Summary Objective To characterize the potential effects of Helicobacter infections on growth velocity in low socioeconomic status young children in a developing country. Methods Children were ...recruited in poor suburbs of Quito, Ecuador. Normally nourished, mildly and substantially malnourished children (defined using weight-for-age Z-scores at recruitment) formed equal strata. Six height and weight measurements were collected during one year. Enrollment and exit serum samples were analyzed for anti-Helicobacter IgG and exit non-diarrheal feces tested for Helicobacter antigen. Results Among 124 participants (enrollment age 19 ± 9 months), 76 (61%) excreted fecal antigen at exit (were infected). Of these, 44 were seropositive at least once (chronic infections) and 32 tested seronegative both times (new or acute phase infections). The adjusted linear growth velocity during follow-up in children with new infections was reduced by 9.7 (3.8, 15.6) mm/year compared to uninfected controls and 6.4 (0.0, 12.9) mm/year compared to children with chronic infections. The effects of Helicobacter infections on ponderal growth were not significant. Conclusion These results suggest that linear growth velocity is reduced in young children during the initial phase of Helicobacter infection.
We evaluated the Binax NOW Streptococcus pneumoniae urinary antigen assay by testing 210 healthy children aged 2-60 months living in urban slums of Quito, Ecuador. Healthy children with ...nasopharyngeal carriage of S. pneumoniae were significantly more likely to have positive urinary antigen test results than were children who were not carriers (30 of 138 vs. 3 of 71 children; chi²=10.8; P<.001). The rate of nasopharyngeal carriage of S. pneumoniae decreased with increasing age; the lowest rates were found in children with the worst nutritional status.
Objective To evaluate whether five days’ treatment with injectable ampicillin plus gentamicin compared with chloramphenicol reduces treatment failure in children aged 2-59 months with community ...acquired very severe pneumonia in low resource settings.Design Open label randomised controlled trial.Setting Inpatient wards within tertiary care hospitals in Bangladesh, Ecuador, India, Mexico, Pakistan, Yemen, and Zambia.Participants Children aged 2-59 months with WHO defined very severe pneumonia.Intervention Chloramphenicol versus a combination of ampicillin plus gentamicin.Main outcome measures Primary outcome measure was treatment failure at five days. Secondary outcomes were treatment failure defined similarly among all participants evaluated at 48 hours and at 10 and 21 days.Results More children failed treatment with chloramphenicol at day 5 (16% v 11%; relative risk 1.43, 95% confidence interval 1.03 to 1.97) and also by days 10 and 21. Overall, 112 bacterial isolates were obtained from blood and lung aspirates in 110 children (11.5%), with the most common organisms being Staphylococcus aureus (n=47) and Streptococcus pneumoniae (n=22). In subgroup analysis, bacteraemia with any organism increased the risk of treatment failure at 21 days in the chloramphenicol group (2.09, 1.41 to 3.10) but not in the ampicillin plus gentamicin group (1.12, 0.59 to 2.13). Similarly, isolation of S pneumoniae increased the risk of treatment failure at day 21 (4.06, 2.73 to 6.03) and death (5.80, 2.62 to 12.85) in the chloramphenicol group but not in the ampicillin plus gentamicin group. No difference was found in treatment failure for children with S aureus bacteraemia in the two groups, but the power to detect a difference in this subgroup analysis was low. Independent predictors of treatment failure by multivariate analysis were hypoxaemia (oxygen saturation <90%), receiving chloramphenicol, being female, and poor immunisation status.Conclusion Injectable ampicillin plus gentamicin is superior to injectable chloramphenicol for the treatment of community acquired very severe pneumonia in children aged 2-59 months in low resource settings.Trial registration Current Controlled Trials ISRCTN39543942.
The proportion of the Latin American population above age 65 y is expected to rise substantially. To better define the prevalence of infectious diseases and micronutrient deficiencies, assess ...immunological status, and evaluate associations between nutritional status and infection, we performed a cross-sectional study of elderly Ecuadorians in a low-income peri-urban community in Quito, Ecuador. Culturally adapted questionnaires, delayed type hypersensitivity (DTH) skin response, micronutrient, and immunological assays were performed in randomly selected Ecuadorians aged greater-than-or-equal65 y. Multiple linear and logistic regression models were developed to assess relationships between micronutrient concentrations and history of infection, DTH, and immune function. Participants (n = 352; mean age ± SD, 74.4 ± 6.4 y) recalled recent episodes of colds/influenza-like syndromes (62.8%), cough (61.0%), urinary tract infection (37.9%), diarrhea (32.2%), fever (24.1%), and pneumonia (3.5%). A prospective substudy of respiratory infections (RI) in 203 elderly revealed similar findings. Colds and pneumonia occurred in 42.8 and 7.9% of participants, respectively, during 737 person-weeks of observation (3.6 ± 1.1 wk per person). Anemia and micronutrient deficiencies, especially for vitamins C, D, B-6, and B-12 and folic acid and zinc, were common. Plasma vitamin C was associated with interferon-γ (IFNγ) (P < 0.01) and zinc with IFNγ and interleukin-2 (each P < 0.0001). RI history was associated with any micronutrient deficiency (P < 0.001). The burden of infectious diseases, micronutrient deficiencies, and anemia was substantial in this elderly Ecuadorian population. Deficiencies of essential vitamins and minerals place these elderly adults at risk for infections through their negative impact on immune function.
