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- Volume 23, Issue 3, 2008
Southern African Journal of Epidemiology and Infection - Volume 23, Issue 3, 2008
Volume 23, Issue 3, 2008
The Southern African Society for Paediatric Infectious Diseases - getting together for children : editorialSource: Southern African Journal of Epidemiology and Infection 23 (2008)More Less
A disproportionately large burden of mortality in children under 5 years of age occurs in Africa. African children comprise only 18% of the global population, yet contribute 35-40% of mortality. Infections are the most important cause of childhood mortality in Africa. Therefore, infectious diseases are a major component of any healthcare practitioner's work in caring for children in Africa. To address advances in prevention, diagnosis, and care and emerging complexities associated with HIV and tuberculosis, the Southern African Society for Paediatric Infectious Diseases (SASPID) was established on 31st May 2008 at the biennial congress of the South African Paediatric Association.
Antibiotic synergy profiles of multidrug-resistant Pseudomonas aeruginosa in a nosocomial environment : original researchSource: Southern African Journal of Epidemiology and Infection 23, pp 7 –9 (2008)More Less
Pseudomonas aeruginosa is one of the most common nosocomial pathogens in intensive care units (ICUs), with an increased prevalence of multidrug resistance in nosocomial infections. This study aimed to determine antibiotic synergy profiles of multidrug-resistant P. aeruginosa originating from ICU patients in a teaching hospital in Pretoria, South Africa. Susceptibility studies and in vitro synergy testing were performed, utilising agar dilution and Etest methodology, respectively. Susceptibility studies revealed 94% of isolates exhibiting resistance to more than three anti-pseudomonal agents tested. Results from antibiotic synergy studies suggested that cefepime (p<0.0001) or meropenem (p<0.0001) in combination with amikacin are possible treatment options available in this specific setting.
Molecular characterisation of resistant Mycobacterium tuberculosis isolates from Dr George Mukhari Hospital, Pretoria, South Africa : original researchSource: Southern African Journal of Epidemiology and Infection 23, pp 11 –14 (2008)More Less
Drug-resistant tuberculosis is a serious problem throughout the world. Resistance to rifampicin (RIF) and isoniazid (INH) is due to mutations in the rpoB and katG genes, respectively. The distribution of rpoB and katG gene mutations in RIF- and INH-resistant clinical Mycobacterium tuberculosis (MTB) isolates from Dr George Mukhari Hospital, Garankuwa, South Africa was determined. The rpoB and katG genes were amplified using PCR and sequenced. Among the 240 resistant MTB isolates obtained, 143/240 (59.6%) were multidrug-resistant (MDR), defined as resistance to INH and RIF, 44/240 (18.3%) were resistant to INH and 4.6% (11/240) to RIF while 17.5% (42/240) isolates were resistant to a combination of drugs. A total of 67.1% (161/240) isolates had mutations in the rpoB region. The most frequent mutations encountered were at codon 516 GAC to GTC 42.2% (68/161), codon 526 CAC to GAC 37.3% (60/161), and the least, at codon 531 TCG to TTG 0.6% (1/161). Codon 315 in the katG gene showed mutations in 70% (168/240) isolates resistant to INH. Of these, 58.3% (98/168) isolates showed a mutational change from AGC to ACC, 23.8% (40/168) from AGC to AAC, AGC to ATC in 10.1% (17/168), AGC to CGC in 4.8% (8/168) and AGC to ACA 3% (5/168) while mutations in codon 314 contributed 9.6% (20/209) with the change from ACC to CCC. This study provided information on the genetic diversity of multidrug-resistant MTB strains as well as the effects it can take on the clinical management of patients.
Source: Southern African Journal of Epidemiology and Infection 23, pp 15 –16 (2008)More Less
A 28-year-old HIV-seropositive man presented to clinic with a four-month history of a rash on his right lower limb. The rash began as painless macules which formed nodules and coalesced (Figure a). Over the last month, new skin lesions had formed on his torso (Figure b) and a painful lesion of his tongue (Figure c) had increased in size, making speech difficult. His chest x-ray was unremarkable and there was no clinical or radiological evidence of organomegaly. A recent CD4 count was 15 cells/µL and he was antiretroviral naïve.
