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- Southern African Journal of Epidemiology and Infection
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- Volume 22, Issue 1, 2007
Southern African Journal of Epidemiology and Infection - Volume 22, Issue 1, 2007
Volume 22, Issue 1, 2007
Author Adrian J. BrinkSource: Southern African Journal of Epidemiology and Infection 22, pp 2 –4 (2007)More Less
ß-lactamase enzymes can be broadly divided into those with a serine residue at the active site and metallo-enzymes utilising zinc as a co-factor. Both are ancient enzymes with the former from their current sequence diversity, estimated to have evolved over the past two billion years. Since ß-lactams have been used in the clinical setting, ß-lactamases have coevolved along with each new antibiotic development. Initially penicillinase-producing Staphylococcus aureus and Neisseria gonorrhoeae and subsequently broader spectrum enzymes such as the extended-spectrum ß-lactamases (ESBLs) and the carbapenem-hydrolysing ß-lactamases (carbapenemases) produced in response to the introduction of cephalosporins and carbapenems, have appeared. Currently, over 400 different types of clinically relevant ß-lactamases have been described (www.lahey.org/studies/webt.htm) but the ESBLs have probably had a greater impact than any other group.
Diversity of bla-type genes in extended-spectrum ß-lactamase-producing Klebsiella pneumoniae isolated during 2003 - 2004 at Pretoria Academic HospitalSource: Southern African Journal of Epidemiology and Infection 22, pp 5 –7 (2007)More Less
Multidrug resistance is emerging in many Gram-negative bacteria like Klebsiella pneumoniae, an important cause of nosocomial infections. Increasing production of extended-spectrum beta-lactamases (ESBLs) in this species has become a growing concern, due to associations with longer duration of hospital stay and greater healthcare costs. A few studies have investigated ESBL production in bacterial isolates collected in Africa but only one included K. pneumoniae. The aim of this study was to determine the prevalence of the ß-lactamases TEM, SHV and CTX-M detected in K. pneumoniae isolated from patients with nosocomial infections at Pretoria Academic Hospital. Fifty K. pneumoniae isolates obtained from blood cultures reported to be resistant to one or more oxyimino-cephalosporins were examined. Detection of sequences coding for blaTEM, blaSHV and blaCTXM were performed with genomic DNA extracted from all isolates. Polymerase chain reaction (PCR) amplification of target DNA was performed and the resulting gel-electrophoresis patterns examined. TEM- and SHV-type ß-lactamases represented 10 and 18%, respectively, in isolates analysed. Isolates that tested negative for both TEM- and SHV-type ß-lactamases comprised 6% of the study population. None of the 50 isolates examined, were positive for blaCTX-M.
Admission trends of adult TB patients at one of the largest tuberculosis hospitals in South Africa : from 2001 to 2003Source: Southern African Journal of Epidemiology and Infection 22, pp 8 –12 (2007)More Less
This study describes the epidemiology, clinical pattern and treatment outcomes of tuberculosis (TB) among adult patients in Gauteng. The main objective was to describe the admission trends of TB among new adult patients at the Charles Hurwitz Santa TB Rehabilitation Centre in Soweto from 2001 to 2003. This is the largest TB hospital in South Africa. A retrospective review of 4148 patient records was carried out. This represented 99.8% of all new adult patients admitted during the study period. Data were collected from the hospital TB registers. The study revealed that the gender ratio of admission was 1.6 : 1 (M : F). TB admissions increased significantly from 2001 to 2003 and HIV co-infection was shown to be a strong contributory factor to this increase. The overall case fatality rate was 27%. The study showed that the risk factors of mortality among TB patients were the female gender, HIV co-infection, sputum negative TB, increasing age and poor treatment compliance (from patients who had previously defaulted from treatment). Despite the high rate of TB admission and mortality, the study revealed a low rate (4%) of treatment interruption and a high rate (85%) of sputum conversion after an average of nine weeks of treatment. Recommendations that would improve the care of TB patients and enhance TB control include routine HIV testing, the introduction of TB support groups, the integration of TB and HIV treatment and education programmes. Special attention should be paid to young female patients, the elderly, patients with extra-pulmonary TB and those that are sputum negative.
