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- Volume 21, Issue 2, 2006
Southern African Journal of Epidemiology and Infection - Volume 21, Issue 2, 2006
Volume 21, Issue 2, 2006
Author Keith P. KlugmanSource: Southern African Journal of Epidemiology and Infection 21, pp 34 –35 (2006)More Less
Fluoroquinolones are widely advocated as first line agents for the management of pneumonia, particularly in the USA, for outpatient therapy of patients who have recently been exposed to antibiotics, or who have comorbidities that increase their risk of serious infection. Empiric therapy guidelines for community-acquired pneumonia in hospitalised pneumonia also include so-called respiratory fluoroquinolones as first line agents. The broad spectrum of their activity against both typical and atypical respiratory pathogens make these agents attractive, especially as they are well absorbed orally and generally well tolerated. The initially licensed fluoroquinolones, ciprofloxacin and ofloxacin, had limited activity against the pneumococcus, and a variety of new agents have come to the market to fill this gap. The L-isomer of ofloxacin was shown to harbour better activity than the D-isomer of that drug and the L-isomer formulation was licensed as levofloxacin and has come to dominate this market. In the current issue Moolman and colleagues compare the activity of levofloxacin to two other more active agents available in South Africa, and conclude both on the basis of in vitro activity, and the achievable drug concentrations that gatifloxacin and moxifloxacin offer greater potential killing of this pathogen.
Source: Southern African Journal of Epidemiology and Infection 21 (2006)More Less
A recent editorial on this subject, with the above title, and written by the editor of the Lancet, revealed that "with more than 60% of adults and 13% of children classified as overweight or obese, the USA has become the fattest nation on earth." Yet, that nation is probably the wealthiest and most sophisticated. As to the situation in the UK, it has been stated that "If overweight and obese groups were combined, over two-thirds of men and over half of women were either overweight or obese in 2001." In the USA, it has been stated that "obesity underlies more than 300 000 deaths per year."1 Since this extent of obesity prevails in these highly economically favoured nations, the question arises : what hopes do those in less favoured countries have of being able to control the current world-wide obesity epidemic? In the initial contributions cited, it was stated that "desperate times call for desperate measures, and not just in the USA." In that country, one adverse factor is that "Americans spend about half of their food budget on meals and drinks consumed outside the home, and consume about a third of their daily energy in this manner."
The comparative in vitro activities of three quinolones against clinical Streptococcus pneumoniae isolatesSource: Southern African Journal of Epidemiology and Infection 21, pp 37 –40 (2006)More Less
Upper and lower respiratory tract infections are increasingly being treated with fluoroquinolones. Unfortunately these agents are not always utilised in an appropriate manner, i.e. in patients allergic to first line agents or where they have failed, or in patients infected with a resistant strain, etc. Their broad spectrum, that includes atypical pathogens, makes them an all too often popular, albeit an inappropriate, first line choice.
Resistance to β-lactams, and reduced susceptibility to carbapenems, in clinical isolates of Klebsiella pneumoniae due to interplay between CTX-M-15 and altered outer membrane permeabilitySource: Southern African Journal of Epidemiology and Infection 21, pp 41 –44 (2006)More Less
Klebsiella pneumoniae strains resistant to cefotaxime, ceftazidime and cefepime, but susceptible to imipenem and meropenem, were isolated from blood samples from two patients. Following treatment with meropenem, K. pneumoniae strains with reduced susceptibilities to imipenem and meropenem were isolated from the patients' stools. PCR assays and DNA sequencing showed that all the strains contain blaCTX-M-15. SDS-PAGE analysis of the outer membrane proteins did not identify OmpK35 and OmpK36 in any of the strains. The carbapenem susceptible strains were OmpK37 sufficient; however, this protein was not apparent in the strains with reduced susceptibility to carbapenems. It was concluded that resistance to extended spectrum β-lactams in the K. pneumoniae strains was due to the production of CTX-M-15, and reduced susceptibility to carbapenems was attributed to a combination of CTX-M and altered outer membrane permeability.
