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- Volume 27, Issue 1, 2012
Southern African Journal of Epidemiology and Infection - Volume 27, Issue 1, 2012
Volume 27, Issue 1, 2012
Source: Southern African Journal of Epidemiology and Infection 27, pp 5 –9 (2012)More Less
The true incidence of Legionella pneumophilia, Mycoplasma pneumoniae, Chlamydophila pneumoniae and Coxiella burnetti, the so-called atypical pathogens that cause adult community-acquired pneumonia in southern Africa, is unknown. Although there are a lack of community-based studies, hospital-based studies suggest that the incidence may be as high as 30% in patients admitted to, but not requiring, an intensive care unit. A lack of specific clinical features that differentiate atypical pathogens, plus the lack of reliable, simple diagnostics, compound the uncertainty regarding the contribution of atypical pathogens to the sum total of community-acquired pneumonia in southern Africa. Without reliable diagnostic tests, macrolide or azalide antibiotics are widely used for in-patients with pneumonia, potentially fuelling the rise of antibiotic resistance to macrolides in other bacteria.
Source: Southern African Journal of Epidemiology and Infection 27, pp 10 –14 (2012)More Less
The use of antiretrovirals (ARVs) in critically ill patients is complicated. Although there are no prospective trials that address timing of initiation of these drugs in ICU, retrospective studies and prospective studies in more stable patients suggest that early initiation of treatment in these patients is probably beneficial. However, use of these drugs in an intensive care population has problems related to ARV administration, toxicities, drug interactions, altered pharmacokinetics of the drugs and the immune reconstitution inflammatory syndrome, and initiation should be carefully weighed in each case. In addition to this, critically ill patients are often unable to give informed consent for HIV testing, or undergo appropriate counseling, which raises ethical issues, as well as problems related to post-ICU compliance with medications. This article summarises the evidence available for the use of ARVs in critically ill patients.
Source: Southern African Journal of Epidemiology and Infection 27, pp 16 –18 (2012)More Less
Yellow fever is a non-contagious, viral, multi-system syndrome, that causes an estimated 200 000 human infections annually, and has a high fatality rate. Yellow fever vaccination is one of the main methods of primary prevention. Although the yellow fever vaccine is largely considered to be safe, adverse events, which are sometimes life-threatening, can occur. This article explores the safety and tolerability of yellow fever vaccines.
Source: Southern African Journal of Epidemiology and Infection 27, pp 19 –23 (2012)More Less
In the medical setting, limited information is available on antimicrobial susceptibilities and resistance development in ureaplasmas. This study addresses tetracycline and doxycycline resistance in clinical isolates of Ureaplasma parvum and Ureaplasma urealyticum. Culture, with species polymerase chain reaction (PCR) confirmatory techniques, was applied to 191 endocervical specimens, collected during the period January - March 2006. Minimum inhibitory concentration (MIC) determinations were performed by microbroth dilution, with tetracycline resistance (tetM), and int-Tn genes were characterised by PCR and sequencing. Sixty-six ureaplasma cultures (35 U. parvum, 9 U. urealyticum, 22 U. parvum and U. urealyticum) were obtained. On screening the ureaplasma cultures, tetM gene regions were demonstrated from tetracycline-susceptible and -resistant ureaplasmas. Seven isolates (six U. parvum and one U. urealyticum) were resistant to tetracycline, with dual doxycycline resistance observed in three strains. Int-Tn gene characterisation of the seven tetracycline-resistant strains revealed that three types were present, indicating that transposons from different origins had integrated into ureaplasma genomes. TetM sequences of five tetracycline-resistant strains were seen to be highly mosaic in structure. The finding of transposon and / or tetM regions in all ureaplasma cultures investigated, with, or without, full expression of tetracycline resistance, in conjunction with tetM and int-Tn gene mosaic or diversity, verifies that ureaplasmas undergo extensive genetic exchange of transposon or resistance genes, with concomitant genomic remodelling.
Amphotericin B in the management of fungal infections in a neonatal intensive care unit : experiences in a teaching hospital : original researchSource: Southern African Journal of Epidemiology and Infection 27, pp 24 –29 (2012)More Less
Invasive systemic fungal infections have emerged as serious nosocomial threats to neonates in the neonatal intensive care unit (NICU). Candidaemia due to fluconazole-resistant Candida-krusei necessitated the use of amphotericin B in the NICU at Dr George Mukhari Hospital. The use of amphotericin B 1 mg/kg/dose in the first 20 patients was monitored. Response to treatment and side effects related to the use of amphotericin B in this population were documented and described. Nephrotoxicity, a common and well described side effect of amphotericin B, was not observed in this study - rather hepatotoxicity. To ensure uniformity in monitoring adverse effects, a monitoring tool has been developed for use in the NICU.
