Assuntos
Bacteriemia/diagnóstico , Carnobacteriaceae/isolamento & purificação , Infecções por Bactérias Gram-Positivas/diagnóstico , Adulto , Bacteriemia/tratamento farmacológico , Translocação Bacteriana , Carnobacteriaceae/efeitos dos fármacos , Carnobacteriaceae/genética , Feminino , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Humanos , Recém-Nascido , Londres , Masculino , Tipagem Molecular , Gravidez , RNA Bacteriano/genética , RNA Ribossômico 16S/genética , Resultado do TratamentoRESUMO
Diagnostic techniques for invasive pneumococcal disease (IPD) in children are insensitive and underestimate both the burden of disease and the cost-effectiveness of pneumococcal conjugate vaccination (PCV). Consequently, there is little demand for the highly effective PCV outside the United States and Europe. In Kenya, diagnosis of pneumococcal pneumonia in adults was achieved with a sensitivity of 0.70 and a specificity of 0.98 using enzyme-linked immunosorbent assays (ELISAs) of paired plasma samples for immunoglobulin G (IgG) to pneumococcal surface adhesin A (PsaA). We aimed to validate the same technique in children. We assayed paired blood samples from 98 children with IPD, 95 age-matched children with malaria/anemia, and 97 age-matched healthy controls by using an ELISA for anti-PsaA IgG. Sensitivity and specificity were determined in IPD patients and healthy controls. Specificity (0.97; 95% confidence interval [CI], 0.91 to 0.99) and sensitivity (0.42; 95% CI, 0.32 to 0.52) were optimized at a 2.7-fold rise in anti-PsaA antibody concentration. Sensitivity was improved to a maximum of 0.50 by restricting testing to children of <2 years old, by excluding IPD patients who were not sampled on the first day of presentation, and by incorporating high existing antibody concentrations in the analysis. Assay performance was independent of nasopharyngeal carriage of pneumococci at recruitment. This assay improves on existing diagnostic tools for IPD in children but would still leave over half of all cases undetected in epidemiological studies. Effective diagnosis of pneumococcal disease in children is urgently required but poorly served by existing technology.
Assuntos
Anticorpos Antibacterianos/sangue , Proteínas de Bactérias , Infecções Pneumocócicas/diagnóstico , Fatores Etários , Proteínas de Bactérias/imunologia , Estudos de Casos e Controles , Criança , Pré-Escolar , Ensaio de Imunoadsorção Enzimática/métodos , Ensaio de Imunoadsorção Enzimática/normas , Feminino , Humanos , Imunoglobulina G/sangue , Lactente , Recém-Nascido , Quênia , Masculino , Testes Sorológicos/métodos , Testes Sorológicos/normas , Streptococcus pneumoniae/imunologia , Streptococcus pneumoniae/isolamento & purificaçãoRESUMO
Etest susceptibilities to amoxicillin, chloramphenicol, and trimethoprim-sulfamethoxazole of 240 invasive isolates of Haemophilus influenzae cultured from children in rural Kenya were 66%, 66%, and 38%, respectively. Resistance increased markedly over 9 years and was concentrated among serotype b isolates. In Africa, the increasing cost of treating resistant infections supports economic arguments for prevention through conjugate H. influenzae type b immunization.