Source: Southern African Journal of Epidemiology and Infection 21, pp 45 –47 (2006)More Less
Diarrhoea and HIV are two of the biggest public health problems in children in Africa. Various patient characteristics namely; socio-demographic/-economic, clinical, health-seeking behaviour, and feeding practices were compared in children with diarrhoea who were HIV-infected, HIV-exposed or HIV-negative. Data were collected prospectively for the period April 2002 - April 2003 on children >6 weeks and <2 years old admitted to the Diarrhoeal Rehydration Unit at the Red Cross War Memorial Children's Hospital. Of the 350 patients enrolled, HIV status was known for 135 (38.6%) : 27 (20%) were HIV-infected, 47 (34.8%) were HIV-exposed and the remainder HIV-negative. No significant differences were found between the three groups for any of the socio-demographic or socio-economic determinants analysed. A significant difference (p=0.048) was observed between groups for health-seeking behaviour with more HIV-infected patients (29.6%) having sought a traditional healer before allopathic care. HIV-infected patients had more recurrent diarrhoea (p=0.001), were more often severely malnourished (p=0.002), were transferred more often to a long stay ward for prolonged care (p<0.001) and were less likely to be breastfed (p=0.005). The association with HIV-infected patients and seeking a traditional healer for healthcare could be due to a wide range of socio-cultural confounders, and requires further exploration.
Impact of cooking and heating fuel use on acute respiratory health of preschool children in South AfricaSource: Southern African Journal of Epidemiology and Infection 21, pp 48 –54 (2006)More Less
Dependence on polluting fuels (wood, coal, crop residues, animal dung, paraffin) for cooking and heating exposes countless women and young children in developing countries to elevated air pollution concentration indoors. This study explored the connection between polluting fuel use for cooking and heating with childhood (<5 years) acute lower respiratory infections (LRIs) in South Africa. Analysis is based on data from 4 679 children living in 2 651 households collected during the 1998 South African Demographic and Health Survey. Cases were defined as those who experienced cough accompanied by short, rapid breathing during the two weeks prior to the survey. Logistic regression was applied to estimate the odds of suffering from acute LRI among children from households using polluting fuels in combination with electricity or liquid petroleum gas/natural gas for cooking and heating relative to those using electricity or liquid petroleum gas/natural gas exclusively, after controlling for potentially confounding factors. Two-thirds of children lived in households using polluting fuels. Nineteen percent suffered from acute LRI. After adjustment, children in households using polluting fuels in combination with electricity or liquid petroleum gas/natural gas for cooking and heating were 27% more likely to have an acute LRI event than children from households using cleaner fuels exclusively (OR 1.27; 95% CI : 1.05-1.55). Although there is potential for residual confounding despite adjustment, international evidence on indoor air pollution and acute LRIs suggests that this association may be real. As nearly half of households in South Africa still rely on polluting fuels, the attributable risk arising from this association, if confirmed, could be substantial. It is trusted that more detailed analytical intervention studies will scrutinise these results in order to develop integrated intervention programmes to reduce children's exposure to air pollution emanating from cooking and heating fuels.
Source: Southern African Journal of Epidemiology and Infection 21, pp 55 –67 (2006)More Less
The design of the school-based Parasite Control Programme (referred to below as a helminth control programme) run in the province of KwaZulu-Natal, South Africa, from 1997-2000 is described. Emphasis is given to the role of the Parasite Control Task Group which provided a forum for a wide variety of issues relating to the programme to be debated before they were agreed upon. The programme targeted the three common geohelminths (Trichuris trichiura, Ascaris lumbricoides and hookworm) and the urinary schistosomiasis (bilharzia) fluke, Schistosoma haematobium. It is expected that a national control programme will be set up in South Africa in the future. With this in mind, new opinions and experiences in several aspects of helminth control that have become available since 2000 are included so that they can be considered for any future programme.
Author K.R.L. HuddleSource: Southern African Journal of Epidemiology and Infection 21 (2006)More Less
Editors' note : this slightly edited content of a speech given by Professor Ken Huddle at the launch of the book Asher's Anthology at the Adler Museum of Medicine on 4 November 2004 serves as an obituary to the late Professor Asher Dubb. We thought it a moving tribute to Asher Dubb who died on 1 January 2005.