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BACKGROUND: Chronic suppurative otitis media (CSOM) is still a significant health problem in developing countries. Therefore, it was pertinent to determine the local Malawian microbiology in order to guide adequate treatment, avoid complications, and provide records for future reference. AIM: The study sought to determine the CSOM-causing microorganisms at Queen Elizabeth Central Hospital in Blantyre, Malawi, and establish their relationship signs and symptoms, and with the demographic pattern of the study. METHODS: This was a hospital-based cross-sectional descriptive study carried out at the ENT outpatient clinic and the Microbiology Department of Queen Elizabeth Central Hospital.The sample comprised 104 patients with unilateral or bilateral active CSOM, who met the inclusion criteria. All patients were evaluated through a detailed history and clinical examination. Pus samples from draining ears were collected by aspiration with a sterile pipette. The specimens were immediately sent for microbiological analysis. Data were analyzed using SPSS.version 20. RESULTS: The study found that Proteus mirabilis, Pseudomonas aeruginosa, and Staphylococcus aureus were the most prevalent aerobic bacteria, while Bacteroides spp. and Peptostreptococcus spp. were the commonest anaerobic bacteria causing CSOM. These CSOM-causing microorganisms were predominant among males aged 18 years and below. Some CSOM-causing microorganisms were-significantly more so than the others-characteristically associated with each of the following clinical features: quantity of pus drainage, mode of onset, otalgia, hearing loss, location of tympanic membrane perforation, and mucosal appearance.
Assuntos
Bactérias Aeróbias/isolamento & purificação , Bactérias Anaeróbias/isolamento & purificação , Infecções Bacterianas/microbiologia , Otite Média Supurativa/microbiologia , Adolescente , Adulto , Idoso , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Bactérias Aeróbias/classificação , Bactérias Aeróbias/efeitos dos fármacos , Bactérias Anaeróbias/classificação , Bactérias Anaeróbias/efeitos dos fármacos , Infecções Bacterianas/diagnóstico , Infecções Bacterianas/epidemiologia , Criança , Pré-Escolar , Doença Crônica , Estudos Transversais , Feminino , Humanos , Malaui/epidemiologia , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Prevalência , Adulto JovemRESUMO
OBJECTIVES: The high seroprevalence of HIV in Malawi might be expected to alter the pattern of pathogens isolated from bacteraemic patients. We aimed to describe the frequency and seasonal pattern of bacterial isolates from blood, their antibiotic susceptibility, and patient outcome, in order to provide data on which to base empirical antibiotic therapy and further studies of pathogenesis. METHODS: Over a 12-month period, blood cultures were taken from all febrile adult medical admissions to Queen Elizabeth Central Hospital, Blantyre. RESULTS: A total of 2789 out of 9298 adult general medical admissions had blood culture performed, of whom 449 (16.1%) grew significant pathogens. Non-typhi salmonellae (NTS) (37%) and Streptococcus pneumoniae (30%) were the two commonest isolates. Mortality was 18% among general medical admissions and 38% among bacteraemic patients. Mortality for individual pathogens was: NTS 33%; S. pneumoniae 36%; Escherichia coli 54%; Klebsiella spp. 58%; Neisseria meningitidis 44%; Salmonella typhi 17%. Despite an overwhelming association between the major pathogens and HIV infection (95% of S. pneumoniae cases and 92% of NTS cases were seropositive for HIV), a seasonal pattern was preserved. Streptococcus pneumoniae was more frequently isolated in the cold dry months, while STM isolates increased following a rise in temperature. A case of bacteraemia with Vibrio cholerae (serotype 01) was detected during a cholera outbreak in the rainy season. Although S. pneumoniae isolates were relatively susceptible to penicillin (88%) and chloramphenicol (74%), S. typhimurium isolates were fully susceptible only to chloramphenicol. CONCLUSIONS: This large study confirms the dominance of NTS and S. pneumoniae in bacteraemia in an area affected by HIV-1 and allows comparison of mortality by individual pathogens. It demonstrates a preserved seasonal pattern of bacteraemia for these major pathogens, despite an overwhelming association with HIV infection.
Assuntos
Bacteriemia/mortalidade , Soroprevalência de HIV , Infecções Pneumocócicas/epidemiologia , Infecções por Salmonella/epidemiologia , Adolescente , Adulto , Idoso , Bacteriemia/epidemiologia , Bacteriemia/microbiologia , Estudos de Coortes , Surtos de Doenças , Resistência Microbiana a Medicamentos , Feminino , Humanos , Malaui/epidemiologia , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Infecções Pneumocócicas/tratamento farmacológico , Infecções Pneumocócicas/microbiologia , Salmonella/isolamento & purificação , Infecções por Salmonella/tratamento farmacológico , Infecções por Salmonella/microbiologia , Estações do Ano , Streptococcus pneumoniae/isolamento & purificaçãoRESUMO
INTRODUCTION: This study set out to identify gaps between policy and practice of HIV and AIDS workplace interventions in the University of Malawi, in particular College of Medicine in line with the UNIMA HIV and AIDS policy. OBJECTIVES: The main objective was to establish whether the HIV and AIDS workplace interventions at College of Medicine were in line and guided by the University of Malawi HIV and AIDS policy. METHODS: This was a cross sectional qualitative study. A random sample of 25 students and 15 members of staff were interviewed using in-depth interviews. Interviews were tape-recorded and data was analyzed using thematic content analysis. RESULTS: There are a number of activities relating to HIV and AIDS in place while others are still in the pipeline, however the majority of respondents did not know about the UNIMA HIV and AIDS policy or any HIV and AIDS activities that are guided by the policy. This is due to lack of interest on their part or lack of knowledge on the existence of the workplace programme. CONCLUSION: The COM HIV and AIDS committee should strive to fast track key programme areas such as VCT centre and clinic and coordination of different activities to increase programme visibility and patronage.
