To ascertain the microbiological consequences of WHO's recommendation for presumptive co-trimoxazole prophylaxis for infants with perinatal HIV exposure.
Using a longitudinal cohort design, we ...followed HIV-exposed and HIV-unexposed infants trimonthly for up to 18 months per infant. HIV-exposed infants received daily co-trimoxazole prophylaxis from 6 weeks to > or = 12 months of age. Using Streptococcus pneumoniae as our sentinel pathogen, we measured how co-trimoxazole altered nasopharyngeal colonization, pneumococcal resistance to antibiotics and serotype distribution as a function of co-trimoxazole exposure.
From 260 infants followed for 3096 patient-months, we detected pneumococci in 360/1394 (25.8%) samples. HIV-exposed infants were colonized more frequently than HIV-unexposed infants (risk ratio, RR: 1.4; 95% confidence interval, CI: 1.0-1.9, P = 0.04). Co-trimoxazole prophylaxis reduced colonization by ca 7% but increased the risk of colonization with co-trimoxazole-resistant pneumococci within 6 weeks of starting prophylaxis (RR: 3.2; 95% CI: 1.3-7.8, P = 0.04). Prophylaxis with co-trimoxazole led to a small but statistically significant increase of nasopharyngeal colonization with pneumococci not susceptible to clindamycin (RR: 1.6; 95% CI: 1.0-2.6, P = 0.04) but did not increase the risk of non-susceptibility to penicillin (RR: 1.1; 95% CI: 0.7-1.7), erythromycin (RR: 1.0; 95% CI: 0.6-1.7), tetracycline (RR: 0.9; 95% CI: 0.6-1.5) or chloramphenicol (RR: 0.8; 95% CI: 0.3-2.3). Co-trimoxazole prophylaxis did not cause the prevailing pneumococcal serotypes to differ from those that are targeted by the 7-valent conjugate pneumococcal vaccine (RR: 1.0; 95% CI: 0.7-1.6).
Co-trimoxazole prophylaxis modestly suppresses pneumococcal colonization but accelerates infant acquisition of co-trimoxazole- and clindamycin-resistant pneumococci. Co-trimoxazole prophylaxis appears unlikely to compromise the future efficacy of conjugate vaccines.
Nasopharyngeal colonization with Streptococcus pneumoniae precedes invasive pneumococcal disease. Human immunodeficiency virus (HIV) infection increases rates of invasive pneumococcal disease, and ...its effect on colonization is unknown. In a longitudinal cohort of Zambian mothers with or without HIV infection, HIV infection increased the risk of colonization (risk ratio RR, 1.9; 95% confidence interval CI, 1.3–2.8) and repeat colonization (RR, 2.4; 95% CI, 1.1–5.3) and reduced the time to new colonization (P=.01). Repeat colonization with homologous sero/factor types occurred only among HIV-positive mothers. Pediatric serotypes 6, 19, and 23 accounted for excess colonization among HIV-positive mothers. HIV infection significantly increases the risk of pneumococcal colonization. Increased rates of colonization by pediatric serotypes suggest a potential role for the 7-valent pneumococcal vaccine in HIV-infected adults
Background. The World Health Organization advocates 2–3 doses of sulfadoxine-pyrimethamine (SP) for intermittent preventive treatment of malaria (SP IPTp). The optimal number of doses and the ...consequences of single-dose therapy remain unclear. Methods. Data were from a randomized, controlled study of human immunodeficiency virus-positive Zambian women comparing monthly versus 2-dose SP IPTp. We compared maternal and neonatal birth outcomes as a function of how many doses the mothers received (1 to ⩾4 doses). Results. Of 387 deliveries, 34 received 1 dose of SP. Single-dose SP was significantly associated with higher proportions of maternal anemia, peripheral and cord blood parasitemia, infant prematurity, and low birth weight. SP conferred dose-dependent benefits, particularly in the transition from 1 to 2 doses of SP. Women randomized to the standard 2-dose regimen were much more likely to receive only 1 dose than were women randomized to monthly IPT (relative risk, 16.4 95% confidence interval, 4.0–68.3). Conclusions. Single-dose SP was a common result of trying to implement the standard 2-dose regimen and was inferior to all other dosing regimens. At a programmatic level, this implies that monthly SP IPTp may ultimately be more effective than the standard regimen by reducing the risk of inadvertently underdosing mothers.
The prevalence of chloroquine-resistant
Plasmodium falciparum malaria has been increasing in sub-Saharan Africa and parts of South America over the last 2 decades, and has been associated with ...increased anaemia-associated morbidity and higher mortality rates. Prospectively collected clinical and parasitological data from a multicentre study of 788 children aged 6–59 months with uncomplicated
P. falciparum malaria were analysed in order to identify risk factors for chloroquine treatment failure and to assess its impact on anaemia after therapy. The proportion of chloroquine treatment failures (combined early and late treatment failures) was higher in the central-eastern African countries (Tanzania, 53%; Uganda, 80%; Zambia, 57%) and Ecuador (54%) than in Ghana (36%). Using logistic regression, predictors of early treatment failure included younger age, higher baseline temperature, and greater levels of parasitaemia. We conclude that younger age, higher initial temperature, and higher baseline parasitaemia predict early treatment failure and a higher probability of worsening anaemia between admission and days 7 or 14 post-treatment.
