Niels Højlyng

Cryptosporidiosis in infancy and childhood mortality in Guinea Bissau, west Africa.

OBJECTIVE--To investigate the epidemiology of and mortality from cryptosporidiosis in young children in Guinea Bissau, West Africa. DESIGN--Three year community study of an open cohort followed up weekly. SETTING--301 randomly selected houses in a semi-urban area in the capital, Bissau. SUBJECTS--1315 children aged less than 4 years. MAIN OUTCOME MEASURES--Cryptosporidium infection detected by examination of stools during episode of diarrhoea and death of a child. RESULTS--Cryptosporidium spp were found in 239 (7.4%) out of 3215 episodes of diarrhoea. The parasite was most common in younger children (median age 12 months) and at the beginning of the rainy seasons. The prevalence of cryptosporidiosis was 15% (77/513) in cases of persistent diarrhoea compared with 6.1% (148/2428) in diarrhoea lasting less than two weeks (p < 0.0001). Cryptosporidiosis was associated with excess mortality in children who had the infection in infancy, and this excess mortality persisted into the second year of life (relative mortality 2.9 (95% confidence interval 1.7 to 4.9)). The excess mortality could not be explained by malnutrition, or by socioeconomic factors, hygienic conditions, or breast feeding. CONCLUSIONS--Cryptosporidiosis is an important cause of death in otherwise healthy children in developing countries.

Prolonged breast feeding, diarrhoeal disease, and survival of children in Guinea-Bissau.

Abstract Objective : To analyse the impact of breast feeding on diarrhoeal disease and survival in children above 1 year of age in Guinea-Bissau, west Africa. Design : A community study of an open cohort followed up weekly by interviews over 15 months. Data on feeding practices, anthropometry, and survival were recorded for three years. Setting : 301 randomly selected houses in a semiurban area in the capital, Bissau. Subjects : 849 children aged less than 3 years. Main outcome measures : Incidence and duration of diarrhoea, weight for age, and death of a child. Results : The incidence of diarrhoea was higher in weaned children than in partially breast fed children, both in 1 year olds (relative risk 1.41; 95% confidence interval 1.23 to 1.62) and in 2 year olds (1.67; 1.29 to 2.15). The mean duration of an episode of diarrhoea was 5.3 days in breast fed children compared with 6.3 days in weaned children (P= 0.001). Independent of the age of weaning, a similar increase was found in an analysis comparing, for each child, the rate and duration of diarrhoea one month before and one month after weaning. Children with low weight for age were breast fed longer than the better nourished children (P=0.02). Children aged 12-35 months who were not breast fed had a 3.5 times higher mortality (1.4 to 8.3) than breast fed children. Conclusions : The beneficial effects of breast feeding are not restricted to infancy. Though children who are partially breast fed after infancy may have a lower state of nutrition than the weaned ones, the benefit in terms of lower morbidity may be more important for child survival in places with a high morbidity from diarrhoea and with high mortality.

The Role of Mycobacteria Other Than Tuberculosis (MOTT) in Patients with Cystic Fibrosis

The purpose of this study was to estimate the frequency of and evaluate the clinical impact of pulmonary mycobacterial infections among cystic fibrosis (CF) patients. 185 CF patients aged 2.2-38.5 years were screened by sputum samples and by intracutaneous skin tests against tuberculin and sensitins produced from Mycobacterium chelonae subsp. abscessus, M. avium, M. intracellulare and M. scrofulaceum (the MAIS complex). The skin tests towards the sensitins in BCG-vaccinated patients (n = 60) were significantly influenced by the vaccination. 26 of the remaining 125 non-vaccinated patients had > or = 1 positive skin test (95% confidence limits 15-29%). The majority reacted against the MAIS complex. However, the reactions were similar to those of healthy siblings and an age-matched control group. Moreover, the lung function, growth and HbA1c were similar among skin test positive and negative patients. Three patients had repeated positive sputum cultures, the point prevalence being 1.6% (M. intracellulare, n = 2 and M. chelonae subsp. abscessus, n = 1). During the subsequent 4 years, 4 additional patients with M. chelonae subsp. abscessus were identified. Based on clinical observations, 5 of the infected patients were considered asymptomatic, while 2 might have been symptomatic. In 1 patient, M. chelonae subsp. abscessus disappeared spontaneously. Despite intensive treatment with new antibiotics against Mycobacteria Other Than Tuberculosis (MOTT) in 4 patients, the mycobacteria were not eradicated. In conclusion, MOTT infection was rare and the clinical impact difficult to prove. Treatment should focus on clinical improvement in the individual patient suspected of suffering from significant symptomatic infection. Eradication of the bacteria should not be expected.

