Southern African Journal of Infectious Diseases最新文献

{"title":"After action review of the COVID-19 pandemic response in North West province, South Africa","authors":"John M. Tumbo, Indiran Govender, D. Nzaumvila","doi":"10.4102/sajid.v38i1.571","DOIUrl":"https://doi.org/10.4102/sajid.v38i1.571","url":null,"abstract":"Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) caused coronavirus disease 2019 (COVID-19) pandemic with major disruptions globally. Northwest Province Department of Health (NWDoH) in South Africa set up comprehensive epidemiological emergency response plans for preventing, finding, containing and stopping the spread of COVID-19 in accordance with the National Disaster Management Act.Objectives: This After-Action Report (AAR) describes the provincial response to the pandemic from September 2020 to October 2022.Method: The AAR was conducted using the World Health Organization AAR methodology. Focus groups discussed five items: coordination, leadership and governance; epidemiology, surveillance and laboratory; case management and continuity of essential services; risk communication and community engagement and COVID-19 vaccination.Results: The timely establishment and activation of provincial intergovernmental and intersectoral coordinating structures led to effective coordination, resource mobilisation, leadership, decision-making and intervention. The effective communication in the department and other stakeholders resulted in improved surveillance data quality, timelier response and increased ownership of data. Dissemination, training and implementation of case management protocols ensured standardised case management. The multi-channel information dissemination targeting different audiences empowered people with real-time knowledge on the infection and encouraged health-seeking behaviours.Conclusion: The AAR demonstrated the importance of coordinated epidemiological, laboratory and communication response that requires significant public health reserve capacity in peacetime for rapid expansion in an emergency.Contribution: This review contributes to the body of knowledge emerging from the COVID-19 pandemic and provides guidance on enhanced public health response to future emergencies.","PeriodicalId":44007,"journal":{"name":"Southern African Journal of Infectious Diseases","volume":"246 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2023-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139173251","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Changing character and waning impact of COVID-19 at a tertiary centre in Cape Town, South Africa","authors":"Lucas E. Hermans, Petro Booysen, L. Boloko, Marguerite Adriaanse, T. D. de Wet, Aimee R. Lifson, Naweed Wadee, N. Papavarnavas, G. Marais, N. Hsiao, Michael-Jon Rosslee, Greg Symons, Gregory L. Calligaro, A. Iranzadeh, Robert J Wilkinson, N. Ntusi, Carolyn Williamson, Mary-Ann Davies, Graeme Meintjes, Sean Wasserman","doi":"10.4102/sajid.v38i1.550","DOIUrl":"https://doi.org/10.4102/sajid.v38i1.550","url":null,"abstract":"Background: The emergence of genetic variants of SARS-CoV-2 was associated with changing epidemiological characteristics throughout coronavirus disease 2019 (COVID-19) pandemic in population-based studies. Individual-level data on the clinical characteristics of infection with different SARS-CoV-2 variants in African countries is less well documented.Objectives: To describe the evolving clinical differences observed with the various SARS-CoV-2 variants of concern and compare the Omicron-driven wave in infections to the previous Delta-driven wave.Method: We performed a retrospective observational cohort study among patients admitted to a South African referral hospital with COVID-19 pneumonia. Patients were stratified by epidemiological wave period, and in a subset, the variants associated with each wave were confirmed by genomic sequencing. Outcomes were analysed by Cox proportional hazard models.Results: We included 1689 patients were included, representing infection waves driven predominantly by ancestral, Beta, Delta and Omicron BA1/BA2 BA4/BA5 variants. Crude 28-day mortality was 25.8% (34/133) in the Omicron wave period versus 37.1% (138/374) in the Delta wave period (hazard ratio [HR] 0.68 [95% CI 0.47–1.00] p = 0.049); this effect persisted after adjustment for age, gender, HIV status and presence of cardiovascular disease (adjusted HR [aHR] 0.43 [95% CI 0.28–0.67] p  0.001). Hospital-wide SARS-CoV-2 admissions and deaths were highest during the Delta wave period, with a decoupling of SARS-CoV-2 deaths and overall deaths thereafter.Conclusion: There was lower in-hospital mortality during Omicron-driven waves compared with the prior Delta wave, despite patients admitted during the Omicron wave being at higher risk.Contribution: This study summarises clinical characteristics associated with SARS-CoV-2 