Background. Intermittent preventive treatment of malaria during pregnancy (IPTp) reduces placental infection, maternal anemia, and low birth weight (LBW). However, the optimal dosing regimen in ...settings in which human immunodeficiency virus (HIV) is highly prevalent among pregnant women remains controversial. Methods. We conducted a randomized, double-blind, placebo-controlled study of IPTp comparing the standard 2-dose sulfadoxine-pyrimethamine (SP) regimen with monthly IPTp among a cohort of HIV-positive pregnant Zambian women. Primary outcomes included placental malaria (by smear and histology) and maternal peripheral parasitemia at delivery. Results. There were no differences between monthly IPTp ( n= 224) and standard IPTp ( n = 232) in placental malaria by histopathology (26% vs. 29%; relative risk RR, 0.90 95% confidence interval {CI}, 0.64–1.26) or placental parasitemia (2% vs. 4%; RR, 0.55 95% CI, 0.17–1.79). There also were no differences in maternal anemia, stillbirths, preterm delivery, LBW, or all-cause mortality of infants at 6 weeks. Conclusions. In an area of mesoendemicity in Zambia, monthly SP IPTp was not more efficacious than the standard 2-dose regimen for the prevention of placental malaria or adverse birth outcomes. IPTp policy recommendations need to take into account local malaria transmission patterns and the prevalence of HIV. Trial registration. ClinicalTrials.gov identifier: NCT00270530.
A prospective cohort study was conducted in two villages in Zambia to compare the efficacy of praziquantel in the treatment of schistosomiasis haematobium in people with and without concomitant ...infection with human immunodeficiency virus (HIV). Five hundred seven individuals with infected with Schistosoma haematobium were enrolled and followed-up for as long as 12 months after treatment with a single dose of praziquantel. Seventy-three were coinfected with HIV. The study demonstrated that praziquantel is still very effective in the treatment and control of S. haematobium even when there is coinfection with HIV (without symptoms and signs of acquired immunodeficiency syndrome AIDS/HIV disease). Resistance to reinfection with S. haematobium is not altered in subjects coinfected with HIV (without symptoms and signs of AIDS/HIV disease). Individuals with coinfection excreted fewer eggs and complained less of hematuria than those without HIV infection, and the sensitivity and positive predictive value of reported hematuria as an indication of heavy infection were lower in the group coinfected with HIV. This observation may have implications for the use of hematuria as an indicator for rapid diagnosis of schistosomiasis in areas where HIV is prevalent.
Metodos Mediante un estudio longitudinal de cohortes, se siguio la evolucion de lactantes expuestos al VIH y no expuestos al VIH con periodicidad trimestral por espacio de hasta 18 meses por ...lactante. Los expuestos al virus recibieron cotrimoxazol profilactico desde las 6 semanas hasta como minimo los 12 meses de edad. Usando Streptococcus pneumoniae come agente patogeno centinela, medimos los efectos del cotrimoxazol en la colonizacion nasofaringea, la resistencia a los antibioticos y la distribucion de los serotipos en funcion de la exposicion al cotrimoxazol.
To study impact of once weekly iron supplementation on praziquantel cure rate, Schistosoma haematobium reinfection, and haematological parameters in pupils aged between 9 and 15 years of age in ...Nchelenge district, Zambia.
Pupils in the intervention group received once weekly dose of ferrous sulphate at 200 mg while those in the control received once weekly vitamin C at 100 mg for up to 9 months. Both study groups received a single dose of praziquantel at baseline.
S haematobium reinfection intensity was significantly lower in boys in the intervention group than in boys in the control group at 6 months (P < 0.001) and 9 months (P < 0.001) of supplementation. Significantly lower S haematobium reinfection intensity was found in girls in the intervention group than in girls in the control group only at 6 months of supplementation (P = 0.018). Boys in the intervention group were 42% (Adjusted Risk Ratio = 0.58, 95% confidence interval 0.39, 0.86) less likely to be reinfected with S haematobium than in the control group at 6 months follow up.
Once weekly iron supplementation can decrease S haematobium reinfection after 6 months and should be incorporated into school based schistosomiasis control programs in highly endemic areas.
A total of 210 blood slides from rural children in Samfya District were examined for malaria parasites. One hundred and seventy two were positive for malaria parasites giving a prevalence of 819 pc. ...Among the children less than one year of age, the prevalence of mixed Plasmodium infection was 124 pc. For children one year and above, the prevalence of mixed Plasmodium infection was 227 pc. There was a statistically significant difference between these two prevalence rates of mixed Plasmodium infection.
PDF
