Definitions of severe or invasive infections in the ZIPS study
| Infection . | Definition . |
|---|---|
| Abscess | Opaque, fluid-filled/fluctuant collection on skin (with purulent discharge if drained) |
| Bacteremia | Children with a positive blood culture with a true pathogen (eg, Staphylococcus aureus, Streptococcus pneumoniae, Salmonella, other gram-negative infections) |
| Cellulitis | Area of reddened, warm skin in a child with a history of fever or measured axillary temperature of ≥37.5°C |
| Diarrhea | More than 3 loose stools in a 24-h period |
| Dysentery | Fever with bloody stools |
| Malaria | Measured fever (axillary temperature ≥ 37·5°C) or fever by history and Plasmodium species infection on blood smear |
| Meningitis/encephalitis | Fever with (1) nuchal rigidity or altered mental status and (2) CSF with >5 WBC or with positive CSF culture for meningitis-associated organisms (e.g, S pneumoniae, Neisseria meningiditis, Haemophilus influenzae) |
| Osteomyelitis | Fever with bone pain, redness of skin over bone and x-ray findings consistent with osteomyelitis |
| Pharyngitis/tonsillitis | Inflamed, erythematous pharynx and/or tonsils, with pharyngeal or tonsillar exudate |
| Pneumonia/ACS | Pneumonia: history of fever or measured axillary temperature ≥37·5°C, with age-specific tachypnea, cough, and an infiltrate and/or effusion on chest x-ray consistent with pneumonia∗ ACS: signs of pneumonia above plus chest pain and/or tenderness |
| Sepsis | Meets modified criteria for SIRS/sepsis in International pediatric sepsis consensus guidelines (2 or more of the following criteria, 1 of which must be abnormal temperature: T ≥ 38·5°C, age-specific tachycardia, age-specific tachypnea, age-specific leukopenia). Modified to remove leukocytosis because, per NOHARM study data, >80% of children with SCA at Mulago Hospital will have age-specific leukocytosis at baseline, which is an IPSC criterion for SIRS/sepsis. Because SIRS in a child with SCA is always suspected to be owing to infection, we will use the term sepsis |
| Sinusitis (acute) | Congestion, nasal discharge or cough for more than 10 days without improvement; or symptoms of congestion with purulent nasal discharge for >3 days |
| Urinary tract infection | Symptoms (fever with urinary frequency, burning or new incontinence after previous toilet training) plus urinalysis positive for LE or nitrite OR clean catch urine culture with >100 000 colonies of a single pathogen |
| Infection . | Definition . |
|---|---|
| Abscess | Opaque, fluid-filled/fluctuant collection on skin (with purulent discharge if drained) |
| Bacteremia | Children with a positive blood culture with a true pathogen (eg, Staphylococcus aureus, Streptococcus pneumoniae, Salmonella, other gram-negative infections) |
| Cellulitis | Area of reddened, warm skin in a child with a history of fever or measured axillary temperature of ≥37.5°C |
| Diarrhea | More than 3 loose stools in a 24-h period |
| Dysentery | Fever with bloody stools |
| Malaria | Measured fever (axillary temperature ≥ 37·5°C) or fever by history and Plasmodium species infection on blood smear |
| Meningitis/encephalitis | Fever with (1) nuchal rigidity or altered mental status and (2) CSF with >5 WBC or with positive CSF culture for meningitis-associated organisms (e.g, S pneumoniae, Neisseria meningiditis, Haemophilus influenzae) |
| Osteomyelitis | Fever with bone pain, redness of skin over bone and x-ray findings consistent with osteomyelitis |
| Pharyngitis/tonsillitis | Inflamed, erythematous pharynx and/or tonsils, with pharyngeal or tonsillar exudate |
| Pneumonia/ACS | Pneumonia: history of fever or measured axillary temperature ≥37·5°C, with age-specific tachypnea, cough, and an infiltrate and/or effusion on chest x-ray consistent with pneumonia∗ ACS: signs of pneumonia above plus chest pain and/or tenderness |
| Sepsis | Meets modified criteria for SIRS/sepsis in International pediatric sepsis consensus guidelines (2 or more of the following criteria, 1 of which must be abnormal temperature: T ≥ 38·5°C, age-specific tachycardia, age-specific tachypnea, age-specific leukopenia). Modified to remove leukocytosis because, per NOHARM study data, >80% of children with SCA at Mulago Hospital will have age-specific leukocytosis at baseline, which is an IPSC criterion for SIRS/sepsis. Because SIRS in a child with SCA is always suspected to be owing to infection, we will use the term sepsis |
| Sinusitis (acute) | Congestion, nasal discharge or cough for more than 10 days without improvement; or symptoms of congestion with purulent nasal discharge for >3 days |
| Urinary tract infection | Symptoms (fever with urinary frequency, burning or new incontinence after previous toilet training) plus urinalysis positive for LE or nitrite OR clean catch urine culture with >100 000 colonies of a single pathogen |
Any child with a standard clinical diagnosis of pneumonia (clinical signs above) will be treated for pneumonia regardless of CXR findings as per the Mulago Hospital Sickle Cell Clinic protocol. Chest radiographs will be read by an on-call radiologist for acute clinical care, and saved for reading by a second radiologist. Specific criteria will be assessed by both radiologists, and only children who meet criteria from the WHO Radiology Working Group for pneumonia will be given a final diagnosis of pneumonia (Cherian T et al, Bulletin of WHO, 2005;83:353-359). Children who do not meet radiographic criteria will be given a final diagnosis of “respiratory infection” and not included in primary category of “severe or invasive infections” that constitute the primary study endpoint. They will be considered the secondary end point of “all clinical infections.” Republished without any changes from Datta et al.21 Originally published under the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/).