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COVID-19 in children aged 0-15 years seen at Amirou Boubacar Diallo National Hospital in Niamey, Niger, 2020-2021

1,2Idé Amadou, H., 3Mahamadou Yacouba, M., 2,4Dodo, B., 5Boua Togola, O., 2,4Aboubacar, S., 6Ousmane, A., 2,4Garba, M., and 2Mainassara, S.

1Medical and Health Research Center (CERMES), BP: 10887, Niamey, Niger

2Amirou Boubacar Diallo National Hospital (HNABD), BP: 10146, Niamey, Niger

3Direction of Surveillance and Response to Epidemics (DSRE), BP: 623, Niamey, Niger

4Faculty of Health Sciences, Abdou Moumouni University of Niamey, BP: 10146, Niamey, Niger 5General Direction of Health and Public Hygiene, BP: 233, Bamako, Mali 6Faculty of Health Sciences, Dan Dicko Dan Koulodo University of Maradi, Niger *Correspondence to: ide.habibatou@yahoo.fr; Tel: 00 227 91 12 50 30/ 98 34 36 68

Abstract:
Background: In 2020, the COVID-19 pandemic affected all age groups. Although COVID-19 is generally benign in children, a diagnostic problem may arise due to clinical similarities with certain pathologies such as malaria, dengue fever and influenza. The objective of this study is to describe the epidemiological profile of COVID 19 in children seen at consultation and to determine the prevalence of influenza, malaria and dengue fever as differential diagnoses. Continue reading “COVID-19 in children aged 0-15 years seen at Amirou Boubacar Diallo National Hospital in Niamey, Niger, 2020-2021”

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Faecal carriage of extended spectrum β-lactamase producing Enterobacterales (ESBL-PE) in children under five years of age at a tertiary hospital in southwest Nigeria

[1]Abayomi, S. A., 2Oladibu, O. T., 3Lawani, O. A., 4Owolabi, K. I., 2Alabi, A. O.,        and *2Onigbinde, M. O.

1Cancer Research UK, Swansea, Wales, United Kingdom

2Department of Paediatrics and Child Health, College of Health Sciences, Ladoke Akintola University of Technology, Ogbomoso, Nigeria

3Department of Medical Microbiology and Parasitology, University of Ilorin Teaching Hospital, Ilorin, Nigeria

42102 Cole Street, Dudley, West Midlands, United Kingdom                                         

*Correspondence to: moonigbinde@lautech.edu.ng

Abstract:  

Background:  The main reservoir of Enterobacterales is the human gut, which has been reported as a source of hospital acquired infection. Enterobacterales carrying the extended spectrum β-lactamase (ESBL) genes have emerged over the years as significant multidrug resistant (MDR) pathogens, that have hindered effective therapy of infections caused by them, and limited treatment to a small number of drugs such as carbapenems, leading to selection pressure and emergent resistance to carbapenems. The objective of this study was to determine the faecal carriage of ESBL-producing Enterobacterales (ESPL-PE) among children under 5 years of age at the Ladoke Akintola University of Technology Teaching Hospital, Ogbomoso, Nigeria.    Continue reading “Faecal carriage of extended spectrum β-lactamase producing Enterobacterales (ESBL-PE) in children under five years of age at a tertiary hospital in southwest Nigeria”

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A systematic review of clinical characteristics, co-morbidities and outcomes of COVID-19 in children and adolescents

 

*1Adegboro, B., 2Musa-Booth, T. O., 3Mba, I. N., 4Ibrahim, R. R., 1Medugu, N.,

5Abayomi, S. A., and 6Babazhitsu, M.

 

Departments of 1Medical Microbiology/Immunology and

3Chemical Pathology, Nile University of Nigeria, Abuja, Nigeria

21928, Woodlawn Drive, Woodlawn, Maryland 21207, USA

4Department of Statistics, Faculty of Science, University of Abuja, Abuja, Nigeria

5Department of Medical Microbiology, LAUTECH Teaching Hospital, Ogbomoso, Nigeria

6Department of Medical Microbiology and Parasitology, Faculty of Basic Clinical Sciences, College of Health Sciences, Usmanu Danfodiyo University, Sokoto, Sokoto State, Nigeria

