Browsing by Author "Gie, Robert P."
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- ItemClinical features and lung function in HIV-infected children with chronic lung disease(Health and Medical Publishing Group, 2015) Weber, Heinrich Christoph; Gie, Robert P.; Wills, Karen; Cotton, Mark F.Background. Although chronic lung disease (CLD) is commonly seen in children with advanced HIV disease, it is poorly studied. Objectives. To report on the clinical manifestations and lung function tests in children with advanced HIV disease at a tertiary care centre, and determine clinical predictors of poor lung function. Methods. We undertook a cross-sectional study of children with advanced HIV disease in whom CLD was suspected. We undertook clinical evaluation and lung function tests, accompanied by a retrospective chart review. Results. In 56 children identified, the median age was 5 (interquartile range (IQR) 2 - 8) years with equal gender ratio. The majority (93%) had been previously treated for tuberculosis and/or pneumonia (71%). The most common CLD identified was lymphocytic interstitial pneumonitis (54%). The median nadir CD4 percentage was 13% (IQR 8.5 - 16%) and the median highest reported viral load was log5.8 (IQR log5.0 - log6.5). The median duration of antiretroviral therapy was 9.8 (IQR 1.1 - 19.5) months. Lung function tests were performed in 27 (48%) children. The median forced expiratory volume in 1 second (FEV1) was 60% (IQR 45.3 - 86.3%) predicted. Previous hospitalisation, respiratory rate, digital clubbing, chest hyperinflation and hyperpigmented skin lesions were associated with a decreased FEV1 in a univariate relationship. In a multiple linear regression analysis, hyperinflation, increased respiratory rate and hyperpigmented skin lesions were associated with poor lung function (percentage FEV1). Conclusion. We identified useful clinical signs predictive of poor lung function in HIV-infected children with CLD, especially in resource-limited settings.
- ItemIndoor air pollution and tobacco smoke exposure : impact on nasopharyngeal bacterial carriage in mothers and infants in an African birth cohort study(European Respiratory Society, 2019) Vanker, Aneesa; Nduru, Polite M.; Barnett, Whitney; Dube, Felix S.; Sly, Peter D.; Gie, Robert P.; Nicol, Mark P.; Zar, Heather J.ENGLISH ABSTRACT: Indoor air pollution (IAP) or environmental tobacco smoke (ETS) exposure may influence nasopharyngeal carriage of bacterial species and development of lower respiratory tract infection (LRTI). The aim of this study was to longitudinally investigate the impact of antenatal or postnatal IAP/ETS exposure on nasopharyngeal bacteria in mothers and infants. A South African cohort study followed mother–infant pairs from birth through the first year. Nasopharyngeal swabs were taken at birth, 6 and 12 months for bacterial culture. Multivariable and multivariate Poisson regression investigated associations between nasopharyngeal bacterial species and IAP/ETS. IAP exposures (particulate matter, carbon monoxide, nitrogen dioxide, volatile organic compounds) were measured at home visits. ETS exposure was measured through maternal and infant urine cotinine. Infants received the 13-valent pneumococcal and Haemophilus influenzae B conjugate vaccines. There were 881 maternal and 2605 infant nasopharyngeal swabs. Antenatal ETS exposure was associated with Streptococcus pneumoniae carriage in mothers (adjusted risk ratio (aRR) 1.73 (95% CI 1.03–2.92)) while postnatal ETS exposure was associated with carriage in infants (aRR 1.14 (95% CI 1.00–1.30)) Postnatal particulate matter exposure was associated with the nasopharyngeal carriage of H. influenzae (aRR 1.68 (95% CI 1.10– 2.57)) or Moraxella catarrhalis (aRR 1.42 (95% CI 1.03–1.97)) in infants. Early-life environmental exposures are associated with an increased prevalence of specific nasopharyngeal bacteria during infancy, which may predispose to LRTI.
- ItemPotentially modifiable factors associated with death of infants and children with severe pneumonia routinely managed in district hospitals in Malawi(Public Library of Science, 2015) Enarson, Penelope M.; Gie, Robert P.; Mwansambo, Charles C.; Chalira, Alfred E.; Lufesi, Norman N.; Maganga, Ellubey R.; Enarson, Donald A.; Cameron, Neil A.; Graham, Stephen M.Objective: To investigate recognised co-morbidities and clinical management associated with inpatient pneumonia mortality in Malawian district hospitals. Methods: Prospective cohort study, of patient records, carried out in Malawi between 1st October 2000 and 30th June 2003. The study included all children aged 0-59 months admitted to the paediatric wards in sixteen district hospitals throughout Malawi with severe and very severe pneumonia. We compared individual factors between those that survived (n = 14 076) and those that died (n = 1 633). Results: From logistic regression analysis, predictors of death in hospital, adjusted for age, sex and severity grade included comorbid conditions of meningitis (OR =2.49, 95% CI 1.50-4.15), malnutrition (OR =2.37, 95% CI 1.94-2.88) and severe anaemia (OR =1.41, 95% CI 1.03-1.92). Requiring supplementary oxygen (OR =2.16, 95% CI 1.85-2.51) and intravenous fluids (OR =3.02, 95% CI 2.13-4.28) were associated with death while blood transfusion was no longer significant (OR =1.10, 95% CI 0.77-1.57) when the model included severe anaemia. Conclusions: This study identified a number of challenges to improve outcome for Malawian infants and children hospitalised with pneumonia. These included improved assessment of co-morbidities and more rigorous application of standard case management.
