Browsing by Author "Cotton, M. F."
Now showing 1 - 20 of 30
Results Per Page
- ItemAntiretroviral treatment for children with peripartum nevirapine exposure(2010) Palumbo, P.; Lindsey, J. C.; Hughes, M. D.; Cotton, M. F.; Bobat, R.; Meyers, T.; Bwakura-Dangarembizi, M.; Chi, B. H.; Musoke, P.; Kamthunzi, P.; Schimana, W.; Purdue, L.; Eshleman, S. H.; Abrams, E. J.; Millar, L.; Petzold, E.; Mofenson, L. M.; Jean-Philippe, P.; Violari A.Background: Single-dose nevirapine is the cornerstone of the regimen for prevention of mother-to-child transmission of human immunodeficiency virus (HIV) in resource-limited settings, but nevirapine frequently selects for resistant virus in mothers and children who become infected despite prophylaxis. The optimal antiretroviral treatment strategy for children who have had prior exposure to single-dose nevirapine is unknown. Methods: We conducted a randomized trial of initial therapy with zidovudine and lamivudine plus either nevirapine or ritonavir-boosted lopinavir in HIV-infected children 6 to 36 months of age, in six African countries, who qualified for treatment according to World Health Organization (WHO) criteria. Results are reported for the cohort that included children exposed to single-dose nevirapine prophylaxis. The primary end point was virologic failure or discontinuation of treatment by study week 24. Enrollment in this cohort was terminated early on the recommendation of the data and safety monitoring board. Results: A total of 164 children were enrolled. The median percentage of CD4+ lymphocytes was 19%; a total of 56% of the children had WHO stage 3 or 4 disease. More children in the nevirapine group than in the ritonavir-boosted lopinavir group reached a primary end point (39.6% vs. 21.7%; weighted difference, 18.6 percentage-points; 95% confidence interval, 3.7 to 33.6; nominal P = 0.02). Baseline resistance to nevirapine was detected in 18 of 148 children (12%) and was predictive of treatment failure. No significant between-group differences were seen in the rate of adverse events. Conclusions: Among children with prior exposure to single-dose nevirapine for perinatal prevention of HIV transmission, antiretroviral treatment consisting of zidovudine and lamivudine plus ritonavir-boosted lopinavir resulted in better outcomes than did treatment with zidovudine and lamivudine plus nevirapine. Since nevirapine is used for both treatment and perinatal prevention of HIV infection in resource-limited settings, alternative strategies for the prevention of HIV transmission from mother to child, as well as for the treatment of HIV infection, are urgently required. Copyright © 2010 Massachusetts Medical Society.
- ItemArginine vasopressin concentrations in the cerebrospinal fluid of children(1991) Cotton, M. F.; Donald, P. R.; Aalbers, C.Cerebrospinal fluid (CSF) arginine vasopressin (AVP) levels are reported in a group of 22 children (median age 24 months) investigated for possible bacterial meningitis and subsequently found not to be suffering from this disease. The mean CSF AVP concentration was 0.80 ± 0.33 pg/ml. The results obtained in patients suffering from febrile convulsions (mean 0.71 pg/ml), other convulsive disorders (mean 0.80 pg/ml) and miscellaneous infectious diseases (mean 0.85 pg/ml) did not differ significantly from one another. Our findings confirm the presence of AVP in the CSF of children and provide reference values for further investigations into the functions of CSF AVP in children.
- ItemBacille Calmette-Guerin (BCG) vaccine and the COVID-19 pandemic : responsible stewardship is needed(The Union, 2020) Schaaf, H. S.; Du Preez, K.; Kruger, M.; Solomons, R.; Taljaard, J. J.; Rabie, H.; Seddon, J. A.; Cotton, M. F.; Tebruegge, M.; Curtis, N.; Hesseling, A. C.We believe that responsible stewardship of the bacille Calmette-Guérin (BCG) vaccine in the context of the COVID-19 epidemic is urgently needed. Live attenuated BCG is currently the only licensed vaccine to protect against tuberculosis (TB). Neonatal BCG vaccination has proven efficacy in protecting infants and young children against life-threatening disseminated forms of TB, including TB meningitis and miliary TB.
