ABSTRACT
Aims: The usefulness of rapid oral fluid HIV antibody tests has rarely been evaluated in exposed babies. Study Design: A diagnostic survey comparing the performance of oral fluid HIV antibody test and the routine rapid blood screening test. Place and Duration of Study: University College Hospital, Ibadan and Nigerian Institute of Medical Research, Lagos, between May 2010 and April 2011. Methodology: The study involved children aged less than 18 months referred for screening in two large HIV care programmes in Nigeria using rapid antibody tests - an oral fluid test (Test A) and the routine blood test (Test B). The testing was blinded and HIV status was confirmed using DNA PCR. Results: A total of 94 children were studied with ages ranging from 0.13 to less than 18months. Out of the 94 parallel tests, when compared with DNA PCR, there were 7 (7.5%) discordant results. Test A gave one false positive, one false negative and no indeterminate result. Test B gave four false positive, one false negative and two indeterminate results. Test A had a sensitivity of 93.3%, specificity of 98.7%, positive predictive value of 93.3% and negative predictive value of 98.7% compared with Test B which had 90.0%, 92.9%, 60.0% and 98.7% respectively. Among the caregivers 88 (93.6%) preferred oral fluid testing to blood as it is painless and easy to perform. Conclusion: Compared with the rapid antibody blood test, the oral fluid test correlates better with DNA PCR in detecting the absence of infection in HIV exposed babies. Given this performance, it may be useful in expanding testing in HIV exposed children in settings where there are challenges with early infant diagnosis.
ABSTRACT
Fever is a common complaint in infancy, and bacteraemia is one of the more serious causes of such fever. However, there exists scanty data on risk of bacteraemia among febrile infants of developing countries and what clinical predictors, if any, could identify those febrile infants with bacteraemia. To address this issue, 102 infants aged 1-12 month(s) attending the Children's Emergency Ward of University College Hospital, Ibadan, Nigeria, with rectal temperatures of > or = 38 degrees C and with a negative history of antimicrobial use for at least one week prior to presentation, were studied to identify clinical predictors of bacteraemia. Infants, meeting the eligibility criteria of the study, underwent a full clinical evaluation and had blood cultures done for aerobic organisms by standard methods. Over 38% of the infants had bacteraemia. Escherichia coli (35.9%), Staphylococcus aureus (33.3%), and Klebsiella spp. (10.3%) of positive cultures were commonly isolated. Three variables, age of < or = 6 months, restlessness, and a white cell count of >15,000/mm3, were significant independent predictors of bacteraemia. Each of these variables was associated with a 3-6-fold increase in risk of bacteraemia (age of < or = 6 months: odds ratio 3.2, p = 0.017; restlessness: odds ratio 6.3, p = 0.019; and white cell count of >15,000/mm3: odds ratio 5.4, p = 0.024). The variables, in combination, correctly classified 70% of the infants into 'bacteraemia' or 'no bacteraemia'. It is concluded that; in the setting of the study, about 4 in 10 febrile infants would have a positive blood culture for aerobic organisms and that age of < or = 6 months, restlessness, and a white cell count of > or = 15,000/mm3 are associated with a significantly increased risk of bacteraemia. Clinicians practising in such a setting need to be aware of the increased risk of bacteraemia in infants with these clinical features.