variants during the COVID-19 pandemic at a South African tertiary hospital, demonstrating a waning impact of COVID-19 on healthcare services over time despite epidemic waves driven by new variants. Findings suggest the absence of increasing virulence from later variants and protection from population and individual-level immunity. ","PeriodicalId":44007,"journal":{"name":"Southern African Journal of Infectious Diseases","volume":" 4","pages":""},"PeriodicalIF":0.9,"publicationDate":"2023-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138964387","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Retrospective review of bacteriological profiles and antibiogram in a tertiary neonatal unit","authors":"Philile F. Buthelezi, Fathima Naby, Yashodhara Kannigan","doi":"10.4102/sajid.v38i1.537","DOIUrl":"https://doi.org/10.4102/sajid.v38i1.537","url":null,"abstract":"Background: Neonatal sepsis remains a major cause of morbidity and mortality. Therefore, early detection and initiation of appropriate empirical antibiotic therapy are crucial.Objectives: The aim of this study was to describe the antibiogram of the neonatal intensive care unit at Grey’s Hospital, a tertiary hospital in KwaZulu-Natal.Method: This was a retrospective descriptive study, reviewing positive cultures from Grey’s Hospital tertiary neonatal intensive care unit (NICU) in KwaZulu-Natal, South Africa for a 3-year period (01 January 2017 to 31 December 2019). All positive cultures from all sites were included.Results: There were 1314 positive organisms cultured. Late-onset sepsis (89.3%) predominated over early-onset sepsis (10.7%). Blood was the source for 55.2% (725/1314) of positive cultures. Of the 1314 organisms cultured, 53.7% (706/1314) were Gram-positive, 45.7% (601/1314) were Gram-negative and 0.5% (7/1314) were Candida species. Klebsiella pneumoniae, 23.5% (313/1314) was the most frequent Gram-negative organism. It was noted to have high resistance to the unit’s first-line antibiotic regimens; 99% were resistant to ampicillin and 92% resistant to gentamicin.Conclusion: Blood cultures yielded most positive results with a predominance of Gram-positive organisms and late-onset sepsis. A significant proportion of the cultured organisms were resistant to the first-line antimicrobials utilised in the unit, ampicillin and gentamicin.Contribution: Ongoing surveillance on positive cultures is recommended to assess the effectiveness of the unit’s current empirical antimicrobial guideline.","PeriodicalId":44007,"journal":{"name":"Southern African Journal of Infectious Diseases","volume":"46 43","pages":""},"PeriodicalIF":0.9,"publicationDate":"2023-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138588459","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Deeply jaundiced: Not so surgical after all.","authors":"Wesley P du Plessis, Sa'ad Lahri, Keethal Somers, Tamsin Lovelock","doi":"10.4102/sajid.v38i1.559","DOIUrl":"10.4102/sajid.v38i1.559","url":null,"abstract":"<p><p>Leptospirosis is an under-recognised disease in sub-Saharan Africa and the diagnosis requires a high index of suspicion. This case report highlights the protean manifestations of leptospirosis. Leptospirosis should be considered in any patient presenting with fever and jaundice, especially when there has been a history of occupational or recreational exposure to water, soil or rodents.</p><p><strong>Contribution: </strong>This case report describes a typical case of leptospirosis, which often presents as a diagnostic dilemma.</p>","PeriodicalId":44007,"journal":{"name":"Southern African Journal of Infectious Diseases","volume":"38 1","pages":"559"},"PeriodicalIF":0.9,"publicationDate":"2023-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10696568/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138499730","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Non-fermenter Gram-negative bacilli at a tertiary hospital, South Africa.","authors":"Sinenhlanhla Ndzabandzaba, Lesego Mothibi, Nina von Knorring","doi":"10.4102/sajid.v38i1.538","DOIUrl":"10.4102/sajid.v38i1.538","url":null,"abstract":"<p><strong>Background: </strong>Non-fermenting Gram-negative bacilli (NFGNB) are a significant cause of healthcare-associated infections and are often implicated in nosocomial outbreaks. Non- fermenting Gram-negative bacilli tend to have variable susceptibility patterns that make the choice of empiric therapy difficult and thus treatment must be based on <i>in vitro</i> susceptibility testing of each antimicrobial agent.</p><p><strong>Objectives: </strong>To describe the epidemiology of the NFGNB isolated from adult patients at Chris Hani Baragwanath Hospital (CHBAH) and to assess their antimicrobial susceptibility patterns in order to guide empiric therapy and inform infection prevention and control practices.