- ItemBacteraemia in children in the south-western Cape. A hospital-based survey(Health & Medical Publishing Group, 1992-01) Cotton, M. F.; Burger, P. J.; Bodenstein, W. J. M.ENGLISH ABSTRACT: During 1989, of the 8524 children admitted to the paediatric wards of Tygerberg Hospital, 165 (1,96%) had bacteraemia. The incidence of community-acquired bacteraemias was 1,6% and that of nosocomial bacteraemias 0,5%. The most important community-acquired isolates were Streptococcus pneumoniae, Staphylococcus aureus and Neisseria meningitidis. The most important nosocomial isolates were Klebsiella and Salmonella spp. Both bacteraemia (relative risk (RR) = 2,08) and severe malnutrition (RR = 3,01) were more common in black patients. Overall, severe malnutrition was more common than mild malnutrition or a normal nutritional status in bacteraemic patients (odds radio (OR) = 3,17). Nineteen patients with bacteraemia died, there was a significantly higher case-fatality rate in patients with extreme malnutrition (P = 0,03; OR = 3,7). Gram-negative bacilli were found more commonly in patients with extreme malnutrition (OR = 5,4) and patients with nosocomial bacteraemia (OR = 4,6). Three of 39 patients (7,6%) with nosocomial bacteraemia had suppurative thrombophlebitis.
- ItemBCG vaccination in South African HIV-exposed infants : risks and benefits(Health and Medical Publishing Group (HMPG), 2009-02) Hesseling, A. C.; Caldwell, J.; Cotton, M. F.; Eley, B. S.; Jaspan, H. B.; Jennings, K.; Marais, B. J.; Nuttall, J.; Rabie, H.; Roux, P.; Schaaf, H. Simon
- ItemCOVID-19 response in low- and middle-income countries : don’t overlook the role of mobile phone communication(Elsevier, 2020-07-26) Verhagen, Lilly M.; de Groot, R.; Lawrence, C. A.; Taljaard, J.; Cotton, M. F.; Rabie, H.Estimates of health capacities in the context of the coronavirus disease 2019 (COVID-19) pandemic indicate that most low- and middle-income countries (LMICs) are not operationally ready to manage this health emergency. Motivated by worldwide successes in other infectious disease epidemics and our experience in Sub-Saharan Africa, we support mobile phone communication to improve data collection and reporting, communication between healthcare workers, public health institutions, and patients, and the implementation of disease tracking and subsequent risk-stratified isolation measures. Programmatic action is needed for centrally coordinated reporting and communication systems facilitating mobile phones in crisis management plans for addressing the COVID-19 pandemic in LMICs. We summarize examples of worldwide mobile phone technology initiatives that have enhanced patient care and public health outcomes in previous epidemics and the current COVID-19 pandemic. In addition, we provide an overview of baseline conditions, including transparency about privacy guarantees, necessary for the successful use of mobile phones in assisting in the fight against COVID-19 spread.
- ItemEvaluation of tuberculosis diagnostics in children: 2. Methodological issues for conducting and reporting research evaluations of tuberculosis diagnostics for intrathoracic tuberculosis in children. Consensus from an expert panel(2012) Cuevas, L. E.; Browning, R.; Bossuyt, P.; Casenghi, M.; Cotton, M. F.; Cruz, A. T.; Dodd, L. E.; Drobniewski, F.; Gale, M.; Graham S. M.; Grzemska, M.; Heinrich, N.; Hesseling, A. C.; Huebner, R.; Jean-Philippe, P.; Kabra, S. K.; Kampmann, B.; Lewinsohn, D.; Li, M.; Lienhardt, C.; Mandalakas A. M.; Marais, B. J.; Menzies, H. J.; Montepiedra, G.; Mwansambo, C.; Oberhelman, R.; Palumbo, P.; Russek-Cohen, E.; Shapiro, D. E.; Smith, B.; Soto-Castellares, G.; Starke, J. R.; Swaminathan, S.; Wingfield, C.; Worrell, C.Confirming the diagnosis of childhood tuberculosis is a major challenge. However, research on childhood tuberculosis as it relates to better diagnostics is often neglected because of technical difficulties, such as the slow growth in culture, the difficulty of obtaining specimens, and the diverse and relatively nonspecific clinical presentation of tuberculosis in this age group. Researchers often use individually designed criteria for enrollment, diagnostic classifications, and reference standards, thereby hindering the interpretation and comparability of their findings. The development of standardized research approaches and definitions is therefore needed to strengthen the evaluation of new diagnostics for detection and confirmation of tuberculosis in children.In this article we present consensus statements on methodological issues for conducting research of Tuberculosis diagnostics among children, with a focus on intrathoracic tuberculosis. The statements are complementary to a clinical research case definition presented in an accompanying publication and suggest a phased approach to diagnostics evaluation; entry criteria for enrollment; methods for classification of disease certainty, including the rational use of culture within the case definition; age categories and comorbidities for reporting results; and the need to use standard operating procedures. Special consideration is given to the performance of microbiological culture in children and we also recommend for alternative methodological approaches to report findings in a standardized manner to overcome these limitations are made. This consensus statement is an important step toward ensuring greater rigor and comparability of pediatric tuberculosis diagnostic research, with the aim of realizing the full potential of better tests for children. © 2012 The Author.
