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Objectives: This study investigated antimicrobial susceptibility and genomic profiling of S. enterica isolated from bloodstream infections at a tertiary referral hospital in Lusaka, Zambia, 2018-2019.Method: This was a prospective hospital-based study involving routine blood culture samples submitted to the microbiology laboratory at the University Teaching Hospital. Identification of S. enterica and determination of antimicrobial susceptibility profiles was achieved through conventional and automated methods. Whole-genome sequencing (WGS) was conducted, and the sequence data outputs were processed for species identification, serotype determination, multilocus sequence typing (MLST) profile determination, identification of antimicrobial resistance determinants, and phylogeny.Results: Seventy-six Salmonella enterica were isolated and 64 isolates underwent WGS. Salmonella Typhi (72%) was the most prevalent serotype. Notable was the occurrence of invasive non-typhoidal Salmonella Typhimurium ST313 (3%), resistance to cephalosporins (4%) and ciprofloxacin (5%), multidrug resistance (46%), and reduced susceptibility to ciprofloxacin (30%) and imipenem (3%). Phylogenetic cluster analysis showed multiple Salmonella serovars with a wide range of genetic diversity.Conclusion: The genetic diversity of Salmonella Typhi, high prevalence of multidrug resistance, and the emergence of ciprofloxacin and cephalosporin resistance warrants improved hygiene and water and sanitation provision, continued surveillance to apprise antibiograms and inform policy, and the introduction of the typhoid conjugate vaccine.

Munchausen syndrome by proxy is a form of abuse in which an adult, usually the mother, deceives health workers by exaggerating, falsifying or directly inducing psychological or physical symptoms in the child victim for psychological gratification. In 2013, the American Academy of Pediatrics coined the term 'caregiver-fabricated illness in a child' to describe this form of child abuse. A 7-year-old girl had many encounters with health workers over a period of 4 years and presented with evolving clinical features including refractory seizures and red urine for which she was followed up as a case of acute intermittent porphyria. She was later discovered to be the victim of chronic monocrotophos organophosphate poisoning by her mother. If all medical staff who manage children are to avoid becoming inadvertent participants in medical child abuse, this case report is an important reminder that a high index of suspicion is warranted in cases which present a diagnostic dilemma and who respond unexpectedly to treatment.

Congenital Pulmonary Airway Malformation (CPAM) is a rare abnormality of pulmonary airway malformation and may remain undiagnosed until it is discovered as an incidental finding later in life. Reported here are two cases of CPAM, a seven-month-old infant and a two-year-old toddler. A seven-month-old ex-premature male infant presented with recurrent pneumonia and failure to thrive. He had an unresolving consolidation on chest radiograph and was eventually treated as pulmonary tuberculosis with no response. Computerised tomography scan (CT-scan) chest revealed bilateral CPAM of lungs. A 2-year-old female toddler presented to the University Teaching Hospital, Department of Paediatrics & Child Health, as a referral from a second level hospital with a long-standing history of recurrent symptoms and signs of pneumonia with failure to thrive. She was commenced on antituberculous treatment with no improvement. A CT-scan of the chest revealed bilateral CPAM of lungs. These two cases highlight clinical, diagnostic and treatment challenges in children with CPAM in a resource limited setting like Zambia.

Background: Recent studies have shown a shift in the traditional aetiologies commonly associated with tropical acute kidney injury (AKI) in some parts of Africa. In many low-income regions limited access to dialysis increases the risk of AKI-associated adverse outcomes. The goal of this study was to evaluate the aetiology, predictors of the need for dialysis, and outcomes of AKI among children evaluated by the renal service in Lusaka, Zambia. Methods: This retrospective study included children less than 16 years old, who were diagnosed with AKI between 2016 and 2021 and followed up by the renal service at the University Teaching Hospitals- Children’s hospital (UTH-CH). AKI was defined and staged using the KDIGO 2012 criteria. Data were extracted from patient folders using a pre-designed tool and then analysed using SPSS version 25. Categorical data were expressed as simple proportions while continuous variables were expressed as either means or median after determination of normality. Correlations were determined using the chi-square test, otherwise Fischer’s exact test in the case of categorical variables, and the independent t-test for continuous variables. The significance level was set at a p-value < 0.05. The predictors of need for dialysis, poor patient outcome, and malaria-associated AKI (MAKI) were identified by using binary logistic regression. Results: The 126 (37.7%) children diagnosed with AKI had a median age of 7.5 (interquartile range 0.3-16) yearsand a male-to-female ratio of 1.4. Of these, a total of 94(74.6%) underwent dialysis with 65(82.1%) receiving peritoneal dialysis (PD), 8(8.5%) receiving haemodialysis (HD), and 4(4.3%) undergoing both modalities. Predictors of need for dialysis were oliguria (OR 10.4, p= 0.002) and anuria (OR 8.7, p, 0.006) while the leading aetiologies of AKI were malaria (77, 60%) and glomerular disease (21, 16.6%). Twenty-three (18.3 %) children developed chronic kidney disease (CKD), 7(5.6 %) died and a year later 97 (77%) were lost to follow-up. Conclusion: Malaria is the leading cause of AKI and children from areas of medium malaria transmission intensity are at increased risk. Three-quarters of children in the cohort required dialysis. CKD and mortality rates may be underestimated due to the high loss to follow- up rate.

Malaria is a common parasitic disease with very high mortality in tropical countries including Zambia.Symmetrical Peripheral Gangrene(SPG) is a rare complication of Malaria associated with Plasmodium falciparum infection.Reported here is a case of SPG in a 2 year 3 month old Zambian Toddler and highlight the need for awareness and prompt diagnosis and treatment.

