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- Volume 31, Issue 1, 2016
Southern African Journal of Infectious Diseases - Volume 31, Issue 1, 2016
Volume 31, Issue 1, 2016
Author Jennifer CoetzeeSource: Southern African Journal of Infectious Diseases 31, pp 1 –2 (2016) http://dx.doi.org/10.1080/23120053.2016.1151157More Less
The polymyxins are a group of antibiotics which were first isolated from a spore-bearing soil bacillus, Bacillus polymyxa, in 1947. Colistin, also known as polymyxin E, was introduced into clinical practice over 50 years ago. Although it has remained available for use since then, it was largely shelved in the 1970s with the discovery of antibiotics that were equally or more effective but considered less toxic.
Source: Southern African Journal of Infectious Diseases 31, pp 3 –7 (2016) http://dx.doi.org/10.1080/23120053.2016.1144285More Less
This document was created to serve as a guideline for colistin prescribing in South Africa. Antimicrobial resistance is threatening the effective prevention and treatment of a wide variety of infections, especially those that are caused by multi-drug-resistant (MDR) gram-negative bacteria. Colistin is typically used as salvage therapy, or last-line treatment, for MDR gram-negative infections. The dosing regimen should be optimised to be therapeutic and halt the emergence of resistance, whilst minimizing toxicity. This document provides evidence-based recommendations for adult and paediatric dosing, dosing in renal impairment, and the use of combination therapy to increase synergistic effects, as well as guidelines on the reconstitution and administration of colistin. This guideline is specifically aimed at healthcare workers who routinely treat patients with MDR gram-negative infections, especially in the intensive care setting.
Laboratory-based surveillance of Pneumocystis jirovecii pneumonia in South Africa, 2006-2010 : survey articleSource: Southern African Journal of Infectious Diseases 31, pp 8 –13 (2016) http://dx.doi.org/10.1080/23120053.2015.1118828More Less
Background: We aimed to establish the characteristics of patients with confirmed Pneumocystis jirovecii pneumonia recruited by passive, sentinel laboratory-based surveillance.
Method: The study design was prospective, observational, cross-sectional, laboratory-based sentinel surveillance. Laboratory-based surveillance of Pneumocystis jirovecii pneumonia (PJP), formerly known as Pneumocystis carinii pneumonia (PCP), was conducted in six South African provinces at 61 hospitals, of which 17 were sentinel sites, where surveillance officers collected clinical and demographic data from cases. A case was defined as a patient with a respiratory tract specimen that was confirmed positive for P. jirovecii by immunofluorescent microscopy or PCR test, either as a first diagnosis or ≥ 30 days after the last confirmed laboratory diagnosis of PJP. The chi-square test or Fisher's exact test were used to compare the categorical variables.
Results: From 2006-2010, 1 537 cases of PJP were recorded. Eighty-nine per cent (460/518) were found to be human immunodeficiency virus (HIV)-infected. This was a first diagnosis of HIV infection in 57% of the cases. The case fatality ratio was 34% (177/525). Recurrent infection was significantly more common in the 26- to 45-year age group, compared to children aged ≤ 5 years (odds ratio 1.7, 95% confidence interval: 1.1-2.8) (p 0.040). Treatment for tuberculosis was common in cases aged ≥ 5 years (37%, 85/229).
Conclusion: PJP was the acquired immune deficiency syndrome-defining illness in more than half of the patients detected through laboratory-based surveillance. The high mortality rate and number of recurrent cases is noteworthy. This study may not have reflected the full spectrum of clinical presentation of the disease as case report forms were only completed for hospitalised patients at sentinel surveillance sites.
A reply to the response to the article entitled, Health policy implications of blood transfusion-related HTLV-1 infection and disease : correspondenceSource: Southern African Journal of Infectious Diseases 31 (2016)More Less
We read with interest the response by Ingram et al. to our report on transfusion-acquired human T-lymphotropic virus 1 (HTLV-1) infection and disease. Firstly, we accept the error of referring to 100 000 transfusions, rather than donors, in the Norwegian study. Table 2 correctly refers to the donors.
The microbiological impact of pulsed xenon ultraviolet disinfection on resistant bacteria, bacterial spore and fungi and viruses : reviewSource: Southern African Journal of Infectious Diseases 31, pp 12 –15 (2016)More Less
Pathogens can persist in the patient care environment and cause the risk of transmission to patients. Pulsed xenon ultraviolet (PX-UV) is increasingly being used to disinfect patient rooms, operating rooms and other areas. Data on the impact of PX-UV on resistant bacteria, bacterial spores, fungi, viruses and the Ebola virus are lacking in the literature. Laboratory data are presented in this paper on the log reductions observed after the exposure of PX-UV to a variety of organisms in a laboratory setting.
Clinico-epidemiological spectrum of melioidosis : a 2-year prospective study in the western coastal region of India : researchAuthor Sagar ChandrakarSource: Southern African Journal of Infectious Diseases 31, pp 14 –19 (2016) http://dx.doi.org/10.1080/23120053.2015.1118830More Less
Objective: To determine the geographical epidemiology, clinical presentations and risk factors associated with melioidosis.
