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1. Evaluation of the initial 12 months of a routine cryptococcal antigen screening program in reduction of HIV-associated cryptococcal meningitis in Uganda

Author

Kagimu Enock, Kiwanuka Julius, Bridget C. Griffith, Derrick Bary Abila, Morris K. Rutakingirwa, John Kasibante, Kiiza Tadeo Kandole, Richard Kwizera, Aggrey Semeere, and David B. Meya

Subjects
Public aspects of medicine, RA1-1270
Abstract

Abstract Background Asymptomatic Cryptococcal Antigenemia (CrAg) patients develop meningitis within a month of testing positive. Pre-emptive antifungal therapy can prevent progression to Cryptococcal meningitis (CM). In April 2016, a national CrAg screening program was initiated in 206 high-volume health facilities that provide antiretroviral therapy in Uganda. We report the evaluation of the CrAg screening cascade focusing on linkage to care, fluconazole therapy for 10 weeks and 6 months follow up, and ART initiation in a subset of facilities. Methods We conducted a retrospective, cross-sectional survey of patients with CD4

Published
2022
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5. Anaemia in HIV-infected children: severity, types and effect on response to HAART

Author

Nyesigire Ruhinda Eunice, Bajunirwe Francis, and Kiwanuka Julius

Subjects
Pediatrics, RJ1-570
Abstract

Abstract Background HIV and anaemia are major health challenges in Africa. Anaemia in HIV-infected individuals is associated with more rapid disease progression and a poorer prognosis if not addressed appropriately. This study aimed at determining the severity and types of anaemia among HIV infected children and its effect on short term response to antiretroviral therapy (ART). Methods At baseline, clinical and haematological parameters of 257 HIV-infected ART-naïve children aged 3 months to 18 years were assessed to determine the prevalence, severity and types of anaemia. ART eligible patients were started on therapy according to WHO criteria, enrolled (n=88) into an observational cohort and followed up for 6 months. Results Anaemia was present in 148/257 (57.6%) of children, including (93/148) 62.2% with mild anaemia, 47/148 (32.0%) moderate anaemia, and 7/148 (4.8%) with severe anaemia. The mean haemoglobin (hb) was lower among children with more advanced HIV disease (p Conclusion Anaemia is highly prevalent among HIV-infected children in a rural Ugandan clinic and is associated with poorer virological suppression. However, the anaemia did not impact clinical and immunological response to ART among these children.

Published
2012
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6. Paenibacillus spp infection among infants with postinfectious hydrocephalus in Uganda: an observational case-control study

Author

Morton, Sarah U, Hehnly, Christine, Burgoine, Kathy, Ssentongo, Paddy, Ericson, Jessica E, Kumar, M Senthil, Hagmann, Cornelia, Fronterre, Claudio, Smith, Jasmine, Movassagh, Mercedeh, Streck, Nicholas, Bebell, Lisa M, Bazira, Joel, Kumbakumba, Elias, Bajunirwe, Francis, Mulondo, Ronald, Mbabazi-Kabachelor, Edith, Nsubuga, Brian K, Natukwatsa, Davis, Nalule, Esther, Magombe, Joshua, Erickson, Tim, Ngonzi, Joseph, Ochora, Moses, Olupot-Olupot, Peter, Onen, Justin, Ssenyonga, Peter, Mugamba, John, Warf, Benjamin C, Kulkarni, Abhaya V, Lane, Jessica, Whalen, Andrew J, Zhang, Lijun, Sheldon, Kathryn, Meier, Frederick A, Kiwanuka, Julius, Broach, James R, Paulson, Joseph N, and Schiff, Steven J

Published
2023
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10. Cytomegalovirus infections in infants in Uganda: Newborn-mother pairs, neonates with sepsis, and infants with hydrocephalus

Author

Hehnly, Christine, Ssentongo, Paddy, Bebell, Lisa M., Burgoine, Kathy, Bazira, Joel, Fronterre, Claudio, Kumbakumba, Elias, Mulondo, Ronald, Mbabazi-Kabachelor, Edith, Morton, Sarah U., Ngonzi, Joseph, Ochora, Moses, Olupot-Olupot, Peter, Mugamba, John, Onen, Justin, Roberts, Drucilla J., Sheldon, Kathryn, Sinnar, Shamim A., Smith, Jasmine, Ssenyonga, Peter, Kiwanuka, Julius, Paulson, Joseph N., Meier, Frederick A., Ericson, Jessica E., Broach, James R., and Schiff, Steven J.

