Acute lower respiratory infections, including pneumonia and bronchiolitis, are the number one cause of under 5 child mortality. Lower respiratory infections are globally the 4th leading cause among all age groups and the 2nd leading cause in low-income countries of death. Given how common and serious these infections are, it is striking how little we know about the specific microorganisms that cause these infections, especially in resource-constrained settings. This isn’t just a matter of academic curiosity — getting the diagnosis right matters because treatment varies depending on the causative pathogen.  This is particularly true in immunocompromised children for whom the list of pathogens can include unusually serious viruses to drug-resistant bacteria to opportunistic molds.

Our Uganda Cancer Institute (UCI) - UMN team is tackling this challenge by deploying emerging metagenomic next-generation sequencing (mNGS) techniques to broadly identify more than 200 causes of acute respiratory infection among children receiving treatment for cancer at the UCI in Kampala, Uganda. UCI has housed a dedicated pediatric oncology service since 2012 and is currently the largest pediatric oncology program in East and Central Africa with up to 600 new children admitted annually. This project co-developed by principal investigators in complementary medical specialties — UCI oncologist Dr. Joyce Balagadde-Kambugu and UMN adult and pediatric infectious diseases consultant Dr. Beth Thielen aims to enhance laboratory diagnosis of the microbiological causes of fever in this immunocompromised population. In high-income countries, community-acquired respiratory viral pathogens are a common cause of fever in neutropenic children just as in the general pediatric population but access to testing is limited in locations like UCI. To address this gap, we are conducting a prospective observational study to describe the epidemiology of respiratory viruses among children with and without fever at the UCI. In addition to answering this critical scientific question, we are also developing a strong educational program for multiple U.S. and Uganda-based trainees in the fundamentals of research methods and supporting capacity development in laboratory diagnostics and research methodology. This project will lay the foundation for further capacity and partnership development, including opportunities to expand diagnostic testing for acute respiratory infections among otherwise healthy children.

Olivia Toles, Drs. Beth Thielen and Svatava Merkle had the opportunity to travel to Uganda to further the collaborative work being done. Here they are with UCI-UMN team members on Lake Victoria.

Greetings from Hyderabad, India! It’s been a little over two months since I’ve arrived in India and I’m having a great time. My work at Paramitha Children’s Hospital primarily revolves around research of a new device founded by one our colleagues, Dr. Stephen John. Aside from that, I have been attending NICU, PICU, and inpatient rounds as well as shadowing the doctors in the outpatient clinic on different days. Moreover, I am working on my own QI project regarding medication administration errors and am helping colleagues here with their own projects/presentations.

Most conveniently, most of my family lives in the city so I have been able to stay with them. I am learning so much good clinical medicine here and seeing the most unique cases and presentations. I am consistently in awe of how much knowledge the doctors here possess. If you’re interested in NICU or learning about research in general, then this is the place for you! 

Most importantly, I can honestly say that I’ve made some friends for a lifetime, and there is no dull day at work because of all the people pictured here. Here are some pics from rounds, hanging out at work and outside of work with NICU residents/fellows!