title: High rates of colonization with drug resistant hemophilus influenzae type B and Streptococccus Pneumoniae in unvaccinated HIV infected children from West Bengal.
abstract: OBJECTIVE
  To determine nasopharyngeal colonization rates of two vaccine preventable bacterial pathogens Hemophilus influenzae type b (Hib), and Streptococcus pneumoniae (Pneumococcus), antibiotic susceptibility of isolates, factors associated with their colonization, and immunization history in a cohort of HIV infected children.
  
  
  METHODS
  The authors conducted a cross-sectional nasopharyngeal swab survey of 151 children affected with HIV presenting for routine outpatient care in West Bengal, India.
  
  
  RESULTS
  151 HIV affected children were enrolled. The median age was 6, 148/151 children were HIV positive, 65% had moderate to severe malnutrition, 53% were moderately to severely immunosuppressed, 17% were on antiretroviral therapy (ART), 90% were on cotrimoxazole prophylaxis (TMP/SMX). None had received the pneumococcal or Hib conjugate vaccines. Hib prevalence was 13% and pneumococcal prevalence was 28%. Children with normal or moderate immune suppression had high rates of colonization compared to those with severe immunosuppression (71% Hib, 61% pneumococcus). Hib and pneumococcal isolates had high rates of resistance to tested antibiotics including TMP/SMX and third generation cephalosporins. Neither ART nor TMP/SMX prevented colonization. Children colonized with multidrug resistant isolates had high rates of exposure to TMP/SMX.
  
  
  CONCLUSIONS
  HIV infection, late access to ART, high rates of colonization to resistant organisms and lack of access to vaccines makes this population vulnerable to invasive disease from Hib and pneumococcus.
authors.affiliation: School of Medical Science and Technology, Indian Institute of Technology Kharagpur, Kharagpur, West Bengal, India, 721302. sangeetab@iitkgp.ac.in
authors.forename: Sangeeta Das
authors.initials: SD
authors.lastname: Bhattacharya
authors.forename: Swapan Kumar
authors.initials: SK
authors.lastname: Niyogi
authors.forename: Subhasish
authors.initials: S
authors.lastname: Bhattacharyya
authors.forename: Sean
authors.initials: S
authors.lastname: Fitzwater
authors.forename: Nageshwar
authors.initials: N
authors.lastname: Chauhan
authors.forename: A
authors.initials: A
authors.lastname: Sudar
authors.forename: Sutapa
authors.initials: S
authors.lastname: Mandal
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000453:epidemiology*; D006192:Haemophilus Infections / Q000453:epidemiology*; D019741:Haemophilus influenzae type b; D006801:Humans; D007194:India / Q000453:epidemiology; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009666:Nose / Q000382:microbiology; D011008:Pneumococcal Infections / Q000453:epidemiology*; D013296:Streptococcus pneumoniae