Background Salmonella enterica bloodstream infections are an important cause of childhood morbidity and mortality, including in Mali. We report 17 years of surveillance for nontyphoidal and typhoidal S. enterica infections among inpatients and outpatients at l’Hôpital Gabriel Touré, the main source of pediatric tertiary care in Bamako, Mali. Methods Between June 2002 and December 2018, a blood culture was collected from 54 748 children aged ≤15 years with fever and/or suspected invasive bacterial infection who provided consent (38 152 inpatients, 16 596 outpatients). Bacterial pathogens were identified using standard microbiological techniques and serovars of S. enterica were determined by PCR and/or agglutination with antisera. Results Nontyphoidal Salmonella (NTS) was identified in 671 enrolled inpatients (1.8% of all enrolled inpatients, 13.8% of enrolled inpatients with a positive culture). S. Enteritidis, the most common NTS serovar, accounted for 38.5% of all NTS isolates (n = 258), followed by S. Typhimurium (31.7%, n = 213). The median (SD) age of children with a culture positive for NTS was 1.8 (3) years. Overall case fatality was 20.9%. An additional 138 inpatients (0.4%) had a positive culture for typhoidal Salmonella. NTS was identified in 11 outpatients (0.07%), while typhoidal Salmonella was found in 49 outpatients (0.3%). The annual incidence of invasive NTS disease decreased over the study period, but case fatality remained high. Conclusions Although incidence decreased, NTS remained a major cause of invasive bacterial infection and mortality among hospitalized children in Bamako, while typhoidal Salmonella was uncommon. Because 87% of NTS belonged to only 4 serovars, a multivalent vaccine may be an effective strategy to reduce the burden and mortality of invasive NTS.
In endemic settings where asymptomatic malaria infections are common, malaria infection can complicate fever diagnosis. Factors influencing fever misdiagnosis, including accuracy of malaria rapid diagnostic tests (mRDTs) and the malaria-attributable fraction of fevers (MAF), require further investigation. We conducted facility-based surveillance in Malawi, from January 2012 through December 2013 in settings of high perennial (Chikhwawa), high seasonal (Thoylo), and moderate seasonal (Ndirande) malaria transmission. Consecutive patients presenting to outpatient departments were screened; those with suspected malaria illness were tested by mRDT or routine thick-smear microscopy. Test positivity rates (TPRs), positive predictive value (PPVs) of mRDTs, and MAFs were calculated by site, age, and season. Of 41,471 patients, 10,052 (24.2%) tested positive for malaria. The TPR was significantly greater in Chikhwawa (29.9%; 95% CI, 28.6–30.0) compared with Thyolo (13.2%; 95% CI, 12.5–13.7) and Ndirande (13.1%; 95% CI, 12.2–14.4). The overall PPV was 77.8% (95% CI, 76.8–78.7); it was lowest among infants (69.9%; 95% CI, 65.5–74.2) and highest among school-age children (81.9%; 95% CI, 80.3–83.4). Malaria infection accounted for about 50% of fevers in children younger than 5 years old with microscopy-confirmed Plasmodium falciparum infection, and less than 20% of such fevers in school-age children. Outpatient settings in Malawi had a high burden of malaria illness, but also possible overdiagnosis of malaria illness. Interventions to reduce malaria transmission and rapid testing for other common febrile illness may improve diagnostic clarity among outpatients in malaria endemic settings.
BackgroundAdvances in HIV care and treatment have resulted in perinatally infected children aging into adulthood. These patients may be at higher risk of HIV-associated non-AIDS conditions, including systemic hypertension (HTN). This study examined the association between HIV infection and the prevalence of HTN among young adults receiving care in West Baltimore.MethodsWe conducted a cross-sectional study of young adults with perinatally-acquired (PA) HIV frequency matched on race and sex to a stratified random sample of young adults with non perinatally-acquired (NPA) HIV and HIV-uninfected young adults (UI). All subjects were aged 18–29 years of age as of September 1, 2014. The outcome of HTN was ascertained through chart review (two systolic blood pressure measurements > = 140 mmHg or diastolic > = 90 mmHg at least three months apart; and/or physician prescription for an antihypertensive mediation). Logistic regression was used to estimate adjusted prevalence odds ratios (aPOR) and 95% confidence intervals (CI) for the association between HIV infection and HTN. All data were collected from clinics within the University of Maryland Medical System.ResultsThree hundred and twenty-four patients were included in the study, 108 per exposure group. The prevalence of HTN was 23% among PA patients, 10% among NPA patients, and 9% among UI patients. The median age was 24 (IQR 22 - 26), 95% were African American, and 42% were male. PA patients had the highest prevalence of chronic kidney disease (CKD) and dyslipidemia (19% and 13% respectively) compared with NPA (1% and 3%) and UI (0% and 5%). PA patients had 3 (95% CI 1.4 - 6.6) times the base odds (controlling for matching variables) of prevalent HTN compared with UI patients and NPA had 1.1 times the base odds (95% CI 0.5 - 2.7) compared with UI patients. After controlling for race, gender, family history of HTN, and CKD, the prevalence odds ratio for HTN was 2.7 (95% CI 1.06 - 7.0) times higher for PA compared with UI, and 1.3 (95% CI 0.5 - 3.4) times higher for NPA compared with UI.ConclusionOur findings suggest that the prevalence of HTN among young adults with PA HIV is significantly higher than sex and race matched UI patients of similar age. HIV providers should carefully monitor these patients for the development of HTN, particularly as they enter adulthood.Disclosures All authors: No reported disclosures.
The highly transmissible SARS-CoV-2 Omicron variant led to increased hospitalizations, staffing shortages, and increased school closures. To reduce spread in school-aged children during the Omicron peak, the District of Columbia implemented a test-to-return strategy in public and public charter schools after a two-week break from in-person learning.
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