Manifestations oto-rhino-laryngologiques de la COVID-19 chez l' enfant à Brazzaville / Otorhinolaryngological manifestations of COVID-19 in Children in Brazzaville

Introduction.Les infections respiratoires hautes représentent environ 80% des affections ORL de l'enfant. L'objectif de ce travail était de contribuer à la connaissance des manifestations ORL de la covid-19 chez l'enfant afin d'en améliorer la prise en charge. Patients et méthodes. Il s'est agi d'uneétudedescriptive de 12 mois incluant les dossiers des enfants âgés de moins de 18 ans symptomatiques et testés positifs à la COVID-19 par RT-PCR. Il s'agissait des enfants reçus en consultation dans les services d'otorhinolaryngologie de l'hôpital de Référencede Talangaï et du CHU de Brazzaville. Tous les prélèvements étaient acheminés au laboratoire national de santé publique où le diagnostic était fait par RT-PCR. Résultats.Sur un total de 1080 enfants consultés pour une symptomatologie respiratoire ORL, seuls 21 étaient testés positifs à la COVID-19 représentant une prévalence de 1,9%. L'âge moyen était de 12,6 ans ± 5,7 (extrêmes: 3 ­17 ans) avec un ratio de 0,9 légèrement en faveur des filles. La tranche d'âge de 13 à 18 ans était la plus représentative (n=13, soit 61,8%) suivie de 9 à 13 ans (n=4, soit 19,1%) correspondant aux enfants ayant un antécédent personnel d'atopie (80,9%). La symptomatologie était dominée par l'angine érythémateuse (n=17, soit 80,9%) suivie de la rhinopharyngite (n=3, soit 14,4%) et du syndrome de Marschall (n=1, soit 4,7%). Tous les enfants étaient orientés auprès des services habiletés à la prise en charge mais seuls 13 d'entre eux (61,9%) étaient contre-référés et déclarés guéris après un contrôle RT-PCR négatif. Conclusion.Si l'angine érythémateuse domine la symptomatologie COVID-19 chez l'enfant, il en ressort que le syndrome de Marschall reste une exception clinique.

Introduction. Upper respiratory infections represent about 80% of ENT diseases in children. The objective of this work was to contribute to the knowledge of the ENT manifestations of covid-19 in children in order to improve their management.Patients and methods. This was a 12-month descriptive study including the files of symptomatic children aged 0 to 18 who tested positive for COVID-19 by RT-PCR. These were children seen in consultation in Introduction. Upper respiratory infections represent about 80% of ENT diseases in children. The objective of this work was to contribute to the knowledge of the ENT manifestations of covid-19 in children in order to improve their management. Patients and methods. This was a 12-month descriptive study including the files of symptomatic children aged 0 to 18 who tested positive for COVID-19 by RT-PCR. These were children seen in consultation in the otorhinolaryngology departments of the Talangaï Reference Hospital and the Brazzaville University Hospital. All the samples were sent to the national public health laboratory where the diagnosis was made by RT-PCR. Results. Out of a total of 1080 children consulted for ENT respiratory symptoms, only 21 tested positive for COVID-19, representing a prevalence of 1.9%. The average age was 12.6 years ± 5.7 (extremes: 3 ­17 years) with a ratio of 0.9 slightly in favor of girls. The age group of 13 to 18 years was the most representative (n=13, or 61.9%) followed by 9 to 13 (n=4, or 19%) corresponding to children with a personal history of atopy (80.9%). Symptoms were dominated by erythematous angina (n=17, or 80.9%) followed by nasopharyngitis (n=3, or 14.4%) and Marschall's syndrome (n=1, or 4.7%). All the children were referred to the care services but only 13 of them (61.9%) were cross-referred and declared cured after a negative RT-PCR control. Conclusion. If angina dominates the COVID-19 symptomatology, it emerges as Marschall's syndrome remains a clinical exception the otorhinolaryngology departments of the Talangaï Reference Hospital and the Brazzaville University Hospital. All the samples were sent to the national public health laboratory where the diagnosis was made by RT-PCR. Results. Out of a total of 1080 children consulted for ENT respiratory symptoms, only 21 tested positives for COVID-19, representing a prevalence of 1.9%. The average age was 12.6 years ± 5.7 (extremes: 3 ­17 years) with a ratio of 0.9 slightly in favor of girls. The age group of 13 to 18 years was the most representative (n=13, or 61.9%) followed by 9 to 13 (n=4, or 19%) corresponding to children with a personal history of atopy (80.9%). Symptoms were dominated by erythematous angina (n=17, or 80.9%) followed by nasopharyngitis (n=3, or 14.4%) and Marschall's syndrome (n=1, or 4.7%). All the children were referred to the care services but only 13 of them (61.9%) were cross-referred and declared cured after a negative RT-PCR control. Conclusion. If angina dominates the COVID-19 symptomatology, it emerges as Marschall's syndrome remains a clinical exception.

