seizures in young This article is protected by copyright. All rights reserved. Accepted Article children, a percentage of whom go on to develop febrile status epilepticus (FSE), but existing data is conflicting and inconclusive. HHV-6A is a distinct species, rarely detected in most parts of the world, but prior studies suggest a higher prevalence in febrile African children. We describe a case control study comparing the frequency of HHV-6A and/or HHV-6B infections in children with febrile seizures (including febrile status epilepticus) and a control group of febrile children without seizures. Methods We recruited children aged 6-60 months admitted with a febrile illness with (cases) or without (controls) seizures presenting within 48 hours of commencement of fever. 3mls of whole blood was centrifuged and plasma stored at-80 o C for pooled screening for HHV-6B and HHV-6A by Taqman Real Time PCR. Results 102 cases and 95 controls were recruited. The prevalence of HHV-6B DNA detection did not differ significantly between cases (5.8% (6/102)) and controls (10.5% (10/95)) but HHV-6B infection was associated with febrile status epilepticus (OR 15; 95% CI, [1.99-120]; p=0.009). HHV-6A was not detected. Conclusion Prevalence of HHV-6B was similar among cases and controls. Within the febrile seizure group, HHV-6B infection was associated with FSE, suggesting HHV-6B infections could play a role in pathogenesis of FSE.
Background. Betaherpesviruses are established causes of morbidity and mortality in immunosuppress... more Background. Betaherpesviruses are established causes of morbidity and mortality in immunosuppressed patient groups but have been little studied in sub-Saharan Africa, the epicenter of the human immunodeficiency virus (HIV) pandemic. In this region, primary infections with human cytomegalovirus (HCMV) and human herpesvirus type 6 (HHV-6) type 6 are endemic in infancy, but the clinical impact of these infections among pediatric inpatient groups is poorly characterized and assumptive, based largely on data from Western populations. Methods. We used TaqMan polymerase chain reaction to screen sera from a group of 303 pediatric inpatients aged between 3 weeks and 2 years, at the University Teaching Hospital in Lusaka, Zambia. We report the prevalence of DNAemia and viral loads within this patient group, and evaluate possible clinical associations/risk factors for betaherpesvirus infections in these hospitalized children. Results. We detected betaherpesvirus DNAemia in 59.1% (179/303) of children. HCMV was the most prevalent (41.3%), followed by HHV-6B (20.5%), HHV-7 (20.1%), and HHV-6A (0.3%). HIV infection (odds ratio [OR], 2.31; 95% confidence interval [CI], 1.37-3.90; P = .002), being underweight (OR, 1.82; 95% CI, 1.06-3.12; P = .03), and an admission diagnosis of suspected meningitis (OR, 5.72; 95% CI, 1.07-30.5; P = .041) were independently associated with an increased odds of HCMV DNAemia. Conversely, HHV-6B and HHV-7 DNAemia were not associated with HIV, underweight, or admission diagnosis. Median HCMV viral load was moderately but significantly higher in HIV-infected children. Conclusions. Highly prevalent HCMV DNAemia was independently associated with HIV infection and being underweight across all age groups, and was also associated with meningitis, with previously underappreciated implications for the health and development of African children.
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