Publications
48 results found
Fitzgerald F, Wing K, Naveed A, et al., 2018, Development of a pediatric Ebola predictive score, Sierra Leone, Emerging Infectious Diseases, Vol: 24, Pages: 311-319, ISSN: 1080-6040
We compared children who were positive for Ebola virus disease (EVD) with those who were negative to derive a pediatric EVD predictor (PEP) score. We collected data on all children <13 years of age admitted to 11 Ebola holding units in Sierra Leone during August 2014-March 2015 and performed multivariable logistic regression. Among 1,054 children, 309 (29%) were EVD positive and 697 (66%) EVD negative, with 48 (5%) missing. Contact history, conjunctivitis, and age were the strongest positive predictors for EVD. The PEP score had an area under receiver operating characteristics curve of 0.80. A PEP score of 7/10 was 92% specific and 44% sensitive; 3/10 was 30% specific, 94% sensitive. The PEP score could correctly classify 79%-90% of children and could be used to facilitate triage into risk categories, depending on the sensitivity or specificity required.
, 2018, Ebola Virus Disease, Publisher: Springer International Publishing, ISBN: 9783319948539
Patel A, Harris KA, Fitzgerald F, 2017, What is broad-range 16S rDNA PCR?, Archives of Disease in Childhood: Education and Practice Edition, Vol: 102, Pages: 261-264, ISSN: 1743-0585
Hakim J, Musiime V, Szubert AJ, et al., 2017, Enhanced prophylaxis plus antiretroviral therapy for advanced HIV infection in Africa, New England Journal of Medicine, Vol: 377, Pages: 233-245, ISSN: 0028-4793
BACKGROUNDIn sub-Saharan Africa, among patients with advanced human immunodeficiency virus (HIV)infection, the rate of death from infection (including tuberculosis and cryptococcus) shortlyafter the initiation of antiretroviral therapy (ART) is approximately 10%.METHODSIn this factorial open-label trial conducted in Uganda, Zimbabwe, Malawi, and Kenya, weenrolled HIV-infected adults and children 5 years of age or older who had not received previousART and were starting ART with a CD4+ count of fewer than 100 cells per cubic millimeter.They underwent simultaneous randomization to receive enhanced antimicrobialprophylaxis or standard prophylaxis, adjunctive raltegravir or no raltegravir, and supplementaryfood or no supplementary food. Here, we report on the effects of enhanced antimicrobialprophylaxis, which consisted of continuous trimethoprim–sulfamethoxazole plus atleast 12 weeks of isoniazid–pyridoxine (coformulated with trimethoprim–sulfamethoxazolein a single fixed-dose combination tablet), 12 weeks of fluconazole, 5 days of azithromycin,and a single dose of albendazole, as compared with standard prophylaxis (trimethoprim–sulfamethoxazole alone). The primary end point was 24-week mortality.RESULTSA total of 1805 patients (1733 adults and 72 children or adolescents) underwent randomizationto receive either enhanced prophylaxis (906 patients) or standard prophylaxis (899 patients)and were followed for 48 weeks (loss to follow-up, 3.1%). The median baseline CD4+count was 37 cells per cubic millimeter, but 854 patients (47.3%) were asymptomatic ormildly symptomatic. In the Kaplan–Meier analysis at 24 weeks, the rate of death with enhancedprophylaxis was lower than that with standard prophylaxis (80 patients [8.9% vs. 108[12.2%]; hazard ratio, 0.73; 95% confidence interval [CI], 0.55 to 0.98; P=0.03); 98 patients(11.0%) and 127 (14.4%), respectively, had died by 48 weeks (hazard ratio, 0.76; 95% CI, 0.58to 0.99; P=0.04). Patients in the
Fitzgerald F, Wing K, Naveed A, et al., 2017, Risk in the "Red Zone": outcomes for children admitted to Ebola holding units in Sierra Leone without Ebola virus disease, Clinical Infectious Diseases, Vol: 65, Pages: 162-165, ISSN: 1058-4838
We collected data on 1054 children admitted to Ebola Holding Units in Sierra Leone and describe outcomes of 697/1054 children testing negative for Ebola virus disease (EVD) and accompanying caregivers. Case-fatality was 9%; 3/630 (0.5%) children discharged testing negative were readmitted EVD-positive. Nosocomial EVD transmission risk may be lower than feared.
Fitzgerald F, Baion DE, Wing K, et al., 2017, The predicament of patients with suspected Ebola, The Lancet Global Health, Vol: 5, Pages: e659-e659, ISSN: 2214-109X
Nambiar B, Hargreaves DS, Morroni C, et al., 2017, Improving health-care quality in resource-poor settings, Bulletin of the World Health Organization, Vol: 95, Pages: 76-78, ISSN: 0042-9686
Improvements in health-care quality can contribute to healthier populations. However, many global and national health strategies are not sufficiently considering the issues of measuring and improving health-care quality in low-resource settings.1 The barriers to delivering high-quality care are often similar across different health systems. However, the extent and mechanisms through which these barriers affect quality improvement interventions may be different in resource-poor settings.2 Investments in health systems strengthening without continuous quality improvement is thought to be a useless effort.3 Conversely, only focusing on quality improvement in a resource-poor context without engaging the broader health system for support is of limited value. Hence, both areas must be improved simultaneously.
