Community-acquired bacteremia in human immunodeficiency virus-infected children in Harare, Zimbabwe.

BACKGROUND: HIV infection is common in mothers and their children in Zimbabwe, and HIV-infected children are particularly susceptible to bacterial infections. There is little information on the etiology and outcome of HIV-related bacteremia in African children. METHODS: Blood cultures from 309 hospitalized children in Zimbabwe, of whom 168 were diagnosed as having HIV, were examined for pathogens. The association among significant bacteremia, HIV infection and mortality was assessed in these children. RESULTS: The most common isolates were coagulase-negative staphylococci (31 children, 25 clinically significant), Staphylococcus aureus (22 children) and Streptococcus pneumoniae (20 children). Nontyphoidal Salmonella (10 children), Escherichia coli (4 children) and Klebsiella sp. (4 children) were the most frequent Gram-negative bacteria. Two children had Rhodococcus equi pneumonia. HIV-infected children showed increased risk of bacteremia (odds ratio (OR) = 2.68), especially if younger than 18 months of age (OR = 2.94), and high risk of enterobacteremia (OR = 15.76). There was no significant association of bacteremia with nutritional status. Mortality was 17% overall but was higher in HIV-infected children up to 6 months of age (OR = 2.81) and in bacteremic children of any age (OR = 2.03). CONCLUSIONS: Prompt recognition of pathogens and early administration of appropriate antimicrobials is important in reducing the morbidity and mortality associated with bacteremia in HIV-infected children in Africa.

PIP: Researchers compared data on 168 HIV-positive pediatric patients with data on 141 HIV-negative pediatric patients to examine the etiology and outcome of HIV-related bacterial infections in a pediatric population admitted to Harare Hospital in Zimbabwe during June 1993 to December 1994. The age of the children ranged from less than 1 month to 96 months. 72% were less than 12 months old. 54% of all pediatric patients tested were HIV-infected. HIV-infected children were more likely to have a bacterial infection than HIV-negative children (40% vs. 20%; odds ratio [OR] = 2.68; p 0.001). The difference in the bacterial infection rate was only significant for children aged less than 18 months (41% vs. 19%; OR = 2.94; p 0.001), however. 14% of the children suffered from severe malnutrition. Nutritional status was not significantly associated with bacterial infection. In both HIV-positive and HIV-negative children, Staphylococcus aureus was the most frequent bacterial pathogen (29% for HIV-positive and 18% for HIV-negative children). Many Gram-positive and Gram-negative isolates were resistant to the combination therapy of trimethoprim-sulfamethoxazole. Only 1 child, who was HIV-positive, had more than one bacterial infection (both Streptococcus pneumoniae and Actinomyces israelii). HIV-positive children were more likely to have an enterobacterial infection than HIV-negative children (10% vs. 0.7%; p 0.001). Mortality was significantly higher among HIV-infected children aged less than 6 months old than their HIV-negative counterparts (28% vs. 12%; OR = 2.81; p 0.05). Even though it was also higher among HIV-positive children aged more than 6 months (17% vs. 7%), the difference was not significant. Regardless of HIV status, children with bacteremia were more likely to die than those without bacteremia (24% vs. 14%; OR = 2.03; p 0.05). These findings stress the importance of early and effective antibiotic therapy. This therapy will reduce the morbidity and mortality associated with bacteriemia in HIV-infected children in Africa.

Neonatal haematology in Zimbabwe. II: The red cell and white cell parameters.

Red cell and white cell parameters were determined in 600 (310 male and 290 female) normal Black Zimbabwean neonates with a mean +/- sd birth weight of 3.0 +/- 0.4 (range 2.04 to 4.50, median 3.0) kg using a Coulter Counter Model S Plus. Cord anaemia (cord Hb < 13.5 gdl-1) was detected in 60 (10 pc) of the neonates. Although the male babies were significantly heavier than the females (p = 0.004), there were no significant differences (p > 0.05) in the red cell and white cell indices between the two sexes. When the haematological parameters of the 540 (90 pc) non-anaemic (cord Hb > or = 13.5 gdl-1) neonates were analysed, the mean +/- sd values which may serve as local reference standards were: Hb 15.2 +/- 1.8 (range 13.5 to 19.4) gdl-1, Hct 47.3 4.9 (range 38.6 to 60.3) pc, MCV 107.8 +/- 9.4 (range 88.8 to 134.3) fl, MCH 31.9 +/- 3.4 (range 25.2 to 45.2) pg, MCHC 32.9 +/- 1.3 (range 30.0 to 38.3) gdl-1, nucleated red blood cells 6.1 +/- 5.9 (range 0 to 55) per 100 white blood cells, reticulocyte count 5.0 +/- 1.9 (range 0 to 24.0) pc, total leucocyte count 13.8 +/- 4.4 (range 4.6 to 132.8) x 10(9)l-1; differential count: neutrophils 7.30 +/- 2.90 (range 1.72 to 18.02) x 10(9) l-1, lymphocytes 5.67 +/- 2.47 (range 0.98 to 16.14) x 10(9) l-1, monocytes 0.81 +/- 0.83 (range 0 to 5.58) x 10(9) l-1, 1 and eosinophils 0.08 +/- 0.13 (range 0 to 0.72) x 10(9)l-1.(ABSTRACT TRUNCATED AT 250 WORDS)