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Infecções por HIV/prevenção & controle , Conhecimentos, Atitudes e Prática em Saúde , Política Organizacional , Local de Trabalho/organização & administração , Sorodiagnóstico da AIDS/estatística & dados numéricos , Aconselhamento , Estudos Transversais , Feminino , Fidelidade a Diretrizes , Guias como Assunto , Infecções por HIV/diagnóstico , Humanos , Entrevistas como Assunto , Malaui , Masculino , Pesquisa Qualitativa , Universidades , Programas VoluntáriosRESUMO
AIM: The aim of this retrospective study was to report causes, antibiotic resistance and outcome of neonatal sepsis (often fatal in developing countries) in Malawi. METHODS: All blood and cerebrospinal fluid isolates collected between January 1996 and December 2001 from inpatients aged 0-30 days with suspected sepsis at Queen Elizabeth Central Hospital, Blantyre, Malawi were reviewed. In vitro resistance to antibiotics commonly used in Malawi was assessed. Case fatality rate was analysed with respect to age, bacterial pathogen and infection site. RESULTS: A total of 801 bacteria were isolated from 784 neonates over 6 years-599 isolates from blood and 202 from cerebrospinal fluid. Overall, 54% of bacteria were gram-positive and 46% gram-negative. The commonest causes of neonatal sepsis were group B Streptococcus (17%) and non-typhoidal Salmonella (14%). In vitro antibiotic susceptibility to the first-line antibiotic combination of penicillin and gentamicin was 78% for all isolates, but in vitro sensitivities to gentamicin for Klebsiella spp and non-typhoidal Salmonella were only 33% and 53%, respectively. In-hospital case fatality rate was known for only 301 cases and was high at 48%. Group B Streptococcus was associated with the best outcome. Mortality was significantly higher if presentation was in the 1st week of life or if sepsis was caused by gram-negative bacteria. The causes of neonatal sepsis in this population show a different pattern from other studies in developing countries.
Assuntos
Infecção Hospitalar , Sepse/microbiologia , Antibacterianos/uso terapêutico , Resistência a Medicamentos , Bactérias Gram-Negativas , Humanos , Incidência , Recém-Nascido , Controle de Infecções , Malaui/epidemiologia , Testes de Sensibilidade Microbiana , Estudos Retrospectivos , Salmonella , Sepse/tratamento farmacológico , Sepse/epidemiologia , Streptococcus , Taxa de SobrevidaRESUMO
Plasma retinol-binding protein (RBP) concentrations have been suggested as surrogate indicators for plasma retinol concentrations in the assessment of vitamin A status in less technologically developed settings. Plasma RBP was measured by radial immunodiffusion and plasma retinol by high performance liquid chromatography in a cross-sectional study of 900 pregnant women at the Queen Elizabeth Central Hospital, Blantyre, Malawi. The Spearman correlation coefficient between plasma RBP and retinol concentrations was 0.95 (p<0.0001). By linear regression, 0.70 micromol l(-1) retinol was equivalent to 21.1 mg l(-1) RBP. With these cut-off points for defining vitamin A deficiency, there was high concordance between categorical descriptions of deficiency using retinol and RBP by chi-square analysis (p<0.001). Measurement of plasma RBP by radial immunodiffusion is simple, inexpensive, and does not require expensive instrumentation. Plasma RBP concentrations measured by radial immunodiffusion are highly correlated with plasma retinol and can be used as a simple surrogate measure for vitamin A concentrations in large field studies.
Assuntos
Estado Nutricional , Proteínas de Ligação ao Retinol/análise , Deficiência de Vitamina A/diagnóstico , Vitamina A/sangue , Adulto , Cromatografia Líquida de Alta Pressão , Estudos Transversais , Feminino , Idade Gestacional , Soropositividade para HIV/sangue , Humanos , Imunodifusão , Gravidez , Proteínas Plasmáticas de Ligação ao RetinolRESUMO
This is a report of blood CSF isolates from the adults medical and paediatric of wards QECH, Blantyre, cultured and identified at the Welcome Trust Research Laboratories during 1996-2002. The commonest causes of adults and children bacteraemia were non-typhoidal Salmonella (35% of all blood isolates for adults and children) and Streptococcus pneumoniae (14% and 13% respectively). Cryptococcus neoformans was the commonest isolates from CSF of adults with meningitis(67%) but was very rare in children. S.pneumoniae was the commonest cause of bacterial meningitis in children and adults (38% and 28% of all CSF isolates respectively). Haemophilus influenzae type b was also a common cause of meningitis in children (27%). Data of in vitro antibiotic sensitivity are also reported. A major concern is the recent marked rise of chloramphenicol resistance among Salmonella enteritidis and Salmonella typhimurium to over 80% resistance.
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We prospectively collected laboratory details and outcome data on all patients with laboratory-confirmed cases of meningitis that presented to our unit in Blantyre, Malawi, from 1 April 1998 through 31 March 1999. There were 502 patients with cases of meningitis; the most common causative organisms were Cryptococcus neoformans and Streptococcus pneumoniae. This pattern probably reflects the local human immunodeficiency virus (HIV) seroprevalence (31%) and is different from the pattern in 1974, when Neisseria meningitidis was the most common isolate. There has been an 8-fold increase in the number of meningitis cases per year since 1974, and a doubling of the percentage of medical admissions due to meningitis. The inpatient mortality rate among patients with cases of pneumococcal meningitis was 61%, and in the group as a whole was 41%. Despite the HIV-related pattern of infecting pathogens among these cases of meningitis and the increased incidence of the condition, there was evidence that the typical seasonal pattern of pneumococcal meningitis, which peaks in the cold, dry season, was preserved.