</p><p><strong>Method: </strong>Organisms isolated from sterile sites of adult in-patients between 01 January 2016 to 31 December 2018 were retrospectively analysed.</p><p><strong>Results: </strong>A total of 2005 NFGNB isolated. Blood cultures were the most common specimen type (91.4%). <i>Acinetobacter</i> species were the most commonly isolated organisms (65.1%), followed by <i>Pseudomonas</i> species (26.5%). The majority of NFGNB were isolated from patients in surgical wards (38.9%) followed by medical wards (35.2%). Most (60%) of the <i>Acinetobacter</i> species were extremely drug resistant. <i>Pseudomonas</i> species were more susceptible than the <i>Acinetobacter</i> species with an overall susceptibility rate of 86% for <i>Pseudomonas</i> species.</p><p><strong>Conclusion: </strong>The rates of antimicrobial resistance demonstrated among <i>Acinetobacter</i> and <i>Pseudomonas</i> species were high, which illustrates the threat of antimicrobial resistance also seen worldwide. An emergence of NFGNB with intrinsic multidrug resistance (<i>Stenotrophomonas maltophilia</i> and <i>Burkholderia cepacia</i>) was noted. We suggest empiric therapy with a carbapenem sparing regimen of piperacillin-tazobactam in combination with amikacin and that empiric therapy be reviewed annually when cumulative antibiograms are done.</p><p><strong>Contribution: </strong>Understanding of the distribution and antimicrobial susceptibility patterns of NFGNB at CHBAH.</p>","PeriodicalId":44007,"journal":{"name":"Southern African Journal of Infectious Diseases","volume":"38 1","pages":"538"},"PeriodicalIF":0.9,"publicationDate":"2023-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10697235/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138499731","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Personal reflections on a new role in infectious diseases.","authors":"Mark F Cotton","doi":"10.4102/sajid.v38i1.583","DOIUrl":"10.4102/sajid.v38i1.583","url":null,"abstract":"","PeriodicalId":44007,"journal":{"name":"Southern African Journal of Infectious Diseases","volume":"38 1","pages":"583"},"PeriodicalIF":0.9,"publicationDate":"2023-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10696578/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138499732","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A descriptive study of vancomycin use at Red Cross War Memorial Children’s Hospital, Cape Town","authors":"Leonore Greybe, Brian S. Eley, Hafsah D. Tootla, Anna M.M. Botha, Wisdom Basera, James J.C. Nuttall","doi":"10.4102/sajid.v38i1.528","DOIUrl":"https://doi.org/10.4102/sajid.v38i1.528","url":null,"abstract":"Background Antimicrobial stewardship principles guide the clinical use of antimicrobials, including vancomycin, but paediatric vancomycin prescribing practices have not been evaluated in South Africa. Objectives To document the use, prescribing practices and monitoring of intravenous vancomycin and the spectrum of bacteria isolated on microbiological culture in children treated with intravenous vancomycin during a 12-month period at Red Cross War Memorial Children’s Hospital (RCWMCH). Method A retrospective audit of intravenous vancomycin use in children admitted to RCWMCH during 2019 was performed. Results All 158 vancomycin prescription episodes for 143 children were included. Overall usage of intravenous vancomycin was 63 days of therapy per 1000 patient days (interquartile range [IQR]: 38–72). The median starting dose was 15 mg/kg per dose (IQR: 14–15) and median daily dose was 45 mg/kg per day (IQR: 43–60). Vancomycin was prescribed as empiric (127/158, 80%) and directed (31/158, 20%) treatment. The median duration of treatment for the directed group (7 days) was longer than the empiric group (4 days) (p = 0.001). Vancomycin serum trough concentrations were performed in 65/98 (66%) episodes where vancomycin treatment exceeded 3 days, with only 16/65 (25%) of these samples obtained before the fourth dose. Prolonged antibiotic treatment of 14 days or more was not associated with Gram-positive bacteria on culture (odds ratio [OR]: 1.02, 95% confidence interval [CI]: 0.17–4.2). Conclusion Dosing errors, prolonged empiric treatment and inappropriate vancomycin monitoring were problems associated with vancomycin prescriptions. Contribution The study identified multiple opportunities for improved vancomycin prescribing and monitoring. Further research and implementation of improved prescribing practices could contribute to the preservation of vancomycin as an effective antibiotic.","PeriodicalId":44007,"journal":{"name":"Southern African Journal of Infectious Diseases","volume":"93 6","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135584199","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Probable endometrial tuberculosis in a patient with rhupus.","authors":"Nimmisha Govind,&nbsp;Tamara Romanini,&nbsp;Lai Ling Winchow","doi":"10.4102/sajid.v38i1.543","DOIUrl":"https://doi.org/10.4102/sajid.v38i1.543","url":null,"abstract":"<p><p>Endometrial tuberculosis (TB) is an uncommon manifestation of disseminated TB. Rhupus is the coexistence of rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). We describe a case of endometrial TB in rhupus patient an immunosuppressed.