Role and contribution of private healthcare sector doctors in the management of HIV-infected patients in the eThekwini Metropolitan area of KwaZulu-NatalSource: Southern African Journal of Epidemiology and Infection 22, pp 13 –17 (2007)More Less
Private healthcare sector doctors have a pivotal role to play in the management of HIV and AIDS infection. These doctors need to have an accurate knowledge of the management of the infection, and a positive attitude towards the treatment of persons with HIV and AIDS. This study investigated the extent of private healthcare sector doctor involvement in the management of HIV and AIDS patients and their training needs. Across sectional descriptive study of private general practitioners and specialists was undertaken in the eThekwini Metro of KwaZulu-Natal. Structured self-report questionnaires were sent to 931 private healthcare sector doctors. Of the 331 (35.6%) responses received, three doctors did not complete the questionnaire, 235 (71.6%) doctors managed HIV and AIDS patients, but 93 (28.4%) doctors did not; of these, 48 (51.61%) had not encountered HIV and AIDS patients, 25 (26.88%) referred such patients to specialists, six (6.45%) cited cost factors as reasons for not treating such patients, whilst 12 (12.90%) doctors, though they indicated that there were other reasons for not managing HIV-infected patients, did not specify the reason. Two doctors (2.15%) indicated that due to inadequate knowledge they did not manage HIV and AIDS patients. Most doctors, 151 (63.5%), managed between 1-20 patients, whilst 19 (8%) managed more than 200 patients. The mean number of years since doctors had qualified was 22.02 (SD 10.58). Significantly more younger (recently qualified) doctors than older (qualified more years) doctors treated HIV/AIDS patients (p<0.001). Most doctors (76.3%) expressed a need for more training/knowledge on the management of HIV patients in areas such as overall HIV care (59%), antiretroviral therapy (53%), side effect management (39%) and therapeutic monitoring (35%); 194 (62.2%) doctors indicated their willingness to participate in a post graduate diploma in HIV and AIDS management. These results suggest that increased private sector doctor involvement in the treatment of HIV/AIDS patients needs to be facilitated. Addressing doctors' training needs could contribute to achieving this.
Source: Southern African Journal of Epidemiology and Infection 22, pp 18 –22 (2007)More Less
Bartholin's gland abscess of the female genital tract is fairly common in South Africa. Relatively few studies on the aetiology of this condition had been conducted before 1992 and even fewer after this date. Early literature suggested that Neisseria gonorrhoeae was the main cause of Bartholin's gland abscesses but it was subsequently shown that the majority of these abscesses had a polymicrobial aetiology with anaerobic bacteria featuring prominently. The study described here was conducted in 1992 and was designed to determine the aetiology of Bartholin's gland abscess in Johannesburg women admitted to the Hillbrow Hospital and at the same time establish the prevalence of genital pathogens in the endocervical canal of these women. Well established techniques were used for the culture of gonococci, Chlamydia trachomatis, mycoplasmas and other aerobic and anaerobic bacteria from properly collected pus aspirates from abscesses and endocervical swabs. Potential pathogens were found in 21 out of 33 aspirates. N. gonorrhoeae was isolated from four abscesses, two of which were in pure culture, while gonococci were also recovered from five endocervical swabs. C. trachomatis could only be isolated from one endocervical swab but not from any of the abscesses. Anaerobic bacteria were recovered in mixed culture from abscesses of nine patients and were the most common organisms found in pus aspirates. Mycoplasmas, including ureaplasmas, featured prominently. Pyogenic streptococci and staphylococci, as well as Escherichia coli and other Gram-negative bacilli were also found in abscesses while the anaerobic bacterium Fusobacterium nucleatum and the aerobic bacillus Brevundimonas vesicularis were each isolated in pure culture from an abscess of two different patients. This study confirms the polymicrobial aetiology of Bartholin's gland abscesses while pyogenic anaerobic and aerobic bacteria, the gonococcus and mycoplasmas were the predominant pathogens.
The association between HIV testing and sexual behaviour amongst rural Zulu high school students in KwaZulu-Natal, South AfricaSource: Southern African Journal of Epidemiology and Infection 22, pp 23 –29 (2007)More Less
This cross-sectional study investigated the prevalence of HIV testing amongst South African high school students, their perceptions about HIV testing, and the influence of HIV testing on their sexual behaviour. Grade 10 students at 28 high schools completed a questionnaire based on the I-Change Model. Of 1,192 students, 57 (4.8%) had been tested for HIV. More tested students knew a person with HIV/AIDS (p<0.005), knew other people who had been tested (p<0.005), perceived support from family (p<0.005) and friends (p=0.003), and reported self-efficacy and further intentions to be tested (p<0.005). HIV counselling and testing can promote prevention messages to reduce the prevalence of HIV infection amongst HIV-seronegative people, and decrease transmission amongst those HIV-seropositive. Early diagnosis and care can improve outcomes for HIV/AIDS. Encouraging HIV testing among school students may contribute to a reduction in HIV incidence and persuade students to reduce risky sexual behaviour.