Nasopharyngeal colonization is the first step in the pathway to Streptococcus pneumoniae (Spn) infection, a leading cause of childhood morbidity and mortality. We investigated the effect of Spn ...colonization at ages 2 and 4 mo on growth at age 6 mo among 389 infants living in rural South India by using data from an Spn carriage study nested within a randomized, double-blind, placebo-controlled community trial designed to evaluate the impact of newborn vitamin A supplementation on Spn carriage in the first 6 mo of life. Primary outcomes were weight, length, and anthropometric indices of nutritional status. Growth data at age 6 mo were available for 84% (389 of 464) of infants in the Spn carriage study. Carriage at age 2 mo was associated with increased odds of stunting OR: 3.07 (95% CI: 1.29, 7.36) P = 0.012 and lower weight β: -266 g (95% CI: -527, -5) P = 0.045, length β: -1.31 cm (95% CI: -2.32, -0.31) P = 0.010, and length-for-age Z scores β: -0.59; (95% CI: -1.05, -0.13) P = 0.012 at age 6 mo. Spn carriage at age 4 mo did not affect growth. Carriage of invasive serotypes at age 2 mo was associated with decreases in mean weight β: -289 g; (95% CI: -491, -106) P = 0.002 and length β:-0.38 cm (95% CI: -1.49, -0.01) P = 0.047 at age 6 mo. Newborn vitamin A supplementation did not modify the association between Spn carriage and growth. Results suggest that pneumococcal carriage at age 2 mo is an independent risk factor for poor growth in young infants. Future studies need to clarify the role of Spn carriage on growth retardation in low-income countries.
Nasopharyngeal colonization is the first step in the pathway to Streptococcus pneumoniae (Spn) infection, a leading cause of childhood morbidity and mortality. We investigated the effect of Spn ...colonization at ages 2 and 4 mo on growth at age 6 mo among 389 infants living in rural South India by using data from an Spn carriage study nested within a randomized, double-blind, placebo-controlled community trial designed to evaluate the impact of newborn vitamin A supplementation on Spn carriage in the first 6 mo of life. Primary outcomes were weight, length, and anthropometric indices of nutritional status. Growth data at age 6 mo were available for 84% (389 of 464) of infants in the Spn carriage study. Carriage at age 2 mo was associated with increased odds of stunting OR: 3.07 (95% CI: 1.29, 7.36) P = 0.012 and lower weight β: -266 g (95% CI: -527, -5) P = 0.045, length β: -1.31 cm (95% CI: -2.32, -0.31) P = 0.010, and length-for-age Z scores β: -0.59; (95% CI: -1.05, -0.13) P = 0.012 at age 6 mo. Spn carriage at age 4 mo did not affect growth. Carriage of invasive serotypes at age 2 mo was associated with decreases in mean weight β: -289 g; (95% CI: -491, -106) P = 0.002 and length β:-0.38 cm (95% CI: -1.49, -0.01) P = 0.047 at age 6 mo. Newborn vitamin A supplementation did not modify the association between Spn carriage and growth. Results suggest that pneumococcal carriage at age 2 mo is an independent risk factor for poor growth in young infants. Future studies need to clarify the role of Spn carriage on growth retardation in low-income countries.
BACKGROUND: Zinc is undergoing evaluation as an inexpensive therapeutic adjuvant for severe pediatric pneumonia. OBJECTIVE: We explored the effect of etiology on the treatment effect of zinc in young ...children hospitalized for severe pneumonia. DESIGN: We analyzed data from a randomized, double-blind, placebo-controlled clinical trial conducted at the Christian Medical College Hospital, a teaching hospital in Tamilnadu, India. Children aged 2-23 mo (n = 299) were randomly assigned to receive a 10-mg tablet of zinc sulfate or placebo twice a day during hospitalization. The primary outcomes were length of hospitalization and time to resolution of severe pneumonia stratified by etiologic classification on the basis of serum C-reactive protein (CRP) concentrations at admission. RESULTS: CRP concentrations were available for 295 (98.7%) of the enrolled cases. Of these 295 cases, 223 (75.6%) were classified as suspected nonbacterial pneumonias (CRP concentrations <=40 mg/L). Etiology modified the treatment effect of zinc on the length of the hospital stay hazard ratio (HR) for interaction term: 0.52; 95% CI: 0.31, 0.91; P = 0.022. In the 72 suspected bacterial cases (CRP concentrations >40 mg/L), the median length of hospitalization was almost equal to20 h longer in the zinc-supplemented group than in the placebo group (87.3 and 68.3 h, respectively; HR: 0.56; 95% CI: 0.34, 0.93; P = 0.025). The treatment effect was not modified in the suspected nonbacterial cases of pneumonia. CONCLUSIONS: Our results suggest that the treatment effect of zinc for severe pediatric pneumonia may be modified by bacterial infection. Further studies are required to develop appropriate recommendations for the use of zinc in the treatment of severe pneumonia. This trial was registered at clinicaltrials.gov as NCT00198666.
