RESUMO
BACKGROUND: Data are lacking on the pneumococcal serotypes present in many developing regions, including the Caribbean. We examined the serotypes of nasopharyngeal (NP) isolates of pneumococci obtained from Jamaican children. METHODS: We obtained NP samples from children seen in the Emergency Department at the Bustamante Children's Hospital. The samples were transported to Canada for isolation and serotyping of pneumococci. RESULTS: We obtained 94 isolates from 276 children; median age 3.4 years. The majority (57%) had symptoms of acute respiratory infection at the time of sampling. The main serotypes carried were 6B (20.5%), 19F (14.5%), and 14 (8.4%). Non-typable isolates accounted for 10.8% of the isolates. Fifty-nine per cent of the serotypes were present among the 11 being considered for candidate pneumococcal conjugate vaccines (95% CI 48-70%); the corresponding proportion present in the recently licensed 7-valent vaccine was 57% (95% CI 45-67%). A significant proportion of the serotypes found is absent from those to be included in future conjugate vaccines (P<0.0001; reference=85% expected serotype representation). Less than 5% of isolates were non-susceptible to penicillin (3.2%), cefotaxime-ceftriaxone (3.2%) and cefuroxime (3.2%), while 8.4% and 1.l% of isolates were resistant to trimethoprim-sulfamethoxazole and erythromycin respectively. There were three isolates with resistance to two or more classes of drug. These isolates were all resistant to penicillin (MIC 2 micro g/mL); the serotypes were 14, 23F, and 19F. CONCLUSION: A significant proportion of the serotypes found is absent from those to be included in future conjugate vaccines.
Assuntos
Infecções Pneumocócicas/microbiologia , Infecções Respiratórias/microbiologia , Streptococcus pneumoniae/classificação , Streptococcus pneumoniae/isolamento & purificação , Adolescente , Antibacterianos/farmacologia , Vacinas Bacterianas , Criança , Pré-Escolar , Farmacorresistência Bacteriana Múltipla , Feminino , Hospitais , Humanos , Lactente , Jamaica/epidemiologia , Masculino , Testes de Sensibilidade Microbiana , Infecções Pneumocócicas/epidemiologia , Infecções Respiratórias/epidemiologia , Sorotipagem , Streptococcus pneumoniae/efeitos dos fármacos , Vacinas ConjugadasRESUMO
OBJECTIVES: To determine the spectrum of serum immunoreactive erythropoietin (SIE) levels amongst HIV-infected children aged <13 years in relation to the levels among healthy children as well as those with renal failure; to examine the relationship between clinical and laboratory parameters and SIE levels. DESIGN: A cross-sectional study with a descriptive non-interventional format. HIV-infected Canadian subjects were recruited through four tertiary Canadian and one Bahamian centre. Children with renal failure and healthy children were recruited from one of the Canadian centres. METHODS: Study subjects had clinical and laboratory profiles determined at baseline and at each of five follow-up periods over 1 year. SIE levels were measured by radio-immunoassay with a normal range of 12-28 IU/I. Data handling and statistical functions were performed by the Canadian HIV Trials Network. RESULTS: Ths study enrolled 133 HIV-infected subjects and 38 controls. Of these, 117 HIV-infected subjects, 24 healthy controls, and 11 controls with renal failure were eligible for analysis. The median age of infected subjects was 44 months, whereas that of healthy controls was 56 months, and 95 months for controls with renal failure. The median SIE levels were 14 and 11 IU/I for subjects with renal failure and healthy subjects, respectively. The median SIE level was 61 IU/I among zidovudine (ZDV)-treated subjects and 22 IU/I among ZDV-naive HIV-infected subjects. HIV-infected children almost invariably had SIE levels < 200 IU/I. The median SIE levels amongst HIV-infected subjects whose hemoglobin levels were < 100 g/l were 98 and 31 IU/I for ZDV-treated and ZDV-naive subjects, respectively (P = 0.002). This difference in median SIE levels between ZDV-treated subjects and ZDV-naive subjects was also observed among subjects whose hemoglobin levels were > 100 g/l (median, 58 and 15 IU/I, respectively; P < 0.001). Hemoglobin level was the most important predictor of log10 SIE (P < 0.001 for ZDV-treated and ZDV-naive subjects). CONCLUSIONS: SIE levels amongst HIV-infected children were affected by HIV infection, use of ZDV, and presence or absence of anemia. SIE levels amongst HIV-infected children were generally lower than 200 IU/I. This characterization of SIE levels will facilitate clinical trials of exogenous recombinant human erythropoietin in HIV-infected children with anemia.(Au)