*Correspondence to: boazadegboro@gmail.com; boaz.adegboro@nileuniverity.edu.ng

Abstract:

Background: COVID-19 is a major global health challenge that has affected all age groups and gender, with over 5 million deaths reported worldwide to date. The objective of this study is to assess available information on COVID-19 in children and adolescents with respect to clinical characteristics, co-morbidities, and outcomes, and identify gaps in the literatures for appropriate actions.                   Continue reading “A systematic review of clinical characteristics, co-morbidities and outcomes of COVID-19 in children and adolescents”

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Faecal carriage of multi-drug resistant Enterobacteriaceae in hospitalized children at University Teaching Hospital Sylvanus Olympio of Lomé, Togo

1Lack, F., 1Tsogbalé, A., 2Doumegno, J. K., 3Dossim, S., 1Dagnra, A., and *1,4Salou, M.

1Laboratory of Molecular Biology and Immunology, Faculty of Health Sciences, University of Lomé, Lomé, Togo

2Laboratory of Microbiology and Food Quality Control, University of Lomé, Togo

3CHU Kara Medical Biology Laboratory, Kara, Togo

4National AMR Reference Laboratory CHU Campus, Lomé, Togo

*Correspondence to: mounerous@gmail.com

Abstract:
Background: High prevalence of infections and associated antibiotherapy may put children at increased risk for development of multidrug-resistance (MDR), mostly to bacterial infections. The objective of this study therefore was to determine the prevalence of gastrointestinal carriage of MDR Enterobacteriaceae among hospitalized children in the Paediatric department of Sylvanus Olympio University Hospital, Lomé, Togo. Continue reading “Faecal carriage of multi-drug resistant Enterobacteriaceae in hospitalized children at University Teaching Hospital Sylvanus Olympio of Lomé, Togo”

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Malaria rapid diagnostic test positivity rate among febrile patients seen at the Paediatric emergency unit of a tertiary care facility

*1Obu, D. C., 1Asiegbu, U. V., 1Okereke, B. E., 1Ukoh, U. C., 2Ujunwa, F. A., 1Afefi, C. O., 1Enya, V. E., 1Item, S., and 3Efunshile, A. M.

1Department of Paediatrics, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Ebonyi State, Nigeria

2Department of Paediatrics, University of Nigeria, Enugu State, Nigeria

3Department of Clinical Microbiology, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Ebonyi State, Nigeria

*Correspondence to: obudora@yahoo.com; +2348037511272

Abstract:
Background: Malaria, a life-threatening parasitic disease transmitted to humans by the female Anopheles mosquito is one of the infectious causes of fever in children. In Nigeria, malaria remains one of the most important health problems, accounting for 25% of infants and 30% of under-five mortalities. The objective of this study was to determine the prevalence of malaria among febrile children presenting at the children’s emergency room (CHER) of a tertiary health facility in Abakaliki using a malaria rapid diagnostic test (mRDT). Continue reading “Malaria rapid diagnostic test positivity rate among febrile patients seen at the Paediatric emergency unit of a tertiary care facility”

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Prevalence and risk factors of acute gastroenteritis caused by Rotavirus among children in tertiary hospitals, southeastern Nigeria

*1Igwe, D., 2Oshun, P., 2Osuagwu, C., 1Efunshile, A., and 2Oduyebo, O.

1Department of Medical Microbiology, College of Medicine/Alex Ekwueme Federal University Teaching Hospital, Abakaliki, PMB 102, Ebonyi State, Nigeria
2College of Medicine/Lagos University Teaching Hospital, Idi-Araba, University of Lagos, Nigeria*Correspondence to: daniel.igwe@npmcn.edu.ng.

Abstract:
Background: Diarrhea is a worldwide problem and rotavirus is the commonest viral etiologic agent. In Nigeria, diarrhea causes more than 315,000 deaths of preschool-age children annually. In Ebonyi State, it is among the leading causes of pediatric emergency visits and one of the major causes of infant morbidity and mortality. This study was aimed at determining the prevalence and associated risk factors of acute gastroenteritis due to rotavirus infection among under-five children in Abakaliki, Ebonyi state.

