Stratifying Sepsis in Uganda Using Rapid Pathogen Diagnostics and Clinical Data: A Prospective Cohort Study

The global burden of sepsis is concentrated in sub-Saharan Africa, where extensive pathogen diversity and limited laboratory capacity challenge targeted antimicrobial management of life-threatening infections. In this context, established and emerging rapid pathogen diagnostics may stratify sepsis patients into subgroups with prognostic and therapeutic relevance. In a prospective cohort of adults (age ≥18 years) hospitalized with suspected sepsis in Uganda, we stratified patients using rapid diagnostics for HIV, tuberculosis (TB), malaria, and influenza, and compared clinical characteristics and 30-day outcomes across these pathogen-driven subgroups. From April 2017 to August 2019, 301 adults were enrolled (median age, 32 years [interquartile range, 26–42 years]; female, n = 178 [59%]). A total of 157 patients (53%) were HIV infected. Sixty-one patients (20%) tested positive for malaria, 52 (17%), for TB (including 49 of 157 [31%] HIV-infected patients), and 17 (6%), for influenza. Co-infection was identified in 33 (11%) patients. The frequency of multi-organ failure, including shock and acute respiratory failure, was greatest among patients with HIV-associated TB. Mortality at 30 days was 19% among patients with malaria, 40% among patients with HIV-associated TB, 32% among HIV-infected patients without microbiological evidence of TB, 6% among patients with influenza, and 11% among patients without a pathogen identified. Despite improvements in anti-retroviral delivery, the burden of sepsis in Uganda remains concentrated among young, HIV-infected adults, with a high incidence of severe HIV-associated TB. In parallel with improvements in acute-care capacity, use of rapid pathogen diagnostics may enhance triage and antimicrobial management during emergency care for sepsis in sub-Saharan Africa, and could be used to enrich study populations when trialing pathogen-specific treatment strategies in the region.

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A Review of African Swine Fever – Disease that is Now a Big Concern in Europe

Contemporary Agriculture ◽

10.2478/contagri-2018-0016 ◽

2018 ◽

Vol 67 (2) ◽

pp. 110-118

Author(s):

Marina Štukelj ◽

Jan Plut

Keyword(s):

Clinical Signs ◽

Specific Treatment ◽

African Swine Fever ◽

Sub Saharan Africa ◽

Rapid Diagnostics ◽

Live Animal ◽

Feral Swine ◽

Sub Saharan ◽

Pork Product ◽

Species Specific

Summary African swine fever (ASF) is a serious disease of domestic and feral swine mainly because of grave clinical course of the disease and its strong socio-economic impact. Not only there is an extremely high mortality (95–100%) around the time of the first outbreak, live-animal, pork meat and other pork product trade is strongly affected on regional and international level. ASF is a species-specific disease; strength of the clinical signs depends on virulence of a viral strain. Exacerbation of body temperature and dysfunction of respiratory system and gastrointestinal tract are most common occurrences. Lesions can be mostly classed as congestive or hemorrhagic. Epidemiologically, ASF varies substantially among regions, countries and continents due to wide panel of different virus genotypes, population of feral swine and other reservoirs of disease, geographical characteristics and social habits of people. ASF is endemic in Sub-Saharan Africa where soft ticks (Argaside) and chronically infected feral swine population serve as reservoirs. It also became endemic in most parts of Russian Federation. Since 1978, ASF is endemic on Sardinia isle, as it was eradicated in all other parts of Europe. First outbreak in Georgia in 2007 has apparently served for transmission to other eastern European countries. Slovenia is currently still ASF-free but disease has already reached some relatively nearby countries (Poland, Romania, Moldova, Czech Republic and Hungary). There is no anti-ASF vaccine currently available ad specific treatment has not been described. Therefore rapid diagnostics and implementation of strict biosecurity measures play a key role in prevention of further transmission.

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Breast cancer survival and survival gap apportionment in sub-Saharan Africa (ABC-DO): a prospective cohort study

The Lancet Global Health ◽

10.1016/s2214-109x(20)30261-8 ◽

2020 ◽

Vol 8 (9) ◽

pp. e1203-e1212 ◽

Cited By ~ 2

Author(s):

Valerie McCormack ◽

Fiona McKenzie ◽

Milena Foerster ◽

Annelle Zietsman ◽

Moses Galukande ◽

...

Keyword(s):

Breast Cancer ◽

Cohort Study ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Cancer Survival ◽

Breast Cancer Survival ◽

Sub Saharan Africa ◽

Sub Saharan

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PO 8719 INTRODUCING A NEW AFRICA MENINGITIS NETWORK – A NORTH-SOUTH COLLABORATION

BMJ Global Health ◽

10.1136/bmjgh-2019-edc.165 ◽

2019 ◽

Vol 4 (Suppl 3) ◽

pp. A63.1-A63

Author(s):

Mosepele Mosepele ◽

Cecilia Kanyama ◽

David Meya ◽

Fiona Cresswell ◽

Timothee Chammard ◽

...

