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- Volume 30, Issue 2, 2015
Southern African Journal of Infectious Diseases - Volume 30, Issue 2, 2015
Volume 30, Issue 2, 2015
Author Jacqueline WeyerSource: Southern African Journal of Infectious Diseases 30, pp 40 –41 (2015)More Less
Rabies. The word invokes divergent thoughts. Firstly, it is one of the oldest infectious diseases known to mankind with ancient scripts referring to the scourge of the rabid dog. Also the knowledge of how to control and prevent the disease has been understood for more than a century. Louis Pasteur showed how to prevent rabies virus infection by applying his crude nervous tissue vaccines in dogs and humans before the turn of the 20th century. Nevertheless, the question of why and how this highly fatal, but preventable, disease can then still be considered one of the most formidable zoonotic diseases in the world today is a burning one. A recent study estimated the burden of rabies globally and the figures are staggering. It is estimated that approximately 59 000 human deaths can be attributed to dog-transmitted rabies, with the brunt borne in the developing countries of Africa and Asia.1 This statistic relates roughly to a human rabies death every 10 minutes. The estimated global economic loss exceed US $ 8.6 billion with a substantial contribution due to the cost of rabies vaccines and immunoglobulin for prevention of rabies in exposed humans.
Autopsies performed at Universitas academic hospital, South Africa, 1990-2010, and perceptions and opinions of health professionals on the importance of autopsies in modern medicine : original research - autopsies at an academic hospitalSource: Southern African Journal of Infectious Diseases 30, pp 42 –44 (2015)More Less
Background: Research has shown that the number of non-medicolegal (non-forensic) autopsies performed has declined worldwide in recent years. The aim of this study was to confirm a perceived decrease in the number of autopsies requested at the Universitas Academic Hospital Complex in Bloemfontein, and to evaluate clinicians' opinions on the possible reasons for this decline.
Methods: All medical autopsies performed in four-year intervals between 1990 and 2010 were included in the study. Questionnaires were distributed to registrars and consultants in the Departments of Internal Medicine and Surgery.
Results: The number of autopsies requested decreased from 308 in 1990 to only 60 in 2010, while the proportion of foetuses sent for autopsy increased from 2.3% of all autopsy requests in 1990 to 55.0% in 2010. Diseases of the respiratory system were the main cause of death in 1990, 1994 and 1998, while congenital conditions were the main finding in 2002, 2006 and 2010. The four most common reasons cited for the decline in the number of requests were difficulty in obtaining consent from relatives of the deceased, administrative problems when making requests for autopsies, the fact that medical autopsies are currently not performed on HIV-positive patients and the delay in obtaining autopsy reports.
Conclusion: Despite the marked decline in autopsy requests, the vast majority of respondents were of the opinion that autopsies still play an important role in modern medicine and medical training.
Characterisation of Pneumocystis jirovecii DHPS genotypes using a simple, inexpensive restriction fragment length polymorphism analysis : original researchSource: Southern African Journal of Infectious Diseases 30, pp 46 –50 (2015)More Less
Pneumocystis jirovecii is an opportunistic fungal pathogen in immunocompromised patients, causing a life-threatening disease, Pneumocystis pneumonia (PCP). The introduction of highly active antiretroviral therapy (HAART) has significantly reduced the incidence of the disease; however, PCP remains one of the leading causes of pneumonia in immunosuppressed patients, especially in developing countries. The drug of choice for PCP treatment is trimethoprim-sulfamethoxazole. However, the widespread use of this drug has raised concerns regarding possible resistance due to dihydropteroate synthase (DHPS) mutations in P. jirovecii infected patients. Molecular epidemiological studies are needed to estimate the prevalenceof mutant DHPS genotypes in PCP patients. We characterised genetic polymorphisms in the DHPS region of P. jirovecii using a rapid, cost-effective restriction fragment length polymorphism (RFLP) method. We used a nested PCR to amplify a DHPS fas gene segment, followed by digestion of the product with restriction endonucleases AccI and HaeIII that identified the presence of DHPS mutations at codons 55 and 57 respectively. A total of 671 samples from 585 patients was characterised by RFLP, with an overall 87% prevalence of DHPS mutations. Most samples had single mutations (50%), 28% had double mutations and the remaining (22%) showed mixed genotypes that could not be resolved by RFLP. These significant results highlight the need for ongoing molecular epidemiological studies on the relationship between P. jirovecii DHPS mutants and sulfa drug resistance.