Reply to S Howie et al Coles, Christian L; Santosham, Mathuram; Bose, Anuradha
The American journal of clinical nutrition,
01/2007, Volume:
85, Issue:
1
Journal Article
Nasopharyngeal (NP) carriage is necessary for Streptococcus pneumoniae (Spn) transmission and invasive infection. This study evaluated the effect of zinc prophylaxis on the association between NP ...colonization with Spn and acute lower respiratory infection (ALRI) in children aged 1-35 mo living in a rural district in southern Nepal. We compared carriage prevalence of Spn in 550 ALRI cases with that of healthy age- and season-matched controls. This study, conducted from December 2003 to July 2005, was nested in a community-randomized trial designed to evaluate the effect of zinc on morbidity and mortality in 1- to 36-mo-old children. They were randomized to receive either 10-mg tablets of zinc or placebo daily until discharge. Approximately 75% of cases and controls were Spn carriers. There was an interaction between zinc and Spn carriage (P = 0.091). Spn carriage increased the risk of ALRI in the placebo group adjusted matched odds ratio (AMOR) = 2.57; P = 0.025 but not in the zinc group (AMOR = 0.95; P = 0.890). Among the subset of symptomatic cases and their controls, the odds of ALRI for Spn carriers in the placebo group was 30 times greater (AMOR = 78.09; P = 0.006) than in the zinc group (AMOR = 2.77; P = 0.288). These findings suggest that zinc prophylaxis may protect children against ALRI associated with carriage of Spn and that the effect may differ by infectious etiology.
Community-acquired alveolar pneumonia (CAAP) is typically associated with bacterial infections and is especially prevalent in vulnerable populations worldwide. The authors studied nutritional status ...and diarrheal history as risk factors for CAAP in Bedouin children <5 years of age living in Israel. In this prospective case-control study (2001–2002), 334 children with radiographically confirmed CAAP were compared with 529 controls without pneumonia with regard to nutritional status and diarrhea history. Controls were frequency matched to cases on age and enrollment month. Logistic regression models were used to evaluate associations of CAAP with nutritional status and recent diarrhea experience. Anemia (adjusted odds ratio (AOR) = 3.32, 95% confidence interval (CI): 2.24, 4.94; p < 0.001), low birth weight (AOR = 2.16, 95% CI: 1.32, 3.54; p = 0.002), stunting (AOR = 2.22, 95% CI: 1.31, 3.78; p = 0.004), serum retinol concentration (AOR = 1.03 per μg/dl, 95% CI: 1.02, 1.05; p < 0.001), and having ≥1 diarrhea episodes within 31 days prior to enrollment (AOR = 2.30, 95% CI: 1.26, 4.19; p = 0.007) were identified as risk factors for CAAP. Results suggest that improving antenatal care and the nutritional status of infants may reduce the risk of CAAP in Bedouin children. Furthermore, they suggest that vaccines developed to prevent diarrhea may also lower the risk of CAAP.
Objectives The study sought to determine the differences in lengths of stay and medical costs between patients admitted to hospital with non-typhoidal salmonellosis that were either quinolone ...resistant (QR) or quinolone susceptible (QS). Design We examined medical records of all patients 1 year of age or older admitted to a Hong Kong hospital between 2003 and 2008 with confirmed salmonellosis diagnosis. Data were collected on length of stay, age, sex, comorbidities, antibiotics and other medication use, diagnostic tests completed, serotype and susceptibility characteristics of isolated and the circumstances of discharge from hospital. We used Cox proportional regression to determine the differences in lengths of stay and quantile regression for differences in hospital costs. Results Median duration of hospitalization among QR salmonellosis patients was 1 day (33%; 95% CI: 13–47%) longer than those with QS salmonellosis, adjusting for confounders. Adjusted median costs were US $399 (35%) and 75th percentile costs were US $760 (43%) higher in the QR group than those in the QS group, indicating a greater difference among sicker patients. Conclusion The finding of substantially longer stays and higher costs associated with QR indicates that interventions that decrease QR prevalence will lead to significant savings for the health system in the management of hospitalized salmonellosis cases.
