| Přispěvatelé: |
University of Helsinki, Faculty of Medicine, Doctoral Program in Clinical Research, Helsingin yliopisto, lääketieteellinen tiedekunta, Kliininen tohtoriohjelma, Helsingfors universitet, medicinska fakulteten, Doktorandprogrammet i klinisk forskning, Hultcrantz, Malou, Pitkäranta, Anne, Pelkonen, Tuula |
| Popis: |
Background: In resource-poor settings, otorrhoea, otitis media (OM) and bacterial meningitis (BM) cause substantial morbidity and mortality in children. Chronic otorrhoea causes disabling hearing impairment (HI) and may progress into intracranial infections, such as BM. In order to treat middle-ear infections, knowledge of the causative agents is crucial in Africa, where limited data are available. Additionally, little is known about the contribution of OM to BM, the effects of a bacterial aetiology and the prognostic value of an auditory brainstem response (ABR) on disease outcomes in resource-poor settings, where childhood BM often kills or leaves survivors with disabling and severe sequelae. Patients and methods: This thesis includes four different studies. The first study investigated the microbiology of otorrhoea samples from children 0 to 15 years of age between 2008 and 2015 from Luanda, Angola in a laboratory-based retrospective set-up and reviewed the related literature among African children over a two-decade period. A randomised treatment trial of 723 children with BM in Luanda, Angola, between 2005 and 2008 served as the basis to study ear- and auditory-related outcomes of childhood BM in subsequent observational studies. The second study investigated the frequency and effect of OM on the disease presentation, course and outcomes. The third study examined the relationship between different bacterial aetiologies and the age at hearing outcomes. And, finally, the fourth study examined the predictive value of the auditory brainstem response (ABR) on the adverse outcomes, and analysed the changes of ABR in childhood BM. Results: Otorrhoea in Luanda was caused by 32 different bacteria, the majority being Gram-negative organisms (85%). Current treatment quidelines appear locally applicable, since resistance to quinolones remained rare. However, among Enterobacteriaceae and Staphylococcus aureus, considerable resistance was noted. Furthermore, the literature review showed a high occurrence of otorrhoea and chronic suppurative otitis media (CSOM) in African children as well as possible gaps in existing knowledge. Among children with BM, OM occurred in 12%, of which the majority was otorrhoea. OM in Angola served as a marker for a more complex presentation, clinical course and outcome of BM. Multivariate analysis indicated that OM significantly increased the odds of dying or complicated clinical course. Furthermore, otorrhoea was associated with HIV positivity and poor socioeconomic conditions among infants. HI was a common sequela of BM, given that 12.8% of survivors became deaf, 6% experienced severe HI and 9% moderate HI. The effect of causative agents was significant only when hearing in both ears was analysed. Meningococcal meningitis caused less HI of any degree compared to other aetiologies (22% vs. 45%). In the age-group analysis (children |
