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- Volume 25, Issue 3, 2010
Southern African Journal of Epidemiology and Infection - Volume 25, Issue 3, 2010
Volume 25, Issue 3, 2010
Source: Southern African Journal of Epidemiology and Infection 25, pp 1 –4 (2010)More Less
Travel Health Africa : bridging the gap between research and reality
Margaretha Isaacson Memorial Lecture : "Immunisation - a question of equity?"
Barriers to childhood vaccination
High-altitude travel : possible problems and preparation
Severe Plasmodium falciparum malaria : the rationale for a multidisciplinary approach in an ICU setting
Vaccines on the African horizon
Yellow fever vaccine uptake in private travel clinics in South Africa
Urban search and rescue travel medicine : the Haiti earthquake mission
Re-emerging threat of cholera in Africa
Author Charles FeldmanSource: Southern African Journal of Epidemiology and Infection 25, pp 3 –4 (2010)More Less
The year 2010 has been designated the "Year of the Lung", led by initiatives from the American Thoracic Society (ATS) and the Forum of International Respiratory Societies (FIRS). The public health campaign was officially launched at the 40th Union World Conference on Lung Health in Cancun, Mexico on 5 December 2009. The FIRS partners, besides the ATS, include the International Union Against Tuberculosis and Lung Disease (The Union), the Asian Pacific Society of Respirology (APSR), the Asociacion Latinoamericana de Torax (ALAT), the European Respiratory Society (ERS), the Pan African Thoracic Society (PATS), and the American College of Chest Physicians (ACCP). The main aims of the campaign are to raise public awareness about the importance of lung health, to initiate action among communities around the world, and to advocate for resources to combat lung diseases, including resources for research and research training. The campaign was convened because of recognition that the lungs have been neglected for too long in public discourse. This lack of awareness is a barrier to progress in diagnosis, treatment and care of patients suffering from lung diseases.
Source: Southern African Journal of Epidemiology and Infection 25, pp 5 –9 (2010)More Less
Herpes simplex viruses (HSVs) are ubiquitous in humans and infection with HSV produces a diverse spectrum of disease. The vast majority of HSV infections in adults are easily recognised and relatively benign in their clinical manifestation but occasionally life-threatening infections involving viscera and the central nervous system can occur. Genital HSV-2 is the most common sexually transmitted infection worldwide and increases the risk of HIV infection. Suppressive antiherpes therapy, despite being effective in reducing genital ulcer recurrence, does not reduce the risk of HIV transmission. Molecular diagnostic tools have revolutionised our ability to diagnose infections involving the central nervous system and disseminated visceral disease accurately and, with the availability of relatively safe and effective antiviral therapy, potentially fatal outcomes can be averted if treatment is instituted early.
Antimicrobial susceptibility patterns of gonococcal isolates in Pretoria, South Africa, over a 20-year period (1984-2004) : original researchSource: Southern African Journal of Epidemiology and Infection 25, pp 10 –13 (2010)More Less
This paper reviews the susceptibility profiles of Neisseria gonorrhoeae over a 20-year period in the Pretoria region. Endourethral specimens were collected from adult men with symptoms of urethritis attending primary health care clinics and private medical practitioners. These swabs were plated on enriched media for isolation of N. gonorrhoeae. Antimicrobial susceptibility of the organisms was performed using the disc diffusion and agar dilution methods. Plasmid analyses were performed on beta-lactamase-producing isolates. Penicillase-producing N. gonorrhoeae strains increased from 4% to 16%, whilst chromosomally mediated penicillin-resistant strains increased dramatically from 0% to 16% from 1984 to 2004. There was an equal distribution of the 3.2 MDa African and 4.4 MDa Asian plasmids. High-level tetracycline-resistant strains (36%) were detected for the first time in 2004. Ciprofloxacin resistance emerged at 7% in the same year. Gonococcal isolates remained susceptible to cefoxitin, ceftriaxone, cefpodoxime, and spectinomycin. However, the minimum inhibitory concentration values for spectinomycin were very close to the breakpoint. We have shown a continuing increase in resistance to penicillin (plasmid and chromosomal), the emergence of high-level tetracycline resistance and an emergence of resistance to ciprofloxacin. Susceptibility testing is essential for successful therapeutic outcomes and needs to be performed in an ongoing basis.
Source: Southern African Journal of Epidemiology and Infection 25, pp 16 –20 (2010)More Less
The provincial health budgets in South Africa are under enormous pressure and, annually, budgets are exceeded by most hospitals and clinics. Laboratory tests requested by clinicians are contributing to the problem of over-expenditure. The aim of this study was to determine from patients' files whether doctors were using laboratory tests prudently during their treatment of patients in the outpatient department (OPD) of the National District Hospital in Bloemfontein. A descriptive study was carried out using all the files of patients who visited the OPD in a three-month period (1 July to 30 September 2005) for whom laboratory tests were requested by the attending physician. The majority (31.3%) of patients for whom laboratory tests were requested presented to the OPD with cardiovascular complaints or diagnoses, followed by endocrine (27.8%) and musculoskeletal (16.3%) complaints or diagnoses. Between one and three tests were requested for most patients, i.e. 33% and 15%, respectively. The most frequently requested tests were erythrocyte sedimentation rate (8.1%), urea and electrolytes (7.7%), urine microscopy, culture and sensitivity (6.4%), cholesterol (6.1%), full blood count (5.7%) and thyroid profile (TSH 4.6%, T4 2.6% and thyroid functions 2.3%). In 70.4% of cases, results were documented and, in 59.1%, the physician's management plans indicated the incorporation of laboratory test results into the patient's treatment regimen. Our findings indicated inappropriate documentation and application of test results. Interventions to improve physician behaviour include education, guidelines, feedback, leadership and redesign of requisition forms.
