Southern African Journal of Infectious Diseases - latest Issue
Volume 31, Issue 4, 2016
Source: Southern African Journal of Infectious Diseases 31, pp 3 –4 (2016)More Less
The rise in microcephaly cases and neurological disorders reported in Brazil shortly after the emergence of Zika virus disease (ZVD) in 2015 prompted the World Health Organization (WHO) to declare ZVD as a Public Health Emergency of International Concern (PHEIC) on 1 February 2016. On 18 November 2016 the WHO Emergency Committee on Zika and microcephaly convened for their fifth meeting during which it was concluded that ZVD and associated neurological complications no longer represent a PHEIC, but the committee recognises that the unprecedented Zika virus (ZIKV) spread and its newly documented virulence remains a huge public health challenge requiring ongoing efforts. However, these efforts can be better addressed by sustained research programmes that are well resourced.
Author Shan NaidooSource: Southern African Journal of Infectious Diseases 31, pp 40 –40 (2016)More Less
Historically, funding of research in the context of North-South Collaborations was more often than not done expediently. The Northern partners and their funders determined the priorities of what research needed to be done and where it was going to be published. The Southern partners were often at the tail end of publications and did not have a say on what the research priorities were that could improve the health of their populations in any substantive way. The few graduates (such as masters and PhDs) in the South were a nice by-product. However, they often subsequently left their own countries to continue studying and pursuing their careers in the North. What is exciting about this book is that it challenges this traditional model.
Epidemiology of cystic fibrosis respiratory pathogens isolated at a South African Hospital, 2006–2010Source: Southern African Journal of Infectious Diseases 31, pp 106 –111 (2016) http://dx.doi.org/10.1080/23120053.2016.1156864More Less
Background: The epidemiology of cystic fibrosis (CF) associated pathogens other than Pseudomonas aeruginosa in the South African cystic fibrosis population has not been previously described.
Methods: A retrospective review of respiratory cultures taken from cystic fibrosis clinic patients at the Charlotte Maxeke Johannesburg Academic Hospital from 2006 to 2010 was performed.
Results: During the study period, Pseudomonas aeruginosa, Stenotrophomonas maltophilia, Burkholderia cepacia complex and Candida albicans prevalence remained stable, Aspergillus fumigatus increased from 8% to 20% (p = 0.0132); Staphylococcus aureus decreased from 66% to 50% (p = 0.0243) and Haemophilus influenzae decreased from 13% to 3% (p = 0.0136). There were significant antimicrobial susceptibility changes to meropenem (p < 0.0001) amongst P. aeruginosa isolates and cloxacillin (p < 0.0001) amongst S. aureus isolates. Prevalence of most bacterial pathogens appeared to increase with increasing age.
Conclusion: The findings of this study illustrate the epidemiology of CF associated respiratory pathogens and the trends in prevalence and susceptibility patterns over a 5-year period.
World Health Organisation staging, adherence to HAART and abnormal cervical smears amongst HIV-infected women attending a government hospital in Johannesburg, South AfricaSource: Southern African Journal of Infectious Diseases 31, pp 112 –118 (2016) http://dx.doi.org/10.1080/23120053.2016.1156873More Less
Introduction: South Africa (SA) has more people living with Human Immunodeficiency Virus (HIV) than any other country in the world. Women infected with HIV have a higher risk of developing cervical dysplasia and cancer than women who are not infected.
Objective: To ascertain the correlation between the World Health Organisation (WHO) HIV staging and adherence to highly active antiretroviral therapy (HAART) with abnormal Pap smear results of HIV-infected women attending a government hospital in Johannesburg, SA.
Methods: A cross-sectional descriptive study was performed by reviewing Pap smears of 390 HIV-positive women. Adherence was measured by the patient’s report and viral load. Data was collected through the use of self-administered questionnaires.
Results: The prevalence of abnormal Pap smears was 57% and low grade squamous intraepithelial lesions (LGSIL) were the most common abnormality seen (142/390, 36%). WHO stage 3 participants were three times more likely to have abnormal Pap smears than those with WHO stage 1 (OR 3.3, 95% CI 1.23-9.04, p = 0.018). Abnormal Pap smears were seen more frequently in participants with a CD4 cell count ≤ 350 cells/μl compared to participants with CD4 cell count ≥ 500 cells/μl (p = 0.001, 95% CI 0.09-0.37). Participants who did not use HAART had more abnormal results compared to those who used HAART (p < 0.028, 95% CI 0.28-0.93). Self-reported adherence to HAART did not show any association with abnormal Pap smears.
Conclusion: Increased immune-suppression measured by WHO staging or CD4 count increases the risk of cervical cancer precursors. The high risk group in this study was found to be participants with CD4 < 350 cells/μl.