This was a cross-sectional study of 275 children under 5 years of age hospitalized for acute watery diarrhea, who were consecutively recruited into the study. Stool samples were collected from each child for rotavirus antigen detection using an enzyme-linked immunosorbent assay (ELISA). Socio-demographic information of each child and selected risk factors were collected using structured questionnaire. Data analysis was done on SPSS software version 20.0, and association of demographic characteristics and risk factors with rotavirus diarrhoea was measured using Chi-square test, odds ratio (and 95% confidence interval). Significant value was set at p < 0.05. Continue reading “Prevalence and risk factors of acute gastroenteritis caused by Rotavirus among children in tertiary hospitals, southeastern Nigeria”

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Comparative analysis of poliovirus-specific IgA and cytokine levels in the sera of Ascaris lumbricoides-infected and helminth-negative Nigerian children after oral poliovirus vaccination

Akinwande, K. S., and *Arinola, G. O

Department of Immunology, University of Ibadan, Nigeria

*Correspondence to: drarinolaog64@yahoo.com; +234 80 23451520

Abstract:

Background: Intestinal helminth infection is associated with altered immune responses and compromised vaccine efficacy in infected children. Altered immune response due to Ascaris lumbricoides infection may compromise efficacy of oral poliovirus vaccination in children. There is no information on humoral immune response during oral poliovirus (OP) vaccination of A. lumbricoides–infected Nigerian children. The objective of this study is to determine the serum levels of cytokines (tumour necrosis factor–alpha TNF-α, interferongamma IFN–γ, interleukins -4, -6, -8, -10) and poliovirus-specific IgA (PV-IgA) antibody in children infected with A. lumbricoides compared with helminth-negative children (control) before and after oral poliovirus vaccination. Continue reading “Comparative analysis of poliovirus-specific IgA and cytokine levels in the sera of Ascaris lumbricoides-infected and helminth-negative Nigerian children after oral poliovirus vaccination”

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Enterovirus and Parechovirus meningitis in children: a review of the epidemiology, diagnostic challenges, and significance of on-site CSF virology tests in tropical paediatric patients’ care

1,2Kabuga, A. I., 1Nejati, A., and *1,3Shahmahmoodi, S.
1Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran 2Department of Medical Microbiology and Parasitology, Faculty of Clinical Sciences, College of Health Sciences, Bayero University, PMB 3011 Kano, Kano State, Nigeria 3Food Microbiology Research Center, Tehran University of Medical Sciences, Tehran, Iran *Correspondence to: shahmahmoodi@tums.ac.ir; +989121909972

Abstract:

Enteroviruses and Parechoviruses are increasingly recognized as the cause of aseptic meningitis, especially in the paediatric age group. However, because of indistinguishable clinical features with bacterial meningitis, many clinicians cannot make a clear distinction in disease presentation, and a large number of cases go undiagnosed. Although polymerase chain reaction is the current standard diagnostic approach, it takes many hours or days to get a result and these tests are not available at primary and secondary levels of care in many resource-poor countries. Furthermore, diagnosis is often difficult in children due to nonspecific cellular and biochemical cerebrospinal fluid findings. Some affected children may develop neurologic or/and systemic complications, resulting in prolonged hospital admission, increasing the risk of avoidable deaths, and healthcare expenditures. This review focuses on epidemiology, presentation, and diagnosis of Enterovirus and Parechovirus meningitis, highlighting the challenges in diagnosis and the potential roles of on-site CSF virology tests in improving the quality of paediatric patient’s care. The information provided should help early case detection, thereby ensuring avoidance of unnecessary antibiotics, minimal complications, a short period of hospital stays, and a reduction in healthcare-associated costs. Continue reading “Enterovirus and Parechovirus meningitis in children: a review of the epidemiology, diagnostic challenges, and significance of on-site CSF virology tests in tropical paediatric patients’ care”

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Phenotypic and genotypic identification of Staphylococcus aureus resistant to clindamycin in Mansoura University Children Hospital, Egypt

1*Abouelnour, A., 2Zaki, M. E., 3Hassan R., and 4Elkannishy, S. M. H.
1,2Department of Clinical Pathology, Faculty of Medicine, Mansoura University, Mansoura 35516, Egypt
3Department of Medical Microbiology, Faculty of Medicine, Mansoura University, Mansoura 35516, Egypt
4Department of Toxicology, Mansoura Hospital, Mansoura University, Mansoura 35516, Egypt
4Department of Pharmacology and Toxicology, Faculty of Pharmacy, University of Tabuk, Tabuk, 71491, Saudi Arabia
Correspondence to: aalaa_abo@yahoo.com