Fitzgerald F, Naveed A, Wing K, et al., 2016, Ebola virus disease in children, Sierra Leone, 2014-2015., Emerging Infectious Diseases, Vol: 22, Pages: 1769-1777, ISSN: 1080-6040
Little is known about potentially modifiable factors in Ebola virus disease in children. We undertook a retrospective cohort study of children <13 years old admitted to 11 Ebola holding units in the Western Area, Sierra Leone, during 2014-2015 to identify factors affecting outcome. Primary outcome was death or discharge after transfer to Ebola treatment centers. All 309 Ebola virus-positive children 2 days-12 years old were included; outcomes were available for 282 (91%). Case-fatality was 57%, and 55% of deaths occurred in Ebola holding units. Blood test results showed hypoglycemia and hepatic/renal dysfunction. Death occurred swiftly (median 3 days after admission) and was associated with younger age and diarrhea. Despite triangulation of information from multiple sources, data availability was limited, and we identified no modifiable factors substantially affecting death. In future Ebola virus disease epidemics, robust, rapid data collection is vital to determine effectiveness of interventions for children.
Fitzgerald F, Awonuga W, Shah T, et al., 2016, Ebola response in Sierra Leone: The impact on children, 13th Hot Topics in Infection and Immunity in Children Meeting, Publisher: W B SAUNDERS CO LTD, Pages: S6-S12, ISSN: 0163-4453
Fitzgerald F, Yeung S, Gibb DM, et al., 2015, Ebola vaccination, LANCET, Vol: 386, Pages: 2478-2478, ISSN: 0140-6736
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Fitzgerald F, Harris K, Henderson R, et al., 2015, Group A streptococcal endophthalmitis complicating a sore throat in a 2-year-old child., BMJ Case Rep, Vol: 2015
A previously well 2-year-old presented to her general practitioner after 5 days of fever, lethargy, sore throat and a slightly red eye. A viral infection was diagnosed. Two days later, she re-presented with a swollen right eyelid and a moderately red eye. Oral amoxicillin and chloramphenicol eye drops were prescribed. The next day, marked periorbital swelling developed. She was admitted to hospital and parenteral ceftriaxone was started. Examination under anaesthetic showed injected globe diffuse corneal clouding and peripheral corneal opacities; ultrasound and CT suggested endophthalmitis. On transfer to a tertiary centre, intraocular vancomycin and subconjunctival cefuroxime were given. Aqueous fluid samples were positive for group A Streptococcus (GAS) by PCR, so parenteral clindamycin was added. GAS endophthalmitis was confirmed 1 day later from the positive intraocular fluid culture results. Visual evoked potentials revealed complete loss of vision. The eye was removed to limit potential spread. She made a good recovery postoperatively and was discharged on oral antibiotics.
Church JA, Fitzgerald F, Walker AS, et al., 2015, The expanding role of co-trimoxazole in developing countries (vol 15, pg 327, 2015), LANCET INFECTIOUS DISEASES, Vol: 15, Pages: 263-263, ISSN: 1473-3099
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- Citations: 2
Church JA, Fitzgerald F, Walker AS, et al., 2015, The expanding role of co-trimoxazole in developing countries, LANCET INFECTIOUS DISEASES, Vol: 15, Pages: 327-339, ISSN: 1473-3099
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- Citations: 64
Doyle RM, Alber DG, Jones HE, et al., 2014, Term and preterm labour are associated with distinct microbial community structures in placental membranes which are independent of mode of delivery, PLACENTA, Vol: 35, Pages: 1099-1101, ISSN: 0143-4004
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- Citations: 104
Fitzgerald F, Harris K, Doyle R, et al., 2013, Short Communication: Evidence That Microbial Translocation Occurs in HIV-Infected Children in the United Kingdom, AIDS RESEARCH AND HUMAN RETROVIRUSES, Vol: 29, Pages: 1589-1593, ISSN: 0889-2229
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- Citations: 11
Fitzgerald F, Howard J, Bailey F, et al., 2013, Back pain in a previously healthy teenager., BMJ Case Rep, Vol: 2013
We present the case of a 14-year-old previously healthy boy who presented to his general practitioner with back pain and fever after rugby training. He was initially treated for suspected discitis but during the course of his admission he rapidly deteriorated and developed severe necrotising pneumonia. He was intubated, ventilated and transferred to a paediatric intensive care unit. Panton-Valentine leukocidin Staphylococcus aureus was suspected and subsequently identified in blood cultures.
Fitzgerald F, Penazzato M, Gibb D, 2013, Development of Antiretroviral Resistance in Children With HIV in Low- and Middle-Income Countries, JOURNAL OF INFECTIOUS DISEASES, Vol: 207, Pages: S85-S92, ISSN: 0022-1899
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- Citations: 34
Fitzgerald FC, Bekker L-G, Kaplan R, et al., 2010, Mother-to-child transmission of HIV in a community-based antiretroviral clinic in South Africa, SAMJ SOUTH AFRICAN MEDICAL JOURNAL, Vol: 100, Pages: 827-831, ISSN: 0256-9574
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- Citations: 27
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