Published
2022
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13. Separating Putative Pathogens from Background Contamination with Principal Orthogonal Decomposition: Evidence for Leptospira in the Ugandan Neonatal Septisome

Author

Schiff, Steven J., Kiwanuka, Julius, Riggio, Gina, Nguyen, Lan, Mu, Kevin, Sproul, Emily, Bazira, Joel, Mwanga, Juliet, Tumusiime, Dickson, Nyesigire, Eunice, Lwanga, Nkangi, Bogale, Kaleb T., Kapur, Vivek, Broach, James, Morton, Sarah, Warf, Benjamin C., and Poss, Mary

Subjects
Quantitative Biology - Genomics
Abstract

Neonatal sepsis (NS) is responsible for over a 1 million yearly deaths worldwide. In the developing world NS is often treated without an identified microbial pathogen. Amplicon sequencing of the bacterial 16S rRNA gene can be used to identify organisms that are difficult to detect by routine microbiological methods. However, contaminating bacteria are ubiquitous in both hospital settings and research reagents, and must be accounted for to make effective use of these data. In the present study, we sequenced the bacterial 16S rRNA gene obtained from blood and cerebrospinal fluid (CSF) of 80 neonates presenting with NS to the Mbarara Regional Hospital in Uganda. Assuming that patterns of background contamination would be independent of pathogenic microorganism DNA, we applied a novel quantitative approach using principal orthogonal decomposition to separate background contamination from potential pathogens in sequencing data. We designed our quantitative approach contrasting blood, CSF, and control specimens, and employed a variety of statistical random matrix bootstrap hypotheses to estimate statistical significance. These analyses demonstrate that Leptospira appears present in some infants presenting within 48 hr of birth, indicative of infection in utero, and up to 28 days of age, suggesting environmental exposure. This organism cannot be cultured in routine bacteriological settings, and is enzootic in the cattle that the rural peoples of western Uganda often live in close proximity. Our findings demonstrate that statistical approaches to remove background organisms common in 16S sequence data can reveal putative pathogens in small volume biological samples from newborns. This computational analysis thus reveals an important medical finding that has the potential to alter therapy and prevention efforts in a critically ill population., Comment: 23 pages, 2 figures

Published
2016

14. Assessment of HIV antiretroviral therapy adherence by measuring drug concentrations in hair among children in rural Uganda.

Author

Olds, Peter K, Kiwanuka, Julius P, Nansera, Denis, Huang, Yong, Bacchetti, Peter, Jin, Chengshi, Gandhi, Monica, and Haberer, Jessica E

Subjects
Hair, Humans, HIV Infections, Nevirapine, Anti-HIV Agents, Longitudinal Studies, Prospective Studies, Reproducibility of Results, Child, Child, Preschool, Rural Population, Uganda, Female, Male, Medication Adherence, adherence, antiretroviral therapy, children, human immunodeficiency virus, Pediatric, HIV/AIDS, Infectious Diseases, Clinical Research, Evaluation of treatments and therapeutic interventions, 6.1 Pharmaceuticals, Infection, Good Health and Well Being, Public Health and Health Services, Psychology, Public Health
Abstract

Current tools for measuring medication adherence have significant limitations, especially among pediatric populations. We conducted a prospective observational study to assess the use of antiretroviral (ARV) drug levels in hair for evaluating antiretroviral therapy (ART) adherence among HIV-infected children in rural Uganda. Three-day caregiver recall, 30-day visual analog scale (VAS), Medication Event Monitoring System (MEMS), and unannounced pill counts and liquid formulation weights (UPC) were collected monthly over a one-year period. Hair samples were collected quarterly and analyzed for nevirapine (NVP) levels, and plasma HIV RNA levels were collected every six months. Among children with at least one hair sample collected, we used univariable random intercept linear regression models to compare log transformed NVP concentrations with each adherence measure, and the child's age, sex, and CD4 count percentage (CD4%). One hundred and twenty-one children aged 2-10 years were enrolled in the study; 74 (61%) provided at least one hair sample, and the mean number of hair samples collected per child was 1.9 (standard deviation [SD] 1.0). Three-day caregiver recall, VAS, and MEMS were found to be positively associated with increasing NVP concentration in hair, although associations were not statistically significant. UPC was found to have a nonsignificant negative association with increasing hair NVP concentration. In conclusion, NVP drug concentrations in hair were found to have nonsignificant, although generally positive, associations with other adherence measures in a cohort of HIV-infected children in Uganda. Hair collection in this population proved challenging, suggesting the need for community education and buy-in with the introduction of novel methodologies.

Published
2015

15. Realtime adherence monitoring of antiretroviral therapy among hiv-infected adults and children in rural uganda

Author

Haberer, Jessica E, Kiwanuka, Julius, Nansera, Denis, Muzoora, Conrad, Hunt, Peter W, So, Jacquelyn, O’Donnell, Michael, Siedner, Mark, Martin, Jeffrey N, and Bangsberg, David R

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Pediatric, Infectious Diseases, HIV/AIDS, Sexually Transmitted Infections, Clinical Research, Behavioral and Social Science, Pediatric AIDS, 7.1 Individual care needs, Infection, Adult, Anti-Retroviral Agents, Antiretroviral Therapy, Highly Active, Child, Cohort Studies, Female, HIV, HIV Infections, Humans, Longitudinal Studies, Male, Medication Adherence, Reminder Systems, Rural Population, Uganda, Viral Load, Biological Sciences, Medical and Health Sciences, Psychology and Cognitive Sciences, Virology, Biomedical and clinical sciences, Health sciences
Abstract