The burden of healthcare-associated infection in Moroccan hospitals: systematic review and meta-analysis

Healthcare-associated infections (HAI), also referred to as nosocomial infections, is defined as an infection acquired in a hospital setting. This infection is considered a HAI if it was not present or incubating at the time of admission. This includes infections acquired in the hospital but appearing after discharge, and also occupational infections among staff of the facility. HAI are a major patient safety measure to be considered in hospitals.

Causes infectieuses de décompensation du diabète: « un prédateur infectieux se cache chez tout diabétique en Afrique¼ / Infectious causes of diabetes decompensation: "an infectious predator hides in any diabetic in Africa"

Introduction : Les infections survenant chez les sujets diabétiques ont été longtemps considérées comme une des causes de l'accroissement de la morbidité et de la mortalité. Elles représentent un motif de plus en plus fréquent d'admission dans le service de médecine interne du Centre Hospitalier Régional et Universitaire de Thiès. Les mécanismes sont plus ou moins élucidés par l'influence de l'hyperglycémie sur les fonctions des polynucléaires neutrophiles. Le but de cette étude est de déterminer les particularités épidémiologiques des infections chez les diabétiques. Patients et Méthode : Il s'agissait d'une étude rétrospective avec recueil de données réalisée sur 24 mois (1er janvier 2016 au 31 décembre 2018) au service de Médecine Interne du Centre Hospitalier Régional et Universitaire de Thiès. Cette étude incluait tous les patients diabétiques quel que soit le genre et le type de diabète, âgés de 15 ans et plus, présentant une infection comme facteur principal de décompensation. Résultats : Durant la période d'étude 2350 patients ont été hospitalisés dans le service de médecine interne dont 390 diabétiques. Parmi eux, 138 patients ont répondu à nos critères d'inclusion soit une prévalence de 35,38%. La moyenne d'âge de nos malades était de 53,49 ans ± 15,65 ans avec un sex-ratio H/F était de 0,70 en faveur des femmes (81 femmes contre 57 hommes). Les infections responsables de la décompensation étaient à localisation cutanéo-muqueuse (30,4%), pulmonaire (22,4%), uro-génitale (18,11%), buccodentaire (10,11%), ORL (1,44%), phanérienne (0,72%). Ailleurs, une infection aux pieds était retrouvée chez 43 patients soit 31,15% des cas. Plusieurs infections pouvaient être présentes chez un même malade. Le diabète était déséquilibré dans 86,2 % (n=94) des cas avec une HbA1c moyenne à 10, 5 % à l'admission Nous n'avons pas noté de corrélation entre l'infection et l'ancienneté du diabète (p =0, 60), l'infection et le type de diabète (p = 0,50) et paradoxalement entre l'infection et le déséquilibre du diabète (p=0,70). Conclusion : Le dépistage des infections chez le diabétique en déséquilibre chronique ou diabétique de novo doit être systématique car généralement ces infections peuvent être asymptomatiques.

Introduction: Infections in people with diabetes have long been considered one of the causes of increased morbidity and mortality. They represent an increasingly frequent reason for admission to the Department of Internal Medicine of the Regional and University Hospital of Thies. The mechanisms are more or less elucidated by the influence of hyperglycemia on neutrophil polynuclear functions. The purpose of this study is to determine the epidemiological characteristics of infections in diabetics. Method: This was a retrospective study with data collected over 24 months (1 January 2016 to 31 December 2018) at the Internal Medicine Department of the Regional and University Hospital of Thies. This study included all diabetic patients, regardless of gender and type of diabetes, aged 15 years and older, with an infection as the primary decompensation factor. Result: During the study period 2,350 patients were hospitalized in the Internal Medicine Department, 390 of whom were diabetic. Of these, 138 patients met our inclusion criteria, a prevalence of 35.38%. The average age of our patients was 53.49 years 15.65 years with a sex-ratio H/F was 0.70 in favor of women (81 Women versus 57 Men). The infections responsible for decompensation were dermal localization (30.4%), pulmonary (22.4%), urogenital (18.11%), oral (10.11%), ENT (1.44%), phanerian (0.72%). Elsewhere, a foot infection was found in 43 patients or 31.15% of cases. Several infections could be present in the same patient. Diabetes was unbalanced in 86.2% (n=94) of cases with an average HbA1c of 10.5% at admission We did not find a correlation between the infection and the age of diabetes (p =0, 60), the infection and the type of diabetes (p = 0.50), and paradoxically between the infection and the imbalance of diabetes (p = 0.70). Conclusion: The detection of infections in diabetics in chronic imbalance or de novo diabetics must be systematic because generally these infections can be asymptomatic.