Neonatal haematology in Zimbabwe. I: The platelet parameters.

Platelet parameters were determined in 600 full term healthy Zimbabwean neonates using a Coulter Counter Model S Plus. The mean +/- s.d. values obtained with ranges were: Platelet count 235 +/- 67 (range 100-410) x 10(9) l-1; Mean Platelet Volume (MPV) 9.5 +/- 1.0 (range 7.1-13.9) fl; Plateletcrit (PCT) 0.269 +/- 0.058 (range 0.142-0.524) and Platelet Distribution Width (PDW) 16.8 +/- 1.0 (range 12.2-19.8). Although platelet counts in this study were comparable to those established by others in both Black and Caucasian infants, the female Zimbabwean neonates had significantly higher counts than the males (p < 0.001). An inverse relationship between the number of circulating platelets and their MPV was also observed. Further studies are needed to delineate the range of normality of these platelet measurements in the African neonate so that abnormal cases can be adequately screened, investigated and appropriately treated.

Acute lower respiratory tract infection in hospitalized children in Zimbabwe.

A descriptive study was undertaken to document clinical and socio-demographic features and also to identify risk factors for mortality in children hospitalized with acute lower respiratory tract infection (ALRI). A total of 704 children aged from 1 month to 5 years admitted to Harare Central Hospital were studied. The peak age group was between 1 and 6 months. Seventy per cent of the children were found to have normal nutrition and 12% severe malnutrition. Seventy-eight per cent had severe and the remainder moderate ALRI (WHO classification). Clinical HIV infection was diagnosed in 219 (31%) children. One hundred and four children died, an overall case fatality rate (CFR) of 15%. In the clinically HIV-infected children, a CFR of 28% occurred, which constituted 60% of the overall ALRI mortality. A much lower CFR of 9% was found in the clinically non-HIV-infected children. Malnutrition, severe ALRI, age of 1 to 6 months, concurrent diarrhoea, duration of cough > or = 14 days and previous history of admission for ALRI were significant risk factors for mortality in ALRI. Low birthweight was not found to be a risk factor in this study. The impact of HIV infection on mortality in children with ALRI is of major concern in Zimbabwe and should be an important component of the national ALRI programme.

Serum electrolytes in children admitted with diarrhoeal dehydration managed with simple salt sugar solution.

PIP: Diarrheal diseases constitute a major cause of childhood morbidity and mortality in Zimbabwe. Since 1982, it has been the policy in Zimbabwe to use home-based Salt Sugar Solution (SSS) as standard Oral Rehydration Solution (ORS) therapy for both prevention and management of dehydration. The recommended formula is incomplete, lacking both potassium and bicarbonate. It may not, therefore, be as efficacious as complete ORS for the prevention or correction of hypokalemia and acidosis during diarrhea. For this reason, a study was carried out at Harare Central Hospital to assess the type and prevalence of electrolyte abnormalities in dehydrated children who had previously been managed with oral salt sugar solution for acute gastroenteritis. 121 such referred patients had their serum urea and electrolytes estimated on admission prior to further management in the Unit; .38 (27.5%) cases of hypokalemia, 12 (8.9%) of hypernatremia, 52 (5.5%) of hypoatremia and 65 (45.7%) of severe acidosis (bicarbonate level 10 mmol/1) were documented. It is concluded that simple salt sugar solution is ideal for the prevention of dehydration but in cases of established dehydration the WHO complete formula is more appropriate for combating hypokalemia and severe metabolic acidosis.^ieng