A real-time wireless electronic adherence monitor (EAM) and weekly self-report of missed doses via interactive voice response (IVR) and short message service (SMS) queries were used to measure antiretroviral therapy adherence in 49 adults and 46 children in rural Uganda. Median adherence was 89.5% among adults and 92.8% among children by EAM, and 99-100% for both adults and children by IVR/SMS self-report. Loss of viral suppression was significantly associated with adherence by EAM (odds ratio 0.58 for each 10% increase), but not IVR/SMS. Wireless EAM creates an exciting opportunity to monitor and potentially intervene with adherence challenges as they are happening.

Published
2013

17. Neonatal Paenibacilliosis: Paenibacillus Infection as a Novel Cause of Sepsis in Term Neonates With High Risk of Sequelae in Uganda

Author

Ericson, Jessica E, primary, Burgoine, Kathy, additional, Kumbakumba, Elias, additional, Ochora, Moses, additional, Hehnly, Christine, additional, Bajunirwe, Francis, additional, Bazira, Joel, additional, Fronterre, Claudio, additional, Hagmann, Cornelia, additional, Kulkarni, Abhaya V, additional, Kumar, M Senthil, additional, Magombe, Joshua, additional, Mbabazi-Kabachelor, Edith, additional, Morton, Sarah U, additional, Movassagh, Mercedeh, additional, Mugamba, John, additional, Mulondo, Ronald, additional, Natukwatsa, Davis, additional, Kaaya, Brian Nsubuga, additional, Olupot-Olupot, Peter, additional, Onen, Justin, additional, Sheldon, Kathryn, additional, Smith, Jasmine, additional, Ssentongo, Paddy, additional, Ssenyonga, Peter, additional, Warf, Benjamin, additional, Wegoye, Emmanuel, additional, Zhang, Lijun, additional, Kiwanuka, Julius, additional, Paulson, Joseph N, additional, Broach, James R, additional, and Schiff, Steven J, additional

Published
2023
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18. Neonatal Paenibacilliosis: Paenibacillus infection as a Novel Cause of Sepsis in Term Neonates with High Risk of Sequelae in Uganda

Author

Ericson, Jessica E, Burgoine, Kathy, Kumbakumba, Elias, Ochora, Moses, Hehnly, Christine, Bajunirwe, Francis, Bazira, Joel, Fronterre, Claudio, Hagmann, Cornelia, Kulkarni, Abhaya V, Kumar, M Senthil, Magombe, Joshua, Mbabazi-Kabachelor, Edith, Morton, Sarah U, Movassagh, Mercedeh, Mugamba, John, Mulondo, Ronald, Natukwatsa, Davis, Nsubuga Kaaya, Brian, Olupot-Olupot, Peter, Onen, Justin, Sheldon, Kathryn, Smith, Jasmine, Ssentongo, Paddy, Ssenyonga, Peter, Warf, Benjamin, Wegoye, Emmanuel, Zhang, Lijun, Kiwanuka, Julius, Paulson, Joseph N, Broach, James R, Schiff, Steven J, Ericson, Jessica E, Burgoine, Kathy, Kumbakumba, Elias, Ochora, Moses, Hehnly, Christine, Bajunirwe, Francis, Bazira, Joel, Fronterre, Claudio, Hagmann, Cornelia, Kulkarni, Abhaya V, Kumar, M Senthil, Magombe, Joshua, Mbabazi-Kabachelor, Edith, Morton, Sarah U, Movassagh, Mercedeh, Mugamba, John, Mulondo, Ronald, Natukwatsa, Davis, Nsubuga Kaaya, Brian, Olupot-Olupot, Peter, Onen, Justin, Sheldon, Kathryn, Smith, Jasmine, Ssentongo, Paddy, Ssenyonga, Peter, Warf, Benjamin, Wegoye, Emmanuel, Zhang, Lijun, Kiwanuka, Julius, Paulson, Joseph N, Broach, James R, and Schiff, Steven J