La pneumopathie aigue bactérienne communautaire du sujet âge en pneumologie au centre hospitalier et universitaire du point-g, Bamako-mali / Community acute bacterial pneumonitis of the subject age in pulmonology at the Point-g hospital and university center, Bamako- Mali

Introduction : Les pneumopathies aiguës bactériennes (PAB) communautaires sont des infections respiratoires basses aiguës, non suppurées, non tuberculeuses du parenchyme pulmonaire acquises au sein de la communauté. Elles ont une présentation clinique atypique et un mauvais pronostic chez le sujet âgé. Matériels et Méthodes : Il s'agissait d'une étude transversale prospective menée au service de pneumologie du centre hospitalier universitaire (CHU) du Point-G, du 30 Octobre 2018 au 30 Septembre 2019. L'objectif était de déterminer les particularités cliniques, étiologiques, thérapeutiques et évolutives de la PAB chez le sujet âgé. Ont été inclus tout âge ≥ 65 ans, présentant des signes cliniques et radiologiques d'une PAB Résultats : Durant la période d'étude 85 patients répondaient aux critères d'inclusion sur 178 hospitalisés. Le sex-ratio était de 3/1. Environ 2/3 étaient tabagiques et 11% était positif au VIH. La fièvre n'était pas constante enregistrée dans 51,76% des cas. Les signes respiratoires étaient dominés par la toux (96, 47%), la dyspnée (94, 11%) et extra respiratoires par le trouble de la conscience. Le Klebsiellapneumoniae était le germe le plus retrouvé. L'antibiotique le plus utilisé était l'amoxicilline-acide clavulanique. La durée moyenne d'hospitalisation était de 9 jours. La mortalité était de 19%. Conclusion: La PAB chez le sujet âgé est d'une symptomatologie clinique frustre. Elle est grave avec une surmortalité

Introduction: Community-acquired acute bacterial pneumonia (ABP) is an acute, non-suppurative, non-tuberculosis lower respiratory infection of the lung parenchyma acquired within the community. They have an atypical clinical presentation and a poor prognosis in the elderly. Materials and Methods: This was a prospective cross-sectional study conducted in the Pneumology department of the University Hospital Center (CHU) of Point-G, from October 30, 2018, to September 30, 2019. The objective was to determine the clinical, etiological, therapeutic and progression of BAP in the elderly. Were included any age ≥ 65 years, presenting clinical and radiological signs of a PAB. Results During the study period, 85 patients met the inclusion criteria out of 178 hospitalized. The sex ratio was 3/1. About 2/3 were smokers and 11% were HIV positive. Fever was not constant recorded in 51.76% of cases. Respiratory signs were dominated by cough (96.47%), dyspnea (94.11%) and extra respiratory by impaired consciousness. Klebsiella pneumoniae was the most found germ. The most commonly used antibiotic was amoxicillin-clavulanic acid. The average length of hospitalization was 9 days. Mortality was 19%. Conclusion: The PAB in the elderly is of a frustrating clinical symptomatology. It is serious with excess mortality

Infections respiratoires aigües virales chez les enfants de moins de 15 ans à Conakry: étiologies et prise en charge / Acute viral respiratory infections of children aged 0-15 years in the city of Conakry: aetiologies and management

Introduction. Les infections respiratoires aiguës (IRA) sont des pathologies ubiquitaires très fréquentes, touchant aussi bien les adultes que les enfants. L'inclusion des vaccins conjugués, contre les pneumocoques et l'Haemophilus influenzae type B a modifié l'épidémiologie en réduisant la prévalence de ces bactéries dans les atteintes infectieuses respiratoires, la prédominance virale est devenue la règle. Notre travail avait pour objectif d'identifier les principaux virus responsables d'IRAS chez les enfants au service de pédiatrie de Donka de décrire la prise en charge des enfants. Patients et méthodes. Étude descriptive prospective de 6 mois allant du 01 Avril au 30 Septembre 2022 incluant les enfants admis au service pour IRAS dont une PCR a été réalisée sur prélèvement nasopharyngé. Résultats. Une proportion de 3,3% des 1584 enfants avaient une IRA virale. 51,1% avaient moins de 5 ans. La proportion des filles était de 63,05% et 76,09% des enfants étaient vaccinés selon le programme élargi de vaccination (PEV). Les motifs de consultation les plus fréquents étaient : fièvre, difficulté respiratoire, asthénie physique, myalgie et toux. La bronchiolite était le diagnostic le plus fréquent. Le diagnostic clinique et radiologique était dominé par la bronchiolite, la bronchopneumonie et la pneumonie. La PCR était positive dans 3,26% des cas dont 2/3 pour le virus influenza et 1/3 pour le coronavirus. Le paracétamol, l'oxygénation, l'antibiothérapie et le sérum physiologique dominaient le traitement. Conclusion. La prévalence des IRA reste élevée avec une faible implication virale. Une étude plus poussée comprenant la microbiologie des prélèvements nasopharyngés et la PCR est nécessaire

