Características sócio-demográficas de uma coorte de crianças nigerianas hiv positivas / Socio-demographic characteristics of a cohort of hiv positive nigerian children

Objetivo: Descrever as características sócio-demográficas e identificar fatores de risco em pacientes pediátricos HIV positivos atendidos no Hospital de Ensino da Universidade de Lagos, Nigéria. Métodos: Estudo transversal no qual foi aplicado um questionário para avaliar as características sócio-demográficas de pacientes infantis HIV durante um período de 12 meses. Os dados foram analisados com o software Epi-Info 2002. Resultados: A maioria dos pais tinha abaixo do nível terciário de educação (mães, 72,7% e pais, 69,1%). Setenta por cento das mães HIV positiva, assim, a transmissão vertical parece ser o fator de risco mais prevalente. A maioria das crianças (68,1%) nasceu em hospitais privados e 78,2% oriundas de parto normal. Histórias de hospitalizações anteriores foram relatadas em 58,2% com a transfusão de sangue prévia em 30,9%. Mais de um terço das crianças (40,0%) pesava entre 2,5 e 2,9 kg ao nascimento. Conclusão: O nível de alfabetização, baixo nível socioeconômico e status de HIV familiar foram os principais fatores que contribuíram entre as crianças estudadas. Intervenções orientadas sobre as barreiras à assistência e conhecimento da infecção pelo HIV deve ser uma parte integrante do programa de prevenção do HIV.

Objective: To describe the socio-demographic characteristics of and identify risk factors in HIV positive paediatric patients presenting at the Lagos University Teaching Hospital.Methods: A descriptive questionnaire based cross-sectional study to assess socio-demographic characteristics of patients presenting to the Paediatric HIV clinic of the Lagos University Teaching Hospital over a 12 month period. The data were analyzed using the Epi-Info 2002 statistical software for windows. Results: Majority of parents had below tertiary level of education; mothers, 72.7 % and fathers, 69.1 %. Seventy percent of the mothers were HIV positive thus mother to child transmission seems to be the most prevalent risk factor. Majority of the children, 68.1% were delivered at private hospitals and 78.2% through normal vagina delivery. History of previous hospitalizations reported in 58.2% with previous blood transfusion in 30.9%. Over one-third of the children, 40.0% weighed between 2.5 and 2.9kg at birth. Conclusions: The literacy level, poor socioeconomic background and parental HIV status were major contributory factors in the children studied. Targeted interventions on barriers to care and knowledge of HIV infection should be an integral part of the HIV prevention program.

Antibiotic resistance among pathogens causing disease in Jamaican children with HIV/AIDS / Resistencia antibiótica entre los patógenos que causan enfermedades en los niños jamaicanos con VIH/SIDA

OBJECTIVE: There are limited data regarding the antimicrobial resistance patterns of pathogens in children with HIV/AIDS from developing countries. We aimed to determine the prevalence and antibiotic susceptibility patterns of bacterial pathogens causing urinary tract infections (UTIs) and sepsis in a cohort of 219 HIV-infected Jamaican children. METHODS: This cross-sectional study examined clinical and microbiological data for children enrolled in the Kingston Paediatric/Perinatal HIV/AIDS programme from September 1, 2002 to May 31, 2007. Cases were defined as physician-diagnosed, laboratory confirmed UTIs and sepsis based on Centers for Disease Control and Prevention (CDC) criteria. Only isolates from urine, blood and sterile sites were considered. RESULTS: Forty-four patients (20.1%) accounted for 74 episodes of UTIs and sepsis. Mean number of infections was 1.7 ± 1.3 per patient. There were 31 males (70.5%) and mean age at time of infection was 5.6 ± 4.7 years. Bacterial infections comprised cystitis (n = 52, 70.3%), bacterial pneumonia (n = 15, 20.3%), meningitis (n = 4, 5.4%), septicaemia (n = 2, 2.7%) and bone infection (n = 1, 1.4%). Among 52 UTIs, 39 were caused by a single organism. The most common UTI isolates included Escherichia coli (n = 21, 53.8%) and Enterobacter spp (n = 5, 12.8%). Among 22 cases of sepsis, isolates included Streptococcus pneumoniae (n = 8, 36.4%) and coagulase negative Staphylococcus (n = 6, 27.3%). All E coli isolates at two of three clinical sites were resistant to cotrimoxazole. There were 79.7% (n = 51) of infectious episodes with a cotrimoxazole-resistant organism occurring among those on cotrimoxazole prophylaxis. CONCLUSIONS: Escherichia coli was the most frequent bacterial isolate. Cotrimoxazole is a poor choice for empiric treatment of sepsis and UTIs in this clinical setting.

OBJETIVO: Los datos existentes en relación con los patrones de resistencia antimicrobiana en los ninos con VIH/SIDA de los países en vías de desarrollo, son limitados. Nuestro objetivo fue determinar la prevalencia y los patrones de susceptibilidad antibiótica de los patógenos bacterianos que causan infecciones de las vías urinarias (IVU) y sepsis en una cohorte de 219 ninos jamaicanos infectados con VIH. MÉTODOS: Este estudio transversal examinó datos clínicos y microbiológicos de ninos enrolados en el programa KPAIDS del 1ero. de septiembre de 2002 al 31 de mayo de 2007. Los casos se definieron como IVU y sepsis de diagnóstico médico, confirmada en el laboratorio, a partir de criterios de los Centros de Control y Prevención de Enfermedades (CCE). Solamente se tuvieron en cuenta aislados de orina, sangre y sitios estériles. RESULTADOS: Cuarenta y cuatro pacientes (20.1%) dieron lugar a 74 episodios de IVU y sepsis. El número promedio de infecciones fue 1.7 ± 1.3 por paciente. Hubo 31 varones (70.5%) y la edad promedio en el momento de la infección fue 5.6 ± 4.7 anos. Las infecciones bacterianas abarcaron: cistitis (n = 52, 70.3%), pulmonía bacteriana (n = 15, 20.3%), meningitis (n = 4, 5.4%), septicemia (n = 2, 2.7%) e infección ósea (n = 1, 1.4%). De las 52 IVU, 39 fueron causadas por un solo microorganismo. Los aislados más comunes de IVU incluyeron Escherichia coli (n = 21, 53.8%) y Enterobacter spp (n = 5, 12.8%). De los 22 casos de sepsis, los aislados incluyeron Streptococcus pneumoniae (n = 8, 36.4%) y Staphylococcus coagulasa negativo (n = 6, 27.3%). Todos los aislados de E coli en dos o tres sitios clínicos eran resistentes al cotrimoxazol. Se produjeron 79.7% (n = 51) episodios infecciosos con un organismo resistente al cotrimoxazol entre los pacientes que se hallaban bajo profilaxis con cotrimoxazol. CONCLUSIONES: Escherichia coli fue el aislado bacteriano más frecuente. El cotrimoxazol es una opción pobre para el tratamiento empírico de sepsis e IVU en esta situación clínica.