To provide epidemiologic data on Streptococcus pneumoniae (Spn) carriage in Nepal. Prospective, population-based study among children in Sarlahi, Nepal to estimate carriage prevalence, identify risk ...factors, and determine antibiotic susceptibility patterns and serotype distribution. Between December 2003 and July 2004, NP specimens were collected from 604 children aged 1-36 months with acute lower respiratory infection (ALRI) and 604 healthy, age- and season-matched controls. Of the 1100 specimens analysed, carriage prevalence was approximately 80% in both groups. In the multivariate analyses, significant risk factors for Spn carriage in controls were Muslim religion adjusted odds ratio (AOR): 2.93 and no latrine in the household (AOR: 2.41). Those treated for a recent illness had lower carriage rates (AOR: 0.37). Results were similar for ALRI cases with the addition of age greater-than-or-equal12 months (AOR: 1.68), and symptomatic infection (AOR: 3.78) as risk factors. The antibiotics and proportions of isolates resistant to them were as follows: penicillin 4.5%, cotrimoxazole 89.2%, chloramphenicol 1.4%, erythromycin 1.5% and tetracycline 22.7%. The most prevalent serogroups/types were 6, 19, 23, 15, 9 and 10. Young children in rural Nepal experience high rates of Spn carriage. Most isolates were resistant to cotrimoxazole. Current conjugate Spn vaccines may substantially reduce the risk of a severe pneumonia and other Spn infections.
Streptococcus pneumoniae is the most frequent bacterial cause of morbidity and mortality in young children. Bacteria carried in the nasopharynx of healthy children reflect the prevalent strains ...circulating in the community.
We recruited 464 newborns from a rural area in South India with endemic vitamin A deficiency. Nasopharyngeal specimens were collected from each infant at ages 2, 4 and 6 months.
Fifty-four percent of study infants were colonized by age 2 months, with 64.1 and 70.2% carriage prevalence at ages 4 and 6 months, respectively. The odds of carriage at 2 months were significantly increased in female infants, infants living in a household in which 20 or more cigarettes were smoked each day, infants whose mothers had less than 1 year of schooling and infants fed colostrum. At age 4 months infants having 2 or more siblings <5 years of age were at significantly increased risk of carriage. At age 6 months none of the potential risk factors examined achieved statistical significance, but maternal night blindness increased the risk of colonization 3-fold. The odds of carrying a PncCRM197 vaccine serotype were increased among infants born to mothers who experienced night blindness during pregnancy. The most prevalent serogroups/types during the first 6 months of life were 6, 9, 10, 11, 14, 15, 19, 23 and 33, accounting for 76.7% of all serotyped isolates.
South Indian infants experience high rates of pneumococcal carriage during the first 6 months of life, which may partially explain their increased risk for pneumonia.
Abstract
Background
Annual influenza epidemics cause significant morbidity and mortality. New, emerging strains threaten to cause catastrophic pandemics. Assay of exhaled breath for volatile organic ...compounds (VOCs) via gas chromatography-mass spectroscopy (GC-MS) is an emerging diagnostic modality ideally suited to fill the gap in influenza diagnostics.
Methods
Patients with influenza like illness (ILI) presenting to the Troop Medical Clinic on JBSA Fort Sam Houston, TX, from 3/2017 to 3/2019 submitted a 2-minute breath sample in addition to a nasopharyngeal swab collected for polymerase chain reaction (PCR) assay for influenza virus. ILI was defined as temperature > 100.40F AND respiratory symptoms like cough, sputum production, chest pain and/or sore throat. Breath VOCs were assayed with GC-MS and data were analyzed in order to identify the significant breath VOC biomarkers that discriminated between ILI patients with and without a PCR assay positive for influenza with greater than random accuracy.
Results
Demographic, clinical, PCR and breath data were available for 237 episodes of ILI. PCR was positive for influenza for 32 episodes (30 influenza A and 2 B). The median age of participants was 21 (IQR 19, 23) and 69% were male. There were no differences in age, gender, education, race, or smoking, between the influenza positive and negative groups. Likewise, there was no difference in days of limited activity or missed work, or symptoms at presentation between the groups. The algorithm achieved near maximal predictive accuracy of 78% with four biomarkers (74% sensitivity and 70% specificity). Based on their mass spectra, these biomarker VOCs were tentatively identified as 2-amino-1-propanol, 2-butanamine, n-nitro, 3-methyl-hexanal, and heptane, which are consistent with products of oxidative stress.
Figure. Accuracy, Sensitivity, and Specificity of Influenza Breath Test. Receiver operating characteristic (ROC) of the breath test (sensitivity versus 1-specificity). The accuracy of the breath test was 78%. With a cutoff point at the “shoulder” of the ROC curve, the test had 74% sensitivity and 70% specificity.
Conclusion
Our findings bolster available benchtop and clinical data suggesting that breath testing may be a useful diagnostic modality for influenza infection. The next step will be to study the predictive algorithm developed in this protocol in a blinded validation cohort. If the predictive algorithm performs well in a validation study, adaptation for its use in a portable, tabletop GC would be warranted to allow for a rapid, accurate, universal point-of-care influenza diagnostic test.
Disclosures
Michael Phillips, MD, Menssana Research, Inc (Grant/Research Support)
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