Introduction. Acute respiratory infections (ARI) are very common ubiquitous pathologies, affecting both adults and children. The inclusion of conjugate vaccines, against pneumococci and Haemophilus influenzae type b, has changed the epidemiology by reducing the prevalence of these bacteria in respiratory infectious diseases, viral predominance has become the rule. The aim of our study was to identify the main viruses responsible for ARI in children at the Donka Pediatric Department and to secribe the management of patients. Patients and methods. This was a prospective descriptive study of 6 months from 01 April to 30 September 2022 including children admitted to the service for IRAS whose PCR was performed on nasopharyngeal swab. Results. A proportion of 3.3% of the 1584 children had viral SARI. 51.1% were under 5 years of age. The proportion of girls was 63.05% and 76.09% of children were vaccinated according to the EPI. The most common reasons for consultations were fever, difficulty breathing, physical asthenia, myalgia and cough. Bronchiolitis was the most common diagnosis, Clinical and radiological diagnosis was dominated by bronchiolitis, bronchopneumonia and pneumonia. PCR was positive in 3.26% of cases including 2/3 for influenza virus and 1/3 for coronavirus. Paracetamol, oxygenation, antibiotic therapy and saline dominated treatment. Conclusion. The prevalence of SARI remains high with low viral involvement. Further study including bacteriology of nasopharyngeal specimens and PCR is needed

Phenotypic and genotypic characterization of plasmid-mediated AmpC beta-lactamases in enteric Gram-negative bacteria from patients with lower respiratory tract infections in a tertiary hospital, southwest Nigeria

Background: AmpC or class C or group 1 beta lactamases are class C cephalosporinases that hydrolyse a wide variety of beta-lactam antibiotics including alpha methoxy beta-lactams (cefoxitin), narrow and broad spectrum cephalosporins. This study was conducted to characterize plasmid-mediated AmpC producing enteric Gram- negative bacteria from patients with lower respiratory tract infections in Obafemi Awolowo University Teaching Hospital Complex (OAUTHC) Ile Ife, Osun State, Nigeria Methodology: A total of 149 patients with clinical features of lower respiratory tract infections (LRTI) were selected by simple random sampling for the study. All Gram-negative isolates recovered from standard microbiological cultures of respiratory specimens of these patients were tested against cefoxitin, third generation cephalosporins (3GCs), and other antibiotics using the disc diffusion AST method, and also screened for production of AmpC beta-lactamases phenotypically by the CLSI method. Plasmid DNA extraction was carried out on twenty-nine cefoxitin-resistant selected isolates using the Kado and Lin method, while genotypic detection of plasmid-mediated AmpC gene was carried out by the polymerase chain reaction (PCR) assay. Results: The results showed that 204 (43.3%) of 471 isolates recovered from the 149 selected patients were resistant to 3GC in the AST assay, among which 121 (59.3%) were resistant to cefoxitin, and 189 of the 471 isolates (40.1%) were AmpC producers. The AmpC producers concurrently showed multiple resistance pattern to other antibiotics tested in this study. Ninety six percent of the 29 selected isolates for plasmid analysis contained plasmids, 45% of which amplified positive on PCR for CMY, 38% for FOX, and 31% for ACC types of AmpC genes. Conclusion: This study showed a high degree of antibiotic resistance among enteric Gram-negative bacteria recovered from patients with LRTIs, as well as high degree of plasmid-encoded AmpC genes responsible for this high antibiotic resistance among the isolates. Proper antibiotic policy and regulation are required to limit the spread of plasmid mediated AmpC ß-lactamase

The use of disinfection tunnels or disinfectant spraying of humans as a measure to reduce the spread of the SARS-CoV-2 virus

In endeavouring to mitigate the spread of the SARS-CoV-2 virus, a concerning practice of spraying individuals with disinfectant via so-called 'disinfection tunnels' has come to light. The Allergy Society of South Africa supports the World Health Organization in strongly condemning all human spraying, owing to lack of efficacy and potential dangers, especially to patients with coexisting allergic conditions

Microbial etiology of community acquired pneumonia among infants and children admitted to zagazig university pediatric hospital