Diarrhoea is the second commonest cause of under-five mortality globally (second to Pneumonia) and kills one (10 percent) out of every 10 children who die before their fifth birthday. In Zambia dehydration due to diarrhoea is a leading cause of morbidity and mortality among under-five children. Hypernatraemic dehydration is the most dangerous and fatal form of dehydration. Despite the availability of well known effective treatment modalities for dehydration in diarrhoea, mortality remains high in many developing countries. The situation is not any different in Zambia and at The University Teaching Hospital (UTH) Department of Paediatrics. This study therefore sought to determine the prevalence and outcome of hypernatraemic dehydration as a possible contributing factor to the high mortality rate among children with diarrhoea.It was a cross sectional study conducted at the UTH Department of Paediatrics. The study population was under-five children presenting with acute diarrhoea with dehydration. Independent variables were age, sex, feeding modality, prior ORS therapy, rotavirus vaccine status and serum sodium. The dependent or outcome variables were discharge/mortality and duration of hospital stay. Data analysis was done with the help of SPSS version 20. There were a total of 148 participants with an almost 1:1 male/female ratio (73/75), mean age of 14.7 months ranging 1-60 months. The prevalence of hypernatraemic dehydration was approximately 19 percent (29/148) among children presenting with diarrhoea and dehydration. Hypernatraemia was associated with a high risk of mortality (7/29) with an OR 5.8 (adjusted OR 3.6, 95% CI 2.9-8.0, p 0.002), compared to (7/74) OR 1.8 (adjusted OR 1.1, 95% CI 0.8-2.2, p 0.06), and (5/33) OR 3.1 (adjusted OR 2.3, 95% CI 1.7-4.4, p 0.03) for normal and low initial sodium level respectively. Hypernatraemia was also associated with longer hospital stay with a mean duration of 3.09 days (74.2hrs) compared to 2.01 days (48.2 hours) and 2.13 days (51.1 hours) for normal and low sodium respectively. Hypernatraemia is prevalent among under-five children presenting with diarrhoea at UTH department of peadiatrics and a major contributing factor to high diarrhoeal associated mortality. Recognition of its occurrence through diligent laboratory services is therefore critical for appropriate patient care.

BACKGROUND Human herpesvirus 6B (HHV-6B) is the causative agent of Roseola infantum, and has also been suggested to play a role in the pathogenesis of febrile seizures in young children, a percentage of whom go on to develop febrile status epilepticus (FSE), but the existing data is conflicting and inconclusive. HHV-6A is a distinct species, rarely detected in most parts of the world, but prior studies suggest a higher prevalence in febrile African children. We describe a case-control study comparing the frequency of HHV-6A and/or HHV-6B infections in children with febrile seizures (including FSE) and a control group of febrile children without seizures. METHODS We recruited children aged 6 to 60 months admitted with a febrile illness with (cases) or without (controls) seizures presenting within 48 hours of commencement of fever. Three milliliters of whole blood was centrifuged and plasma stored at -80°C for pooled screening for HHV-6B and HHV-6A by Taqman real-time polymerase chain reaction. RESULTS 102 cases and 95 controls were recruited. The prevalence of HHV-6B DNA detection did not differ significantly between cases (5.8% (6/102)) and controls (10.5% (10/95)) but HHV-6B infection was associated with FSE (OR, 15; 95% CI, [1.99-120]; P= 0.009). HHV-6A was not detected. CONCLUSION Prevalence of HHV-6B was similar among cases and controls. Within the FS group, HHV-6B infection was associated with FSE, suggesting HHV-6B infections could play a role in the pathogenesis of FSE.

Background Safety data regarding exposure to artemisinin-based combination therapy in pregnancy are limited. This prospective cohort study conducted in Zambia evaluated the safety of artemether-lumefantrine (AL) in pregnant women with malaria. Methods Pregnant women attending antenatal clinics were assigned to groups based on the drug used to treat their most recent malaria episode (AL vs. sulphadoxine-pyrimethamine, SP). Safety was assessed using standard and pregnancy-specific parameters. Post-delivery follow-up was six weeks for mothers and 12 months for live births. Primary outcome was perinatal mortality (stillbirth or neonatal death within seven days after birth). Results Data from 1,001 pregnant women (AL n = 495; SP n = 506) and 933 newborns (AL n = 466; SP n = 467) showed: perinatal mortality (AL 4.2%; SP 5.0%), comprised of early neonatal mortality (each group 2.3%), stillbirths (AL 1.9%; SP 2.7%); preterm deliveries (AL 14.1%; SP 17.4% of foetuses); and gestational age-adjusted low birth weight (AL 9.0%; SP 7.7%). Infant birth defect incidence was 1.8% AL and 1.6% SP, excluding umbilical hernia. Abortions prior to antenatal care could not be determined: abortion occurred in 4.5% of women treated with AL during their first trimester; none were reported in the 133 women exposed to SP and/or quinine during their first trimester. Overall development (including neurological assessment) was similar in both groups. Conclusions These data suggest that exposure to AL in pregnancy, including first trimester, is not associated with particular safety risks in terms of perinatal mortality, malformations, or developmental impairment. However, more data are required on AL use during the first trimester.

There was an outbreak of "a mysterious disease" at a Zambian school dormitory in September, 1993. Investigation with questionnaire and collection of throat swab specimens for virus isolation were carried out on 46 patients to identify the causative agent. In this outbreak, most of the patients showed similar symptoms such as fever, headache, sore throat, cough, etc. The disease had spread to all dormitories within a couple of days after the onset of the first cases. From these patients, 13 influenza viruses A/H3N2 were isolated on MDCK cell line. This was a first ever confirmed outbreak of influenza virus infection in Zambia.