Methods: A total of 28 confirmed cultures of Burkholderia pseudomallei were isolated and prospectively analysed with respect to clinico-demographic factors.
Results: Age groups ranged from neonate to 84 years of age. Five children were less than 12 years of age. There was a male predominance of 71.4%. There was a crude mortality of 25%; all deaths were due to septic shock, 42.8% of which occurred within 48 hours of admission. A strong linear association (p = 0.01) was found between intensity of rainfall and presentation of cases. Proportion of cases and mortality were greater among those with occupational or recreational exposure to soil (75%). Pneumonia (32.1%) was the most frequent primary clinical presentation and diabetes mellitus (64.3%) constituted a major risk factor for both development and death due to melioidosis. Higher occurrence of mortality was noted among patients with chronic kidney disease (CKD) than others (Fischer's exact test p = 0.04). One case of recurrence was noted.
Conclusion: Melioidosis is quite prevalent in the western coastal region of India and is strongly associated with intensity of rainfall. There is increased risk among diabetics and to those who are exposed to soil and surface water. Melioidotic lymphadenopathy may mimic tuberculosis, hence should be considered as a differential diagnosis. Patients with bacteraemia have a poorer prognosis; and, septic shock relates to imminent death.
First outbreak of vancomycin-resistant Enterococcus in a haematology unit in Durban, South Africa : researchSource: Southern African Journal of Infectious Diseases 31, pp 20 –24 (2016) http://dx.doi.org/10.1080/23120053.2015.1118819More Less
Vancomycin resistant enterococci (VRE) are increasingly important causes of morbidity and mortality in developed countries. Although VRE is a significant cause of nosocomial sepsis in these countries, limited data is available on the role that this pathogen plays in South Africa. We describe the demographic, clinical and genotypic data of seven patients involved in the first outbreak of VRE in a haematology unit at a tertiary hospital in Durban and also report the isolation of VRE from six patients from other wards in this hospital and from hospitals outside Durban. The outbreak occurred from 19 April 2011 to 9 November 2011. Pulse Field Gel Electrophoresis (PFGE) was conducted on 15 clinical and environmental samples. Two closely-related clusters and a unique strain were identified from both clinical and environmental samples. Furthermore, the predominant cluster was found in other hospitals in KwaZulu-Natal. After infection control practices were reinforced, the outbreak terminated. Our study highlights that VRE is an emerging pathogen in KZN, especially in high risk units. The environment serves as a significant reservoir of VRE and infection control strategies should be directed to reduce the transmission of VRE from environmental sources.
Maternal HIV infection and preterm delivery outcomes at an urban district hospital in KwaZulu-Natal 2011 : researchSource: Southern African Journal of Infectious Diseases 31, pp 25 –28 (2016) http://dx.doi.org/10.1080/23120053.2016.1118838More Less
Background: The seroprevalence of human immunodeficiency virus (HIV) in pregnant women attending public facilities in KwaZulu-Natal province in 2011 was 37%, the highest in South Africa. An association between the HIV status of the pregnant women and preterm delivery, with associated poorer clinical outcomes, has been reported in many studies. The aim of this study was to explore the relationship between preterm delivery and maternal HIV infections at an urban district hospital in KwaZulu-Natal in 2011.
Method: The associations and outcomes of preterm deliveries at a high patient load urban district hospital were determined using a retrospective cohort study.
Results: Of the 250 consecutively enrolled patients, 23 women (9%) [95% confidence interval (CI): 5.90-13.50] delivered 25 preterm infants. Ninety-two women (37%) (95% CI: 30.80-43.10) were found to be HIV positive, of whom 13 (14%) (95% CI: 7.70-23.00) delivered preterm neonates, compared to 10 of the 158 women (6%) (95% CI: 3.10-11.30) of the HIV-negative mothers. HIV-positive mothers were significantly more likely (~ 4 fold) to have preterm deliveries than their HIV-negative counterparts, following multivariable adjustment [odds ratio (OR) 4.09, 95% CI: 1.37-12.17] (p 0.010). Hypertension was the only other risk factor to remain significantly associated with preterm delivery following multivariable adjustment (OR 0.07, 95% CI: 0.02-0.28) (p < 0.001).
Conclusion: The risk of preterm delivery is elevated in HIV-infected pregnant women. HIV-positive pregnant women should be targeted for improved antenatal care and intensive counselling.
Molecular detection and characterisation of mumps virus in cerebrospinal fluid in a Gauteng laboratory : short articleSource: Southern African Journal of Infectious Diseases 31, pp 29 –31 (2016) http://dx.doi.org/10.1080/23120053.2016.1118843More Less
The study aimed to determine the presence of mumps virus (MuV) in cerebrospinal fluid (CSF) specimens and to genetically characterise detected MuV strains. A real-time reverse transcription-polymerase chain reaction (RT-PCR) was used to detect the MuV F gene, and characterisation was performed by sequencing of the SH gene. Mumps virus was detected in 1.2% (3/260) of specimens. Phylogenetic analysis of one MuV strain revealed that it clustered with the Jeryl-Lynn and RIT4385 vaccine strains. As far as the authors could ascertain this is the first study to provide viral proof that these vaccine-like strains may be associated with aseptic meningitis.