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- Volume 29, Issue 3, 2014
Southern African Journal of Infectious Diseases - Volume 29, Issue 3, 2014
Volume 29, Issue 3, 2014
Lest we forget, fungi are flourishing and fatal in man - and now the fear of resistance! : editorialAuthor Mervyn MerSource: Southern African Journal of Infectious Diseases 29, pp 95 –96 (2014)More Less
Fungal infections currently result in approximately 150 deaths globally every hour. Over several years, the number of patients with systemic fungal infections has increased substantially with resultant significant morbidity and mortality. This is in stark contrast to the 48 cases of invasive fungal infections described in the literature just 50 years ago! The recent escalation in the number of reports of antifungal drug resistance in Candida spp. is compounding this flourishing phenomenon.
Antifungal susceptibility profile of yeast isolates from sterile sites at a tertiary hospital in South Africa : original researchSource: Southern African Journal of Infectious Diseases 29, pp 97 –100 (2014)More Less
Invasive infections caused by yeasts are associated with high mortality and morbidity, and resistance to antifungal agents is increasing. Candida spp. has emerged as the leading cause of systemic nosocomial fungal infections. The aim of this study was to identify yeast isolates from sterile site specimens to species level, and to determine their susceptibility to fluconazole and voriconazole, at the National Health Laboratory, Service Dr George Mukhari Tertiary Laboratory from March to August 2007. Candida isolates were identified to species level using a germ tube test and/or Api® ID 32C kits. Antifungal susceptibility testing to fluconazole and voriconazole was performed using the disc diffusion method in accordance with the Clinical and Laboratory Standards Institute guidelines. All of the Candida isolates were from the neonatal intensive care unit (NICU), with the exception of two. The distribution of yeast isolates was as follows: C. krusei (41.9%), C. albicans (32.3%), C. inconspicua (5.5%), C. parapsilosis (2%), C. tropicalis (1.5%), C. sake (1.5%), C. lambica (1.5%), and C. valida (0.5%). Cryptococcus neoformans (11%), C. albidus (0.5%), Rhodotorula glutinis (1%), and C. humicola (0.5%) were also isolated. Of the isolated C. albicans, 61% were susceptible to fluconazole. A possible C. krusei outbreak could have occurred in the NICU during the study period. Voriconazole was the most susceptible antifungal agent to various yeast pathogens. The results of this study on azoles susceptibility testing of yeasts show that voriconazole may prove to be a valuable alternative antifungal agent in this tertiary hospital for the treatment of infections caused by yeasts, including Candida spp.
Low seroprevalence of antibodies to Toxoplasma gondii in blood donors in central Namibia : original researchSource: Southern African Journal of Infectious Diseases 29, pp 101 –104 (2014)More Less
Although emphasis has been placed on research relating to human immunodeficiency virus (HIV), tuberculosis and malaria, several researchers in Africa are focusing on other threats to human health, such as neglected tropical diseases. Toxoplasma gondii is a possible neglected tropical disease in Namibia, although the country has a diversity of climate, ranging from tropical in the north to semi-desert in the south. Except for one study in 1978, no recent studies have determined the burden of T. gondii infection in Namibia. Three hundred and twelve convenience samples were collected from volunteer blood donors in central Namibia. Donors provided informed consent to participate in the study, and 5 ml blood was collected. Demographic information was collected by means of a questionnaire. Serum was analysed using CaptiaT. gondii immunoglobulin G (Ig) G enzyme-linked immunosorbent assay (ELISA) kit. Only samples that tested positive or equivocal for IgG antibodies were then tested for IgM antibodies using CaptiaT. gondii IgM ELISA kit. Of the 312 samples, 3 (0.961%) tested positive for IgG antibodies to T. gondii. One sample (0.3%) tested positive for IgM antibodies to T. gondii. These donors lived in urban areas in central Namibia and interacted regularly with animals, such as cats and dogs. The prevalence of antibodies to T. gondii in Namibian blood donors was found to be considerably lower than that reported in other African countries, but comparable to that in a recent report from South Africa. It is notable that most of the donors lived in the arid central regions of Namibia, where the high altitude could also affect parasite survival.
Immune reconstitution in human immunodeficiency virus-positive patients on highly active antiretroviral therapy at an urban public sector district hospital : original researchSource: Southern African Journal of Infectious Diseases 29, pp 105 –109 (2014)More Less
Immune reconstitution is measured by circulating CD4 T cells that follows a biphasic pattern. Not everyone who is on highly active antiretroviral therapy (HAART) will attain immune reconstitution at the same rate, or to the same extent. This study aimed to describe the patterns of immune reconstitution in an urban public district hospital. A retrospective review of clinical files was performed on 354 patients who maintained virological suppression to < 50 copies/ml over three years, following the initiation of HAART. Changes in CD4 T-cell count were described using descriptive statistics. Non-parametric analysis was conducted. Ninety-four per cent (n = 334) of patients had a baseline CD4 count ≤ 200 cells/ul, while only 0.3% (n = 1) had a baseline > 350 cells/ul. The CD4 count increased from a median baseline of 92 cells/ul to 429 cells/ul over the three-year period. The CD4 count increased by 184 cells/ul, 72 cells/ul and 62 cells/ul in the first, second and third years, respectively. At the last determination, 37.3% (132) had a CD4 count ≥ 500 cells/ul and 6.8% (24) had a CD4 count < 200 cells/ul. Females had a statistically significant (p-value < 0.001) overall increase of 349 cells/ul, compared to the 273 cells/ul seen in males. Only 27.6% (53) of patients with a baseline CD4 cell count < 100 cells/ul were able to attain levels ≥ 500 cells/ul. Despite the good response to HAART, patients with a baseline CD4 cell count < 100 cells/ul were less likely to attain a normal CD4 count after three years of virological suppression on HAART than those with a higher baseline.
