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1
Bloodstream Infections and Frequency of Pretreatment Associated With Age and Hospitalization Status in Sub-Saharan Africa

Nichols, Chelsea,Cruz Espinoza, Ligia Maria,von Kalckreuth, Vera,Aaby, Peter,Ahmed El Tayeb, Muna,Ali, Mohammad,Aseffa, Abraham,Bjerregaard-Andersen, Morten,Breiman, Robert F.,Cosmas, Leonard,Crump, J Oxford University Press 2015 Clinical infectious diseases Vol.61 No.suppl4
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Background. The clinical diagnosis of bacterial bloodstream infections (BSIs) in sub-Saharan Africa is routinely confused with malaria due to overlapping symptoms. The Typhoid Surveillance in Africa Program (TSAP) recruited febrile inpatients and outpatients of all ages using identical study procedures and enrollment criteria, thus providing an opportunity to assess disease etiology and pretreatment patterns among children and adults.Methods. Inpatients and outpatients of all ages with tympanic or axillary temperatures of ≥38.0 or ≥37.5°C, respectively, and inpatients only reporting fever within the previous 72 hours were eligible for recruitment. All recruited patients had one blood sample drawn and cultured for microorganisms. Data from 11 TSAP surveillance sites in nine different countries were used in the analysis. Bivariate analysis was used to compare frequencies of pretreatment and BSIs in febrile children (<15 years old) and adults (≥15 years old) in each country. Pooled Cochran Mantel–Haenszel odds ratios (ORs) were calculated for overall trends.Results. There was no significant difference in the odds of a culture-proven BSI between children and adults among inpatients or outpatients. Among both inpatients and outpatients, children had significantly higher odds of having a contaminated blood culture compared with adults. Using country-pooled data, child outpatients had 66% higher odds of having Salmonella Typhi in their bloodstream than adults (OR, 1.66; 95% confidence interval [CI], 1.01–2.73). Overall, inpatient children had 59% higher odds of pretreatment with analgesics in comparison to inpatient adults (OR, 1.59; 95% CI, 1.28–1.97).Conclusions. The proportion of patients with culture-proven BSIs in children compared with adults was similar across the TSAP study population; however, outpatient children were more likely to have Salmonella Typhi infections than outpatient adults. This finding points to the importance of including outpatient facilities in surveillance efforts, particularly for the surveillance of typhoid fever. Strategies to reduce contamination among pediatric blood cultures are needed across the continent to prevent the misdiagnosis of BSI cases in children.
2
Are brucellosis, Q fever and melioidosis potential causes of febrile illness in Madagascar?

Boone, Ides,Henning, Klaus,Hilbert, Angela,Neubauer, Heinrich,von Kalckreuth, Vera,Dekker, Denise Myriam,Schwarz, Norbert Georg,Pak, Gi Deok,Krü,ger, Andreas,Hagen, Ralf Matthias,Frickmann, Hagen Elsevier 2017 Acta tropica Vol.172 No.-
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Abstract Brucellosis, Q fever and melioidosis are zoonoses, which can lead to pyrexia. These diseases are often under-ascertained and underreported because of their unspecific clinical signs and symptoms, insufficient awareness by physicians and public health officers and limited diagnostic capabilities, especially in low-resource countries. Therefore, the presence of Brucella spp., Coxiella burnetii and Burkholderia pseudomallei was investigated in Malagasy patients exhibiting febrile illness. In addition, we analyzed zebu cattle and their ticks as potential reservoirs for Brucella and C. burnetii, respectively. Specific quantitative real-time PCR assays (qPCRs) were performed on 1020 blood samples drawn from febrile patients. In total, 15 samples (1.5%) were Brucella-positive, mainly originating from patients without travel history, while DNA from C. burnetii and Bu. pseudomallei was not detected. Anti-C. burnetii antibodies were found in four out of 201 zebu serum samples (2%), whereas anti-Brucella antibodies could not be detected. Brucella DNA was detected in a single zebu sample. Three out of 330 ticks analyzed (1%) were positively tested for C. burnetii DNA but with high Ct values in the qPCR assay. Our data suggest that zebus as well as Amblyomma and Boophilus ticks have to be considered as a natural reservoir or vector for C. burnetii, but the risk of cattle-to-human transmission is low. Since bovine brucellosis does not seem to contribute to human infections in Madagascar, other transmission routes have to be assumed.
3
Presence of Borrelia spp. DNA in ticks, but absence of Borrelia spp. and of Leptospira spp. DNA in blood of fever patients in Madagascar

Hagen, Ralf Matthias,Frickmann, Hagen,Ehlers, Julian,Krü,ger, Andreas,Margos, Gabriele,Hizo-Teufel, Cecilia,Fingerle, Volker,Rakotozandrindrainy, Raphael,Kalckreuth, Vera von,Im, Justin,Pak, Gi De Elsevier 2018 Acta tropica Vol.177 No.-
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Abstract The occurrence of tick-borne relapsing fever and leptospirosis in humans in Madagascar remains unclear despite the presence of their potential vectors and reservoir hosts. We screened 255 Amblyomma variegatum ticks and 148 Rhipicephalus microplus ticks from Zebu cattle in Madagascar for Borrelia-specific DNA. Borrelia spp. DNA was detected in 21 Amblyomma variegatum ticks and 2 Rhipicephalus microplus ticks. One Borrelia found in one Rhipicephalus microplus showed close relationship to Borrelia theileri based on genetic distance and phylogenetic analyses on 16S rRNA and flaB sequences. The borreliae from Amblyomma variegatum could not be identified due to very low quantities of present DNA reflected by high cycle threshold values in real-time-PCR. It is uncertain whether these low numbers of Borrelia spp. are sufficient for transmission of infection from ticks to humans. In order to determine whether spirochaete infections are relevant in humans, blood samples of 1009 patients from the highlands of Madagascar with fever of unknown origin were screened for Borrelia spp. − and in addition for Leptospira spp. − by real-time PCR. No target DNA was detected, indicating a limited relevance of these pathogens for humans in the highlands of Madagascar. Highlights <UL> <LI> Borrelia spp. DNA was detected in Amblyomma (A.) variegatum ticks and Rhipicephalus (R.) microplus ticks in Madagascar. </LI> <LI> DNA of a Borrelia (B.) theileri-related borreliae was detected in R. microplus for the first time in Madagascar. </LI> <LI> Only low amounts of Borrelia spp. DNA were detected in the assessed ticks, indicating low numbers of organisms and indicating an at the most limited risk of transmission to humans. </LI> <LI> Borrelia spp. DNA was absent in the blood of fever patients from the highlands in Madagascar. </LI> <LI> Leptospira (L.) spp. DNA was absent in the blood of fever patients from the highlands in Madagascar. </LI> </UL>

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