Etiology of serious infections in young Gambian infants

Background. Despite improvements in infant mortality rates in many developi ng countries including The Gambia, neonatal mortality remains high and many neonatal deaths are caused by infection. The study described in this paper was conducted to determine the bacterial and viral etiology of serious inf ections in Gambian infants younger than 91 days old. Methods. At a first level health facility 497 infants with symptoms that co uld indicate serious infection were enrolled, of whom 239 with 1 or more si gns of serious infection and 55 with no signs were investigated, yielding 1 7 cases with positive bacterial cultures of blood and/or cerebrospinal flui d, At a nearby pediatric referral hospital 198 infants were seen and 182 we re investigated, yielding 35 positive bacterial cultures, Results. There were 15 culture positive cases of meningitis caused by Strep tococcus pneumoniae (7), Streptococcus pyogenes (2), Enterobacter cloacae ( 2), Escherichia coli (1), Haemophilus influenzae type b (1), Streptococcus agalactiae (1) and Salmonella spp, (1), Six of these children died, Thirty- three infants without meningitis had positive blood cultures for Staphyloco ccus aureus (17), S. pneumoniae (3), Salmonella spp, (5), E, coli (3), othe r enterobacteria (4) and S. agalactiae (1), of whom 14 died, Nasopharyngeal aspirates from 438 children were investigated for common respiratory virus es. Respiratory syncytial virus was found in 51, influenza A in 46, influen za B in 22, parainfluenza in 26 and adenovirus in 16, Respiratory syncytial virus and influenza A isolates were found most frequently toward the end o f the wet season. Nasopharyngeal carriage of S, pneumoniae and H, influenza e was studied in 320 infants recruited during the first year. Of these 184 (58%) were positive for S, pneumoniae and 141 (44%) were positive for H, in fluenzae, 18 of which were type b, Infants with a bacterial isolate from bl ood or cerebrospinal fluid were more likely than the rest to die, whereas t hose with a viral isolate were less likely to die. Conclusions. The most important causes of serious infections in young Gambi an infants are Staphylococcus aureus, S, pneumoniae and Salmonella spp.