Evaluating antibiotic use in a secondary level hospital neonatal unit in the Western Cape, South Africa : original researchSource: Southern African Journal of Epidemiology and Infection 25, pp 21 –25 (2010)More Less
Perinatal infection significantly contributes to neonatal morbidity and mortality. There are no reliable rapid diagnostic tests. Drug resistance is increasing in organisms acquired in hospital. There are little data on the indications for antibiotic use and the prevalent organisms in lower resource settings, and none in regional hospitals in South Africa. We conducted a retrospective cohort study of risk factors, indications for and drugs used at Worcester Provincial Hospital Neonatal Unit. A systematic sample of every alternate neonate listed in the admissions register from 1 July 2005 to 30 June 2006 was taken. Charts for all cases were reviewed. Early antibiotic use was defined as therapy within 72 hours of life. One hundred and ninety-five infants where included; 144 (74%) had 194 antibiotic events. Antibiotic events occurred at a rate of 99 events per 100 neonates. Prematurity was common (83% of admissions) and, in conjunction with prolonged rupture of membranes, was the major driver of early antibiotic use. Ceftriaxone use within 72 hours of birth was significantly associated with subsequent antibiotic events, compared with penicillin alone or in combination with an aminoglycoside (p<0.04). Longer duration of treatment for early events was associated with subsequent empiric need for antibiotics (p<0.02). Prematurity is the major driver for antibiotic use at this unit. Antibiotics are prescribed appropriately but earlier discontinuation, which may be complicated by the inability to confirm / refute infection, should be practised. Alternatives to third generation cephalosporins should be available to treat hospital infection at secondary level.
Rapid identification and susceptibility testing of Gram-negative bacilli from blood cultures using the Vitek® 2 system : original researchSource: Southern African Journal of Epidemiology and Infection 25, pp 28 –31 (2010)More Less
Providing rapid results for blood culture isolates is a critical function of clinical microbiology laboratories. This study evaluated the accuracy and turnaround time for identification and susceptibility testing of Gram-negative bacilli inoculated directly from positive blood cultures into the Vitek® 2 system. Direct inoculation was compared to conventional methods, which included biochemical tests, commercial identification systems and disc diffusion susceptibility testing. Two hundred and ninety-one of 327 isolates (89%) were correctly identified to at least genus level by the direct Vitek® method. Susceptibility test results were compared for 3,925 organism antibiotic combinations. The overall rate of categorical agreement of direct and conventional antimicrobial susceptibility testing was 92% with less than 3% very major and major errors combined. The mean turnaround time for identification and susceptibility testing was 7.5 hours (SD 3.0 hours) compared to a mean of 32.3 hours (SD 14.7 hours) for the conventional method. These results suggest that direct inoculation of the Vitek® 2 system from blood cultures provides accurate, reliable identification and antimicrobial susceptibility results for the majority of commonly occurring Gram-negative pathogens, while the significantly reduced turnaround time should benefit patients and permit earlier rationalisation of antibiotic therapy, with a reduction in the use of broad spectrum antibiotics. A suggested protocol for routine use is included.
Spatial epidemiology risk assessment for rehabilitated former asbestos mining areas in Limpopo Province, South Africa, using remote sensing and conventional analytical methods : original researchSource: Southern African Journal of Epidemiology and Infection 25, pp 32 –39 (2010)More Less
The aim of this study was to conduct a comparative analysis using remote sensing and conventional sample analysis to assess asbestos pollution in rehabilitated former asbestos mining areas. The study focused on the Mafefe and Mathabatha areas of Limpopo Province, South Africa. Field-based remote sensing techniques were used to spectrally differentiate various types of asbestos minerals in order to determine their efficacy in assessing asbestos pollution. X-ray diffraction and scanning electron microscopy were employed for the identification and characterisation of traces of asbestos minerals in soil and water samples collected from the rehabilitated areas. The samples were also examined using in situ remote sensing. An Analytical Spectral Devices field spectrometer was used for spectral analysis of asbestos minerals and that of soil and water samples to compare and validate reflectance spectroscopy findings with laboratory results. Results show that in situ remote sensing techniques are able to reveal traces of asbestos minerals on rehabilitated dry surface areas, suggesting that they can play a significant role in monitoring the distribution of the asbestos minerals for epidemiological risk assessment. However, the spectral characteristics of asbestos minerals in the water medium were not as distinct as compared to laboratory methods. Overall, the results show potential for using remote sensing techniques in spatial epidemiology studies.
Secondarily infected syphilitic aortic arch aneurysm in a patient on chronic renal dialysis with fatal haemoptysis : case studySource: Southern African Journal of Epidemiology and Infection 25, pp 41 –44 (2010)More Less
This paper reports a case study of a 45-year-old man with known chronic renal failure requiring haemodialysis, hypertension and ischaemic heart disease, who presented with a three-week history of dyspnoea, orthopnoea and a productive cough. He developed sudden onset chest pain and haemoptysis without associated back pain. He was treated for pneumonia and Staphylococcus aureus sepsis, which was confirmed with two separate blood cultures. Chest radiography revealed a widened mediastinum. Computed tomography of the chest confirmed a saccular aortic arch aneurysm. Serodiagnostic tests for syphilis were positive. The patient consequently died due to massive haemoptysis. Postmortem investigation showed a ruptured aortic arch aneurysm, surrounded by a large haematoma, bulging into the patient's left lung. The case reported here should serve as a reminder of the importance of adequate treatment of primary syphilis in order to reduce the incidence of tertiary syphilis often associated with grave complications.