- ItemA framework for preventing healthcare-associated infection in neonates and children in South Africa(Health & Medical Publishing Group, 2017) Dramowski, Angela; Cotton, M. F.; Whitelaw, A.Healthcare-associated infection (HAI) is a frequent and serious complication affecting 4 - 8% of hospitalised children and neonates in high-income countries. The burden of HAI in South African (SA) paediatric and neonatal wards is substantial but underappreciated, owing to a lack of HAI surveillance and reporting. Maternal and child health and infection prevention are priority areas for healthcare quality improvement in the National Core Standards programme. Despite increasing recognition in SA, infection prevention efforts targeting hospitalised children and neonates are hampered by health system, institutional and individual patient factors. To ensure safe healthcare delivery to children, a co-ordinated HAI prevention strategy should promote development of infection prevention norms and policies, education, patient safety advocacy, healthcare infrastructure, surveillance and research. We present a framework for SA to develop and expand HAI prevention in hospitalised neonates and children.
- ItemGuideline for the management of upper respiratory tract infections(Health & Medical Publishing Group, 2004) Brink, A. J.; Cotton, M. F.; Feldman, C.; Geffen, L.; Hendson W.; Hockman, M. H.; Maartens, G.; Madhi, S. A.; Mutua-Mpungu, M.; Swingler G. H.Introduction. Inappropriate use of antibiotics for upper respiratory tract infections (URTIs), many of which are viral, adds to the burden of antibiotic resistance. Antibiotic resistance is increasing in Streptococcus pneumoniae, responsible for most cases of acute otitis media (AOM) and acute bacterial sinusitis (ABS). Method. The Infectious Diseases Society of Southern Africa held a multidisciplinary meeting to draw up a national guideline for the management of URTIs. Background information reviewed included randomised controlled trials, existing URTI guidelines and local antibiotic susceptibility patterns. The initial document was drafted at the meeting. Subsequent drafts were circulated to members of the working group for modification. The guideline is a consensus document based upon the opinions of the working group. Output. Penicillin remains the drug of choice for tonsillopharyngitis. Single-dose parenteral administration of benzathine penicillin is effective, but many favour oral administration twice daily for 10 days. Amoxycillin remains the drug of choice for both AOM and ABS. A dose of 90 mg/kg/day is recommended in general, which should be effective for pneumococci with high-level penicillin resistance (this is particularly likely in children ≤ 2 years of age, in day-care attendees, in cases with prior AOM within the past 6 months, and in children who have received antibiotics within the last 3 months). Alternative antibiotic choices are given in the guideline with recommendations for their specific indications. These antibiotics include amoxycillin-clavulanate, some cephalosporins, the macrolide/azalide and ketolide groups of agents and the respiratory fluoroquinolones. Conclusion. The guideline should assist rational antibiotic prescribing for URTIs. However, it should be updated when new information becomes available from randomised controlled trials and surveillance studies of local antibiotic susceptibility patterns.
- ItemHIV sero-conversion during late pregnancy - when to retest(AOSIS, 2013) Kalk, E.; Slogrove, Amy L.; Speert, D.; Bettinger, J.; Cotton, M. F.; Esser, M.The South African National Prevention of Mother-to-Child Transmission of HIV programme has resulted in significant reductions in vertical transmission, but new infant HIV infections continue to occur. We present two cases of HIV seroconversion during late pregnancy, demonstrating the limitations of the current programme. These could be mitigated by expanding the programme to include maternal testing at delivery and at immunisation clinic visits as we pursue the elimination of mother-tochild transmission.