Abstract

Paenibacillus thiaminolyticus may be an underdiagnosed cause of neonatal sepsis. We prospectively enrolled a cohort of 800 full-term neonates presenting with a clinical diagnosis of sepsis at two Ugandan hospitals. Quantitative polymerase chain reaction specific to P. thiaminolyticus and to the Paenibacillus genus were performed on the blood and cerebrospinal fluid (CSF) of 631 neonates who had both specimen types available. Neonates with Paenibacillus genus or species detected in either specimen type were considered to potentially have paenibacilliosis, (37/631, 6%). We described antenatal, perinatal, and neonatal characteristics, presenting signs, and 12-month developmental outcomes for neonates with paenibacillosis vs. clinical sepsis. Median age at presentation was 3 days (interquartile range 1, 7). Fever (92%), irritability (84%) and clinical signs of seizures (51%) were common. Eleven (30%) had an adverse outcome: 5 (14%) neonates died during the first year of life; 5 of 32 (16%) survivors developed postinfectious hydrocephalus (PIH) and one (3%) additional survivor had neurodevelopmental impairment without hydrocephalus. Paenibacillus species was identified in 6% of neonates with signs of sepsis who presented to two Ugandan referral hospitals; 70% were P. thiaminolyticus. Improved diagnostics for neonatal sepsis are urgently needed. Optimal antibiotic treatment for this infection is unknown but ampicillin and vancomycin will be ineffective in many cases. These results highlight the need to consider local pathogen prevalence and the possibility of unusual pathogens when determining antibiotic choice for neonatal sepsis. [Abstract copyright: © The Author(s) 2023. Published by Oxford University Press on behalf of Infectious Diseases Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.]

Published
2023

19. Paenibacillus spp infection among infants with postinfectious hydrocephalus in Uganda:an observational case-control study

Author

Morton, Sarah U, Hehnly, Christine, Burgoine, Kathy, Ssentongo, Paddy, Ericson, Jessica E, Kumar, M Senthil, Hagmann, Cornelia, Fronterre, Claudio, Smith, Jasmine, Movassagh, Mercedeh, Streck, Nicholas, Bebell, Lisa M, Bazira, Joel, Kumbakumba, Elias, Bajunirwe, Francis, Mulondo, Ronald, Mbabazi-Kabachelor, Edith, Nsubuga, Brian K, Natukwatsa, Davis, Nalule, Esther, Magombe, Joshua, Erickson, Tim, Ngonzi, Joseph, Ochora, Moses, Olupot-Olupot, Peter, Onen, Justin, Ssenyonga, Peter, Mugamba, John, Warf, Benjamin C, Kulkarni, Abhaya V, Lane, Jessica, Whalen, Andrew J, Zhang, Lijun, Sheldon, Kathryn, Meier, Frederick A, Kiwanuka, Julius, Broach, James R, Paulson, Joseph N, Schiff, Steven J, Morton, Sarah U, Hehnly, Christine, Burgoine, Kathy, Ssentongo, Paddy, Ericson, Jessica E, Kumar, M Senthil, Hagmann, Cornelia, Fronterre, Claudio, Smith, Jasmine, Movassagh, Mercedeh, Streck, Nicholas, Bebell, Lisa M, Bazira, Joel, Kumbakumba, Elias, Bajunirwe, Francis, Mulondo, Ronald, Mbabazi-Kabachelor, Edith, Nsubuga, Brian K, Natukwatsa, Davis, Nalule, Esther, Magombe, Joshua, Erickson, Tim, Ngonzi, Joseph, Ochora, Moses, Olupot-Olupot, Peter, Onen, Justin, Ssenyonga, Peter, Mugamba, John, Warf, Benjamin C, Kulkarni, Abhaya V, Lane, Jessica, Whalen, Andrew J, Zhang, Lijun, Sheldon, Kathryn, Meier, Frederick A, Kiwanuka, Julius, Broach, James R, Paulson, Joseph N, and Schiff, Steven J

Abstract

Paenibacillus thiaminolyticus is a cause of postinfectious hydrocephalus among Ugandan infants. To determine whether Paenibacillus spp is a pathogen in neonatal sepsis, meningitis, and postinfectious hydrocephalus, we aimed to complete three separate studies of Ugandan infants. The first study was on peripartum prevalence of Paenibacillus in mother-newborn pairs. The second study assessed Paenibacillus in blood and cerebrospinal fluid (CSF) from neonates with sepsis. The third study assessed Paenibacillus in CSF from infants with hydrocephalus. In this observational study, we recruited mother-newborn pairs with and without maternal fever (mother-newborn cohort), neonates (aged ≤28 days) with sepsis (sepsis cohort), and infants (aged ≤90 days) with hydrocephalus with and without a history of neonatal sepsis and meningitis (hydrocephalus cohort) from three hospitals in Uganda between Jan 13, 2016 and Oct 2, 2019. We collected maternal blood, vaginal swabs, and placental samples and the cord from the mother-newborn pairs, and blood and CSF from neonates and infants. Bacterial content of infant CSF was characterised by 16S rDNA sequencing. We analysed all samples using quantitative PCR (qPCR) targeting either the Paenibacillus genus or Paenibacillus thiaminolyticus spp. We collected cranial ultrasound and computed tomography images in the subset of participants represented in more than one cohort. No Paenibacillus spp were detected in vaginal, maternal blood, placental, or cord blood specimens from the mother-newborn cohort by qPCR. Paenibacillus spp was detected in 6% (37 of 631 neonates) in the sepsis cohort and, of these, 14% (5 of 37 neonates) developed postinfectious hydrocephalus. Paenibacillus was the most enriched bacterial genera in postinfectious hydrocephalus CSF (91 [44%] of 209 patients) from the hydrocephalus cohort, with 16S showing 94% accuracy when validated by qPCR. Imaging showed progression from Paenibacillus spp-related meningitis to postinfectious

