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ItemNo Preview AvailableRecommendations for treatment of childhood non-severe pneumoniaGrant, GB ; Campbell, H ; Dowell, SF ; Graham, SM ; Klugman, KP ; Mulholland, EK ; Steinhoff, M ; Weber, MW ; Qazi, S (ELSEVIER SCI LTD, 2009-03-01)WHO recommendations for early antimicrobial treatment of childhood pneumonia have been effective in reducing childhood mortality, but the last major revision was over 10 years ago. The emergence of antimicrobial resistance, new pneumonia pathogens, and new drugs have prompted WHO to assemble an international panel to review the literature on childhood pneumonia and to develop evidence-based recommendations for the empirical treatment of non-severe pneumonia among children managed by first-level health providers. Treatment should target the bacterial causes most likely to lead to severe disease, including Streptoccocus pneumoniae and Haemophilus influenzae. The best first-line agent is amoxicillin, given twice daily for 3-5 days, although co-trimoxazole may be an alternative in some settings. Treatment failure should be defined in a child who develops signs warranting immediate referral or who does not have a decrease in respiratory rate after 48-72 h of therapy. If failure occurs, and no indication for immediate referral exists, possible explanations for failure should be systematically determined, including non-adherence to therapy and alternative diagnoses. If failure of the first-line agent remains a possible explanation, suitable second-line agents include high-dose amoxicillin-clavulanic acid with or without an affordable macrolide for children over 3 years of age.
ItemPneumocystis pneumonia in HIV-positive adults, Malawivan Oosterhout, JJG ; Laufer, MK ; Perez, MA ; Graham, SM ; Chimbiya, N ; Thesing, PC ; Alvarez-Martinez, MJ ; Wilson, PE ; Chagomerana, M ; Zijlstra, EE ; Taylor, TE ; Plowe, CV ; Meshnick, SR (CENTERS DISEASE CONTROL & PREVENTION, 2007-02-01)In a prospective study of 660 HIV-positive Malawian adults, we diagnosed Pneumocystis jirovecii pneumonia (PcP) using clinical features, induced sputum for immunofluorescent staining, real-time PCR, and posttreatment follow-up. PcP incidence was highest in patients with the lowest CD4 counts, but PcP is uncommon compared with incidences of pulmonary tuberculosis and bacterial pneumonia.
ItemPoor potential coverage for 7-valent pneumococcal conjugate vaccine, MalawiGordon, SB ; Kanyanda, S ; Walsh, AL ; Goddard, K ; Chaponda, M ; Atkinson, V ; Mulwafu, W ; Molyneux, EM ; Zijlstra, EE ; Molyneux, ME ; Graham, SM (CENTER DISEASE CONTROL, 2003-06-01)Streptococcus pneumoniae infections can be prevented by using new conjugate vaccines, but these vaccines have limited serogroup coverage. We report the first serogrouping data from carried and invasive isolates obtained from children and adults in Malawi. The 7-valent vaccine would cover 41% of invasive isolates from children and 25% from adults. A 9-valent vaccine, including types 1 and 5, would cover 66% of invasive isolates from children and 55% from adults.
ItemInvasive group B streptococcal infection in infants, MalawiGray, KJ ; Bennett, SL ; French, N ; Phiri, AJ ; Graham, SM (CENTERS DISEASE CONTROL & PREVENTION, 2007-02-01)Group B streptococci (GBS) are a recently identified cause of neonatal sepsis in Malawi. In Queen Elizabeth Central Hospital, Blantyre, Malawi, during May 2004-June 2005, GBS were isolated from routine blood and cerebrospinal fluid cultures from 57 infants. The incidence of early (EOD) and late onset (LOD) invasive GBS disease was 0.92 and 0.89 cases per 1,000 live births, respectively. Sepsis (52%) was the most common manifestation of EOD; meningitis (43%) and sepsis (36%) were the principal manifestations of LOD. The case-fatality rate was 33% overall (38% EOD, 29% LOD). Serotypes Ia and III were responsible for 77% of disease. All isolates were susceptible to penicillin, but 21% were resistant to erythromycin. The rate and manifestations of neonatal GBS disease in Malawi are similar to those in industrialized countries, but the case-fatality rate is higher than in industrialized countries. Effective locally relevant prevention strategies are needed.