Background: While recognizing the etiology of community-acquired pneumonia is necessary for formulating local antimicrobial guidelines, limited data is published about this etiology in Egyptian pediatric patients. The aim of this study is to elucidate the common bacterial pathogens causing CAP among immunocomptent infants and preschool children admitted to Zagazig university Pediatric hospital. Methods: 48 infant and preschool children admitted to pediatric hospital of Zagazig university and presented with signs of pneumonia according to WHO. Etiological agents were identified using conventional bacteriological identification methods and Ig M antibodies detection against common a typical bacteria and respiratory viruses. Results: Staph. Aureus 35.4% is the most common pathogen detected in sputum regardless the age group .In blood culture results negative results in most cases of pneumonia 62.5%. Staph. Aureus is the most common pathogen detected in blood culture in positive cases regardless the age group 18.7% , E Coli 6.25%, Klebsiella 2.08.In Serology results significant difference according to age in viral pneumonia occurrence and non significant difference in bacterial pneumonia based on serological findings with higher diagnosis of Legionella pneumophila 33.33% as a causative organism. Conclusion: This study provides preliminary data regarding the spectrum and frequency of microorganisms causing CAP in infants and preschool children

Molecular detection of enterovirus D68 among children with acute respiratory tract infection in Ghana

Background: Acute respiratory tract infections of viral origin remain a leading cause of morbidity, mortality and economic loss regardless of age or gender. A small number of acute respiratory tract infection cases caused by enterovirus D68 (EV-D68) have been reported regularly to Centers for Disease Control and Prevention since 1987 by countries in North America, Europe and Asia. However, in 2014 and 2015, the number of reported confirmed EV-D68 infections was much greater than in previous years. The National Influenza Centre (NIC), Ghana carries out surveillance of respiratory infections, focusing on those caused by influenza virus; however, there is inadequate information on other viruses causing respiratory infections in Ghana, including EV-D68.Objectives: To investigate the association of EV-D68 with Severe Acute Respiratory Infections (SARI) and Influenza-Like Illness (ILI) in Ghana.Methods: This was a retrospective cross-sectional study which involved archived human respiratory specimens stored at ­80 °C at the NIC from 2014 to 2015. Using a random sampling method, oropharyngeal and nasopharyngeal swabs from patients with SARI and ILI that were negative by real-time PCR for human influenza viruses were screened for EV-D68 using real-time reverse transcription-polymerase chain reaction (rRT-PCR).Results: Enterovirus D68 was detected in 4 (2.2%) out of 182 SARI samples tested. EV-D68 was detected in children younger than 5 years (4 ­ 100% of positives) and was not detected in children older than 5 years. Enterovirus D68 was detected more frequently in SARI cases (3%) than in ILI cases (1.2%).Conclusion: This study has shown for the first time the presence of EV-D68 in acute respiratory infections in Ghana. The results confirmed minimal EV-D68 circulation in the Ghanaian population

Treatment of bacterial respiratory infections

Acute respiratory tract infections are one of the most common reasons that result in general practitioner consultations. Viruses are the most common cause of both upper- and lower respiratory tract infections,however pneumonia is usually bacterial in origin.When from a bacterial origin,S.pneumoniae, non-typical H. influenzae and M. catarrhalis are mostly the cause of acute otitis media, acute bacterial rhinosinusitis and acute exacerbations of chronic bronchitis, while S. pyogenes are usually the presenting organisms in acute pharyngotonsillitis. B. pertussis, C. pneumoniae or M. pneumoniae are common organisms associated with acute bronchitis and community-acquired pneumonia (atypical). Pneumonia is a serious life-threatening condition, and organisms mostly associated with it include S. pneumoniae, S. aureus, H. influenzae type b, K. pneumoniae, Legionella species or P. jirovecii.Common symptoms and signs include coughing, facial pain, fever, nasal congestion, sore throat,dyspnoea,and tachypnoea.Most of the acute uncomplicated respiratory tract infections are self-limiting in nature. It is in many instances a challenge to distinguish between acute bronchitis and pneumonia because of the similarity in presenting symptoms. Antibiotics are in many instances inappropriately prescribed to treat the infections resulting in the burden of antibiotic resistance patterns within the community.Treatment options are usually amoxicillin, amoxicillin-clavulanic acid or the 2nd or 3rd generation cephalosporins

A study of self-reported handwashing practices of caregivers in relation to acute respiratory infections and gastroenteritis in infants in a peri-urban community in KwaZulu-Natal Province, South Africa

Background. Handwashing is a recognised cost-effective intervention for the prevention of common childhoodinfections, including pneumonia and diarrhoeal disease. Globally, handwashing practices may be poor and little is known about handwashing practices in South Africa.Objectives. To describe and compare handwashing practises of caregivers whose infants are admitted with acute gastroenteritis and acute lower respiratory tract infection with those of healthy infants who are attending primary healthcare clinics for routine immunisation.Methods. A cross-sectional study of self-reported handwashing practices was conducted among caregivers of infants from the Vulindlela area,Pietermaritzburg. Respondents were interviewed regarding household structure, services and handwashing practices.Results. During the 3-month study period, 137 respondents were interviewed. Of these, 41 (30%) had infants with pneumonia, 41 (30%) with diarrhoea and 55 (40%) had healthy infants. A high rate of handwashing with soap and water (81.8%) was found in this study, with 58.4% of the respondents using running rather than stagnant water. Logistic regression identified some variables associated with higher odds of having a healthy infant, namely: a monthlyhousehold income >ZAR2 000 (odds ratio (OR) 4.74; 95% confidence interval (CI)1.99 - 11.25); washing hands with soap and running water (OR 3.88; 95% CI 1.55 - 9.76); washing hands before eating (OR 7.41; 95% CI 0.79 - 68.76), and washing hands after household chores (OR 9.24; 95% CI 1.85 - 46.25).Conclusion. A higher than anticipated number of participants washed their hands with soap and running water and at critical moments