Published
2023

20. 1328. Paenibacillosis: An Emerging Cause of Neonatal Sepsis and Postinfectious Hydrocephalus

Author

Ericson, Jessica E, primary, Burgoine, Kathy, additional, Hehnly, Christine, additional, Kumbakumba, Elias, additional, Ochora, Moses, additional, Bajunirwe, Francis, additional, Bazira, Joel, additional, Fronterre, Claudio, additional, Hagmann, Cornelia, additional, Kulkarni, Abhaya, additional, Senthil Kumar, M, additional, Magombe, Joshua, additional, Mbabazi-Kabachelor, Edith, additional, Morton, Sarah, additional, Movassagh, Mercedeh, additional, Mugamba, John, additional, Mulondo, Ronald, additional, Muwanguzi, Abraham, additional, Natukwatsa, Davis, additional, Kaaya, Brian Nsubuga, additional, Olupot-Olupot, Peter, additional, Onen, Justin, additional, Sheldon, Kathryn, additional, Smith, Jasmine, additional, Ssentongo, Paddy, additional, Ssenyonga, Peter, additional, Warf, Benjamin, additional, Wegoye, Emmanuel, additional, Zhang, Lijun, additional, Broach, James, additional, Kiwanuka, Julius, additional, Paulson, Joseph, additional, and Schiff, Steven, additional

Published
2022
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22. Cell Phone Usage among Adolescents in Uganda: Acceptability for Relaying Health Information

Author

Mitchell, Kimberly J., Bull, Sheana, Kiwanuka, Julius, and Ybarra, Michele L.

Abstract

The increase in cell phone use has manifested a growing interest in using this technology for health promotion. The portability and "always on" features of the cell phone, along with increasing capability for the devices to carry and transfer data suggest that they will reach more people than computers and the Internet in coming years. Self-reported quantitative survey data from 1503 secondary school students in Mbarara, Uganda collected in 2008-2009 suggest that 27% currently have cell phones and about half (51%) of all students and 61% of those who owned a cell phone believe that they would access a text messaging-based HIV prevention program if it were available. Other forms of program delivery modality (e.g. Internet, religious organizations, schools) were preferred to text messaging however. We are in need of effective HIV prevention programs that can reach large audiences at low cost and are culturally relevant for the East African context. Researchers are encouraged to consider translation of effective HIV prevention programs for cell phone delivery in Africa.

Published
2011
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23. Neonatal Paenibacilliosis:Paenibacillus thiaminolyticusas a Novel Cause of Neonatal Sepsis with High Risk of Sequelae in Uganda

Author

Ericson, Jessica E., primary, Burgoine, Kathy, additional, Kumbakumba, Elias, additional, Ochora, Moses, additional, Hehnly, Christine, additional, Bajunirwe, Francis, additional, Bazira, Joel, additional, Fronterre, Claudio, additional, Hagmann, Cornelia, additional, Kulkarni, Abhaya V., additional, Kumar, M. Senthil, additional, Magombe, Joshua, additional, Mbabazi-Kabachelor, Edith, additional, Morton, Sarah U., additional, Movassagh, Mercedeh, additional, Mugamba, John, additional, Mulondo, Ronald, additional, Natukwatsa, Davis, additional, Kaaya, Brian Nsubuga, additional, Olupot-Olupot, Peter, additional, Onen, Justin, additional, Sheldon, Kathryn, additional, Smith, Jasmine, additional, Ssentongo, Paddy, additional, Ssenyonga, Peter, additional, Warf, Benjamin, additional, Wegoye, Emmanuel, additional, Zhang, Lijun, additional, Kiwanuka, Julius, additional, Paulson, Joseph N., additional, Broach, James R., additional, and Schiff, Steven J., additional

Published
2022
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27. 1328. Paenibacillosis: An Emerging Cause of Neonatal Sepsis and Postinfectious Hydrocephalus