Assuntos
Criança , Pré-Escolar , Estudo Comparativo , Feminino , Humanos , Masculino , Lactente , Fármacos Anti-HIV/uso terapêutico , Eritropoetina/sangue , Zidovudina/uso terapêutico , Infecções por HIV/sangue , Bahamas , Canadá , Estudos Transversais , Hemoglobinas/análise , Infecções por HIV/tratamento farmacológico , Insuficiência Renal/sangue , Anemia/prevenção & controleRESUMO
The objectives of this cross-sectional survey were to determine the prevalence and clinical significance of mutations conferring ZDV genotypic resistance among HIV-1 strains from HIV infected Canadian children. We screened for mutations at reverse transcriptase (RT) codons 215 and 219 by direct sequencing of polymerase chain reaction (PCR) products amplified from HIV-1 proviral DNA. An automated AB1 373A sequencer and a Taq Dye Dideoxy cycle seqencing kit were used for gentopic testing. Among 51 ZDV-experienced children evaluated prior to December 31, 1995, the mean (ñSD) age was 84.8 (ñ59) months. The RT mutations at 215 and 219 were deduced in 25/51 (49 percent) of subjects. The mean duration of ZDV treatment among children with mutations was 23.4 months (SDñ16.6) compared with 9.9 (SDñ17.5) months for those without mutations (P = <.007). Children with mutations had lower baseline CD4 counts (means ñ SD, 359 ñ 542/mm versus 705 ñ 548/mm, P = .03). Similarly, there was significant difference in CD4 counts (means ñ SD, 225 ñ 439/mm versus 559 ñ 556/mm, respectively; P = .04). HIV-1 RT mutations at codons 215 and 219 were found in a significant number of children in our cohort and were associated with evidence of advanced disease. Periodical genotypic surveys will guide antiretroviral therapy in HIV infected children in setting similar to ours. However, given the potential for transmission of resistant strains globally, such surveys may be of value in selected populations to assess the potential of drug resistance prior to initiation of antiretroviral therapy.(AU)
Assuntos
Criança , Humanos , Zidovudina/imunologia , Zidovudina/análise , HIV-1/imunologia , HIV-1/crescimento & desenvolvimento , Estudos Transversais , Canadá , Transcriptase Reversa do HIV/imunologia , Reação em Cadeia da Polimerase , Estudos de CoortesRESUMO
The objectives of this study were to define the extent ofzidovudine (ZDV) resistance and to determine the association between resistance and clinical, virologic and epidemiologic variables among HIV-infected children. Subjects were recruited from 7 Canadian centres. Epidemiologic, clinical and laboratory data were collected on all subjects. Mononuclear cells from heparinized anticoagulated blood from each subject were isolated by density gradient centrifugation and quantitative cultures established for the determination of viral titres. Quantitative cultures were also performed in the presence of 5 um of zidovudine for 14 days; a reduction in viral titre in the presence of the drug was taken as a marker of susceptibility. The study has enrolled 102 subjects. Preliminary data on the first 52 children show that 76 per cent had perinatallly-acquired infection, while tranfusions and sexual transmission accounted for 24 per cent. The country of maternal birth was Canada in 64 per cent. The mean age was 84 months (sd ñ 57) and the HIV disease stage was P2 in 85 per cent. The mean CD4 count was 464/mm3; mean duration of ZDV treatment 17.2 months. ZDV resistance was found in 25 per cent (13/52) while 13.5 per cent (7/52) had intermediate susceptibility. Among factors potentially associated with resistance, duration of ZDV therapy was significant (p = 0.03) We are currently examining the relationship between resistance and viral load and phenotype, respectively. These preliminary data document the growing problem of zidovudine resistance among HIV-infected children in Canada, with 1 child out of every 4 in our cohort having ZDV-resistant virus. This highlights the need for a careful review of current anti-retroviral treatment strategies for HIV-infected children (AU)