Abstract:

Background: Clindamycin has been a good alternative drug to penicillins in the treatment of infections caused by Staphylococcus aureus but resistance to this agent has led to therapeutic failure. Inducible clindamycin resistance in staphylococci carrying erm genes may not be detectable by routine disk diffusion test. The objective of this study is to phenotypically detect clindamycin resistance in clinical S. aureus isolates and determine the prevalence of ermA, ermB and ermC carriage among these isolates.
Methodology: A total of 230 non-duplicate S. aureus were isolated from children admitted to Mansoura University Children Hospital during the period January 2016 and June 2017 by conventional microbiology method. Invitro antibiotic susceptibility to selected antibiotics including erythromycin was performed by the disk diffusion technique. The „D-zone‟ test was used to phenotypically detect inducible clindamycin resistance. The presence of ermA, ermB and ermC genes was confirmed by multiplex polymerase chain reaction (m-PCR) assay. Results: One hundred and seven (46.6%) isolates were phenotypically resistant to erythromycin while 109 (47.3%) were methicillin (cefoxitin) resistant S. aureus (MRSA). The macrolide-lincosamin-streptograminB (MLSB) phenotypes among the erythromycin resistant isolates were 47 (44%) inducible MLSB and 46 (43%) constitutive MLSB, while 14 (13.0%) were MS phenotype. Although, the MLSB phenotype was more predominant in MRSA (n=60, 56.1%) than MSSA (n=33, 30.7%) while the MS phenotype was more predominant in MSSA (n=9, 8.4%) than MRSA (n=5, 4.6%) isolates, the difference was not statistically significant (p=0.0777). The ermA (29.0%, n=31) and ermC (18.7%, n=20) were the most prevalent genes carried by the isolates while ermB was carried by a few (4.7%, n=5). Forty six (43%) isolates did not carry any detectable erm gene.
Conclusion: In this study, both inducible and constitutive clindamycin resistance phenotypes were common among S. aureus isolates. Although the genetic basis for this may be attributed to carriage of ermA, ermB and ermC genes, a number of the resistant isolates did not carry any of these genes.

Keywords: phenotypic, genotypic, macrolide-lincosamide-streptogramin B, S. aureus, children
Received July 20, 2019; Revised September 22, 2019; Accepted September 28, 2019
Copyright 2020 AJCEM Open Access. This article is licensed and distributed under the terms of the Creative Commons Attrition 4.0 International License (//creativecommmons.org/licenses/by/4.0), which permits unrestricted use, distribution and reproduction in any medium, provided credit is given to the original author(s) and the source.

Identification phénotypique et génotypique de Staphylococcus aureus résistant à la clindamycine à l’Hôpital Universitaire Mansoura, Egypte

1*Abouelnour, A., 2Zaki, M. E., 3Hassan R., et 4Elkannishy, S. M. H.
1,2Département de pathologie clinique, Faculté de médecine, université Mansoura, Mansoura 35516, Égypte
3Département de microbiologie médicale, Faculté de médecine, université Mansoura, Mansoura 35516, Égypte 4ème département de toxicologie, hôpital Mansoura, université Mansoura, Mansoura 35516, Égypte
4Département 3D de pharmacologie et de toxicologie, faculté de pharmacie, université de Tabuk, Tabuk, 71491, Arabie saoudite
Correspondance à: aalaa_abo@yahoo.com

Abstrait:

