ObjectiveThe objective was to assess the association between nutritional and clinical characteristics and quantitative PCR (qPCR)-diagnosis of bacterial diarrhoea in a multicentre cohort of children ...under 2 years of age with moderate to severe diarrhoea (MSD).DesignA secondary cross-sectional analysis of baseline data collected from the AntiBiotics for Children with Diarrhoea trial (NCT03130114).PatientsChildren with MSD (defined as >3 loose stools within 24 hours and presenting with at least one of the following: some/severe dehydration, moderate acute malnutrition (MAM) or severe stunting) enrolled in the ABCD trial and collected stool sample.Study periodJune 2017–July 2019.InterventionsNone.Main outcome measuresLikely bacterial aetiology of diarrhoea. Secondary outcomes included specific diarrhoea aetiology.ResultsA total of 6692 children with MSD had qPCR results available and 28% had likely bacterial diarrhoea aetiology. Compared with children with severe stunting, children with MAM (adjusted OR (aOR) (95% CI) 1.56 (1.18 to 2.08)), some/severe dehydration (aOR (95% CI) 1.66 (1.25 to 2.22)) or both (aOR (95% CI) 2.21 (1.61 to 3.06)), had higher odds of having likely bacterial diarrhoea aetiology. Similar trends were noted for stable toxin-enterotoxigenic Escherichia coli aetiology. Clinical correlates including fever and prolonged duration of diarrhoea were not associated with likely bacterial aetiology; children with more than six stools in the previous 24 hours had higher odds of likely bacterial diarrhoea (aOR (95% CI) 1.20 (1.05 to 1.36)) compared with those with fewer stools.ConclusionThe presence of MAM, dehydration or high stool frequency may be helpful in identifying children with MSD who might benefit from antibiotics.
Background. Enteroaggregative Escherichia coli (EAEC) is a cause of epidemic and sporadic diarrhea, yet its role as an enteric pathogen is not fully understood. Methods. We characterized 121 EAEC ...strains isolated in 2008 as part of a case-control study of moderate to severe acute diarrhea among children 0-59 months of age in Bamako, Mali. We applied multiplex polymerase chain reaction and comparative genome hybridization to identify potential virulence factors among the EAEC strains, coupled with classification and regression tree modeling to reveal combinations of factors most strongly associated with illness. Results. The gene encoding the autotransporter protease SepA, originally described in Shigella species, was most strongly associated with diarrhea among the EAEC strains tested (odds ratio, 5.6 95% confidence interval, 1.92-16.17; P = .0006). In addition, we identified 3 gene combinations correlated with diarrhea: (1) a clonal group positive for sepA and a putative hemolysin; (2) a group harboring the EAST-1 enterotoxin and the flagellar type H33 but no other previously identified EAEC virulence factor; and (3) a group carrying several of the typical EAEC virulence genes. Conclusion. Our data suggest that only a subset of EAEC strains are pathogenic in Mali and suggest that sepA may serve as a valuable marker for the most virulent isolates.
Abstract
Background
Bacterial pathogens cause substantial diarrhea morbidity and mortality among children living in endemic settings, yet antimicrobial treatment is only recommended for dysentery or ...suspected cholera.
Methods
AntiBiotics for Children with severe Diarrhea was a 7-country, placebo-controlled, double-blind efficacy trial of azithromycin in children 2–23 months of age with watery diarrhea accompanied by dehydration or malnutrition. We tested fecal samples for enteric pathogens utilizing quantitative polymerase chain reaction to identify likely and possible bacterial etiologies and employed pathogen-specific cutoffs based on genomic target quantity in previous case-control diarrhea etiology studies to identify likely and possible bacterial etiologies.
Results
Among 6692 children, the leading likely etiologies were rotavirus (21.1%), enterotoxigenic Escherichia coli encoding heat-stable toxin (13.3%), Shigella (12.6%), and Cryptosporidium (9.6%). More than one-quarter (1894 28.3%) had a likely and 1153 (17.3%) a possible bacterial etiology. Day 3 diarrhea was less common in those randomized to azithromycin versus placebo among children with a likely bacterial etiology (risk difference RDlikely, −11.6 95% confidence interval {CI}, −15.6 to −7.6) and possible bacterial etiology (RDpossible, −8.7 95% CI, −13.0 to −4.4) but not in other children (RDunlikely, −0.3% 95% CI, −2.9% to 2.3%). A similar association was observed for 90-day hospitalization or death (RDlikely, −3.1 95% CI, −5.3 to −1.0; RDpossible, −2.3 95% CI, −4.5 to −.01; RDunlikely, −0.6 95% CI, −1.9 to .6). The magnitude of risk differences was similar among specific likely bacterial etiologies, including Shigella.
