Publications (5)16.99 Total impact
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Article: Procalcitonin and C-reactive protein as predictors of blood culture positivity among hospitalised children with severe pneumonia in Mozambique.
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ABSTRACT: Objectives To evaluate the benefits of using procalcitonin (PCT) and C-reactive protein (CRP) as pre-screening tools to predict blood culture positivity among Mozambican children with clinical severe pneumonia (CSP). Methods 586 children <5 years with CSP and no concurrent malaria fulfilled criteria to be included in the study groups. We determined PCT and CRP for all children with positive bacterial culture (BC+ group, n = 84) and of a random selection of children with negative bacterial culture (BC- group, n = 246). Results PCT and CRP levels were higher in the BC+ group than the BC- one (PCT: median 7.73 versus 0.48 ng/ml, P < 0.001; CRP: 177.65 mg/l vs. 26.5 mg/l, P < 0.001). In multivariate analysis, PCT was the only independent predictor of the group. To be used as pre-screening tool, PCT presented higher specificities for predetermined sensitivities (≥85%) than CRP. Pursuing a sensitivity of 95%, PCT could reduce the need for bacterial culture by 49% and overall diagnosis costs by 7-35% [assuming variable costs for PCT measurement (ranging from 10 to 30 USD) and a fixed cost of 72.5 USD per blood culture]. Conclusions Among hospitalised children with CSP and absence of concurrent malaria, PCT pre-screening could help reduce the number of blood cultures and diagnosis costs by specifically targeting patients more likely to yield positive results.Tropical Medicine & International Health 07/2012; 17(9):1100-7. · 2.80 Impact Factor -
Article: Serum biomarkers for the diagnosis of malaria, bacterial and viral infections in children living in malaria-endemic areas.
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ABSTRACT: This review assesses current knowledge on the use of serum biomarkers for the diagnosis of malaria, bacterial and viral infections in sick children living in malaria-endemic areas. Reducing pediatric morbidity and mortality remains an essential challenge in these areas, where malaria and bacterial infections are the leading cause of death. In such settings, diagnostic tools that aid to overcome this problem are scarce and diagnosis relies mainly on clinical observations that can lead to incorrect treatment prescriptions. Currently, only malaria RDTs (rapid diagnostic tests) fulfill the criteria for a wide implementation under the operational conditions of resource-limited settings. New, affordable, simple and rapid diagnostic tools for bacterial diagnosis are crucial to guarantee adequate management of antibiotics. Serum biomarkers such as C-reactive protein or procalcitonin, used in developed countries, could form the basis for these tools. Few studies have, however, assessed their validity in malaria-endemic areas and data remain inconclusive. Viral diagnosis is not of highest priority in places where no specific etiological treatment is available and the presence of a virus cannot exclude bacterial/malarial coinfections. Although future studies may elucidate the diagnostic role of certain biomarkers in malaria-endemic areas, understanding the operational and sociological conditions of these settings will remain essential for the successful implementation of current and new diagnostic tools.Drugs of today (Barcelona, Spain: 1998) 01/2011; 47(1):63-75. · 1.28 Impact Factor -
Article: Estimating the vaccine-preventable burden of hospitalized pneumonia among young Mozambican children.
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ABSTRACT: Polysaccharide-protein conjugate vaccines against Haemophilus influenzae type b (Hib) and Streptococcus pneumoniae have proven efficacy against radiologically confirmed pneumonia. Measurement of pneumonia incidence provides a platform to estimate of the vaccine-preventable burden. Over 24 months, we conducted surveillance for radiologically confirmed severe pneumonia episodes among children <2 years of age admitted to a rural hospital in Manhiça, southern Mozambique. Study children were tested for HIV during the second year of surveillance. Severe pneumonia accounted for 15% of 5132 hospital admissions and 32% of in-hospital mortality among children <2 years of age. Also, 43% of chest radiographs were interpreted as radiologically confirmed pneumonia. HIV-infection was associated with 81% of fatal pneumonia episodes among children tested for HIV. The minimum incidence rate of radiologically confirmed pneumonia requiring hospitalization was 19 episodes/1000 child-years. Incidence rates among HIV-infected children were 9.3-19.0-fold higher than HIV-uninfected. Introduction of Hib and pneumococcal conjugate vaccines would have a substantial impact on pneumonia hospitalizations among African children if vaccine effects are similar to those observed in clinical trials.Vaccine 04/2010; 28(30):4851-7. · 3.77 Impact Factor -
Article: Surveillance of acute bacterial meningitis among children admitted to a district hospital in rural Mozambique.
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ABSTRACT: Acute bacterial meningitis (ABM) remains an important cause of mortality among African children. Epidemiologic data with regard to ABM infection are necessary for prioritizing public health interventions. We strengthened hospital-based surveillance of ABM among children admitted to Manhiça District Hospital (Maputo, Mozambique). Cerebrospinal fluid (CSF) samples were collected from children admitted to the hospital who met clinical criteria of ABM. Laboratory determinations were performed. Clinical information and outcome of cases were recorded. During the first 12 months of surveillance, which began in January 2006, CSF samples were collected from 642 children <15 years of age with suspected meningitis (18% of all pediatric patients admitted to the hospital during that time). ABM was confirmed in 43 (7%) of the 642 cases. Haemophilus influenzae type b (Hib) (14 cases), pneumococcus (9 cases), and meningococcus (7 cases) represented approximately 70% of confirmed cases. Four of the 9 pneumococci were serotypes covered by the 7-valent pneumococcal conjugate vaccine. The case fatality rate among patients with ABM was 24% (8 of 33 with known outcome); an additional 8 patients left the hospital before discharge. The incidence of ABM was 85 per 100,000 population, which peaked at 2-12 months of age at 1078 cases per 100,000 population. All 9 pneumococci isolates were susceptible to chloramphenicol, and 8 were susceptible to penicillin (the additional 1 had intermediate resistance). For the 10 Hib isolates tested, only 1 was susceptible to chloramphenicol, and 5 were susceptible to ampicillin. These data reinforce the importance of ABM as a cause of hospital admission and death in rural sub-Saharan Africa. Most observed ABM cases could have been prevented by current pneumococcal and Hib conjugate vaccines.Clinical Infectious Diseases 03/2009; 48 Suppl 2:S172-80. · 9.15 Impact Factor -
Article: Estimating the vaccine-preventable burden of hospitalized pneumonia among young Mozambican children
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ABSTRACT: Polysaccharide-protein conjugate vaccines against Haemophilus influenzae type b (Hib) and Streptococcus pneumoniae have proven efficacy against radiologically confirmed pneumonia. Measurement of pneumonia incidence provides a platform to estimate of the vaccine-preventable burden. Over 24 months, we conducted surveillance for radiologically confirmed severe pneumonia episodes among children <2 years of age admitted to a rural hospital in Manhiça, southern Mozambique. Study children were tested for HIV during the second year of surveillance. Severe pneumonia accounted for 15% of 5132 hospital admissions and 32% of in-hospital mortality among children <2 years of age. Also, 43% of chest radiographs were interpreted as radiologically confirmed pneumonia. HIV-infection was associated with 81% of fatal pneumonia episodes among children tested for HIV. The minimum incidence rate of radiologically confirmed pneumonia requiring hospitalization was 19 episodes/1000 child-years. Incidence rates among HIV-infected children were 9.3–19.0-fold higher than HIV-uninfected. Introduction of Hib and pneumococcal conjugate vaccines would have a substantial impact on pneumonia hospitalizations among African children if vaccine effects are similar to those observed in clinical trials.Vaccine.