Author

Ericson, Jessica E, Burgoine, Kathy, Hehnly, Christine, Kumbakumba, Elias, Ochora, Moses, Bajunirwe, Francis, Bazira, Joel, Fronterre, Claudio, Hagmann, Cornelia, Kulkarni, Abhaya, Senthil Kumar, M, Magombe, Joshua, Mbabazi-Kabachelor, Edith, Morton, Sarah, Movassagh, Mercedeh, Mugamba, John, Mulondo, Ronald, Muwanguzi, Abraham, Natukwatsa, Davis, Kaaya, Brian Nsubuga, Olupot-Olupot, Peter, Onen, Justin, Sheldon, Kathryn, Smith, Jasmine, Ssentongo, Paddy, Ssenyonga, Peter, Warf, Benjamin, Wegoye, Emmanuel, Zhang, Lijun, Broach, James, Kiwanuka, Julius, Paulson, Joseph, Schiff, Steven, Ericson, Jessica E, Burgoine, Kathy, Hehnly, Christine, Kumbakumba, Elias, Ochora, Moses, Bajunirwe, Francis, Bazira, Joel, Fronterre, Claudio, Hagmann, Cornelia, Kulkarni, Abhaya, Senthil Kumar, M, Magombe, Joshua, Mbabazi-Kabachelor, Edith, Morton, Sarah, Movassagh, Mercedeh, Mugamba, John, Mulondo, Ronald, Muwanguzi, Abraham, Natukwatsa, Davis, Kaaya, Brian Nsubuga, Olupot-Olupot, Peter, Onen, Justin, Sheldon, Kathryn, Smith, Jasmine, Ssentongo, Paddy, Ssenyonga, Peter, Warf, Benjamin, Wegoye, Emmanuel, Zhang, Lijun, Broach, James, Kiwanuka, Julius, Paulson, Joseph, and Schiff, Steven

Abstract

Background The etiology of neonatal sepsis is often not identified. Molecular methods can identify pathogens that culture-based methods miss. Most cases of neonatal sepsis globally are treated empirically per WHO guidelines with intravenous ampicillin and gentamicin, which may not be the best regimen for all pathogens. Methods We prospectively enrolled 800 neonates presenting with signs of sepsis to two Ugandan hospitals. Blood and cerebrospinal fluid were subjected to 16S rRNA sequencing, which identified Paenibacillus thiaminolyticus in 33/800 (4%) neonates. We confirmed the presence of P. thiaminolyticus by quantitative polymerase chain reaction (PCR). We describe neonatal and birth characteristics, presenting signs, and 12-month developmental outcomes for neonates with paenibacillosis. We performed antibiotic susceptibility testing and genomic analyses on three clinical isolates successfully grown in the laboratory. Results Neonates presented at a median age of 3 (1, 7) days. Fever (86%), irritability (78%) and seizures (52%) were common presenting signs (Figure). Most neonates were born vaginally (73%) at a medical facility (79%). Twelve (36%) had an adverse outcome: 5 (15%) neonates died; 4 (14%) survivors developed postinfectious hydrocephalus and three (9%) additional survivors had neurodevelopmental impairment. All three isolates were resistant to vancomycin, two were resistant to penicillin and ampicillin and one was unlikely to be sensitive to ceftriaxone; all were susceptible to gentamicin and meropenem. The genomes of all three strains contained multiple beta-lactamase genes and a cluster of genes that encodes a type IV pilus. Clinical signs at presentation for neonates with good and poor outcomes followng paenibacillosis. Conclusion Molecular methods such as 16S rRNA sequencing and PCR can be used to improve the identification of pathogens causing neonatal sepsis. Paenibacillosis is an important emerging cause of neonatal sepsis in Uganda and is likely

Published
2022

31. Paenibacillus Infection Causes Neonatal Sepsis and Subsequent Postinfectious Hydrocephalus in Ugandan Infants

Author

Morton, Sarah U., primary, Hehnly, Christine, additional, Burgoine, Kathy, additional, Ssentongo, Paddy, additional, Ericson, Jessica E., additional, Kumar, M. Senthil, additional, Hagmann, Cornelia, additional, Fronterre, Claudio, additional, Smith, Jasmine, additional, Movassagh, Mercedeh, additional, Streck, Nicholas, additional, Bebell, Lisa, additional, Bazira, Joel, additional, Kumbakumba, Elias, additional, Bajunirwe, Francis, additional, Mulondo, Ronald, additional, Mbabazi-Kabachelor, Edith, additional, Kaaya, Brian, additional, Natukwatsa, Davis, additional, Nalule, Esther, additional, Magombe, Joshua, additional, Erickson, Tim, additional, Ngonzi, Joseph, additional, Ochora, Moses, additional, Olupot Oluput, Peter, additional, Onen, Justin, additional, Ssenyonga, Peter, additional, Mugamba, John, additional, Warf, Benjamin, additional, Kulkarni, Abhaya V., additional, Lane, Jessica, additional, Whalen, Andrew, additional, Zhang, Lijun, additional, Sheldon, Kathryn, additional, Meier, Frederick A., additional, Kiwanuka, Julius, additional, Broach, James R., additional, Paulson, Joseph N., additional, and Schiff, Steven, additional

Published
2022
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33. Evaluation of the Initial 12 Months of a Routine Cryptococcal Antigen Screening Program in Reduction of HIV-Associated Cryptococcal Meningitis in Uganda

Author

Kiwanuka Julius, Derrick Bary Abila, John Kasibante, Aggrey Semeere, Kiiza Tadeo Kandole, Kagimu Enock, Bridget C Griffith, David B. Meya, Richard Kwizera, and Morris K Rutakingirwa

