Elevated cerebrospinal fluid tumour necrosis factor is associated with acute and long-term neurocognitive impairment in cerebral malaria.

Systemic tumour necrosis factor-α (TNF-α) may contribute to the pathogenesis of cerebral malaria (CM) by promoting endothelial activation and parasite sequestration. However, less is known about the role of central nervous system (CNS) TNF-α in CM. We assessed plasma (n=249) and cerebrospinal fluid (CSF) (n=167) TNF-α levels in Ugandan children with CM, plasma TNF-α in Ugandan community control children (n=198) and CSF TNF-α in North American control children who had recovered from leukaemia (n=13). Plasma and CSF TNF-α were measured by magnetic bead assay. We compared plasma and CSF TNF-α levels in children with CM to mortality, acute and chronic neurologic deficits and long-term neurocognitive impairment. Plasma and CSF TNF-α levels were higher in CM than control children (P<.0001 for both). CSF TNF-α levels were higher in children who had neurologic deficits at discharge or 6-month follow-up (P≤.05 for both). Elevated CSF but not plasma TNF-α was associated with longer coma duration (Spearman's rho .18, P=.02) and deficits in overall cognition in children 5 years and older (ß coefficient -.74, 95% CI -1.35 to -0.13, P=.02). The study findings suggest that CNS TNF-α may be involved in the development of acute and chronic neurologic and cognitive sequelae in children with CM.

Comparison of three methods of collecting nasal specimens for respiratory virus analysis.

BACKGROUND: Nasopharyngeal aspiration (NPA) is used widely in the collection of nasal specimens for respiratory virus diagnosis. The method has limitations in relation to technical expertise, patient anxiety, and apparatus dependence. Nasal washing (NW) offers an alternative approach. OBJECTIVE: To identify the merits of two different NW methods in comparison with NPA. DESIGN: Two hundred children with acute respiratory infection (ARI) were randomised to receive one of three collection devices: (i) standard NPA, (ii) NW using a 30ml ear-syringe bulb (NWb), or (iii) NW using a 5ml syringe (NWs) with a shortened (9cm) 8FG tube. Assessment focused on ease of procedure, acceptability to parent and child, and adequacy of epithelial cell yield for immunofluorescence testing. A short questionnaire was delivered. SETTING: Paediatric Ward of Kilifi District Hospital, (KDH) Kilifi, Kenya. SUBJECTS: Any child admitted with ARI between 5th November 2001 and 24th January 2002. RESULTS: Children recruited into NPA, NWb and NWs procedures numbered 62, 76 and 62, respectively (median age of 8 months). A higher proportion of children receiving NWb did not cry (43%) compared to those receiving NPA (13%) (OR 5.18; 95% CI 2.17-12.4). Whereas 66% of mothers were comfortable with NPA procedure, the proportion for NWs was 40% (OR 0.341; 0.163-0.714). Acceptability to the operator was marginally lower for NWs than NPA (79% vs 92%, OR 0.324, 0.107-0.974). For other observations there were no differences between the procedures; these were length of procedure (98% <5mins), the acceptable time interval for repeating a procedure (64% <1 week), comparison with blood collection (77% preferred the nasal specimen) and slides with 20 or more epithelial cells (overall 82%). CONCLUSION: Nasal washing methods provide simple and effective alternatives to NPA, with the NWb being the more acceptable, and have merits for use in resource poor and home settings.

Causes and outcome of young infant admissions to a Kenyan district hospital.

AIMS: To provide a comprehensive description of young infant admissions to a first referral level health facility in Kenya. These data, currently lacking, are important given present efforts to standardise their care through the integrated management of childhood illness (IMCI) and for prioritising both health care provision and disease prevention strategies. METHODS: Prospective, 18 month observational study in a Kenyan district hospital of all admissions less than 3 months of age to the paediatric ward. RESULTS: A total of 1080 infants were studied. Mortality was 18% overall, though in those aged 0-7 days it was 34%. Within two months of discharge a further 5% of infants aged <60 days on admission had died. Severe infection and prematurity together accounted for 57% of inpatient deaths in those aged <60 days, while jaundice and tetanus accounted for another 27%. S pneumoniae, group B streptococcus, E coli, and Klebsiella spp. were the most common causes of invasive bacterial disease. Hypoxaemia, hypoglycaemia, and an inability to feed were each present in more than 20% of infants aged 0-7 days. Both hypoxaemia and the inability to feed were associated with inpatient death (OR 3.8 (95% CI 2.5 to 5.8) and 7.4 (95% CI 4.8 to 11.2) respectively). CONCLUSIONS: Young infants contribute substantially to paediatric inpatient mortality at the first referral level, highlighting the need both for basic supportive care facilities and improved disease prevention strategies.

Growth and mortality in sheep and goats under high tsetse challenge in Kenya.

Trypanosomosis is a major impediment to livestock production and economic development in those areas of Africa where it is endemic. Although small ruminants appear to perform better than cattle in various agro-ecological zones, the importance of trypanosomosis has not been extensively investigated in these livestock. This study was designed to investigate the prevalence of trypanosomosis in sheep and goats in an endemic area and to evaluate the performance of different breeds under high tsetse challenge and the potential role of chemoprophylaxis in the control of the disease. The results showed that tsetse flies feed readily on small ruminants, and that these animals are susceptible to trypanosomosis. The Small East African goats acquired fewer infections than the Black Head Persian and Dorper sheep used in the study. In both sheep and goats, chemoprophylaxis with isometamidium chloride (Samorin, Rhone Merieux, Annecy, France) was protective, resulting in fewer infections and higher body weight gain. Trypanosomosis caused anaemia in both sheep and goats, and animals whose PCV fell below 15% rarely recovered, even with trypanocidal drug treatment. The peak transmission period was between 1 and 3 months after the peak tsetse fly density, which raises the possibility of effective strategic prophylaxis.