- ItemHorizontal HIV transmission to children of HIV-uninfected mothers : a case series and review of the global literature(Elsevier, 2020-09-01) Myburgh, D.; Rabie, H.; Slogrove, A. L.; Edson, C.; Cotton, M. F.; Dramowski, A.Background: Vertical transmission is the predominant route for acquisition of HIV infection in children, either in utero, intrapartum or postnatally through breast feeding. Less frequently, children may acquire HIV by horizontal transmission. Horizontal transmission may be healthcare-associated (infusion of HIV-contaminated blood products, use of contaminated needles, syringes and medical equipment, or through ingestion of HIV in expressed breastmilk). Community-acquired HIV transmission to children may occur following surrogate breastfeeding, pre-mastication of food, and sexual abuse. Methods: Children with suspected horizontally acquired HIV infection were identified by retrospective folder review of existing patients (2004–2014) and by prospective interview and examination of new patients (from 2009 onwards), at a hospital-based paediatric antiretroviral clinic in Cape Town, South Africa. The global literature on horizontal HIV transmission to children (1 January 1986–1 November 2019) was reviewed, to contextualize the local findings. Results: Among the 32 children with horizontal HIV transmission (15 identified retrospectively and 17 prospectively), the median age at first diagnosis was 79 months (interquartile range 28.5–91.5); most children (90.6%) had advanced HIV disease at presentation. HIV transmission was considered healthcare-associated in 15 (46.9%), community-associated in ten (31.3%), possibly healthcare or community-associated in five (15.6 %); and unknown in two children (6.3%). Conclusion: Horizontal HIV transmission to children is an important public health issue, with prevention efforts requiring intervention at healthcare facility- and community-level. Greater effort should be made to promptly identify and comprehensively investigate each horizontally HIV-infected child to establish possible routes of transmission and inform future prevention strategies.
- ItemHuman metapneumovirus infection in hospital referred South African children(2004) Ijpma, F. F. A.; Beekhuis, D.; Cotton, M. F.; Pieper, C. H.; Kimpen, J. L. L.; Van Den Hoogen, B. G.; Van Doornum, G. J. J.; Osterhaus, D. M. E.Human metapneumovirus (hMPV) was first described in Dutch children with acute respiratory symptoms. A prospective analysis of the epidemiology, clinical manifestation, and seroprevalence of hMPV and other respiratory viruses in South African children referred to hospital for upper or lower respiratory tract infection were carried out during a single winter season, by using RT-PCR, viral culture, and enzyme-linked immunosorbent assays. In nasopharyngeal aspirates from 137 children, hMPV was detected by RT-PCR in 8 (5.8%) children (2-43 months of age) as a sole viral pathogen, respiratory syncytial virus (RSV) in 21 (15%), influenza A virus in 18 (13%) and influenza B virus in 20 (15%). Pneumonia was diagnosed in seven children and upper respiratory tract infection in one of the hMPV-infected children. One hMPV-infected child was admitted to the intensive care unit in need of mechanical ventilation and one child was infected with human immunodeficiency virus (HIV). No statistically significant differences were found between hMPV, RSV, and influenza virus infected groups with regard to clinical signs and symptoms and chest radiograph findings. The seropositive rate of hMPV specific IgG antibodies was 92% in children aged 24-36 months, the oldest seronegative child in our study was 7 years and 6 months of age. In conclusion, hMPV contributes to upper and lower respiratory tract morbidity in South African children. © 2004 Wiley-Liss, Inc.
- ItemLeadership and early strategic response to the SARS-CoV- 2 pandemic at a COVID-19 designated hospital in South Africa(Health & Medical Publishing Group, 2020-04-23) Parker, A.; Karamchand, S.; Schrueder, N.; Lahri, S.; Rabie, H.; Aucamp, A.; Abrahams, R.; Ciapparelli, P.; Erasmus, D. S.; Cotton, M. F.; Lalla, U.; Leisegang, Rory; Meintjes, J.; Mistry, R.; Moosa, M. R.; Mowlana, A.; Koegelenberg, C. F. N.; Prozesky, H.; Smith, W.; Van Schalkwyk, M.; Taljaard, J. J.While many countries are preparing to face the COVID-19 pandemic, the reported cases in Africa remain low. With a high burden of both communicable and non-communicable disease and a resource-constrained public healthcare system, sub-Saharan Africa is preparing for the coming crisis as best it can. We describe our early response as a designated COVID-19 provincial hospital in Cape Town, South Africa (SA).While the first cases reported were related to international travel, at the time of writing there was evidence of early community spread. The SA government announced a countrywide lockdown from midnight 26 March 2020 to midnight 30 April 2020 to stem the pandemic and save lives. However, many questions remain on how the COVID-19 threat will unfold in SA, given the significant informal sector overcrowding and poverty in our communities. There is no doubt that leadership and teamwork at all levels is critical in influencing outcomes.
