ABSTRACT
BACKGROUND: Neonatal septicaemia remains a major cause of morbidity and mortality. The aetiology, risk factors and outcome of this problem need to understood. OBJECTIVE: To determine the aetiology, risk factors and immediate outcome of bacteriologically confirmed neonatal septicaemia in Mulago hospital. METHODS: Blood cultures were aseptically obtained from neonates presenting with clinical sepsis by WHO criteria to Mulago during a five month period between July and November 2002. Blood was placed in Brain Heart Infusion media and incubated within 30 minutes. Subcultures were plated daily up to 7 days on blood, chocolate and MacConkey agar and incubated in aerobic and 5% carbon dioxide conditions. Pure colonies were identified by Gram stain and biochemical tests and antibiotic sensitivities were obtained. RESULTS: Gram positive organisms were predominant (69.2%) followed by E. coli (17%) and Group B Streptococci (GBS) (7%). Staphylococcus aureus and E. coli dominated isolates in early and late onset sepsis. S. aureus was more sensitive to gentamicin than to cloxacillin. The sensitivity of E. coli to ceftriaxone was 94.1%. Factors significantly associated with neonatal septicaemia were male sex, history of convulsions, hypoglycaemia, lack of antenatal care, late onset sepsis and umbilical pus discharge. Mortality in sepsis cases was 18.1%, and 84% of deaths occurred in the first 2 days of admission. Hypoglycaemia was significantly associated with death (p < 0.01). CONCLUSION: S. aureus predominates the aetiology of neonatal septicaemia followed by E.coli. Most deaths occur in the first 48 hours of admission and hypoglycaemia is significantly associated with death.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Cause of Death , Sepsis/drug therapy , Sepsis/epidemiology , Cohort Studies , Developing Countries , Female , Hospitals, Teaching , Humans , Incidence , Infant, Newborn , Infant, Newborn, Diseases/diagnosis , Infant, Newborn, Diseases/drug therapy , Infant, Newborn, Diseases/epidemiology , Intensive Care Units, Neonatal , Logistic Models , Male , Microbial Sensitivity Tests , Probability , Risk Factors , Sepsis/microbiology , Severity of Illness Index , Staphylococcal Infections/diagnosis , Staphylococcal Infections/drug therapy , Staphylococcal Infections/epidemiology , Staphylococcus aureus/drug effects , Staphylococcus aureus/isolation & purification , Survival Analysis , Treatment Outcome , UgandaABSTRACT
To examine the effect of HIV infection old infectiousness of TB. Design: Cross-sectional prevalence study of household contacts to smear positive TB patients. Methods: HIV-infected and non-infected index TB cases with sputum smear positive TB; were enrolled from a major TB clinic at Mulago Hospital in Kampala; Uganda. All full-time household contacts of the index cases were evaluated by: medical history and physical examination; Mantoux purified protein derivative (PPD) skin tests; chest x-ray; BCG vaccination status; HIV test (in consenting subjects); TB symptoms and demographic and household environment. a contact with signs and/or symptoms of TB underwent a complete work-up for active TB. The main outcome measures were PPD positively and active TB. APPD skin-test readingor=5mm was considered positive. Results: 699 contacts of 170 index TB cases were included in this analysis. 319 (46) were contacts of 82 HIV+index TB cases. No significant differences were noted in the proportion of PPD positively; between contacts of HIV-infected and those pf the HIV-non-infected index cases [79versus 79; P=0.984]. Risk factors for PPD-positivity in contacts were: AFB smear grade of the index case [Odds Ratio (OR) = 1.7; 95CI: 1.16-2.37]; cavitary disease in the index case [OR=5.9; 95CI: 2.53-14.0]; age of the contact [OR = 1.1; 95CI: 1.05-1.10]; and household size [OR=0.9;95CI:0.85-0.96]. Risk factors for active TB in contacts were: cavitary disease in the index case [OR = 2.0;95CI: 1.07-3.58]; age of the contact [OR = 1.1; 95CI:0.89-0.96]; HIV status of the contact [OR=5.9;95CI:1.69-21.9]; and sharing of bed or bedroom with the index case [OR=2.5; 95CI: 1.54-3.92]. Conclusion: Transmission of M. tuberculosis within households was comparable among HIV-infected and non-infected index TB cases. However; transmission differed depending on: whether the index case had cavitary disease; the sputum AFB smear; household sixe and age of the contact. HIV-infected contacts; children and intimate contacts of the index cases were at increased risk of having active TB at the time of household evaluation
Subject(s)
HIV , Family Characteristics , TuberculosisABSTRACT
SETTING: In Uganda, bacille-Calmette Guerin (BCG) vaccination coverage at birth is between 82 and 84%. OBJECTIVE: To evaluate the effect of neonatal BCG vaccination on tuberculin skin test positivity in Ugandan children exposed to infectious cases. DESIGN: As part of an ongoing prevalence study of household contacts of new tuberculosis cases, 365 children were evaluated to determine if BCG vaccination at birth had an impact on tuberculin skin testing. The children were classified as contacts (179) and non-contacts (186) depending on the presence of a sputum acid-fast bacilli (AFB) smear-positive adult tuberculosis case in the household. RESULTS: Regardless of prior BCG vaccination, children exposed to a smear-positive adult were more likely to have a positive skin test (purified protein derivative >5mm) (68% versus 36%, P < 0.01). BCG-vaccinated children below 1 year of age without a known household contact with active tuberculosis had a lower frequency of tuberculin skin reactions (29%) compared to their counterparts in the contact households (65%, P = 0.031). CONCLUSION: BCG vaccination at birth had no important effect on the interpretation of the tuberculin skin test reactivity in this group of Ugandan children. The tuberculin skin test remains a valuable tool for the evaluation of household contacts and suspected cases of tuberculosis in BCG-vaccinated children.
