POST-INFECTIOUS HYDROCEPHALUS IN UGANDAN INFANTS: MICROBIAL ORIGINS OF INFECTION AND THE ROLE OF CLIMATE IN DISEASE DISTRIBUTION

Open Access
Author:
Ranjeva, Sylvia Lise
Area of Honors:
Engineering Science
Degree:
Bachelor of Science
Document Type:
Thesis
Thesis Supervisors:
  • Steven Schiff, Thesis Supervisor
  • Judith A Todd, Honors Advisor
  • Christine Masters, Faculty Reader
Keywords:
  • post-infectious hydrocephalus
  • engineering
Abstract:
The diagnosis and treatment of neonatal infectious disease in Africa and throughout the developing world begs for the collaborative intervention of engineering in biomedical research. The international prevalence of post-infectious hydrocephalus (PIH) in infants serves not only as a fascinating issue in the dynamical consequences of infectious disease but also reveals the socio-economic barrier to treatment of infectious disease in the developing world. Identifying the microbial spectrum that causes PIH could lead to strategies to alleviate the disease from the regions of the world where treatment remains the most elusive. It is further imperative to understand the driving environmental factors, such as climate and rainfall patterns, which lead to the spread of this infectious bacterial syndrome. My current research with PIH in Uganda addresses these possibilities. Throughout this project I have worked with Dr. Steven Schiff, director of Penn State University's Center for Neural Engineering, Dr. Mary Poss, director of the Penn State Center for Infectious Disease, and Dr. Benjamin Warf, a pediatric neurosurgeon at Harvard University and the former Medical Director of CURE Children’s Hospital of Uganda. The first phase of the project aimed to determine the infectious agents present in the bacterial diversity of cerebral spinal fluid (CSF) among infants with PIH throughout Uganda. Bacterial DNA was recovered from 94% of patients. The most common potential pathogens were Gram-negative Proteobacteria. Gammaproteobacteria were the most common in patients presenting for infections during the rainy season, and Betaproteobactreia were most common across patients presenting during the dry season. Within the cohort of patients presenting after the rainy season, Acinetobacter species were identified in the majority of samples. This study suggested a possible bacterial source of infection of PIH, and more notably suggested seasonality in the nature of PIH infections. In a second study, a spatio-temporal correlation of climate statistics (rainfall averages) with disease distribution aimed to quantify the relationship between climate and the incidence of PIH. Date and location of patients presenting for PIH over a six-year time series were compared with corresponding rainfall values. A time series analysis of cases and rainfall patterns was performed. Infections were shown to occur at intermediate levels of rainfall. Four infection onset peaks overlay twice-yearly rainfall peaks, suggesting a dependence of case onset on phase of the rainfall cycle. In conjunction with microbial analysis suggesting a pathogenic seasonal difference in PIH infection, this study suggests the importance of climate in preventative measures taken to combat the spread of newborn infections causing PIH.