Subjects
Cryptococcal antigen, business.industry, Immunology, Human immunodeficiency virus (HIV), medicine, medicine.disease_cause, business, Cryptococcal meningitis
Abstract

Background: Asymptomatic Cryptococcal Antigenemia (CrAg) patients develop meningitis within a month of testing positive. Pre-emptive antifungal therapy can prevent progression to Cryptococcal meningitis(CM). In April 2016, a national CrAg screening program was initiated in 206 high-volume health facilities that provide antiretroviral therapy in Uganda. We report the evaluation of the CrAg screening cascade focusing on linkage to care, fluconazole therapy for 10 weeks, and ART initiation in a subset of facilities.Methods: We conducted a retrospective, cross-sectional survey of patients with CD4Results:We evaluated 359 patient records; the majority (358/359, 99.7%) were from government owned health facilities and just over half (193/359, 53.8%) had a median baseline CD4 cell count of Conclusion:There was a critical gap in the follow-up of patients after initiation on fluconazole therapy. ART had been initiated in almost 40% of patients prior to CrAg screening, which predisposes them to unmasking Cryptococcal IRIS. Higher antigenemia patients presenting with CNS symptoms could be related to late presentation. There is need to address these gaps after a more thorough evaluation.

Published
2021
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34. Evaluation of the initial 12 months of a routine cryptococcal antigen screening program in reduction of HIV-associated cryptococcal meningitis in Uganda

Author

Kagimu Enock, Kiwanuka Julius, Bridget C. Griffith, Derrick Bary Abila, Morris K. Rutakingirwa, John Kasibante, Kiiza Tadeo Kandole, Richard Kwizera, Aggrey Semeere, and David B. Meya

Subjects
Cross-Sectional Studies, Health Policy, Humans, Mass Screening, HIV Infections, Uganda, Meningitis, Cryptococcal, CD4 Lymphocyte Count, Retrospective Studies
Abstract

Background Asymptomatic Cryptococcal Antigenemia (CrAg) patients develop meningitis within a month of testing positive. Pre-emptive antifungal therapy can prevent progression to Cryptococcal meningitis (CM). In April 2016, a national CrAg screening program was initiated in 206 high-volume health facilities that provide antiretroviral therapy in Uganda. We report the evaluation of the CrAg screening cascade focusing on linkage to care, fluconazole therapy for 10 weeks and 6 months follow up, and ART initiation in a subset of facilities. Methods We conducted a retrospective, cross-sectional survey of patients with CD4 Results We evaluated 359 patient records between April 2016 to March 2017; the majority (358/359, 99.7%) were from government owned health facilities and just over half (193/359, 53.8%) had a median baseline CD4 cell count of Conclusion There was a critical gap in the follow-up of patients after initiation on fluconazole therapy. ART had been initiated in almost 40% of patients prior to CrAg screening.. Higher antigenemia patients presenting with CNS symptoms could be related to late presentation. There is need to address these gaps after a more thorough evaluation.

Published
2021

37. Internet use among Ugandan adolescents: implications for HIV intervention

Author

Ybarra, Michele L., Kiwanuka, Julius, Emenyonu, Nneka, and Bangsberg, David R.

Subjects
Technology application, Usage, Health aspects, Forecasts and trends, Market trend/market analysis, Internet, Internet -- Usage -- Forecasts and trends -- Health aspects -- Technology application, Early intervention -- Technology application -- Forecasts and trends -- Health aspects -- Usage, Youth -- Health aspects -- Forecasts and trends -- Usage -- Technology application, Teenagers -- Health aspects -- Forecasts and trends -- Usage -- Technology application
Abstract

Background The Internet is fast gaining recognition as a powerful, low-cost method to deliver health intervention and prevention programs to large numbers of young people across diverse geographic regions. The [...]

Published
2006

38. Quality of life and associated factors among HIV positive patients after completion of treatment for Cryptococcal meningitis

Author

Kitonsa, Jonathan, primary, Kiwanuka, Julius, additional, Anywaine, Zacchaeus, additional, Kansiime, Sheila, additional, Katumba, Kenneth, additional, Aeron, Namirembe, additional, Beardsley, Justin, additional, Kibengo, Freddie, additional, Gray, Alastair, additional, Kaleebu, Pontiano, additional, and Day, Jeremy, additional

Published
2021
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39. Determinants of two-year mortality among HIV positive patients with Cryptococcal meningitis initiating standard antifungal treatment with or without adjunctive dexamethasone in Uganda

Author

Kitonsa, Jonathan, primary, Nsubuga, Rebecca, additional, Mayanja, Yunia, additional, Kiwanuka, Julius, additional, Nikweri, Yofesi, additional, Onyango, Martin, additional, Anywaine, Zacchaeus, additional, Ggayi, Abu-Baker, additional, Kibengo, Freddie Mukasa, additional, Kaleebu, Pontiano, additional, and Day, Jeremy, additional