- ItemLongitudinal developmental profile of children from low socio-economic circumstances in Cape Town, using the 1996 Griffiths Mental Development Scales(Health & Medical Publishing Group, 2010) Laughton, Barbara; Springer, P. E.; Grove, D.; Seedat, S.; Cornell, M.; Kidd, M.; Madhi, S. A.; Cotton, M. F.Background. The Griffiths Mental Development Scales (GMDS) have not been standardised in South African children. Neurodevelopmental scores of infants from deprived environments decline with age, but there is no evidence on how young South African children from such backgrounds perform on serial assessments. Aim. To describe the longitudinal developmental profile of infants from low socio-economic backgrounds at Tygerberg Children's Hospital by comparing the GMDS scores performed at 10 - 12 months and 20 - 22 months. Methods. Infants born to HIV-uninfected women attending the public service programme were recruited from a vaccine study in Cape Town, South Africa. The GMDS 0 - 2 years and a neurological examination were performed between 10 and 12 months and between 20 and 22 months. Results. Thirty-one infants (14 girls, 17 boys) were assessed. Their mean (standard deviation (SD)) age was 11.6 (0.8) months and 21.0 (0.5) months at the first and second assessments, respectively. The mean (SD) general quotient decreased significantly from 107.3 (11.7) to 95.0 (11.0) (p<0.001). All sub-quotients decreased significantly except for locomotor. The hearing and language sub-quotient was most affected, with a decrease in mean quotients from 113.0 to 93.2 (p<0.001). There was no evidence of intercurrent events to explain the decline. Interpretation. Scores on the GMDS of this group of children from low socio-economic backgrounds were normal at 11 months and, other than locomotor, decreased significantly at 21 months, with language the most affected. Further research is needed to determine the specific reasons for the decline.
- ItemManagement of upper respiratory tract infections in children(Taylor & Francis, 2008) Cotton, M. F.; Innes, S.; Jaspan, H.; Madide, A.; Rabie, H.Upper respiratory tract infection (URTI) occurs commonly in both children and adults and is a major cause of mild morbidity. It has a high cost to society, being responsible for absenteeism from school and work and unnecessary medical care, and is occasionally associated with serious sequelae. URTIs are usually caused by several families of virus; these are the rhinovirus, coronavirus, parainfluenza, respiratory syncytial virus (RSV), adenovirus, human metapneumovirus, influenza, enterovirus and the recently discovered bocavirus. This review will mainly focus on the rhinovirus, where significant advances have been made in understanding the epidemiology, natural history and relationship with other pathogens.
- ItemNecrotising enterocolitis as an infectious disease : evidence from an outbreak of invasive disease due to extended-spectrum beta-lactamase-producing Klebsiella pneumoniae (Health & Medical Publishing Group, 2001) Cotton, M. F.; Pieper, C. H.; Kirsten, G. F.; Orth, H.; Theron, D. C.Necrotising enterocolitis (NEC) is a severe gastro-intestinal disorder, predominantly seen in hospitalised low-birth-weight newborn infants. It is associated with significant morbidity and mortality. Infants with NEC require parenteral nutrition and intravenous antibiotics with prolongation of hospitalisation. Severe cases require surgical resection of necrotic bowel wall with the attendant problems of the short gut syndrome.' NEC places an enormous burden on resource-poor institutions.