An unusual case of fatal gastrointestinal Rhizopus oryzae infection in a diabetic patient : case reportSource: Southern African Journal of Epidemiology and Infection 23, pp 18 –20 (2008)More Less
Zygomycoses (mucormycoses) are rare, angiotropic infections caused by fungi in the class Zygomycetes of the order Mucorales. This paper reports a case of a mildly obese patient with uncontrolled type 2 diabetes mellitus who was admitted with symptoms of sinusitis. At admission she presented with a hyperosmolar, non-ketotic coma and metabolic acidosis. Six days after admission, following a cardiac arrest, the patient was transferred to the multi-disciplinary intensive care unit. She initially had a low Glascow coma scale. Computerised tomography of the brain and nasopharyngeal lavages showed no signs of mucormycosis or brain abscess and sinusitis was confirmed. Gastroscopy and laparotomy revealed disseminated necrosis and infiltrates of the gastrointestinal tract which was confirmed as mucormycosis by microbiological and histological investigations. This extensive gastrointestinal and multi-organ invasion resulted in demise of the patient 12 days after admission.
Author P. VincentSource: Southern African Journal of Epidemiology and Infection 23, pp 22 –26 (2008)More Less
Thanks to the relative ease of modern travel, more and more immunocompromised people are able to travel for pleasure, business, and visiting friends and relatives in all corners of the world. They represent a very important group of travellers due to two main additional risk factors: they have a greater risk of becoming ill with travel-related diseases and they may experience an exacerbation or complication of their underlying disease. International travel is feasible in most cases, but occasionally itineraries may need to be modified or additional recommendations given to make trips safer and therefore more enjoyable. The medical advisor must ensure that the traveller understands the risks involved in the proposed itinerary, based on his/her medical needs and tolerance for the risks of the proposed interventions.
Author F. GuidozziSource: Southern African Journal of Epidemiology and Infection 23, pp 29 –31 (2008)More Less
Author A.D. BlackSource: Southern African Journal of Epidemiology and Infection 23, pp 34 –38 (2008)More Less
Community-acquired pneumonia (CAP) is a common clinical presentation in general practice. The prevalence and burden of disease caused by the atypical bacteria (Mycoplasma pneumoniae, Chlamydophila pneumoniae and Legionella pneumophila) are not well defined in South Africa. Each of the atypical bacteria is discussed individually with regard to clinical presentation, diagnosis and treatment. A unified approach to CAP and its management is discussed.
Author E. PrenticeSource: Southern African Journal of Epidemiology and Infection 23, pp 43 –44 (2008)More Less
Since the time of the first recorded medical texts, it seems to me that medicine from whatever tradition has made believing 'impossible things' one of its most important areas of practice. Of the model of medicine dominant in most of the world today I think it's fair to say that up until the 17th century this practice was indeed based on belief in the strict sense. However, with the arrival of new ways of questioning that marks this time as revolutionary to many modern thinkers, medical belief especially, began to be tested. Many beliefs were thus elevated to facts. This, however, would not have been possible without new instruments enabling new ways of seeing the human body: Vesalius used the newly secular scalpel; Harvey used the simple ligature, and a Dutch draper, one Antoni van Leeuwenhoek, used the microscope.
Epidemiology : A Research Manual for South Africa 2nd edition, Gina Joubert and Rodney Ehrlich (Eds.) : book reviewAuthor Shan NaidooSource: Southern African Journal of Epidemiology and Infection 23 (2008)More Less
The foreword by Mervyn Susser and Zena Stein introduces the manual quite succinctly as follows : "The second edition of this book continues the mode of the first, being self contained, systematic, and wherever possible, South Africa-based". This is its strength in that it has built on the success of the first edition and has relevant new chapters as well as pertinent South African information.