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- Volume 30, Issue 3, 2015
Southern African Journal of Infectious Diseases - Volume 30, Issue 3, 2015
Volume 30, Issue 3, 2015
Source: Southern African Journal of Infectious Diseases 30 (2015)More Less
Christopher Charles Appleton was born in England on 11 July 1944, and educated in South Africa, matriculating at Diocesan College, Cape Town, in 1962. His first degree was a Bachelor's degree in Science (BSc) in Zoology in 1968 from the University of Cape Town, followed by an Honours degree from Potchefstroom University in 1971. In 1976, he obtained his MSc (Cum laude) in freshwater malacology from Rhodes University. He also obtained a PhD in parasitology from Murdoch University, Perth, Western Australia, in 1981.
Locating bilharzia transmission sites in South Africa : guidelines for public health personnel : researchSource: Southern African Journal of Infectious Diseases 30, pp 78 –85 (2015) http://dx.doi.org/10.1080/23120053.2015.10More Less
Bilharzia surveillance at local authority level in South Africa relies on public health personnel being able to locate transmission sites. Although several methods have been tried, the method of choice is collecting snails, identifying those that serve as intermediate hosts for bilharzia, and examining them for evidence of infection. Unfortunately, public health personnel are seldom trained to recognise these snails or the parasites' larval stages, and few laboratories are able to assist. Therefore, the intention is that these guidelines will help to equip personnel with the basic information needed to collect and identify the bilharzia-carrying snails, and then examine them for infection. The intramolluscan or larval stages of trematode parasites likely to be encountered in dissected snails are described. However, emphasis is placed on the furcocercariae, a group which includes the infective stage of bilharzia flukes. A family key to furcocercariae is presented.
A multi-centre, phase IV study to evaluate the steady-state plasma concentration and serum bactericidal activity of a generic teicoplanin preparation : researchSource: Southern African Journal of Infectious Diseases 30, pp 86 –94 (2015) http://dx.doi.org/10.1080/23120053.2015.1076165More Less
Introduction: Teicoplanin is an effective treatment option against methicillin-resistant, Gram-positive bacteria, like Staphylococcus aureus. It is a glycopeptide antibiotic, produced through microbial fermentation, a process resulting in variations in the N-acylside chain. Concerns that these variations may affect the pharmacokinetic profile and the clinical efficacy of generic teicoplanin preparations have been raised.
Method: To address this issue, a multi-centre observational study was conducted to evaluate steady-state peak and trough serum concentrations, and the serum bactericidal activity (SBA) and safety of a generic teicoplanin preparation in critically ill patients. Additionally, the composition of the generic teicoplanin was compared to that of the innovator drug to assess differences in the composition.
Results: Following pre-determined loading and maintenance dose schedules, the mean peak and trough teicoplanin serum concentrations were 20.98 mg/l and 10.38 mg/l, respectively. A statistically significant association was observed between teicoplanin pharmacotherapy and increased ex vivo SBA. It was found using independent analysis that the composition of the generic teicoplanin preparation was similar to that of the innovator drug, and that both formulations met the European Pharmacopoeia specifications.
Conclusion: The loading and maintenance schedules employed in this study were effective in establishing therapeutic serum teicoplanin concentrations in critically ill patients. Evidence of bactericidal activity measured in patients' ex vivo serum samples, following treatment with the generic preparation, supports this finding.
Neonatal septicaemia : prevalence and antimicrobial susceptibility patterns of common pathogens at Princess Marina Hospital, Botswana : researchSource: Southern African Journal of Infectious Diseases 30, pp 96 –101 (2015) http://dx.doi.org/10.1080/23120053.2015.1074443More Less
Background: Septicaemia is the third most common cause of neonatal death after prematurity and birth asphyxia. The prevalence of neonatal sepsis and the spectrum of causative microorganisms fluctuates over time, thus facility-specific surveillance of neonatal bloodstream infections is important. Increasing levels of antimicrobial resistance documented worldwide, necessitate regular monitoring of institutional resistance patterns to ensure appropriate and effective empirical antimicrobial therapy.
Method: The laboratory blood culture reports and patient records from a neonatal unit at a Botswana referral hospital were retrospectively reviewed to determine the one-year prevalence of neonatal sepsis and the antimicrobial susceptibility patterns of common pathogens.
