Campylobacter bacteremia in children.

OBJECTIVE: To describe clinical and laboratory data for, and to propose pathogenesis and management of, children from impoverished communities with Campylobacter bacteremia. METHODS: A retrospective review of patient data generated from laboratory records in an urban tertiary care hospital in Soweto and a rural mission hospital in Eastern Transvaal, South Africa. Participants were 19 children presenting to either hospital with Campylobacter bacteremia. Clinical and laboratory data were collated. RESULTS: Nineteen children with Campylobacter bacteremia were identified; all isolates were Campylobacter jejuni. Sixteen (84%) had malnutrition; 13 of these were severely malnourished. Thirteen (68%) were febrile at the time of bacteremia. Four children (21%) did not have diarrhea. The case fatality rate was 16% and may not have been influenced by aminoglycoside administration. CONCLUSION: Malnourished children may be more likely to have gastrointestinal C. jejuni infection. Immunodeficiency and intestinal mucosal compromise secondary to malnutrition may render such children at increased risk of C. jejuni bacteremia and its consequences. C. jejuni bacteremia is potentially life-threatening and should be managed accordingly.

Bacteraemia in malnourished rural African children.

During a 5-month study period, 323 of 863 (37.5%) children below 5 years of age admitted to Shongwe Mission Hospital in rural South Africa were malnourished, two-thirds severely so. The incidence of bacteraemia in malnourished children was 9.6%, 11.8% in those severely malnourished and 5.8% in nutritional dwarfs. The predominant organisms retrieved were Gram-negative enteric bacilli (48.5%). Amongst the severely malnourished, who empirically receive intravenous ampicillin and gentamicin, 95.8% of all isolates were sensitive to this antibiotic combination. The case fatality rate of severely malnourished bacteraemic children was 20.8%. In malnutrition categories overall, the case fatality rate for bacteraemic children (22.6%) was significantly greater than in those without bacteraemia (9.3%). In hospitals with limited resources, full identification of bacteria may not be necessary, provided that regular surveillance for emerging resistance is conducted.

PIP: There are an estimated 170 million children in the world who are malnourished, 20 million severely. The authors determined the prevalence of bacteremia in malnourished children admitted to Shongwe Mission Hospital, documented the effect of bacteremia upon mortality, and provide a basis for antimicrobial use in malnourished children with suspected bacteremia. 323 of 863 children under age 5 years admitted to the hospital between May 23 and October 22, 1992, were malnourished, 66% severely. There was a 9.6% prevalence of bacteremia in malnourished children, 11.8% in those severely malnourished, and 5.8% in nutritional dwarfs. Gram-negative enteric bacilli were retrieved in 48.5% of cases. 95.8% of all isolates among the severely malnourished children were sensitive to the combination of intravenous ampicillin and gentamicin. There was a 20.8% case fatality rate among severely malnourished bacteremic children. In malnutrition categories overall, the case fatality rate for bacteremic children (22.6%) was significantly greater than in those without bacteremia (9.3%). The authors note that it may not be necessary to fully identify bacteria in hospitals with limited resources as long as regular surveillance for emerging resistance is conducted.

Urinary tract infection in malnourished rural African children.

During an 8-month period from 1 September 1992 to 30 April 1993, 134 children less than 5 years of age admitted with all grades of malnutrition to a rural hospital were investigated for urinary tract infection. Thirty-five (26.1%) had proven infection. Incidence rates amongst malnutrition categories did not vary significantly. Antibiotic sensitivities with reference to ongoing surveillance and antimicrobial usage is discussed. The value of dipstick screening tests was analysed for predictability and found to be an unreliable alternative to traditional culture techniques. This study emphasizes that urinary tract infection in malnutrition is common and should be routinely investigated.

PIP: Although numerous studies have documented an association between child malnutrition and urinary tract infection, few have used suprapubic aspiration to ensure the collection of uncontaminated urine specimens. This method was used to measure infection rates in 134 children under 5 years of age (median, 17 months) admitted to Shongwe Hospital (South Africa) in an 8-month period in 1992-93. 72 children (53.7%) had kwashiorkor, 44 (32.8%) were nutritional dwarfs, 11 (8.2%) had marasmus, and 7 (5.2%) had marasmic kwashiorkor. 35 children (26.1%) had proven urinary tract infection. The incidence rate of urinary tract infection did not vary significantly by child nutritional status. Most isolates were gram-negative enteric bacilli and sensitive to a combination of ampicillin and gentamicin. The sensitivity of use of leukocytes and nitrates, alone or in combination, had a low positive predictive value. Urinary tract infection should be actively investigated in children with malnutrition of any grade and regular surveillance of related pathogens and their antibiotic sensitivity is recommended.

Infection by enteric adenoviruses, rotaviruses, and other agents in a rural African environment.

From February 1985 to January 1986, 432 stool samples, 310 from rural African children with diarrhea and 122 from controls, were analysed for the presence of enteric viruses known to be associated with diarrhea. Group A rotavirus ELISA indicated 12.9% positivity among patients and 2.5% positivity among controls. Only 23 of the 43 rotavirus ELISA-positive stools were also positive by electron microscopy. Nine children, three of whom were controls, were found to be shedding coronavirus-like particles, detected by electron microscopy. Stools from all but one of the nine children had been taken within 1 month of each other. Dot-blot hybridization tests for the presence of Ad40 or Ad41 DNA revealed 44 positive stools, 41 of which were from patients (13.2% positivity). Only three of the Ad40-or Ad41-positive stools by DNA hybridization were positive by electron microscopy, and only these three strains could be grown in semipermissive Chang conjunctival cells and their identity checked by restriction enzyme analysis. Further attempts to rescue the other strains using a helper virus failed, but nine of the stools proved positive by ELISA using a subgroup F-specific monoclonal antibody. On the basis of the DNA hybridization results alone, subgroup F adenoviruses were encountered as frequently as rotavirus in the study and were significantly associated with diarrhea, although the viability and intactness of virus particles by the time of laboratory analysis appeared to be very low.