Association of bacteria with hydrocephalus in Ugandan infants

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>Infantile hydrocephalus in East Africa is predominantly postinfectious. The microbial origins remain elusive, since most patients present with postinfectious hydrocephalus after antecedent neonatal sepsis (NS) has resolved.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>To characterize this syndrome in Ugandan infants, the authors used polymerase chain reaction targeting bacterial 16S ribosomal DNA from CSF to determine if bacterial residua from recent infections were detectable. Bacteria were identified based on the relationship of genetic sequences obtained with reference bacteria in public databases. The authors evaluated samples from patients presenting during dry and rainy seasons and performed environmental sampling in the villages of patients.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>Bacterial DNA was recovered from 94% of patients. Gram-negative bacteria in the phylum Proteobacteria were the most commonly detected. Within this phylum, Gammaproteobacteria dominated in patients presenting after infections during the rainy season, and Betaproteobacteria was most common following infections during the dry season. <jats:italic>Acinetobacter</jats:italic> species were identified in the majority of patients admitted after rainy season infection.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Postinfectious hydrocephalus in Ugandan infants appears associated with predominantly enteric gram-negative bacteria. These findings highlight the need for linking these cases with antecedent NS to develop more effective treatment and prevention strategies.</jats:p></jats:sec>

Effectiveness of the Bactiseal Universal Shunt for reducing shunt infection in a sub-Saharan African context: a retrospective cohort study in 160 Ugandan children

“…4,5 But in Uganda, where neonatal ventriculitis is the most common cause of infant hydrocephalus, 11 we recently found evidence for a high prevalence of enteric organisms, especially Acinetobacter species, in the CSF of these infants, as well as in their home environments. 3 While clindamycin and rifampicin are effective against staphylococcal species, this is not true for gram-negative and enteric organisms. With the potential for a different spectrum of pathogens, and without a prior study of Bactiseal shunts in a limited-resource setting, the efficacy of these shunts in reducing the risk of shunt infection in Uganda was unknown.…”

Global surgery for pediatric hydrocephalus in the developing world: a review of the history, challenges, and future directions

“…In the developing world, gram-negative organisms, but rarely Group B Streptococcus, predominate. 32,36 Furthermore, differences in bacterial speciation may depend on the season: cases of postinfectious hydrocephalus had a greater prevalence of Acinetobacter species in the ventricular CSF of Ugandan infants during the rainy season. 36 Another study in Uganda found that the peak incidence of postinfectious hydrocephalus was related to climate, with infection-onset peaks in the intermediate period between rainy and dry seasons.…”

“…32,36 Furthermore, differences in bacterial speciation may depend on the season: cases of postinfectious hydrocephalus had a greater prevalence of Acinetobacter species in the ventricular CSF of Ugandan infants during the rainy season. 36 Another study in Uganda found that the peak incidence of postinfectious hydrocephalus was related to climate, with infection-onset peaks in the intermediate period between rainy and dry seasons. 49 Bacteriological studies to date raise concerns as to whether current antimicrobial protocols in developing nations include adequate coverage of gram-negative bacteria.…”

“…2,3,19,23,28,63,65 The spectrum of bacteria causing neonatal sepsis and postinfectious hydrocephalus also differs between developing and developed countries. 32,36 In developed countries, Group B Streptococcus, Escherichia coli, and Listeria monocytogenes most commonly cause neonatal sepsis. In the developing world, gram-negative organisms, but rarely Group B Streptococcus, predominate.…”

Reducing neurodevelopmental disorders and disability through research and interventions

“…Higher birth rates and limited perinatal care contribute to a greater burden of care for hydrocephalus in LMICs 57 (for example, there are 100,000-250,000 new infant cases of hydrocephalus annually in sub-Saharan Africa alone 41 ). In addition to the expected burden of congenital hydrocephalus in LMICs, climate-driven neonatal ventriculitis of unknown pathogenesis has recently been identified as one of the chief causes of infant hydrocephalus (60% of cases in Uganda) [58][59][60][61] . In sub-Saharan Africa, rates of neonatal sepsis are estimated to be 170 per 1,000 births, with a corresponding mortality of 10 deaths per 1,000 births 62 .…”