Results: Of 909 neonates investigated for suspected sepsis using 1 119 blood cultures, 89 (9.8%) had laboratory-confirmed episodes of bloodstream infection (septicaemia). The most prevalent pathogens included Klebsiella pneumoniae (29.4%), groupB streptococcus (16.3%) and Escherichia coli (11.9%). Blood culture contamination rates were high at 18.6% (208/1 119). Gramnegative pathogens showed low susceptibility to gentamicin (40%) and cefotaxime (47%), but high susceptibility to amikacin (86%). Streptococci and enterococci were moderately sensitive to ampicillin (79%), and fully susceptible to vancomycin. Methicillin-resistant Staphylococcus aureus was not isolated. Exposure to maternal syphilis and previous antibiotic exposure were significantly associated with neonatal septicaemia.
Conclusion: Neonatal sepsis is common, with a predominance of Gram-negative pathogens. The high rate of blood culture contamination should be addressed. Emerging antibiotic resistance may require clinicians to review currently used antibiotics for the empirical treatment of late-onset neonatal septicaemia.
NDM-1, novel TEM-205, novel TEM-213 and other extended-spectrum β-lactamases co-expressed in isolates from cystic fibrosis patients from South Africa : researchSource: Southern African Journal of Infectious Diseases 30, pp 102 –106 (2015) http://dx.doi.org/10.1080/23120053.2015.1074441More Less
Background: β-lactamase-mediated resistance was investigated in isolates from cystic fibrosis (CF) patients attending clinics in the public and private health sectors in Durban, South Africa.
Method: Fifteen Pseudomonas aeruginosa, two Enterobacter cloacae and one each of Klebsiella pneumoniae, Burkholderia cepacia complex and Stenotrophomonas maltophilia, were subjected to minimum inhibitory concentration determination, PCR and sequencing for blaTEM, blaSHV, blaCTX-M, blaCMY, blaPER, blaVEB,, blaOXA, blaKPC, blaGES, blaIMP, blaVIM and blaNDM genes.
Results: All but one isolate carried multiple β-lactamases from two or more different Ambler classes. Novel Temoneira-205 (TEM- 205) (GenBank Accession No. KC900516) was found in a single isolate in combination with New Delhi metallo-β-lactamase-1 (NDM-1), reported for the first time in P. aeruginosa in South Africa. TEM-205 showed five amino acid changes compared with TEM-1 viz. V84I, E104 K, R164S, M182T and A184 V, while novel TEM-213 (GenBank Accession No. KC663615), identified in three isolates, showed a single amino acid change, Y105F. Resistance phenotypes did not routinely correlate with the genotypes. This is the first report of NDM-1 from B. cepacia complex in South Africa.
Conclusion: The co-expression and/or co-carriage of Ambler classes A, B and C β-lactamases in various permutations in single isolates severely restricts the clinical management of CF, not only with β-lactam antibiotics, but also with aminoglycosides and fluoroquinolones, the resistance genes of which commonly occur on the same genetic determinants of resistance. The presence of NDM-1, in combination with the Cephamycins (CMY) class C/AmpC β-lactamases, TEM, sulfhydryl-variable (SHV) and cefotaximase-M (CTX-M) extended-spectrum β-lactamases, is of grave concern, leaving colistin as the sole remaining treatment option for this pathogen.
Experiences in the implementation of provider-initiated counselling and testing and linkage to HIV services at urban public sector health facilities in KwaZulu-Natal : researchSource: Southern African Journal of Infectious Diseases 30, pp 108 –112 (2015) http://dx.doi.org/10.1080/23120053.2015.1More Less
Background: A provider-initiated counselling and testing (PICT) strategy replaced the voluntary counselling and testing (VCT) strategy with respect to the provision of human immunodeficiency virus (HIV) counselling and testing (HCT) in KwaZulu-Natal province with the aim of increasing the uptake of HIV services. VCT depended on clients requesting HCT, whereas HCT is routinely offered to all persons utilising health facilities, regardless of the reason for the visit with the provision of PICT. This study reports on the feasibility and early outcomes of using the PICT strategy in KwaZulu-Natal.
Method: Health workers were trained to provide PICT to patients presenting at the outpatient department (OPD) of two public health institutions in KwaZulu-Natal from December 2010 to May 2011. Data on the offering and uptake of HIV services were recorded and analysed using univariate and multivariate analysis to compare HCT uptake and other systematic barriers before and after the introduction of PICT.
Results: A significant change in the uptake of HCT after the introduction of PICT at both sites (p = 0.242 and p = 0.224) and in the uptake of HIV testing (p = 0.062 and p = 0.224) was not observed. PICT offering was weakest at the OPDs (p < 0.001), and was solely provided by counsellors (85.5%). Few (29.2%) clients were screened for tuberculosis. Immunological and clinical staging was performed on 29.8% and 1.0% of HIV-positive patients, respectively. The linkage to prevention services was low with 12.2% of clients referred for further care.