Assuntos
Humanos , Criança , Infecções por HIV/tratamento farmacológico , Zidovudina/uso terapêutico , Resistência Microbiana a MedicamentosRESUMO
The HIV pandemic continues to increase in virtually all regions. Prevention remains the most important and cost-effective means of controlling the pandemic. However, as individuals are surviving for longer periods than in the early stages of the pandemic, clinicians face specific new therapeutic challenges in caring for HIV-infected individuals. Among the various challenges are the emergence of AZT-resistant HIV among adults and children, the appropriate treatment strategies for the growing population of long-term survivors, as well as the unique aspects of paediatric AIDs. Treatment guidelines are often based on the clinical spectrum of problems faced in the developed countries. However, these approaches may not be applicable to developing countries, due in part to economic factors as well as to the different spectrum of microbial agents. This presentation reviews the current suggested approaches to the cost-effective treatment of HIV/AIDs in the Caribbean in the context of emerging data. Specific clinical scenarios are outlined to illustrate the treatment of important clinical problems. The unique aspects of paediatric HIV are outlined. The approach to treatment of perinatal cases (rapidly progressive HIV with encephalopathy versus slowly progressive disease) is discussed (AU)
Assuntos
Humanos , Criança , Adulto , Síndrome da Imunodeficiência Adquirida/terapia , Índias Ocidentais/epidemiologiaRESUMO
A decision analysis was conducted to examine whether short-term (42 days) zidovudine should be recommended for Caribbean health care workers (HCWs), following percutaneous exposure to blood, as well as to determine the value of testing "donor" (patient's) blood. The results were compared with a similar analysis based on a North American model. The options analyzed were "TREAT ALL", "TREAT NONE"; and "TEST". In the "TREAT ALL" option, all HWCs receive short-term zidovudine immediately after exposure, "TREAT NONE" option no one receives zidovudine and in the "TEST" option, "donor" blood is tested, and if HIV-positive, zidovudine is given. Each outcome was expressed as a utility; this is a method of quantifying the values that individuals place on health states. The results showed that the "TEST" option is preferred. The value of testing "donor" blood is derived from the fact that the vast majority of HCWs would be reassured by a negative test. Sensitivity analyses indicated that even if the risk of seroconversion or the effectiveness of zidovudine is zero, this option is preferred; thus confirming the above value of testing, rather than merely identifying HCWs who should receive zidovudine. If HIV-seropositivity exceeds 42 per cent, the "TREAT NONE" option is preferred. This was found to be due to the fact that increased numbers of HCWs would be told that they were exposed to HIV-positive blood. The "worrying factor" associated with such an exposure is such that above 42 per cent HIV seropositivity, the "TREAT NONE" option is preferred. In summary, the real value of testing "donor" blood is in identifying those persons who could be told that they were exposed to HIV-negative blood; that is reducing their "worry factor" to zero. If the risk of HIV-positivity exceeds 42 per cent, in particular groups of Caribbean patients, the "TREAT NONE" option is preferred. Because AIDS is a fatal disease, and given that zidovudine is the only available prophylactic agent at present, the drug has a role to play if its effectiveness is greater than zero. In this regard, the approach should be similar to that adopted for developed countries (AU)
Assuntos
Humanos , Adulto , Ocupações em Saúde , Região do Caribe , Zidovudina/administração & dosagem , Doadores de Sangue , Soropositividade para HIV , Síndrome da Imunodeficiência Adquirida , Técnicas de Apoio para a DecisãoRESUMO
Maternal deaths in th 1975-80 period, UHWI were analysed as an elective project. Most deaths were referred from other hospitals. Most deaths were preventable and the traditional triad of haemorrhage, infection and toxaemia were responsible for most deaths (AU)