- ItemReducing deaths from severe pneumonia in children in Malawi by improving delivery of pneumonia case management(PLoS, 2014-07-22) Enarson, Penelope M.; Gie, Robert P.; Mwansambo, Charles C.; Maganga, Ellubey R.; Lombard, Carl J.; Enarson, Donald A.; Graham, Stephen M.Objective: To evaluate the pneumonia specific case fatality rate over time following the implementation of a Child Lung Health Programme (CLHP) within the existing government health services in Malawi to improve delivery of pneumonia case management. Methods: A prospective, nationwide public health intervention was studied to evaluate the impact on pneumonia specific case fatality rate (CFR) in infants and young children (0 to 59 months of age) following the implementation of the CLHP. The implementation was step-wise from October 1st 2000 until 31st December 2005 within paediatric inpatient wards in 24 of 25 district hospitals in Malawi. Data analysis compared recorded outcomes in the first three months of the intervention (the control period) to the period after that, looking at trend over time and variation by calendar month, age group, severity of disease and region of the country. The analysis was repeated standardizing the follow-up period by using only the first 15 months after implementation at each district hospital. Findings: Following implementation, 47,228 children were admitted to hospital for severe/very severe pneumonia with an overall CFR of 9•8%. In both analyses, the highest CFR was in the children 2 to 11 months, and those with very severe pneumonia. The majority (64%) of cases, 2–59 months, had severe pneumonia. In this group there was a significant effect of the intervention Odds Ratio (OR) 0•70 (95%CI: 0•50–0•98); p = 0•036), while in the same age group children treated for very severe pneumonia there was no interventional benefit (OR 0•97 (95%CI: 0•72–1•30); p = 0•8). No benefit was observed for neonates (OR 0•83 (95%CI: 0•56–1•22); p = 0•335). Conclusions: The nationwide implementation of the CLHP significantly reduced CFR in Malawian infants and children (2–59 months) treated for severe pneumonia. Reasons for the lack of benefit for neonates, infants and children with very severe pneumonia requires further research.
- ItemStool culture for diagnosis of pulmonary tuberculosis in children(American Society for Microbiology, 2017-12) Walters, Elisabetta; Demers, Anne-Marie; Van der Zalm, Marieke M.; Whitelaw, Andrew; Palmer, Megan; Bosch, Corne; Draper, Heather R.; Gie, Robert P.; Hesseling, Anneke C.Bacteriological confirmation of Mycobacterium tuberculosis is achieved in the minority of young children with tuberculosis (TB), since specimen collection is resource intensive and respiratory secretions are mostly paucibacillary, leading to limited sensitivity of available diagnostic tests. Although molecular tests are increasingly available globally, mycobacterial culture remains the gold standard for diagnosis and determination of drug susceptibility and is more sensitive than molecular methods for paucibacillary TB. We evaluated stool culture as an alternative to respiratory specimens for the diagnosis of suspected intrathoracic TB in a subgroup of 188 children (median age, 14.4 months; 15.4% HIV infected) enrolled in a TB diagnostic study at two local hospitals in Cape Town, South Africa. One stool culture was compared to overall bacteriological confirmation by stool Xpert and by Xpert and culture of multiple respiratory specimens. After decontamination/digestion with NALC (N-acetyl-l-cysteine)-NaOH (1.25%), concentrated fluorescent smear microscopy, Xpert MTB/RIF, and liquid culture were completed for all specimens. Culture contamination of stool specimens was high at 41.5%. Seven of 90 (7.8%) children initiating TB treatment were stool culture positive for M. tuberculosis. Excluding contaminated cultures, the sensitivity of stool culture versus confirmed TB was 6/25 (24.0%; 95% confidence interval [CI] = 9.4 to 45.1%). In addition, stool culture detected TB in 1/93 (1.1%) children with “unconfirmed TB.” Testing the same stool by Xpert increased sensitivity to 33.3% (95% CI = 18.0 to 51.8%). In conclusion, stool culture had low sensitivity for M. tuberculosis detection in children with intrathoracic TB. Reducing culture contamination through improved laboratory protocols may enable more reliable estimates of its diagnostic utility.
- ItemUsefulness of lateral radiographs for detecting tuberculous lymphadenopathy in children - confirmaiton using sagittal CT reconstruction with multiplanar cross-referencing(AOSIS Publishing, 2012-09-10) Andronikou, Savvas; Van der Merwe, Dirk Johannes; Goussard, Pierre; Gie, Robert P.; Tomazos, NicoletteENGLISH SUMMARY : Background: Diagnosis of pulmonary tuberculosis (PTB) in children remains difficult. Lateral chest radiographs are frequently used to facilitate diagnosis, but interpretation is variable. In this study, lateral chest radiographs (CXRs) are evaluated against sagittal CT reconstructions for the detection of mediastinal lymphadenopathy. Aim: To correlate suspected lymphadenopathy on lateral CXR with sagittal CT reconstructions and determine which anatomical group of lymph nodes contributes to each lateral CXR location. Methods and materials: Thirty TB-positive children’s lateral CXRs were retrospectively reviewed for presence of mediastinal lymphadenopathy in 3 pre-determined locations in relation to the carina: retrocarinal, subcarinal and precarinal. Findings of the CT sagittal reconstructions were then correlated with the CXRs for the presence of lymphadenopathy in the same 3 pre-determined areas across the width of the mediastinum. Axial and coronal CT crossreferencing confirmed the position of the lymphadenopathy. Results: The most frequent locations for lymphadenopathy were the subcarinal (28) and right hilar (25). Sensitivity and specificity values of the CXRs were moderate, with the precarinal region having the best sensitivity and specificity for presence of lymphadenopathy. Contribution to each zonal group on lateral CXR were from multiple anatomical lymph node sites. Conclusion: The precarinal zone on CXR had the best specificity and sensitivity, and represented mainly subcarinal and right hilar lymph node groups. Attention should be paid to this area on lateral CXRs for detecting lymphadenopathy in children with suspected PTB.