Conclusion: PICT implementation and integration with other services faces human resource, infrastructural and conceptual barriers, and is not currently feasible at OPDs. The urgent provision of operational guidance and training for providers is needed.
A pilot study on the use of amikacin in neonates : who should be monitored for ototoxicity? : researchSource: Southern African Journal of Infectious Diseases 30, pp 114 –118 (2015) http://dx.doi.org/10.1080/23120053.2015.1074432More Less
Background: Aminoglycosides (AGs) cause irreversible hearing loss. The toxic effects of AGs are dose dependent and correlate with increasing drug serum concentrations.
Method: Purposive sampling was used to identify newborn infants in the neonatal intensive care unit who had been initiated on amikacin therapy. Distortion product otoacoustic emission (DPOAE) testing, as the baseline for outer hair cell functioning, was performed. The tests were repeated on the third day of therapy, and therapeutic drug monitoring performed using a onecompartment, open pharmacokinetic model.
Results: The neonates who were classified as extremely preterm (n = 5), had a mean peak amikacin level of 50.91 Î¼g/ml (± 10.59µg/ml), the very preterm neonates (n = 9) a mean peak of 53.29 µg/ml (± 18.49 µg/ml), the moderate- to late-preterm neonates(n = 2) 54.15 µg/ml (± 0.76 µg/ml), and the full-term neonates (n = 6) 43.38 µg/ml (± 10.08 µg/ml). The mean trough level was the highest in the extremely preterm category, at 7.31 µg/ml (± 3.19 µg/ml). The mean trough concentrations were 5.23 µg/ml (± 5.17 µg/ml) in the very preterm neonates, 5.69 µg/ml (± 6.97 µg/ml) in moderate- to late-preterm neonates, and 2.51 µg/ml (± 1.39 µg/ml) in the full-term neonates. There was a change in the DPOAE test amplitude reading between baseline and follow-up of more than 2.4 dB sound pressure level, at one or more frequency levels, in 13 neonates (59%, n = 22).
Conclusion: Premature neonates should be the target population when monitoring the pharmacokinetics of ototoxic medication and when performing diagnostic DPOAE testing.
Source: Southern African Journal of Infectious Diseases 30, pp 120 –175 (2015)More Less
Source: Southern African Journal of Infectious Diseases 30, pp 177 –190 (2015)More Less
Atypical manifestation of Takayasu's disease masquerading as tuberculosis in an adolescent male : case studySource: Southern African Journal of Infectious Diseases 30, pp 191 –193 (2015) http://dx.doi.org/10.1080/23120053.2015.1074435More Less
Introduction: Takayasu's disease is a chronic idiopathic vasculitis that mainly affects the aorta and/or its main branches. It affects young adult women most commonly. Although pulmonary artery involvement in Takayasu's disease is well documented, most patients remain asymptomatic and the pulmonary manifestations are frequently overshadowed by systemic involvement. The literature is suggestive that there is pulmonary involvement in Takayasu's disease, which masquerades as pulmonary embolism, but only a few reports discuss patients having symptoms as the initial manifestation that are due to pulmonary infarction. We describe the case of young adolescent male with Takayasu's disease who presented with pulmonary infarction, but who was misdiagnosed initially as having pulmonary Koch's bacillus infection.
Source: Southern African Journal of Infectious Diseases 30, pp 194 –197 (2015) http://dx.doi.org/10.1080/23120053.2015.1More Less
Tetanus is a disease caused by a Clostridium tetani infection, a complication of wounds. We present a case in which a patient presented with seizures and was incorrectly assessed to have epilepsy. Permission to publish this report was obtained from the patient. The clinical diagnosis was tetanus. A review of the literature is provided. Due to the fatality of this disease, primary care health professionals need to have a high index of suspicion of it as the consequences could be fatal if missed.
Epidemiology : a research manual for South Africa, Rodney Ehrlich and Gina Joubert (eds.) : book reviewAuthor Shan NaidooSource: Southern African Journal of Infectious Diseases 30 (2015)More Less
It gives me great pleasure to review the latest edition of this important contribution to the learning of epidemiology in the southern African context. I reviewed the previous edition which was published in 2007 in this same journal, and I now offer my comments on the third edition. The foreword is introduced quite succinctly by Neil Pearce as follows: "Its development reflects not only the development of epidemiology in South Africa, but also its development as a truly global discipline". It has built on the success of the first two editions, and contains relevant new chapters, as well as pertinent South African information. Wide use was made of the earlier editions in introductory courses in research methods and epidemiology, both locally and abroad. I found it easy to read and comprehend, and both useful and enjoyable.