Antimicrobial prescribing in South Africa using a large pharmacy database: a drug utilisation study : original research - autopsies at an academic hospitalAuthor Ilse TruterSource: Southern African Journal of Infectious Diseases 30, pp 52 –56 (2015)More Less
The primary aim was to determine the general prescribing trends of antimicrobial drugs to patients whose prescriptions were dispensed by community pharmacies. A retrospective, cross-sectional drug utilization study was conducted on 2010 data of a national community pharmacy group in South Africa. A total of 660 500 patients received 1 576 593 antimicrobial products during 2010. The average age of patients was 34.23 (SD=19.92) years. Most patients were female (58.32%). Patients between 40 and 49 years received the highest average of 3.22 antimicrobial prescriptions during the year. Beta-lactams were the most often prescribed (34.56% of antimicrobial prescriptions), followed by antiviral agents (20.92%) and quinolones (11.12%). Differences were observed between females and males with respect to the prescribing frequency of different antimicrobial classes (x2=12763; d.f.=11; p<0.0001), especially between antifungal agents and beta-lactam antibiotics. Within the beta-lactam class, penicillins accounted for 76.47% of products and cephalosporins for 23.44%. The most frequently prescribed trade name product was a generic combination of amoxicillin and clavulanic acid. Antiviral agents were the most expensive (R195.67), followed by aminoglycosides (R188.42). Prescribing peaked during the winter months. This study provides a general overview of antimicrobial prescribing that can be used for comparative studies with other population groups, African countries and for more specific investigations.
The findings on initial admission chest radiograph of patients presenting with an acute exacerbation of COPD - a South African study : original researchSource: Southern African Journal of Infectious Diseases 30, pp 57 –60 (2015)More Less
Introduction: Despite the recognition that infections (including both viral and/or bacterial) play an important role in acute exacerbations of chronic obstructive pulmonary disease (AECOPD) there have been relatively few studies documenting the radiological changes in patients hospitalized with an AECOPD, which was the aim of the current study.
Methods: This was a retrospective record review of consecutive hospitalized cases admitted to the Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa, between June 2011 and February 2013, in whom an admission chest radiograph was available for review.
Results: Overall 34 patients were entered into the study. Evidence of hyperinflation was documented in 29 of 33 cases (87.9%). In 2 cases hyperinflation was the only radiological finding. Additional abnormalities noted on the chest radiographs (sometimes multiple) were as follows: parenchymal changes in 24, interstitial changes in 4, and pleural changes in 8 cases. Eleven patients (33%) had evidence of consolidation on the chest radiograph, compatible with a diagnosis of pneumonia although this had not been documented clinically.
Conclusion: This study documents a considerable number of chest radiographic changes in patients presenting with acute exacerbation of COPD. Changes compatible with community acquired pneumonia (CAP) were documented in 33.3% of cases, which was not clinically evident in any of these cases.
A comparative evaluation of the Gram stain and India ink stain for the rapid diagnosis of cryptococcal meningitis in HIV infected patients in Durban : brief reportSource: Southern African Journal of Infectious Diseases 30, pp 61 –63 (2015)More Less
Background: Cryptococcal meningitis is the most common systemic fungal infection in HIV infected patients. The India ink stain is currently recommended for the microscopic detection of cryptococci. There is very little published data on the utility of the Gram stain. We therefore, undertook a comparative evaluation of the Gram stain and India ink stain for the rapid diagnosis of cryptococcal meningitis in HIV infected patients.
Methodology: Gram and India ink stains were performed on 90 cerebrospinal fluid (CSF) samples. Culture was used as the gold standard.Results: Of the 83 culture positive samples, the India ink was positive in 84% [70 /83] and the Gram stain was positive in 89% [74/83]. The specificity for both methods was 100%.
Discussion: Our results indicate that the Gram stain is a simple, cheap and reliable method for the diagnosis of cryptococcal meninigitis. It is routinely performed on all CSF samples received in the laboratory and would therefore detect cryptococci in cases where the clinician had not specifically requested the India ink stain. Although the Gram stain is the most widely used stain in microbiology laboratories, it is not routinely recommended for the laboratory diagnosis of cryptococcal meningitis.
Conclusion: We therefore suggest that the Gram stain be included as part of the routine workup for cryptococcal meningitis, particularly in resource-poor countries. However, further studies are required to verify our results.
Source: Southern African Journal of Infectious Diseases 30, pp 64 –66 (2015)More Less
Brucella endocarditis is a rare condition which occurs as a focal complication of chronic brucellosis. We report a case of Brucella abortus endocarditisin a 21 year old male with a prosthetic aortic heart valve. Due to the high mortality of Brucella endocarditis, it is essential for clinicians to maintain a high index of suspicion in patients at risk for brucellosis who present with infective endocarditis.
Hand-foot-and-mouth disease caused by coxsackievirus A6 in a patient infected with HIV : case reportSource: Southern African Journal of Infectious Diseases 30, pp 67 –69 (2015)More Less
Hand, foot and mouth disease (HFMD) is common in children ≤ 5 years of age, and is mainly caused by enterovirus 71 and coxsackievirus A16 (CVA6). A 12-year-old boy on treatment for human immunodeficiency virus (HIV) presented to an HIV clinic with fever and a rash on the palms and soles. The syphilis test were negative. Enterovirus was identified from a stool sample by PCR and characterised as as coxsackievirus A6(CVA6). The patient completely recovered a week later. CVA6 has recently been associated with HFMD. This case highlights the significance of the laboratory confirmation of suspected HFMD cases and phylogenetic analysis of the identified virus.