Published
2020
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40. Paenibacillus infection with frequent viral coinfection contributes to postinfectious hydrocephalus in Ugandan infants

Author

Paulson, Joseph N., primary, Williams, Brent L., additional, Hehnly, Christine, additional, Mishra, Nischay, additional, Sinnar, Shamim A., additional, Zhang, Lijun, additional, Ssentongo, Paddy, additional, Mbabazi-Kabachelor, Edith, additional, Wijetunge, Dona S. S., additional, von Bredow, Benjamin, additional, Mulondo, Ronnie, additional, Kiwanuka, Julius, additional, Bajunirwe, Francis, additional, Bazira, Joel, additional, Bebell, Lisa M., additional, Burgoine, Kathy, additional, Couto-Rodriguez, Mara, additional, Ericson, Jessica E., additional, Erickson, Tim, additional, Ferrari, Matthew, additional, Gladstone, Melissa, additional, Guo, Cheng, additional, Haran, Murali, additional, Hornig, Mady, additional, Isaacs, Albert M., additional, Kaaya, Brian Nsubuga, additional, Kangere, Sheila M., additional, Kulkarni, Abhaya V., additional, Kumbakumba, Elias, additional, Li, Xiaoxiao, additional, Limbrick, David D., additional, Magombe, Joshua, additional, Morton, Sarah U., additional, Mugamba, John, additional, Ng, James, additional, Olupot-Olupot, Peter, additional, Onen, Justin, additional, Peterson, Mallory R., additional, Roy, Farrah, additional, Sheldon, Kathryn, additional, Townsend, Reid, additional, Weeks, Andrew D., additional, Whalen, Andrew J., additional, Quackenbush, John, additional, Ssenyonga, Peter, additional, Galperin, Michael Y., additional, Almeida, Mathieu, additional, Atkins, Hannah, additional, Warf, Benjamin C., additional, Lipkin, W. Ian, additional, Broach, James R., additional, and Schiff, Steven J., additional

Published
2020
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41. The Bacterial and Viral Complexity of Postinfectious Hydrocephalus in Uganda

Author

Paulson, Joseph N., primary, Williams, Brent L., additional, Hehnly, Christine, additional, Mishra, Nischay, additional, Sinnar, Shamim A., additional, Zhang, Lijun, additional, Ssentongo, Paddy, additional, Mbabazi-Kabachelor, Edith, additional, Wijetunge, Dona S. S., additional, von Bredow, Benjamin, additional, Mulondo, Ronnie, additional, Kiwanuka, Julius, additional, Bajunirwe, Francis, additional, Bazira, Joel, additional, Bebell, Lisa M., additional, Burgoine, Kathy, additional, Couto-Rodriguez, Mara, additional, Ericson, Jessica E., additional, Erickson, Tim, additional, Ferrari, Matthew, additional, Gladstone, Melissa, additional, Guo, Cheng, additional, Haran, Murali, additional, Hornig, Mady, additional, Isaacs, Albert M., additional, Kaaya, Brian Nsubuga, additional, Kangere, Sheila M., additional, Kulkarni, Abhaya V., additional, Kumbakumba, Elias, additional, Li, Xiaoxiao, additional, Limbrick, David D., additional, Magombe, Joshua, additional, Morton, Sarah U., additional, Mugamba, John, additional, Ng, James, additional, Olupot-Olupot, Peter, additional, Onen, Justin, additional, Peterson, Mallory R., additional, Roy, Farrah, additional, Sheldon, Kathryn, additional, Townsend, Reid, additional, Weeks, Andrew D., additional, Whalen, Andrew J., additional, Quackenbush, John, additional, Ssenyonga, Peter, additional, Galperin, Michael Y., additional, Almeida, Mathieu, additional, Atkins, Hannah, additional, Warf, Benjamin C., additional, Lipkin, W. Ian, additional, Broach, James R., additional, and Schiff, Steven J., additional

Published
2020
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42. Quality of life and associated factors among HIV positive patients after completion of treatment for Cryptococcal meningitis

Author

Kitonsa, Jonathan, primary, Kiwanuka, Julius, additional, Anywaine, Zacchaeus, additional, Kansiime, Sheila, additional, Katumba, Kenneth, additional, Aeron, Namirembe, additional, Beardsley, Justin, additional, Kibengo, Freddie, additional, Gray, Alastair, additional, Kaleebu, Pontiano, additional, and Day, Jeremy, additional

Published
2020
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45. Additional file 1 of Prevalence, associated factors and clinical features of congenital syphilis among newborns in Mbarara hospital, Uganda

Author

Oloya, Sam, Lyczkowski, David, Orikiriza, Patrick, Irama, Max, Yap Boum, Migisha, Richard, Kiwanuka, Julius P., and Mwanga-Amumpaire, Juliet

Abstract

Additional file 1. Prevalence, associated factors, and clinical features of Congenital Syphilis among newborns in Mbarara Regional Referral Hospital, South Western Uganda.

Published
2020
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