Bacterial contamination of stored water and stored food: a potential source of diarrhoeal disease in West Africa

The food and water hygiene in two Liberian communities was studied in a house-to-house diarrhoea survey. The level of contamination with enterobacteria of drinking water stored in the households was significantly higher than at the water sources. Food hygiene standards were low, particularly in the urban slum where storage of cooked food for long periods led to bacterial multiplication at high levels. Infant foods were particularly heavily contaminated. It is concluded that when water supply programmes are planned, the presence of other risk factors for water-related diseases should be investigated. To ensure maximum health benefits, water projects should as a rule be accompanied by other interventions.

Persistent and acute diarrhoea as the leading causes of child mortality in urban Guinea Bissau.

An investigation of child mortality in a semi-urban community, Bandim II, in the capital of Guinea Bissau was carried out from April 1987 to March 1990. 153 deaths were recorded among 1426 live-born children who were followed for 2753 child-years. The under-five mortality risk was 215 per 1000 children (95% confidence interval [CI] 176-264), infant mortality 94 per 1000 (95% CI 73-115), and perinatal mortality 52 per 1000 (95% CI 41-63). By prospective registration of morbidity, post-mortem interviews, and examination of available hospital records, a presumptive cause of death was established in 86% of the deaths. Persistent and acute diarrhoea were the most frequent causes of death, accounting for 43 and 31 deaths per 1000 children, respectively. Fever deaths (possibly malaria), neonatal deaths, acute respiratory infections, and measles were other frequent causes. The access to health services was relatively easy: 75% of the children who died had attended for treatment at a hospital or a health centre. It is important to find ways of preventing and managing persistent diarrhoea, the major cause of death, and to improve the control of acute diarrhoea by a targeted approach.

Mass spectrometry: Pneumococcal meningitis verified and Brucella species identified in less than half an hour

Abstract Matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS) is currently being introduced for the rapid and accurate identification of bacteria. We describe 2 MALDI-TOF MS identification cases – 1 directly on spinal fluid and 1 on grown bacteria. Rapidly obtained results had great value for the continued treatment and for the elucidation of exposure.

A Case of Helicobacter cinaedi Bacteraemia in a Previously Healthy Person with Cellulitis.

Helicobacter cinaedi is an infrequent, but well recognized cause of gastroenteritis in immunosuppressed patients. Here we report a case of an extra-intestinal infection in a previous healthy 61-year old heterosexual male. Focus for the infection was most likely cellulitis on the lower right leg. The bacterium was cultured from blood twice within one week. Electron microscopy of the isolate visualized bipolar flagella. Partial DNA sequencing of the 16S rRNA gene and phenotypic characterization of the isolate established the species diagnosis. The patient was treated with rifampicin. After end of treatment blood cultures were negative and the cellulitis had disappeared.

An epidemic outbreak of cryptosporidiosis: a prospective community study from Guinea Bissau.

In the first year of a prospective community study of childhood diarrhea conducted in a semiurban area in the capital of Guinea Bissau, Cryptosporidium sp. was found in 73 (6.0%) of 1216 episodes of diarrhea. The parasite was the second most prevalent intestinal parasite, and the only one significantly associated with diarrhea (OR = 2.79, P = 0.0006). The seasonal distribution was striking, with a peak prevalence in the beginning of the rainy season (May 17.6%) when an epidemic outbreak of diarrhea started. The prevalence was highest in children younger than 18 months, an age at which prevalences of other intestinal parasites were low. This reverse age pattern may possibly be explained by the small infective dose needed to create severe infections, by air-borne transmission and by the development of protective immunity.

High prevalence of campylobacter excretors among Liberian children related to environmental conditions

Campylobacter was the bacterial pathogen most prevalent in 859 children, aged 6-59 months, examined in a house-to-house diarrhoea survey in two Liberian communities. 44.9% of the children from an urban slum and 28.4% from a rural area were excretors. Since the prevalence of diarrhoea was very high and consequently many convalescent carriers were found, it was not possible to evaluate the pathogenic role of campylobacter. The excretor rate increased with age and was significantly correlated to the use of supplementary feeding, inversely correlated to the quality of the water supply, and also associated with helminthic infestation. Results from re-examination of 172 children suggested a high intensity of transmission. The findings all indicate the existence of a heavy environmental contamination with campylobacter, probably of both human and animal faecal origin.

Brucellosis in immigrants in Denmark.

Brucellosis is a rarely encountered infection in northern Europe. We report 4 cases of Brucella abortus bacteremia occurring in Denmark during 1999-2000. The clinical presentation was characteristically vague and brucellosis was not suspected by the attending physicians, partly because incomplete patient histories were obtained as a result of language barriers. The diagnosis was finally established by means of blood cultures, which were performed because of fever of unknown origin.