The proportion of the Latin American population above age 65 y is expected to rise substantially. To better define the prevalence of infectious diseases and micronutrient deficiencies, assess ...immunological status, and evaluate associations between nutritional status and infection, we performed a cross-sectional study of elderly Ecuadorians in a low-income peri-urban community in Quito, Ecuador. Culturally adapted questionnaires, delayed type hypersensitivity (DTH) skin response, micronutrient, and immunological assays were performed in randomly selected Ecuadorians aged ≥65 y. Multiple linear and logistic regression models were developed to assess relationships between micronutrient concentrations and history of infection, DTH, and immune function. Participants (n = 352; mean age ± SD, 74.4 ± 6.4 y) recalled recent episodes of colds/influenza-like syndromes (62.8%), cough (61.0%), urinary tract infection (37.9%), diarrhea (32.2%), fever (24.1%), and pneumonia (3.5%). A prospective substudy of respiratory infections (RI) in 203 elderly revealed similar findings. Colds and pneumonia occurred in 42.8 and 7.9% of participants, respectively, during 737 person-weeks of observation (3.6 ± 1.1 wk per person). Anemia and micronutrient deficiencies, especially for vitamins C, D, B-6, and B-12 and folic acid and zinc, were common. Plasma vitamin C was associated with interferon-γ (IFNγ) (P < 0.01) and zinc with IFNγ and interleukin-2 (each P < 0.0001). RI history was associated with any micronutrient deficiency (P < 0.001). The burden of infectious diseases, micronutrient deficiencies, and anemia was substantial in this elderly Ecuadorian population. Deficiencies of essential vitamins and minerals place these elderly adults at risk for infections through their negative impact on immune function.
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The number of the elderly in Latin America is expected to rise substantially. To define the prevalence of infections and micronutrient deficiencies, and immunological status, and to ...evaluate associations between nutritional status and infection, we performed a cross‐sectional study of elderly Ecuadorians in a low‐income peri‐urban community in Quito, Ecuador. Anthropometric measurements, delayed type hypersensitivity (DTH) skin testing, and blood micronutrient and immunological assays were performed in 352 randomly selected Ecuadorians, aged≥65 y. Relationships between micronutrients, immune function, and history of infection was assessed by multiple linear and logistic regression models. Participants recalled recent episodes of colds/influenza‐like syndromes (63%), cough (61%), urinary tract infection (38%), diarrhea (32%), fever (24%), and pneumonia (3.5%). Anemia and micronutrient deficiencies, especially for vitamins C, D, B
6
, and B
12
, folic acid, and zinc were common. Plasma vitamin C was associated with IFN‐γ (P<0.01); and zinc with IFN‐γ and IL‐2 (each P<0.0001). History of respiratory infection was associated with micronutrient deficiency (P<0.0001). The burden of infection, micronutrient deficiencies, and anemia was substantial in elderly Ecuadorians and place them at risk for infections through their negative impact on immune function. Supported by NIH Fogarty International Center (1 R03 TW005779‐01A1), NIA (2R01 AG009140‐10A1), and USDA (#58‐1950‐7‐707).
We evaluated the Binax NOW Streptococcus pneumoniae urinary antigen assay by testing 210 healthy children aged 2–60 months living in urban slums of Quito, Ecuador. Healthy children with ...nasopharyngeal carriage of S. pneumoniae were significantly more likely to have positive urinary antigen test results than were children who were not carriers (30 of 138 vs. 3 of 71 children; χ2 = 10.8; P < .001). The rate of nasopharyngeal carriage of S. pneumoniae decreased with increasing age; the lowest rates were found in children with the worst nutritional status.
To determine the risk for diarrheal disease (DD) in day-care centers (DCC) for children residing in a poor urban slum area of Quito, Ecuador, compared with that for children from the same environment ...but cared for in their own residential home (RH), a prospective age-, sex- and locale-controlled study of DD was conducted, including 115 children in DCC and 115 in RH, ages 12 to 42 months. The overall incidence of DD was 46/1000 child weeks. Diarrhea was more common in DCC than in RH (relative risk (RR), 1.75; 95% confidence interval (CI), 1.38 to 2.22; P < 0.001). Poor hygienic practices were more prevalent in DCC than in RH. The use of reused water for child handwashing before eating and for washing raw vegetables was associated with a higher risk of DD in DCC than in RH (RR = 4.08, CI 2.93 to 5.67, P < 0.001; RR = 3.90, CI 2.79 to 5.44, P < 0.001, respectively). These two practices were risk factors in the DCC (RR = 2.74, CI 2.08 to 3.68, P < 0.001; RR = 2.05, CI 1.55 to 2.71, P < 0.001, respectively) when compared with their absence in the same DCC. Shigella (RR = 3.58, CI 1.19 to 10.78, P < 0.02), Aeromonas (RR = 10.47, CI 1.35 to 81.05, P < 0.01), rotavirus (RR = 2.86, CI 1.87 to 4.39, P < 0.001) and Giardia (RR = 1.59, CI 1.00 to 2.59, P < 0.05) were more common in DCC than in RH. More than two-fifths of the Shigella and Aeromonas isolates were resistant to trimethoprim-sulfamethoxazole.
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