Risk factors for latent tuberculosis infection among healthcare workers in a university-affiliated hospital : original researchSource: Southern African Journal of Epidemiology and Infection 27, pp 30 –33 (2012)More Less
Healthcare workers represent an important risk group for exposure, infection, and potentially disease by Mycobacterium tuberculosis. The aim of this study was to assess the prevalence and risk factors for latent tuberculosis infection among healthcare workers in a teaching hospital. A cross-sectional study was conducted in 2009 at the Fatemieh Hospital, Semnan, Iran. Information about age, gender, occupation, history of BCG vaccination and duration of employment was obtained by a structured questionnaire. All subjects received a Mantoux tuberculin skin test. Induration of ≥10 mm was considered a positive test. A total of 180 healthcare workers (60.5% female, 39.5% male) were enrolled. Twenty-five (13.9%) had a positive skin test. History of BCG vaccination was detected in 159 (88.3%) of participants. In logistic regression analysis, employment for >five years (OR=4.10; 95% CI, 1.07-15.68) and for >10 years (OR=4.59; 95% CI, 1.45-14.59) was significantly associated with increased risk of a positive test. Age, gender, history of BCG vaccination and type of occupation were not significantly associated with a positive TST response. A low prevalence of latent tuberculosis infection was found among healthcare workers in this hospital. Longer duration of employment was significantly associated with increased risk of positive tuberculin skin test.
The use of blood transfusions in the obstetric unit of an academic hospital in South Africa : brief reportsSource: Southern African Journal of Epidemiology and Infection 27, pp 34 –36 (2012)More Less
Transfusions with blood products form an essential part of obstetric practice. A retrospective record review of all mothers (26) who received blood transfusions over a period of one month in May 2010 was performed at the Charlotte Maxeke Johannesburg Academic Hospital. Descriptive analysis was performed. Blood transfusion was commonly observed in women with late antenatal booking, human immunodeficiency virus positivity, multiparity, anaemia at first visit, and normal vaginal delivery. Iron supplementation usage was very poor in this group of women. The most common indication for transfusion was postpartum haemorrhage. These associated factors should be used to identify pregnant women at risk, so that timely and adequate treatment of anaemia may decrease the need for transfusion. Adequate care should also be given in the management of the third stage of labour, to prevent avoidable morbidities (postpartum haemorrhage, retained products of conception, and vaginal lacerations), leading to excessive blood loss and the need for transfusions.
Source: Southern African Journal of Epidemiology and Infection 27, pp 36 –38 (2012)More Less
Obesity is an epidemic that affects all age groups, including adolescents. Obesity studies on pregnant adolescents are few in number. This pilot study was conducted to determine the obesity prevalence and complications among pregnant South African adolescents. A retrospective review of 54 pregnant adolescents was carried out over a two-month period at the Charlotte Maxeke Johannesburg Academic Hospital. Adolescents were divided into different body mass index categories, and the data were compared. Descriptive statistics (mean and standard deviation, and median and interquartile range) and inferential statistics (unpaired t-test and analysis of variance) were analysed. Twenty-six per cent of the adolescents were obese. Six per cent of the adolescents were morbidly obese, and experienced greater pregnancy complications, such as post-dates pregnancies, preterm labour, pregnancy-induced hypertension, and induction of labour. Obesity among pregnant South African adolescents is common, and is associated with increased complications.
Author L. NkombuaSource: Southern African Journal of Epidemiology and Infection 27, pp 38 –39 (2012)More Less
Certain risk factors play an important role in a person's chances of developing heart disease. The more risk factors a person has, the greater the likelihood of developing heart disease. Proactively addressing the modifiable risk factors reduces the chances for a person to develop a cardiovascular disease or die from its complications. The author wished to establish the prevalence of the risk factors for cardiovascular diseases in workers at a district hospital. From September 2007 to the end of October 2007, workers were invited, on a voluntary basis, to know their 'numbers' (measured levels) as far as the risk for cardiac disease was concerned. A total of 108 participants were recruited. Among them, 6% had a random glucose of between 7.8 to 11.0 mmol/l and 3% had a random glucose of more than 11.1 mmol/l. Of the participants, 12% had stage 1 hypertension, 14 % had stage 2 hypertension and 3% had severe hypertension. Among the participants, 47 % had a body mass index above the norm, hence being at risk of heart disease; 88% did not engage in any form of physical exercises and 7.5% were active smokers. The survey clearly established that the workers employed at a district hospital had risk factors for heart disease. Some of them had established conditions such as diabetes mellitus, overweight and hypertension.
Pansinusitis in an HIV-infected patient due to Scedosporium apiospermum (Pseudallescheria boydii complex) : case report, Southern African Journal of Epidemiology and Infection, 26 (2) 2011 : pp. 88-89 : errataSource: Southern African Journal of Epidemiology and Infection 27 (2012)More Less