Contexte: La clindamycine était un bon médicament alternatif aux pénicillines dans le traitement des infections causées par Staphylococcus aureus, mais la résistance à cet agent a entraîné un échec thérapeutique. La résistance inductible à la clindamycine chez les staphylocoques porteurs du gène erm peut ne pas être détectable par le test de diffusion systématique sur disque. L’objectif de cette étude est de détecter phénotypiquement la résistance à la clindamycine dans les isolats cliniques de S. aureus et de déterminer la prévalence du portage d’ermA, d’ermB et d’ermC parmi ces isolats. sélection d‟antibiotiques, notamment à l‟érythromycine, a été réalisée par la technique de diffusion sur disque. Le test de la «zone D» a été utilisé pour détecter phénotypiquement la résistance inductible à la clindamycine. La présence des gènes ermA, ermB et ermC a été confirmée par un test de réaction en chaîne de la polymérase multiplexe (m-PCR).
Résultats: Cent sept isolats (46,6%) étaient phénotypiquement résistants à l’érythromycine, tandis que 109 (47,3%) étaient résistants à la méthicilline (céfoxitine) S. aureus (MRSA). Les phénotypes macrolide-lincosamin-streptogramine B (MLSB) parmi les isolats résistants à l’érythromycine étaient 47 (44%) MLSB inductibles et 46 (43%) MLSB constitutifs, alors que 14 (13,0%) étaient des phénotypes MS. Bien que le phénotype MLSB soit plus prédominant dans le SARM (n=60, 56,1%) que le MSSA (n=33, 30,7%), le phénotype MS était plus prédominant dans le MSSA (n=9, 8,4%) que le SARM (n=5, 4,6%), la différence n’était pas statistiquement significative (p=0,0777). ErmA (29,0%, n=31) et ermC (18,7%, n=20) étaient les gènes les plus prévalents portés par les isolats, tandis que ermB était porté par quelques-uns (4,7%, n=5). Quarante-six (43%) isolats ne portaient aucun erm gène détectable.
Conclusion: Dans cette étude, les phénotypes de résistance à la clindamycine tant inductibles que constitutifs étaient courants parmi les isolats de S. aureus. Bien que la base génétique de ceci puisse être attribuée au portage des gènes ermA, ermB et ermC, un certain nombre des isolats résistants ne portaient aucun de ces gènes.

Clindamycin resistant S. aureus in Egypt Afr. J. Clin. Exper. Microbiol. 2020; 21 (1): 30 – 35

Mots-clés: phénotypique, génotypique, macrolide-lincosamide-streptogramine B, S. aureus, enfants

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Phenotypic and genotypic identification of Staphylococcus aureus resistant to clindamycin in Mansoura University Children Hospital, Egypt

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Cytomegalovirus co-infection with HIV in children and adolescents on antiretroviral therapy in Abuja, Nigeria

Cytomegalovirus co-infection with HIV in children and adolescents on antiretroviral therapy in Abuja, Nigeria

1*Okechukwu, A. A., and 2Thairu, Y.
1Deparment of Paediatrics, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
2Department of Microbiology, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
Correspondence to: nebokest@yahoo.com; +2348036719906

Abstract:
Background: Cytomegalovirus (CMV) co-infection with human immunodeficiency virus (HIV) is known to accelerate HIV disease progression. It has the potential of being a killer disease or a silent lifetime companion in HIV patients. There is dearth of information on CMV prevalence among HIV infected children and adolescents in our environment. We therefore conducted this study to determine its sero-prevalence, and risk factors for co-infection among HIV infected children and adolescents on highly active antiretroviral therapy (HAART) in our center.
Method: A descriptive cross sectional study of HIV-infected children and adolescents aged 2 months to 18 years on HAART was conducted over a 6 month period between October 2017 and March 2018 in our health facility. Blood samples of subjects were screened for CMV IgM using commercial test kits. Biodata of subjects, CD4 cell count, and viral load were collected into a designed proforma, and statistical analysis was done with SPSS version 22.0.
Result: A total of 161 HIV-infected children and adolescents were recruited, 103 (64.0%) were males, 83 (51.6%) were between the ages of 5 and <10 years, 113 (70.2%) were from lower socio-economic class, and 138 (85.7%) were on 1st line HAART. Of the 17 (10.6%) subjects positive for CMV IgM, 3 (17.6%) were less than 5 years old, 11 (64.7%) were between the ages of 5-10 years, and none was older than 15 years. Univariate analysis showed significant differences in the mean age, weight, length/height, and systolic blood pressure between CMV IgM positive and negative patients (p<0.05), but no significant difference in gender, socioeconomic class, types of antiretroviral drugs, CD4 cell count, and viral load (p>0.05). Multivariate analysis however did not show any significant difference in age, weight, length/height, and systolic blood pressure. Conclusion: The prevalence of active CMV infections among HIV infected children and adolescents on HAART in our centre is high. Low CD4 cell count and high viral load were not associated with active CMV disease, and no risk factor for co-infection was also identified. Identifying those with primary/active infection will be necessary for possible treatment with anti-herpes drugs before development of reactivated CMV disease.