Keyword(s):

Treatment Strategies ◽

Sub Saharan Africa ◽

High Dose ◽

Diagnostic Strategies ◽

Cns Infections ◽

Study Protocols ◽

Sub Saharan ◽

Novel Treatment Strategies ◽

Set Up ◽

Randomised Controlled

BackgroundCentral nervous system infections, including meningitis, continue to cause significant morbidity in Africa. HIV has contributed to the epidemiology of CNS infections in this setting. Notable advances in the study of CNS infections by several groups have demonstrated the utility of new diagnostic strategies and impact of novel treatment strategies. However, efforts to coordinate meningitis research in Africa, and between Africa and the rest of the world remain very limited.MethodsIn a bid to promote a coordinated study of CNS infections across Africa, and in collaboration with other meningitis groups globally, the researchers of the AMBITION study (High Dose Ambisome on a Fluconazole Backbone for Cryptococcal Meningitis Induction Therapy in Sub-saharan Africa: A Randomised Controlled Non-inferiority Trial) are leveraging the EDCTP support for the AMBITION trial to set up an Africa Meningitis Trials Network.ResultsThe Africa Meningitis Trials Network (AMNET) was launched in Malawi in early 2018. Main achievements since the launch of the network, include an internal review of meningitis research across network sites and launch of the network website. The network also has two study protocols pending ethics review at all sites. These studies will provide much needed information on resources available for meningitis care, research and provide a baseline epidemiology of meningitis in Africa.ConclusionAMNET provides a rare opportunity for investigators interested in meningitis research to leverage the ongoing AMBITION trial to conduct Africa-wide preliminary research on meningitis. The network is recruiting additional members in Africa and globally to collaborate on meningitis research, and also apply for research funding to support meningitis work. Anyone interested in knowing more about the network should contact the AMNET communications officer, Ms Phum’lani Machao, [email protected]

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Blood lead level in infants and subsequent risk of malaria: A prospective cohort study in Benin, Sub-Saharan Africa

PLoS ONE ◽

10.1371/journal.pone.0220023 ◽

2019 ◽

Vol 14 (7) ◽

pp. e0220023

Author(s):

Amanda Garrison ◽

Babak Khoshnood ◽

David Courtin ◽

Jacqueline Milet ◽

André Garcia ◽

...

Keyword(s):

Cohort Study ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Blood Lead Level ◽

Lead Level ◽

Blood Lead ◽

Sub Saharan Africa ◽

Sub Saharan ◽

Subsequent Risk

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OC 8494 DRIVING REDUCED AIDS-ASSOCIATED MENINGO-ENCEPHALITIS MORTALITY

BMJ Global Health ◽

10.1136/bmjgh-2019-edc.24 ◽

2019 ◽

Vol 4 (Suppl 3) ◽

pp. A10.2-A10

Author(s):

Angela Loyse ◽

Godfrey S Mfinanga ◽

Cecilia Kanyama ◽

Charles Kounfack ◽

Sokoine Lesikari ◽

...

Keyword(s):

High Mortality ◽

Routine Care ◽

Sub Saharan Africa ◽

Contributing Factors ◽

Train The Trainer ◽

Csf Analysis ◽

Laboratory Capacity ◽

Poor Access ◽

Microbiological Techniques ◽

Sub Saharan

BackgroundDREAMM is an implementation study aiming to reduce meningo-encephalitis related mortality. Delays in diagnosis and treatment through poor access to diagnostics and treatments are significant contributing factors to the ongoing high mortality of HIV-associated central nervous system (CNS) infections, causing up to 25% of all HIV-related deaths in sub-Saharan Africa.MethodsA before-after design is being implemented across 3 sites in Africa; Lilongwe, Malawi, Dar Es Salaam, Tanzania and Yaoundé, Cameroon. The study is composed of 3 phases: Observation, Training and Implementation.ResultsThe observation phase (audit of practice) happened between November 2016 – May 2017 in Malawi and Tanzania. Overall, 110 patients were included. Ten-week all-cause mortality was 64% (42/66) in Tanzania and 37% (13/35) in Malawi. Approximately 75% of patients were ART experienced. Across sites, 76.6% of patients presented with abnormal mental status, with a median baseline CD4 count of 50 cells/µL. Only 2/75 patients in Tanzania had a lumbar puncture ordered compared to 27/35 in Malawi. All patients in Tanzania received empirical Fluconazole monotherapy whereas almost 1/3 patients in Malawi (11/35) were treated with Amphotericin B which is not readily available in both countries.The training phase (completed in November 2017 for Malawi and Tanzania) used the train-the-trainer approach. Interactive workshops on using rapid diagnostic tests (RDTs), performing basic microbiological techniques and safe administration of medicines were chosen as the most pertinent to reducing mortality. Patient and laboratory pathways were optimised afterwards by increasing the routine laboratory capacity, performing CSF analysis, providing infectious diseases mentorship for clinicians and procuring RDTs and reagents not locally available.Implementation is underway in Malawi and Tanzania and the audit phase is scheduled for autumn in Cameroon. Upon completion, the project is expected to create a sustainable approach to reduce the high mortality of HIV-related meningo-encephalitis with the optimised patient and laboratory pathways embedded within routine care.

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