</p><p><strong>Contribution: </strong>We describe an uncommon presentation of disseminated TB, endometrial TB, in a rare rheumatic disease, rhupus. A high index of suspicion for TB is imperative in immunocompromised patients presenting with chronic urogenital symptoms especially in an endemic area.</p>","PeriodicalId":44007,"journal":{"name":"Southern African Journal of Infectious Diseases","volume":"38 1","pages":"543"},"PeriodicalIF":0.9,"publicationDate":"2023-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10623593/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71487183","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A case of pericardial schistosomiasis and non-Hodgkin high grade B-cell lymphoma.","authors":"Michael J Boyd,&nbsp;Marc Mendelson,&nbsp;Sipho K Dlamini,&nbsp;Sean Wasserman,&nbsp;Ghaalied Fakier,&nbsp;Riyaadh Roberts,&nbsp;Nectarios S Papavarnavas","doi":"10.4102/sajid.v38i1.524","DOIUrl":"10.4102/sajid.v38i1.524","url":null,"abstract":"<p><p>Chronic schistosomiasis affects either the genitourinary or gastrointestinal tract. Rarely, schistosomes cause ectopic disease, such as in the case of a South African woman from a non-endemic province, who presented with suspected pericardial tamponade because of tuberculosis. However, histology and polymerase chain reaction from pericardial biopsy confirmed <i>Schistosoma haematobium.</i> A finding of mediastinal non-Hodgkin lymphoma came to light when our patient's clinical condition unexpectedly deteriorated.</p><p><strong>Contribution: </strong>This case highlights an unusual manifestation of schistosomiasis.</p>","PeriodicalId":44007,"journal":{"name":"Southern African Journal of Infectious Diseases","volume":"38 1","pages":"524"},"PeriodicalIF":0.9,"publicationDate":"2023-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10546256/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41165364","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Severe efavirenz associated neurotoxicity: A retrospective cohort study.","authors":"Priyadarshini Arnab,&nbsp;Roland Croxford,&nbsp;Janet Scott,&nbsp;Sameshan Perumal,&nbsp;Zahraa Mohammed,&nbsp;Lubbe Wiesner,&nbsp;Karen Cohen,&nbsp;Sean Wasserman","doi":"10.4102/sajid.v38i1.522","DOIUrl":"10.4102/sajid.v38i1.522","url":null,"abstract":"Background Efavirenz (EFV) is associated with neuropsychiatric symptoms. Severe neurotoxicity has been reported but the clinical phenotype and risk factors are poorly defined. Objectives To characterise clinical presentations, risk factors and outcomes to help clinicians recognise severe neurotoxicity earlier. Method The authors retrospectively identified adults with supratherapeutic EFV concentrations (> 4 mg/L) obtained during routine clinical care in Cape Town, South Africa. Clinical and laboratory data at the time of EFV quantification were extracted from medical records. Logistic regression was performed to identify associations with neuropsychiatric symptoms, and with severe neurotoxicity. Results Eighty one patients were included; 62 with neuropsychiatric manifestations (most frequently ataxia [n = 20] and psychomotor slowing [n = 24]); and 19 with hepatotoxicity. Overall, 28 (34.6%) were male, 49 (60.5%) had concomitant isoniazid exposure, and median EFV concentration was 12.1 mg/L (interquartile range [IQR]: 6.6–20.0). Neuropsychiatric symptoms were associated with longer duration of EFV therapy, adjusted odds ratio (aOR) 1.3/180-day increment (95% confidence interval [CI]: 1.0–1.7); higher EFV concentrations, aOR 1.2/1 mg/L increase (95% CI: 1.0–1.4) and isoniazid exposure, aOR 8.2 (95% CI: 2.5–26.7). Severe neuropsychiatric symptoms occurred in 47 (75%) patients at a median of 5.9 months (IQR: 2.1–40.8) after EFV initiation. Severe symptoms odds were 1.2-fold higher (95% CI: 1.1–1.4) per 1 mg/L increase in EFV concentration. Symptoms resolved completely within 1 month in 25 (76%) patients with severe neurotoxicity who discontinued EFV. Conclusion A concentration–effect relationship for severe neurotoxicity exists, which occurred late and resolved in most patients after EFV discontinuation. Contribution The authors highlighted clinical heterogeneity and morbidity of EFV-associated neurotoxicity.","PeriodicalId":44007,"journal":{"name":"Southern African Journal of Infectious Diseases","volume":"38 1","pages":"522"},"PeriodicalIF":0.9,"publicationDate":"2023-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10397354/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41164412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}