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- Volume 24, Issue 3, 2009
Southern African Journal of Epidemiology and Infection - Volume 24, Issue 3, 2009
Volume 24, Issue 3, 2009
The 3rd Joint FIDSSA Congress, 20-23 August 2009, Sun City, North West Province, South Africa : editorialAuthor Adrian BrinkSource: Southern African Journal of Epidemiology and Infection 24 (2009)More Less
Globally, infectious diseases constitute the single largest burden of illness afflicting mankind, especially in poorer regions of the world. The current and potential future impact of HIV / AIDS, tuberculosis, and of novel, emerging and re-emerging infectious diseases, as well as the critical need to prevent these infections, necessitates an integrated approach towards infectious diseases in southern Africa.
Author M.J. AbzugSource: Southern African Journal of Epidemiology and Infection 24, pp 5 –8 (2009)More Less
Large regional epidemics of enterovirus 71 disease have occurred in Asia and other parts of the world since the late 1990s, primarily affecting young children. Manifestations range from benign hand-foot-disease and herpangina to neurological disease that includes meningitis, brainstem encephalitis, and acute flaccid paralysis. Cardiopulmonary complications, including pulmonary oedema, pulmonary haemorrhage, interstitial pneumonitis, and cardiopulmonary collapse, occur in a subset of children with brainstem encephalitis, associated with rapid clinical decompensation and high mortality rates, and, among survivors, frequent neurological and neurodevelopmental sequelae. Virological diagnosis is primarily based on nucleic acid amplification or viral culture of peripheral specimens such as throat and rectal swabs and vesicular fluid, rather than of cerebrospinal fluid, which has a relatively low yield. Treatment is primarily supportive. Development of candidate antiviral compounds and vaccines is being actively pursued.
Author A.D. HarriesSource: Southern African Journal of Epidemiology and Infection 24, pp 10 –12 (2009)More Less
HIV-infected patients with tuberculosis (TB) have much higher case fatality rates compared with non-HIV-infected patients. There are various reasons for this high mortality that include delayed presentation and advanced TB at the time of diagnosis, incorrect diagnosis of smearnegative TB and HIV-related diseases. More attention must be paid to reducing the time from symptoms to diagnosis of TB, ensuring as far as possible that the diagnosis of TB is correct and administering rifampicin-throughout anti-tuberculosis treatment. In high HIV prevalence areas, all TB patients should routinely be offered HIV testing as this is the gateway to cotrimoxazole preventive therapy and antiretroviral therapy, both of which will reduce case fatality if started soon enough. Despite severe malnutrition often being present in HIV-infected TB patients, two randomised controlled trials have demonstrated no effect of nutritional supplements in reducing case fatality. The jury is still out about whether adjunctive corticosteroids have a significant benefit or not. Finally, it is important to reliably monitor treatment outcomes and to recognise that significant unreported mortality lies hidden in treatment categories such as default and transfer out.
Source: Southern African Journal of Epidemiology and Infection 24, pp 16 –52 (2009)More Less
Childhood tuberculosis guidelines of the Southern African Society for Paediatric Infectious Diseases : guidelinesAuthor David P. MooreSource: Southern African Journal of Epidemiology and Infection 24, pp 57 –68 (2009)More Less
The World Health Organization has led the way in terms of guiding global policy in the management of children with suspected and / or confirmed tuberculosis (TB), through the publication in 2006 of its 'Guidance for national tuberculosis programmes on the management of tuberculosis in children'. National policy documents in settings with a high TB burden may not comply with these latest management strategies. This document, formulated on behalf of the Southern African Society for Paediatric Infectious Diseases, sets out to inform healthcare workers in southern Africa about the latest policies with regard the management of children with suspected TB in the region, in order to streamline case management according to current evidence and practice. As such, its main objectives are to raise awareness about the burden of childhood TB in the region, to intensify case finding and to conform management according to common, contemporary practice which will hopefully benefit childhood TB outcomes.