• Diagnostic and Prognostic Value of Procalcitonin and C-Reactive Protein in Malnourished Children

      Page, A-L; de Rekeneire, N; Sayadi, S; Aberrane, S; Janssens, A-C; Dehoux, M; Baron, E (American Academy of Pediatrics, 2014-01-20)
      Early recognition of bacterial infections is crucial for their proper management, but is particularly difficult in children with severe acute malnutrition (SAM). The objectives of this study were to evaluate the accuracy of C-reactive protein (CRP) and procalcitonin (PCT) for diagnosing bacterial infections and assessing the prognosis of hospitalized children with SAM, and to determine the reliability of CRP and PCT rapid tests suitable for remote settings.
    • Enteric bacterial pathogens in children with diarrhea in niger: diversity and antimicrobial resistance

      Langendorf, C; Le Hello, S; Moumouni, A; Gouali, M; Mamaty, A-A; Grais, RF; Weill, F-X; Page, A-L (Public Library of Science, 2015-03-23)
      Although rotavirus is the leading cause of severe diarrhea among children in sub-Saharan Africa, better knowledge of circulating enteric pathogenic bacteria and their antimicrobial resistance is crucial for prevention and treatment strategies.
    • Health care seeking behavior for diarrhea in children under 5 in rural Niger: results of a cross-sectional survey.

      Page, A-L; Hustache, S; Luquero, F J; Djibo, A; Manzo, M L; Grais, RF; Epicentre, Paris, France. anne-laure.page@epicentre.msf.org (2011-05-25)
      Diarrhea remains the second leading cause of death in children under 5 years of age in sub-Saharan Africa. Health care seeking behavior for diarrhea varies by context and has important implications for developing appropriate care strategies and estimating burden of disease. The objective of this study was to determine the proportion of children under five with diarrhea who consulted at a health structure in order to identify the appropriate health care levels to set up surveillance of severe diarrheal diseases.
    • Infections in Children Admitted with Complicated Severe Acute Malnutrition in Niger

      Page, A-L; de Rekeneire, N; Sayadi, S; Aberrane, S; Janssens, A-C; Rieux, C; Djibo, A; Manuguerra, J-C; Ducou-le-Pointe, H; Grais, RF; et al. (Public Library of Science, 2013-07-17)
      Although malnutrition affects thousands of children throughout the Sahel each year and predisposes them to infections, there is little data on the etiology of infections in these populations. We present a clinical and biological characterization of infections in hospitalized children with complicated severe acute malnutrition (SAM) in Maradi, Niger.
    • Massive Increase, Spread, and Exchange of Extended Spectrum {beta}-Lactamase-Encoding Genes Among Intestinal Enterobacteriaceae in Hospitalized Children With Severe Acute Malnutrition in Niger.

      Woerther, P-L; Angebault, C; Jacquier, H; Hugede, H-C; Janssens, A-C; Sayadi, S; El Mniai, A; Armand-Lefèvre, L; Ruppé, E; Barbier, F; et al. (2011-10)
      Background. From the time of CTX-M emergence, extended-spectrum β-lactamase-producing enterobacteria (ESBL-E) have spread worldwide in community settings as well as in hospitals, particularly in developing countries. Although their dissemination appears linked to Escherichia coli intestinal carriage, precise paths of this dynamic are largely unknown. Methods. Children from a pediatric renutrition center were prospectively enrolled in a fecal carriage study. Antibiotic exposure was recorded. ESBL-E strains were isolated using selective media from fecal samples obtained at admission and, when negative, also at discharge. ESBL-encoding genes were identified, their environments and plasmids were characterized, and clonality was assessed with polymerase chain reaction-based methods and pulsed-field gel electrophoresis for E. coli and Klebsiella pneumoniae. E. coli strains were subjected to multilocus sequence typing. Results. The ESBL-E carriage rate was 31% at admission in the 55 children enrolled. All children enrolled received antibiotics during hospitalization. Among the ESBL-E-negative children, 16 were resampled at discharge, and the acquisition rate was 94%. The bla(CTX-M-15) gene was found in >90% of the carriers. Genetic environments and plasmid characterization evidenced the roles of a worldwide, previously described, multidrug-resistant region and of IncF plasmids in CTX-M-15 E. coli dissemination. Diversity of CTX-M-15-carrying genetic structures and clonality of acquired ESBL E. coli suggested horizontal genetic transfer and underlined the potential of some ST types for nosocomial cross-transmission. Conclusions. Cross-transmission and high selective pressure lead to very high acquisition of ESBL-E carriage, contributing to dissemination in the community. Strict hygiene measures as well as careful balancing of benefit-risk ratio of current antibiotic policies need to be reevaluated.