[Values of clinical signs and rapid diagnostic test in the diagnosis of influenza A (H1N1) new variant in pediatric emergency department.]
ABSTRACT AIM OF THE STUDY: To evaluate the values of clinical signs and the rapid diagnostic test (RDT) in the diagnosis of influenza H1N1 new variant in the pediatric emergency room. METHOD: From 18 August to 1st December 2009, children admitted to the pediatric emergency department of CHU Nord (Marseille, France) and suspected of flu according to French guidelines, were tested for influenza using both an influenza RDT and a polymerase chain reaction (PCR) assay specific for H1N1. From 3 November to 3 December, clinical signs were also noted (fever, headaches, myalgia-arthralgia, shivers, diarrhea). RESULTS: A total of 1122 children were tested: 367 children (32.1%) had a positive specific PCR. The RDT value was: sensitivity 65.2% [55.8-73.6], specificity 99.5% [98.1-100], positive predictive value (PPV) 97.5% [91.8-100], negative predictive value (NPV) 91.2% [90.3-91.5], positive likelihood ratio (LRP) 153.7 [53.5-452.9] and negative likelihood ratio (LRN) 0.393 [0.387-0.411]. Clinical data were available for 504 children (328 over 2 years of age). In children more than 2 years of age and in multivariate analysis, headaches were the only sign significantly associated with a positive PCR (aOR=2.53 [1.25-5.12]). Overall, headaches and/or myalgia-arthralgia were valuable indicators for clinical diagnosis of flu, with a 75.8% NPV. Among children with a positive PCR, diarrhea was more frequent in children under 2 years of age (OR=2.76 [1.19-6.40]). The sensitivity of the RDT improved (90.9% [85.2-94.6]) when flu signs were also present. CONCLUSION: Associating clinical signs and RDT for the diagnosis of influenza A (H1N1) new variant in a pediatric emergency room improves selection of children requiring appropriate antiviral treatment.
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ABSTRACT: To assess the socio-economic impact of infectious intestinal disease (IID) on the health care sector, cases and their families, cases of IID ascertained from a population cohort component and those presenting to general practices were sent a socio-economic questionnaire 3 weeks after the acute episode. The impact of the illness was measured and the resources used were identified and costed. The duration, severity and costs of illness linked to viruses were less than those linked to bacteria. The average cost per case of IID presenting to the GP was £253 and the costs of those not seeing a GP were £34. The average cost per case was £606 for a case with salmonella, £315 for campylobacter, £164 for rotavirus and £176 for SRSV. The estimated cost of IID in England was £743m expressed in 1994/5 prices. The costs of IID are considerable and the duration of the illness was found to be longer than previous reports have suggested.Epidemiology and Infection 01/2003; 130(01):1 - 11. DOI:10.1017/S0950268802007690 · 2.54 Impact Factor
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ABSTRACT: Prevalence of thermophilic Campylobacter infections in humans, chickens and crows was determined in a cross-sectional study that was carried out in urban and rural areas of Morogoro region, Tanzania during the period of January 2003 to December 2004. A total of 632 human stool samples, 536 cloacal swabs from local and broiler chickens and 22 intestinal contents from crows were screened for presence of thermophilic campylobacters using Skirrow's protocol. Representative Campylobacter jejuni isolates from human and chicken samples were also analysed by polymerase chain reaction (PCR) as a definitive identification method. The overall prevalence of thermophilic campylobacters was 9.3% (95% CI: 7.2-11.9), 69.8% (95% CI: 65.7-73.6) and 72.7% (95% CI: 49.8-89.3) in humans, chickens and crows respectively. In humans, 59 thermophilic campylobacters were isolated of which 96.6% were C. jejuni and 3.4%Campylobacter coli. There was a significantly (P<0.001) higher prevalence in young individuals (16%) than in adults (7%). Of 341 isolates from chickens, 91.2% were C. jejuni and 8.8% were C. coli. A significantly (P<0.05) higher infection rate was observed in rural local chicken (76%) than in broilers (60%). In crows, of 16 isolates, 93.8% were C. jejuni and 6.2% were C. coli. Definitive identification of C. jejuni by PCR revealed positive results in 74.1% of 243 analysed isolates. Findings in this study indicate high prevalence of thermophilic campylobacters in humans, chickens and crows in Morogoro, and a higher infection rate of C. jejuni than that of C. coli in different animal species. Age of humans and location of chickens were identified as risk factors for thermophilic Campylobacter infections. Positive isolates to biochemical tests that indicated negative results on PCR indicates the additional value of PCR for definitive diagnosis of C. jejuni.Journal of Veterinary Medicine Series B 04/2006; 53(3):116-21. DOI:10.1111/j.1439-0450.2006.00926.x · 1.57 Impact Factor
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ABSTRACT: The study aimed to identify sources of campylobacter in 10 housed broiler flocks from three United Kingdom poultry companies. Samples from (i) the breeder flocks, which supplied the broilers, (ii) cleaned and disinfected houses prior to chick placement, (iii) the chickens, and (iv) the environments inside and outside the broiler houses during rearing were examined. Samples were collected at frequent intervals and examined for Campylobacter spp. Characterization of the isolates using multilocus sequence typing (MLST), serotyping, phage typing, and flaA restriction fragment length polymorphism typing was performed. Seven flocks became colonized during the growing period. Campylobacter spp. were detected in the environment surrounding the broiler house, prior to as well as during flock colonization, for six of these flocks. On two occasions, isolates detected in a puddle just prior to the birds being placed were indistinguishable from those colonizing the birds. Once flocks were colonized, indistinguishable strains of campylobacter were found in the feed and water and in the air of the broiler house. Campylobacter spp. were also detected in the air up to 30 m downstream of the broiler house, which raises the issue of the role of airborne transmission in the spread of campylobacter. At any time during rearing, broiler flocks were colonized by only one or two types determined by MLST but these changed, with some strains superseding others. In conclusion, the study provided strong evidence for the environment as a source of campylobacters colonizing housed broiler flocks. It also demonstrated colonization by successive campylobacter types determined by MLST during the life of a flock.Applied and Environmental Microbiology 02/2006; 72(1):645-52. DOI:10.1128/AEM.72.1.645-652.2006 · 3.67 Impact Factor