Browsing by Author "Nichols, Chelsea"

Filter results by typing the first few letters
Now showing 1 - 2 of 2
  • Thumbnail Image
    ItemOpen Access
    Bloodstream Infections and Frequency of Pretreatment Associated With Age and Hospitalization Status in Sub-Saharan Africa.
    (Clin Infect Dis, 2015-11-01) Nichols, Chelsea; Cruz Espinoza, Ligia Maria; von Kalckreuth, Vera; Aaby, Peter; Ahmed El Tayeb, Muna; Ali, Mohammad; Aseffa, Abraham; Bjerregaard-Andersen, Morten; Breiman, Robert F; Cosmas, Leonard; Crump, John A; Dekker, Denise Myriam; Gassama Sow, Amy; Gasmelseed, Nagla; Hertz, Julian T; Im, Justin; Kabore, Leon Parfait; Keddy, Karen H; Konings, Frank; Valborg Løfberg, Sandra; Meyer, Christian G; Montgomery, Joel M; Niang, Aissatou; Njariharinjakamampionona, Andriamampionona; Olack, Beatrice; Pak, Gi Deok; Panzner, Ursula; Park, Jin Kyung; Park, Se Eun; Rabezanahary, Henintsoa; Rakotondrainiarivelo, Jean Philibert; Rakotozandrindrainy, Raphaël; Raminosoa, Tiana Mirana; Rubach, Matthew P; Teferi, Mekonnen; Seo, Hye Jin; Sooka, Arvinda; Soura, Abdramane; Tall, Adama; Toy, Trevor; Yeshitela, Biruk; Clemens, John D; Wierzba, Thomas F; Baker, Stephen; Marks, Florian
    BACKGROUND: The clinical diagnosis of bacterial bloodstream infections (BSIs) in sub-Saharan Africa is routinely confused with malaria due to overlapping symptoms. The Typhoid Surveillance in Africa Program (TSAP) recruited febrile inpatients and outpatients of all ages using identical study procedures and enrollment criteria, thus providing an opportunity to assess disease etiology and pretreatment patterns among children and adults. METHODS: Inpatients and outpatients of all ages with tympanic or axillary temperatures of ≥38.0 or ≥37.5°C, respectively, and inpatients only reporting fever within the previous 72 hours were eligible for recruitment. All recruited patients had one blood sample drawn and cultured for microorganisms. Data from 11 TSAP surveillance sites in nine different countries were used in the analysis. Bivariate analysis was used to compare frequencies of pretreatment and BSIs in febrile children (<15 years old) and adults (≥15 years old) in each country. Pooled Cochran Mantel-Haenszel odds ratios (ORs) were calculated for overall trends. RESULTS: There was no significant difference in the odds of a culture-proven BSI between children and adults among inpatients or outpatients. Among both inpatients and outpatients, children had significantly higher odds of having a contaminated blood culture compared with adults. Using country-pooled data, child outpatients had 66% higher odds of having Salmonella Typhi in their bloodstream than adults (OR, 1.66; 95% confidence interval [CI], 1.01-2.73). Overall, inpatient children had 59% higher odds of pretreatment with analgesics in comparison to inpatient adults (OR, 1.59; 95% CI, 1.28-1.97). CONCLUSIONS: The proportion of patients with culture-proven BSIs in children compared with adults was similar across the TSAP study population; however, outpatient children were more likely to have Salmonella Typhi infections than outpatient adults. This finding points to the importance of including outpatient facilities in surveillance efforts, particularly for the surveillance of typhoid fever. Strategies to reduce contamination among pediatric blood cultures are needed across the continent to prevent the misdiagnosis of BSI cases in children.
  • Thumbnail Image
    ItemOpen Access
    The Relationship Between Invasive Nontyphoidal Salmonella Disease, Other Bacterial Bloodstream Infections, and Malaria in Sub-Saharan Africa.
    (Clin Infect Dis, 2016-03-15) Park, Se Eun; Pak, Gi Deok; Aaby, Peter; Adu-Sarkodie, Yaw; Ali, Mohammad; Aseffa, Abraham; Biggs, Holly M; Bjerregaard-Andersen, Morten; Breiman, Robert F; Crump, John A; Cruz Espinoza, Ligia Maria; Eltayeb, Muna Ahmed; Gasmelseed, Nagla; Hertz, Julian T; Im, Justin; Jaeger, Anna; Parfait Kabore, Leon; von Kalckreuth, Vera; Keddy, Karen H; Konings, Frank; Krumkamp, Ralf; MacLennan, Calman A; Meyer, Christian G; Montgomery, Joel M; Ahmet Niang, Aissatou; Nichols, Chelsea; Olack, Beatrice; Panzner, Ursula; Park, Jin Kyung; Rabezanahary, Henintsoa; Rakotozandrindrainy, Raphaël; Sampo, Emmanuel; Sarpong, Nimako; Schütt-Gerowitt, Heidi; Sooka, Arvinda; Soura, Abdramane Bassiahi; Sow, Amy Gassama; Tall, Adama; Teferi, Mekonnen; Yeshitela, Biruk; May, Jürgen; Wierzba, Thomas F; Clemens, John D; Baker, Stephen; Marks, Florian
    BACKGROUND: Country-specific studies in Africa have indicated that Plasmodium falciparum is associated with invasive nontyphoidal Salmonella (iNTS) disease. We conducted a multicenter study in 13 sites in Burkina Faso, Ethiopia, Ghana, Guinea-Bissau, Kenya, Madagascar, Senegal, South Africa, Sudan, and Tanzania to investigate the relationship between the occurrence of iNTS disease, other systemic bacterial infections, and malaria. METHODS: Febrile patients received a blood culture and a malaria test. Isolated bacteria underwent antimicrobial susceptibility testing, and the association between iNTS disease and malaria was assessed. RESULTS: A positive correlation between frequency proportions of malaria and iNTS was observed (P = .01; r = 0.70). Areas with higher burden of malaria exhibited higher odds of iNTS disease compared to other bacterial infections (odds ratio [OR], 4.89; 95% CI, 1.61-14.90; P = .005) than areas with lower malaria burden. Malaria parasite positivity was associated with iNTS disease (OR, 2.44; P = .031) and gram-positive bacteremias, particularly Staphylococcus aureus, exhibited a high proportion of coinfection with Plasmodium malaria. Salmonella Typhimurium and Salmonella Enteritidis were the predominant NTS serovars (53/73; 73%). Both moderate (OR, 6.05; P = .0001) and severe (OR, 14.62; P < .0001) anemia were associated with iNTS disease. CONCLUSIONS: A positive correlation between iNTS disease and malaria endemicity, and the association between Plasmodium parasite positivity and iNTS disease across sub-Saharan Africa, indicates the necessity to consider iNTS as a major cause of febrile illness in malaria-holoendemic areas. Prevention of iNTS disease through iNTS vaccines for areas of high malaria endemicity, targeting high-risk groups for Plasmodium parasitic infection, should be considered.