p24 antigen detection on dried blood spots is a feasible and reliable test for infant HIV infection in rural Tanzania.

The difficulty of diagnosing HIV in infants is a major obstacle to early antiretroviral therapy (ART) in resource-limited settings. As serological tests are unreliable during the first 18 months of life, and the cost and complexity of polymerase chain reaction (PCR)-based assays limit their access in resource-limited settings, p24 antigen detection has emerged as an alternative diagnostic tool. In this study, the performance of an ultrasensitive p24 antigen assay on dried blood spots was evaluated under field conditions in rural Tanzania. Specimens were stored and shipped at tropical room temperature, and analysed within six weeks. In total, 27 consecutive children aged <18 months and exposed to vertical HIV transmission were enrolled. Overall sensitivity and specificity was 100% (95% confidence interval [CI], 47.8-100) and 95.5% (95% CI, 77.2-99.9), respectively. Our findings suggest that detection of p24 antigen on dried blood spots can be a reliable and feasible diagnostic tool for infant HIV infection in rural resource-limited settings.

Bacteria isolated from bloodstream infections at a tertiary hospital in Dar es Salaam, Tanzania--antimicrobial resistance of isolates.

OBJECTIVE: A bloodstream infection (BSI) is a life-threatening condition. We studied the causative agents of BSIs and antimicrobial susceptibility patterns of bacterial isolates at Muhimbili National Hospital (MNH) in Dar es Salaam, Tanzania. METHODS: A retrospective analysis of blood culture results obtained at MNH from January 2005 to December 2009 was done. Blood culture isolates judged to be clinically significant and antimicrobial susceptibility results of the bacteria were included. The frequencies and proportions of bacteria isolated and antimicrobial susceptibility results were analysed and compared using Pearson's chi-square test and Fisher's exact test where applicable, or the Mann-Whitney U-test. RESULTS: A total of 13 833 blood cultures were performed. Bacterial pathogens were detected in 1 855 (13.4%), Gram-positive bacteria (1 523; 82.1%) being significantly more prevalent than Gram-negative bacteria (332; 17.9%) (p=0.008). The most common bacterial pathogens isolated were coagulase-negative staphylococci (CoNS) (1 250; 67.4%), S. aureus (245; 13.2%), Escherichia coli (131; 7%) and Klebsiella spp. (130; 7.0%). All bacteria isolated showed high resistance to penicillin G (70.6%), tetracycline (63.8%), cefotaxime (62.5%) and ampicillin (62.3%). Moderate to high resistance was seen against chloramphenicol (45.2%), erythromycin (35.0%), ciprofloxacin (29.3%), co-trimoxazole (25.0%) and gentamicin (23.5%). Of S. aureus isolates, 23.3% were resistant to methicillin. CONCLUSIONS: CoNS accounted for two-thirds of the bacterial pathogens isolated. High-level resistance was seen to first-line and inexpensive antimicrobial agents. Routine screening for extended-spectrum beta-lactamase production and methicillin resistance among Gram-negative rods and S. aureus from blood cultures should be instituted to monitor spread of multidrug-resistant isolates.

Immunoglobulin profile in HIV-1 infected children in Dar es Salaam.

OBJECTIVE: To determine immunoglobulin levels in HIV-1 seronegative and HIV-1 seropositive children at different clinical stages of HIV infection. DESIGN: Cross-sectional study. SETTING: Lugalo and Mwanayamala mother and child clinics in Dar es Salaam. SUBJECTS: Two hundred and ninety-nine children aged 18 months to five years. MAIN OUTCOME MEASURES: Estimation of immunoglobulin classes (IgG, IgA, IgM, IgD and IgE). RESULTS: Mean serum levels of all immunoglobulin classes were significantly higher (p < 0.0001) among the HIV-1 seropositive children (IgG = 22.9 g/l, IgA = 2.2 g/l, IgM 2.7 g/l, IgD 101.5 IU/ml and IgE 887.7 IU/ml) than among the HIV-1 seronegative children (IgG = 11.3 g/l, IgA = 1.0 g/l, IgM = 1.5 g/l, IgD = 27.8 UI/ml and IgE 341.3 UI/ml). The percentages of HIV-infected children with immunoglobulin concentrations above mean level were 83% for IgG, 77% for IgA, 78% for IgM, 73% for IgD and 78% for IgE. CONCLUSION: HIV seropositive children have higher levels of immunoglobulin than seronegative children. There was no correlation between the levels of immunoglobulin classes and CDC clinical staging.

PIP: This cross-sectional analysis examined serum levels of the 5 immunoglobulin (Ig) isotypes in HIV-1 seronegative and HIV-1 seropositive children at different clinical stages of HIV infection in Dar es Salaam, Tanzania. The study employed 299 children between 18 months and 5 years of age attending the mother and child health clinics at Lugalo and Mwanayamala. Blood samples from 150 HIV-1 seropositive (75 males and 75 females) and 149 HIV-1 seronegative (82 males and 67 females) were collected and examined via Ig assay and HIV serology. Results revealed that the mean serum Ig levels were higher (p 0.0001) among HIV-1 seropositive children (IgG = 22.9 g/l, IgA = 2.2 g/l, IgM = 2.7 g/l, IgD = 101.5 IU/ml, IgE = 887.7 IU/ml) than among HIV-1 seronegative children (IgG = 11.3 g/l, IgA = 1.0 g/l, IgM = 1.5 g/l, IgD = 27.8 IU/ml, IgE = 341.3 IU/ml). The percentage of Ig concentrations were significantly higher in the HIV-1 seropositive than in the HIV-1 seronegative children (83% for IgG, 77% for IgA, 78% for IgM, 73% for IgD, and 78% for IgE). In conclusion, this study confirms the increase in serum Ig levels in HIV-1 seropositive children and the insignificant correlation between high Ig levels and US Centers for Disease Control clinical staging.