Conclusions
Acute watery diarrhea confirmed or presumed to be of bacterial etiology may benefit from azithromycin treatment.
Clinical Trials Registration
NCT03130114.
Improved clinical outcomes among children with acute watery diarrhea of bacterial etiology in this reanalysis of the ABCD trial suggest that a short course of azithromycin may be warranted if bacterial etiologies could be identified at the point of care.
Background. In 2002, following establishment of a clinical microbiology laboratory in the government hospital that admits children with severe illnesses in Bamako, Mali, surveillance to identify ...pathogens causing invasive bacterial infections (septicemia, bacteremia, meningitis, etc) was initiated. Methods. Parents/guardians of children aged <16 years admitted to l'Hôpital Gabriel Touré with high fever or clinical syndromes compatible with focal invasive bacterial disease were asked for consent to culture their child's blood/body fluid. Standard bacteriologic techniques speciated isolates; Salmonella serovars were determined. Results. From July 2002 through June 2014, 687 nontyphoidal Salmonella (NTS) isolates were obtained from 667 children; 667 yielded a single serovar and 20 grew 2 Salmonella serovars, 1 being NTS. Four serovars accounted for 87% of the 687 NTS isolates, including Salmonella Enteritidis (n = 244 35.5%), Salmonella Typhimurium (n = 221 32.2%), I:4,5,12:i:- (n = 42 6.1%), and Salmonella Dublin (n = 89 13.0%). Of 553 patients with invasive NTS from whom 1 of the 4 predominant serovars was isolated in pure culture, 448 (81.0%) were aged <5 years and case fatality was 20.3%; Salmonella Enteritidis case fatality (27.8%) was higher than for other serovars (P = .0009). NTS disease showed a seasonal peak following the rainy season and into the cool, dry season. Since 2010, Salmonella Enteritidis cases have risen and Salmonella Typhimurium fallen. Conclusions. NTS has become the predominant invasive pathogen as Haemophilus influenzae type b and pneumococcal vaccine use in Mali has diminished invasive disease due to those pathogens. The age distribution and limited serovars involved make control of NTS disease by vaccines epidemiologically feasible, if products under development prove safe and efficacious.
Les céphalées et la lombalgie restent un motif fréquent de consultation en médecine. Elles constituent de part leur handicap psychosocial un grand problème de santé publique.
Étudier les ...connaissances attitudes et pratiques des tradithérapeutes de la ville de Bamako en matière de prise en charge des céphalées et des lombalgies.
Il s’est agi une étude prospective, descriptive et transversale de un an (octobre 2016 à septembre 2017), effectuée auprès des tradipraticiens et herboristes de la ville de Bamako.
Au total, 110 tradipraticiens ont été colligés. Le sex-ratio était 0,8. La tranche d’âge la plus représentée était 41–60 ans, plus de 98 % était de confession musulmane dont une majorité non scolarisée (67 %). L’expérience professionnelle était supérieure à 10 ans pour 88,18 % d’entre eux. La lombalgie et la céphalée étaient des motifs fréquents de consultation. Dans 83 % des cas une origine organique était évoquée. Les moyens thérapeutiques utilisés étaient la phytothérapie dans 64 % des cas.
Le sexe féminin prédominait comme dans la plupart des études. L’expérience professionnelle s’acquiert au fil des années. L’étiologie surnaturelle était évoquée comme étiologie possible cependant l’origine organique était aussi évoquée par la majorité des tradipraticiens. La thérapie était basée essentiellement sur la phytothérapie mais certains avaient recours à d’autres moyens traditionnels (incantation, fumigation, verset coranique etc.).
La prise en charge de la douleur doit intégrer ses représentations ou dimensions socioculturelles. La connaissance des déterminants socioculturelles est le gage d’un système intégrée de prise en charge de la douleur en Afrique.
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