- ItemNeoCLEAN : a multimodal strategy to enhance environmental cleaning in a resource-limited neonatal unit(BMC (part of Springer Nature), 2021-02-12) Dramowski, A.; Aucamp, M.; Bekker, A.; Pillay, S.; Moloto, K.; Whitelaw, A. C.; Cotton, M. F.; Coffin, S.Background: Contamination of the hospital environment contributes to neonatal bacterial colonization and infection. Cleaning of hospital surfaces and equipment is seldom audited in resource-limited settings. Methods: A quasi-experimental study was conducted to assess the impact of a multimodal cleaning intervention for surfaces and equipment in a 30-bed neonatal ward. The intervention included cleaning audits with feedback, cleaning checklists, in-room cleaning wipes and training of staff and mothers in cleaning methods. Cleaning adequacy was evaluated for 100 items (58 surfaces, 42 equipment) using quantitative bacterial surface cultures, adenosine triphosphate bioluminescence assays and fluorescent ultraviolet markers, performed at baseline (P1, October 2019), early intervention (P2, November 2019) and late intervention (P3, February 2020). Results: Environmental swabs (55/300; 18.3%) yielded growth of 78 potential neonatal pathogens with Enterococci, S. marcescens, K. pneumoniae, S. aureus and A. baumannii predominating. Highest aerobic colony counts were noted from moist surfaces such as sinks, milk kitchen surfaces, humidifiers and suction tubing. The proportion of surfaces and equipment exhibiting no bacterial growth increased between phases (P1 = 49%, P2 = 66%, P3 = 69%; p = 0.007). The proportion of surfaces and equipment meeting the ATP “cleanliness” threshold (< 200 relative light units) increased over time (P1 = 40%, P2 = 54%, P3 = 65%; p = 0.002), as did the UV marker removal rate (P1 = 23%, P2 = 71%, P3 = 74%; p < 0.001). Conclusion: Routine environmental cleaning of this neonatal ward was sub-optimal at baseline but improved significantly following a multimodal cleaning intervention. Involving mothers and nursing staff was key to achieving improved environmental and equipment cleaning in this resource-limited neonatal unit.
- ItemNitazoxanide for severe cryptosporidial diarrhea in human immunodeficiency virus infected children(2008) Abraham, D. R.; Rabie, H.; Cotton, M. F.[No abstract available]
- ItemNosocomial endocarditis due to extended-spectrum beta-lactamase-producing Klebsiella pneumoniae in a child(Health & Medical Publishing Group, 2001) Shipton, S. E.; Cotton, M. F.; Wessels, G.; Wasserman, E.Extended-spectrum beta-lactamase-producing organisms resistant to third-generation cephalosporins have been increasingly implicated in nosocomial infection.'Extended-spectrum beta-lactamase-producing Klebsiella pneumoniae (ESKP) has been endemic at Tygerberg Hospital since 1993, and has recently been implicated in an outbreak of sepsis in the neonatal unit.' Despite improved infection control practices, sporadic episodes of nosocomial sepsis due to ESKP still occur both in the neonatal unit and in other paediatric wards. To the best of our knowledge this is the first report of a child with endocarditis due to ESKP.
- ItemOtorrhoea is a marker for symptomatic disease in HIV-infected children(Health and Medical Publishing Group (HMPG), 2007) Karpakis, J.; Rabie, H.; Howard, J.; Van Rensburg, A. J.; Cotton, M. F.Background. Chronic otorrhoea occurs commonly in HIV-infected children. However, there are few data on incidence and severity. Objective. To document the prevalence of otorrhoea in the clinic attendees. Methods. A retrospective chart review was done of all HIV-I infected children seen at the Family Clinic for HIV from 1 February 1997 to 31 December 2001, a period preceding widespread availability of antiretrovirals: Otorrhoea was classified into two groups, viz. group 1 (mild): an episode lasting less than 1 month, and group 2 (severe): an episode lasting more than 1 month or more than 1 episode of otorrhoea. The clinical and immune stages of the children were noted. Results. Of 326 children seen during the study period, 104 (32%) had otorrhoea. Forty-five (13.8%) had mild and 59 (18.1%) severe otorrhoea. Two hundred and eighty-eight (88.6%) had either Centers for Disease Control stage B or C disease. The median CD4 percentage in children with otorrhoea was 17.5% (8.3 - 23%) versus 21% (14 - 28%) in those without otorrhoea (p=0.004). The odds ratio (OR) of children in stage B or C not having severe otorrhoea was 0.1 (0.01 - 0.72, p = 0.013). The OR for immune class 2 or 3 without severe otorrhoea was 0.39 (0.18 - 0.85, p = 0.021). Conclusions. Otorrhoea contributes to the morbidity of HIV infection in children. It is a marker for symptomatic disease and CD4 depletion and should be included in clinical classification.