Source: Southern African Journal of Infectious Diseases 29, pp 110 –113 (2014)More Less
Well-child visits have been shown to be of benefit. In Nigeria, many children aged five years and younger do not receive any scheduled preventive healthcare services after the receipt of their last vaccination. This was a descriptive cross-sectional survey. Using an interviewer-administered questionnaire, the perception of mothers on well-child visits was determined. The respondents were mothers who brought their children for immunisation at the Child Welfare Clinic of the Institute of Child Health, University of Benin, Benin City, Nigeria. Almost all of the surveyed mothers 200/203 (98.5%) agreed that their children should regularly engage in well-child visits. Many of the 203 studied mothers 96 (47.3%) preferred monthly visits, while almost 60% wanted the visits to be scheduled outside of routine working hours. Most mothers 178 (87.7%) expected that their children's health would be ensured through screening for disease. 16.6% of the mothers indicated that they would be unwilling to pay for the service. Nigerian mothers consider well-child visits to be important. Success of their implementation depends on the flexibility of the schedule and the affordability of services.
Vancomycin versus teicoplanin in the treatment of serious Gram-positive infections : what do the minimum inhibitory concentration data tell us? : original researchAuthor W. LowmanSource: Southern African Journal of Infectious Diseases 29, pp 114 –117 (2014)More Less
Glycopeptides are the mainstay of treatment against serious drug-resistant Gram-positive infections. The two principal agents are vancomycin and teicoplanin. Optimal dosing of both these antimicrobial agents, in terms of clinical outcomes and achievement of pharmacodynamic targets, has been shown to be dependent on the minimum inhibitory concentration (MIC). There are no MIC susceptibility data for vancomycin and teicoplanin in South Africa, and susceptibility from a clinical perspective is usually considered to be a class-specific phenomenon, and thus the two agents are often used interchangeably. The aim of this study was to assess and compare the MIC of teicoplanin with that of vancomycin, using broth microdilution, against a number of clinically significant Gram-positive isolates. Staphylococci and enterococci were collected from the Charlotte Maxeke Johannesburg Academic Hospital. Broth microdilution antimicrobial susceptibility testing was performed simultaneously for both vancomycin and teicoplanin. MIC data were analysed using descriptive statistics (mean, mode, MIC50 and MIC90) and comparative assessment using Student's t-test and Spearman's rank correlation coefficient. Vancomycin and teicoplanin MIC distribution differed for both staphylococci (n = 100) and enterococci (n = 27). There was a significant difference between the mean MIC of vancomycin and teicoplanin for all isolate groups (p-value < 0.0001-0.0168). A non-significant positive and negative correlation was noted between vancomycin and teicoplanin MIC for all of the isolates, indicating that susceptibility to one is generally independent of the other. Glycopeptide MIC data for Gram-positive bacteria indicate distinct differences between vancomycin and teicoplanin with regard to a variety of clinical isolates. This suggests that, from a clinical perspective, these agents should not be used interchangeably, and that more appropriate MIC-based utilisation would assist in dose optimisation.
Tuberculosis complicating hepatitis C therapy with pegylated interferon and ribavirin : new infection in a high tuberculosis incidence area : case studySource: Southern African Journal of Infectious Diseases 29, pp 118 –119 (2014)More Less
Interferon and ribavirin therapy for hepatitis C is associated with a variety of side-effects. These include haematological, autoimmune, dermatological, metabolic and infectious complications. The propensity of this combination of treatment to readily cause neutropaenia, and in some instances, lymphopaenia, renders patients susceptible to a wide range of severe bacterial infections. Evidence from studies that have included reports on adverse outcomes indicates that tuberculosis is included in these infections. Unlike other immunomodulatory therapies, such as anti-tumour necrosis factor, there is no requirement to exclude latent tuberculosis infection prior to the initiation of pegylated interferon or ribavarin. Sub-Saharan Africa has a high incidence of tuberculosis, with an incidence of 255 per 100 000 population per year, according to the 2012 World Health Organization statistics. Tuberculosis, as a complication of antiviral therapy for hepatitis C with pegylated interferon and ribavirin, potentially poses more of a threat to patients receiving this therapy in high-incidence areas of tuberculosis. This case study highlights the complexity of the diagnosis and management of tuberculosis in the context of antiviral therapy with pegylated interferon and ribavirin for hepatitis C.
Preventive therapy for children following contact with a tuberculosis source case : cause for debate in a high-burden setting? : opinion papersSource: Southern African Journal of Infectious Diseases 29, pp 120 –124 (2014)More Less
The identification of vulnerable children following contact with an infectious tuberculosis source case, and their subsequent treatment with effective preventive therapy, reduces the risk of tuberculosis disease progression. The majority of countries in the world recommend preventive therapy for young and human immunodeficiency virus-infected children, and yet in most low-resource countries, where the highest burden of tuberculosis exists, delivery is incomplete and inadequate. This opinion paper discusses the provision of preventive therapy in children living in a high-burden setting. It presents the arguments offered by both sides in the debate, and provides the evidence cited by both positions. Finally, the article suggests interventions that could be investigated to improve the uptake of preventive therapy should it be advocated.