Profil des affections respiratoires du sujet âgé au service de pneumologie du CHU de Brazzaville

Les défaillances du système immunitaire induites par l'âge avancé favorisent le développement d'affections diverses en association avec les comorbidités et les mauvaises conditions socioéconomiques.L'objectif de cette étude était de décrire les caractéristiques cliniques et évolutifs du sujet âgé hospitalisé en milieu pneumologique Congolais. Matériels et Méthodes:Nous avons réalisé une étude rétrospective, comparative entre groupes de patients : 4008 patients âgés de moins de 65ans et 570 hospitalisés pour une pathologie respiratoire du service de pneumologie du centre hospitalier universitaire (CHU) de Brazzaville. Résultats:Sur les 4578 dossiers enregistrés, la proportion de patients âgés de plus 64ans a été 12,45% (570 cas/4578). L'analyse multi variée a permis de retenir les résultats suivants : les sujets âgés étaient plus de sexe masculin (OR=1,22[1,01-1,48], p=0,03), avec comme co morbité une HTA (OR=1,95[1,37-2,79], p<0,001). Le statut VIH de ces patients était inconnu (OR=0,16[0,11-0,25], p<0,001). La tuberculose était moins retrouvée avec OR=0,50[0,38-0,66], p<0,001 par contre La BPCO, Le Cancer broncho-pulmonaire et pleural étaient prépondérant respectivement avec des OR=5,95[3,49-10,14], p<0,001 ; OR=3,42[2,08-5,66] et OR=4,15[2,20-7,81]. Le taux de mortalité était de 23,68% chez les sujets âgés versus 19,14% chez les jeunes (p<0,001).Conclusion : Le sujet âgé hospitalisé au service de pneumologie présentait des pathologies liées au tabac, et des pathologies tumorales. L'infection tuberculeuse était moins retrouvée

Feeding patterns of infants admitted with lower respiratory tract infections in an HIV-endemic area

Background. Lower respiratory tract infections (LRTIs) remain a major cause of mortality and morbidity in infants in South Africa (SA).Exclusive breastfeeding has been shown to decrease mortality and morbidity in infants with LRTIs, especially in the context of HIV/AIDS.Major effort has been put into educating HIV-positive mothers on the benefits of exclusive breastfeeding within effective prevention of mother-to-child transmission (PMTCT) programmes.Objectives. To determine the feeding practices among infants admitted with LRTIs in an HIV-endemic area.Methodology. The study was a retrospective chart review of all infants admitted with a diagnosis of LRTI between 1 January 2015 and 31December 2015 at King Edward VIII Hospital, Durban, SA. Data on feeding patterns, socioeconomic status, maternal HIV status and clinical outcomes of LRTI admissions were collected.Results. Of the 308 infants enrolled, 63% were male. Exclusive breastfeeding rates of those aged <6 months with LRTIs were higher thant hose found in previous studies; however, these feeding patterns were significantly associated with the HIV status of the mother(p=0.003).Mothers who were HIV-negative were twice as likely to breastfeed as those who were HIV-positive (odds ratio 2.25; 95% confidence interval 1.32- 3.88). There was no association between the type of feeding and the clinical outcomes for LRTIs.Conclusion. Maternal HIV status influenced the feeding patterns of infants admitted with LRTIs with lower exclusive breastfeeding rates in the HIV-exposed group. Despite extensive efforts to promote breastfeeding within effective PMTCT programmes, HIV-positive mothers are still not harnessing the benefits that exclusive breastfeeding provides

Review of supplemental oxygen and respiratory support for paediatric emergency care in sub-Saharan Africa