Keywords: CMV, HIV, co-infection, anti-retroviral,  children, adolescents

Received June 27, 2019; Revised October 10, 2019; Accepted October 12, 2019

Copyright 2020 AJCEM Open Access. This article is licensed and distributed under the terms of the Creative Commons Attrition 4.0 International License (//creativecommmons.org/licenses/by/4.0), which permits unrestricted use, distribution and reproduction in any medium, provided credit is given to the original author(s) and the source.

Co-infection par le cytomégalovirus et le VIH chez des enfants et des adolescents sous traitement antirétroviral à Abuja, au Nigéria

1*Okechukwu, A. A., et 2Thairu, Y.
1Département de pédiatrie, Hôpital universitaire de Abuja, Gwagwalada, Abuja, Nigéria 2Département de microbiologie, hôpital universitaire de Abuja, Gwagwalada, Abuja, Nigéria Correspondance à: nebokest@yahoo.com; +2348036719906

Abstrait:

Contexte: On sait que la co-infection par le cytomégalovirus (CMV) et le virus de l’immunodéficience humaine (VIH) accélère la progression de la maladie. Il a le potentiel d’être une maladie mortelle ou un compagnon
silencieux à vie chez les patients VIH. Il existe peu d’informations sur la prévalence du CMV chez les enfants et les adolescents infectés par le VIH dans notre environnement. Nous avons donc mené cette étude pour déterminer sa séroprévalence et les facteurs de risque de co-infection chez les enfants et les adolescents infectés par le VIH sous traitement antirétroviral hautement actif (HAART) dans notre centre. Méthode: Une étude transversale descriptive des enfants et adolescents infectés par le VIH et âgés de 2 mois à 18 ans sous multithérapie a été menée sur une période de 6 mois entre octobre 2017 et mars 2018 dans notre établissement de santé. Des échantillons de sang de sujets ont été testés pour l’IgM de CMV en utilisant des kits de test commerciaux. Les données biologiques des sujets, le nombre de cellules CD4 et la charge virale ont été recueillis dans un formulaire conçu à cet effet et une analyse statistique a été réalisée avec SPSS version 22.0. Résultat: 161 enfants et adolescents infectés par le VIH ont été recrutés, dont 103 (64,0%) étaient des hommes, 83 (51,6%) étaient âgés de 5 à moins de 10 ans, 113 (70,2%) étaient issus de milieux socio-économiques inférieurs. et 138 (85,7%) suivaient la multithérapie de première ligne. Sur les 17 (10,6%) sujets positifs pour l’IgM du CMV, 3 (17,6%) avaient moins de 5 ans, 11 (64,7%) étaient âgés de 5 à 10 ans et aucun n’avait plus de 15 ans. Une analyse univariée a montré des différences significatives dans l’âge moyen, le poids, la taille / taille et la pression artérielle systolique entre les patients positifs et négatifs pour IgM anti-CMV (p<0,05), mais aucune différence significative entre le sexe, la classe socio-économique, les types de médicaments antirétroviraux et les cellules CD4 nombre et charge virale (p>0,05). L’analyse multivariée n’a cependant montré aucune différence significative d’âge, de poids, de taille / taille et de pression artérielle systolique. Conclusion: La prévalence des infections à CMV actives chez les enfants et les adolescents infectés par le VIH sous HAART dans notre centre est élevée. Un faible nombre de cellules CD4 et une charge virale élevée n’étaient pas associés à la maladie à CMV active et aucun facteur de risque de co-infection n’a également été identifié. Identifier les personnes présentant une infection primaire / active sera nécessaire pour un traitement éventuel avec des médicaments anti-herpès avant le développement d’une maladie à CMV réactivée.

Mots-clés: CMV, HIV, co-infection, anti-rétroviral, Enfants, les adolescents

CMV and HIV co-infection in children Afr. J. Clin. Exper. Microbiol. 2020; 21 (1): 36 – 44

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Cytomegalovirus co-infection with HIV in children and adolescents on antiretroviral therapy in Abuja, Nigeria