Source: Southern African Journal of Infectious Diseases 31, pp 119 –121 (2016) http://dx.doi.org/10.1080/23120053.2016.1156874More Less
Background: Non-nucleoside reverse transcriptase inhibitors (NNRTI) are recommended as part of first-line treatment by the World Health Organisation (WHO) for antiretroviral treatment (ART) naïve subjects. Due to reports of cross-toxicity between nevirapine (NVP) and efavirenz (EFV), there is reluctance to substitute EFV for NVP when serious toxicity occurs. In such cases lopinavir/ritonavir (LPV/r) remains the only alternative. We report on our experience of patients with Stevens-Johnson Syndrome (SJS) secondary to NVP who were challenged with EFV under careful supervision.
Methods: A retrospective chart review of patients who presented with SJS presumed to be secondary to NVP who were challenged with EFV and were followed up for at least 2 months.
Results: The study included 13 patients. All were female, median age 28 years and median weight 66.5 kg. The median CD4 cell count at ART initiation was 160 cells/μl. Twelve patients (92%) developed a rash within 4 weeks of NVP. The median alanine transaminase at SJS presentation was 30 U/l. The median time to EFV challenge was 30 days. The median hospital stay for SJS was 30 days and median follow up was 19 months. Eleven (85%) patients tolerated co-trimoxazole rechallenge, two had no prior exposure. Median hospital stay for EFV challenge was additional 10 days. Twelve patients (92%) tolerated the EFV challenge. One patient developed a pruritic maculo-papular eruption within 3 days of challenge which led to discontinuation of EFV.
Conclusion: The risk of recurrence of SJS with EFV challenge in patients with NVP induced SJS is low. It is safe to challenge patients with EFV with careful observation.
Environmental health factors associated with diarrhoeal diseases among underfive children in the Sebeta town of EthiopiaSource: Southern African Journal of Infectious Diseases 31, pp 122 –129 (2016) http://dx.doi.org/10.1080/23120053.2016.1156876More Less
The aim of this study was to assess and explore household environmental health factors associated with the occurrence of diarrhoea experienced by children under five years of age in Sebeta town of Ethiopia. A cross-sectional study, using stratified random sampling was used to conduct the research. A total of 477 households’ mothers/caregivers had participated in the study. The study showed that the prevalence of childhood diarrhoea was 9.9%. A number of risk factors including demographic variables, water and hygienic practices, and knowledge of risk factors showed significant association with childhood diarrhoea on bivariate analysis. The multivariate analysis showed that four variables were protective factors for childhood diarrhoea, including the type of toilet facility (AOR: 0.37; 95% CI 0.16 – 0.87; p = 0.023), availability of specific hand-washing places (AOR: 0.40; 95% CI 0.18 – 0.90; p = 0.026), availability of hand-washing facilities (AOR: 0.20; 95% CI 0.06 – 0.70; p = 0.012) and mothers’ knowledge on diarrhoea causation (AOR: 3.09; 95% CI 1.24 – 7.68; p = 0.015). The study, thus, recommends that effective measures to curtail prevalence of diarrhoea in urban contexts should be substantially increased by enhancing protective factors such as urban sanitation promotion programmes with emphasis on accelerating universal access to improved sanitation and hand-washing facilities, together with efforts in promoting proper hygiene behaviours.
Source: Southern African Journal of Infectious Diseases 31, pp 130 –134 (2016) http://dx.doi.org/10.1080/23120053.2016.1156868More Less
Subacute Sclerosing Panencephalitis (SSPE) is a rare, rapidly progressive neurodegenerative disease caused by the measles virus. Spontaneous remission and survival longer than 4 years is rare. The disease commonly affects children and adolescents from less privileged socio-economic backgrounds. Prior to immunisation, the incidence of SSPE in South Africa (SA) was 2.6/100 000 people per year, which is higher than the global estimate of 1/1 000 000 per year. The post-immunisation incidence has dropped to 0.43/100 000 people per year. Currently, there is no curative treatment for SSPE. In developed countries, patients have been treated with antiviral therapy and interferon alpha (IFNα) with promising results. There have been no reported studies of children with SSPE treated with IFNα in South Africa. We report on a patient successfully treated with intraventricular INFα.
Characteristics of tuberculosis patients and the evaluation of compliance to the national TB management guidelines at clinics in a rural community from Mpumalanga province, South AfricaSource: Southern African Journal of Infectious Diseases 31, pp 135 –137 (2016) http://dx.doi.org/10.1080/23120053.2016.1156879More Less
This study serves as baseline investigation into tuberculosis (TB) patient population characteristics and the compliance of clinics in rural settings to the national TB guidelines in terms of diagnosing the disease. A total of 62 TB positive patients’ files were reviewed. Patients were diagnosed using: smear microscopy (41.9%); chest radiography (37.1%); Xpert MTB/RIF (9.7%); symptoms (3.2%); abdomen sonar (1.6%); and, no record (6.5%). Lack of complete compliance was identified, including large dependencies on chest X-ray as the first line of diagnosis and inadequate diagnosis of extra-pulmonary TB. These findings could assist identifying health system gaps for provincial and national control programs.