Introduction:In African countries, respiratory infections and severe sepsis are common causes of respiratory failure and mortality in children under five years of age. Mortality and morbidity in these children could be reduced with adequate respiratory support in the emergency care setting. The purpose of this review is to describe management priorities in the emergency care of critically ill children presenting with respiratory problems. Basic and advanced respiratory support measures are described for implementation according to available resources, work load and skill-levels.Methods:We did a focused search of respiratory support for critically ill children in resource-limited settings over the past ten years, using the search tools PubMed and Google Scholar, the latest WHO guidelines, international 'Advanced Paediatric Life Support' guidelines and paediatric critical care textbooks.Results:The implementation of triage and rapid recognition of respiratory distress and hypoxia with pulse oximetry is important to correctly identify critically ill children with increased risk of mortality in all health facilities in resource constrained settings. Basic, effective airway management and respiratory support are essential elements of emergency care. Correct provision of supplemental oxygen is safe and its application alone can significantly improve the outcome of critically ill children. Non-invasive ventilatory support is cost-effective and feasible, with the potential to improve emergency care packages for children with respiratory failure and other organ dysfunctions. Non-invasive ventilation is particularly important in severely under-resourced regions unable to provide intubation and invasive mechanical ventilation support. Malnutrition and HIV-infection are important co-morbid conditions,associated with increased mortality in children with respiratory dysfunction.Discussion:A multi-disciplinary approach is required to optimise emergency care for critically ill children in low-resource settings. In this context, it is important to consider aspects of training of staff, technical support and pragmatic research

Association between HIV and proven viral lower respiratory tract infection in paediatric intensive care unit (PICU) patients at Inkosi Albert Luthuli Central Hospital (IALCH), Durban, South Africa

Acute viral respiratory infections are common within the paediatric population.Nucleic Acid amplification tests can identify a wide range of respiratory viruses. Virally infected patients can now be diagnosed early and more accurately in the acute phase of illness.Objectives:The objective was to examine the association between HIV status and mortality in children with viral lower respiratory tract infection (LRTI) and to delineate the profile of viruses identified.Methods:A retrospective review of charts of children aged from birth to 10yrs of age admitted to PICU at IALCH with a viral lower respiratory tract infection from December 2010 to May 2015 was conducted. Only patients who had a positive respiratory viral multiplex test were eligible for entry into the study. Patients were divided into HIV positive; and negative; patients and mortality in the two groups was assessed.Results:Three hundred and thirty eight records were entered into the study. Sixty five patients tested HIV positive (19.23%) and 273 tested HIV negative (80.77%).There was a total of 55 deaths among the charts that were reviewed. Of these 55 deaths, 12 were amongst the 65 HIV positive patients (18.46%), and 43 amongst the 273 HIV negative patients (15.75%). The difference in mortality according to HIV status was not statistically different (p = 0.595).RSV was the most prevalent virus identified overall, with adenovirus being most prevalent in the HIV positive group.Conclusion:The results showed that patients with viral LRTI requiring respirato

Childhood respiratory morbidity and cooking practices among households in a predominantly rural area of Ghana

Background: Household air pollution is a leading risk factor for respiratory morbidity and mortality in developing countries where biomass fuel is mainly used for cooking. Materials and Method: A household cross-sectional survey was conducted in a predominantly rural area of Ghana in 2007 to determine the prevalence of respiratory symptoms and their associated risk factors. Household cooking practices were also assessed as part of the survey. Results: Household heads of twelve thousand; three hundred and thirty-three households were interviewed. Fifty-seven percent 7006/12333) of these households had at least one child less than five years of age. The prevalence of symptoms of acute lower respiratory infections (ALRI) was 13.7% (n= 957; 95% CI 12.8 - 15.5%). A majority (77.8%; 95% CI; 77.7 - 78.5%) of households used wood as their primary fuel. Majority of respondents who used wood as their primary fuel obtained them by gathering wood from their neighborhood (95.6%; 9177/9595) and used a 3-stone local stove for cooking (94.9%; 9101/9595). In a randomly selected subset of respondents; females were the persons who mostly gathered firewood from the fields (90.8%; 296/326) and did the cooking (94.8%; 384/406) for the household. Conclusion: Symptoms of ALRI reported by caregivers is high in the Kintampo area of Ghana where biomass fuel use is also high. There is the need to initiate interventions that use improved cook stoves and to test the health benefits of such interventions

Clinical Presentation of Infants Hospitalised with Pertussis

Background. Despite the widespread use of pertussis vaccine; there has been a resurgence of pertussis cases in developed and developing countries. South Africa lacks data regarding clinical presentation and healthcare impact of pertussis.Objectives. To describe the clinical presentation and healthcare impact in hospitalised infants with confirmed pertussis.Methods. This was a retrospective cohort study; conducted in Bloemfontein between April 2008 and September 2012. Infants with laboratory-confirmed pertussis (group 1; N=102); were compared with infants with a negative pertussis result (group 2; N=104) and infants with a lower respiratory tract infection of unspecified aetiology (group 3; N=104). The following data were extracted from the clinical records: demographics; presenting symptoms; paediatric intensive care unit (PICU) admission; length of stay in the general ward and PICU; overall hospital stay and outcome.Results. There were no significant demographic differences between the groups. A larger percentage of infants in group 1 (n=41; 40%) required PICU admission compared with group 2 (n=37; 36%) and group 3 (n=20; 19%). The median PICU stay of group 1 was longer (11 days) compared with group 2 (6 days) and group 3 (5 days). The presence of cough and post-tussive vomiting was significantly higher in group 1 than groups 2 and 3. There was no significant difference in mortality between the groups. Conclusion. Pertussis results in significant morbidity in infants. Measures to identify and manage this vaccine-preventable disease should be considered at a national level

Chlamydophila pneumoniae; Mycoplasma pneumoniae; and Influenza in Children with Respiratory Infections in Alexandria; Egypt

Introduction: Acute respiratory infections (ARI) are the leading cause of pediatric morbidity and mortality worldwide. Information about etiological agents of ARI in developing countries is still limited. Methodology: Throat swabs collected from children hospitalized with ARI between December 2009 and May 2010 were investigated for Chlamydophila pneumoniae; Mycoplasma pneumoniae; and influenza viruses by molecular analyses. Results: This study conducted in Alexandria; Egypt; was designed to determine the prevalence of several microorganisms in 156 children hospitalized with ARI. Overall; samples from 76 individuals (49) were found to be positive for at least one pathogen; and 10 of them were positive for two agents. C. pneumoniae was the most commonly detected agent; followed by M. pneumonia and H1N1 pandemic influenza virus. Positivity for C. pneumoniae was associated with colder months and mild disease of the upper respiratory tract such as laryngitis. Conclusions: Further studies are needed to identify other possible agents of ARI (e.g.; RSV; adenoviruses; other bacterial infections) in this population and to better understand the causal role of atypical bacteria detected in respiratory samples

Risk Factors for Acute Respiratory Tract Infections in Under-Five Children in Enugu Southeast Nigeria

Background: Acute respiratory tract infections (ARIs) constitute the major causes of mortality and morbidity among under-five children of the developing world. The prevalence of ARIs is determined individually or collectively by a number of factors which may be prevalent in our environment. Aim: The present study is aimed to determine the risk factors that affect the prevalence of ARIs in under-five children in Enugu. Subjects and Methods: A cross-sectional study of 436 under-five children diagnosed with ARI was carried out in three hospitals in Enugu. Participants were consecutively enrolled after being diagnosed as a case of ARI. Structured pro foma was used to collect sociodemographic characteristics; anthropometric data and risk profile. Data were analyzed using Epi info version 6.0 and significant probability value was 5 . Results: A total of 436 patients were enrolled for the study 224 males and 212 females M: F 1.06:1. The mean age of the population was 18.75(13.38) months and there were 31.6 (138/436) cases of pneumonia 6.9 (30/436) cases of bronchiolitis and 61.5 (268/436) cases of acute upper respiratory tract infections. Children less than 20 months accounted for 60.9 (84/138 cases) of pneumonia; 86.7 (26/30 cases) of bronchiolitis; and 64.5 (173/268 cases) of acute upper respiratory tract infections. Pneumonia was noted in about 75.7 (56/74) of inadequately nourished children compared to 22.6 (82/362) in adequately nourished children. Other risk factors identified in the study include inadequate breast feeding; poor immunization statues; attendance to daycare centers; large family size; poor parental educational statues; parental smoking; living in the urban area and use of biofuels. Conclusion: ARIs are affected by socio-demographic and socio-cultural risk factors; which can be modified with simple strategies. It is recommended that control program for ARIs should be multifaceted with a strong political will

Evaluation of IgG antibodies against respiratory syncytial virus (RSV), and associated risk factors for severe respiratory tract infections in pre-school children in North-central, Nigeria

Background: Childhood mortality and morbidity due to RSV is increasing. Our current study was aimed at determining the sero-prevalence rate of RSV IgG antibodies and investigates certain known risk factors for RSV disease severity in infants and pre-school children presenting with various forms of respiratory tract infections in Ilorin, Nigeria. Materials and Methods: About 280, children and 30, aged matched controls were enrolled into the study at the specialist hospital Ilorin. Blood testing for anti RSV IgG was done using a commercial ELISA kit by IVD Research Inc® Carlsbad. California U.S.A. Information regarding Nutritional status, socio-economic status and other demographic variables were collected. Results: A prevalence rate of 85.7% was recorded among tested children and 23.3%, in controls, across age groups and gender. A statistically significant difference in age groups were recorded among patients with LRTI, (p <0.05), age <1 41%, age 1 <5, 27.6%. This was also the case for children with SRTI (Pneumonia and Bronchiolitis), with age < 1yr, 9%, and 1 <5yr, 19.8%. Analysed risk factors for disease severity showed thatnutritional status of children were statistically significant for disease severity, p-value, 0.039 (Chi square test). Conclusions: We report a high level of exposure to RSV in infancy and early childhood among children from a representative population in a major central Nigerian City, further studies into neutralising antibody levels and subtype distribution of RSV are advocated