Southern African Journal of Infectious Diseases最新文献

Background: Marburg virus disease (MVD) poses an emerging threat to Nigeria, particularly following the 2022 outbreak in neighbouring Ghana. With Nigeria already managing Lassa fever and Mpox outbreaks, assessing healthcare workers' preparedness at viral haemorrhagic disease reference centres is crucial for effective outbreak response.

Objectives: This study aimed to assess healthcare workers' knowledge, attitudes and preparedness regarding MVD at Nigeria's primary viral haemorrhagic fever reference centre.

Method: A cross-sectional study was conducted at Irrua Specialist Teaching Hospital, from May 2024 to October 2024. Healthcare workers were recruited using simple random sampling and data collected via semi-structured questionnaires. Descriptive and inferential statistics were analysed using Stata 17.

Results: Of the 216 participants, 126 (58.3%) were doctors and 90 (41.7%) were nurses. Doctors demonstrated significantly higher knowledge of MVD symptoms (65.9% vs 46.7%, p < 0.001) and risk factors, with fever being the most recognised symptom (68.0%). Only 19.1% of doctors and 10.0% of nurses had received formal MVD training. Confidence in hospital preparedness was paradoxically lower among doctors (32.5%) than nurses (65.6%, p < 0.001). Most participants felt inadequately equipped with personal protective equipment, with only 38.1% of doctors and 48.9% of nurses reporting adequate protection.

Conclusion: Significant gaps exist in MVD health literacy and outbreak preparedness among Nigerian healthcare workers at a major viral haemorrhagic disease centre.

Contribution: Enhanced training programmes, improved resource allocation and systematic preparedness protocols are urgently needed to strengthen Nigeria's capacity for MVD outbreak response.

Glucose-6-phosphate dehydrogenase (G6PD) deficiency is an X-linked disorder that increases red blood cell susceptibility to oxidative damage. While haemolysis is common, methaemoglobinaemia is a rare complication. A 39-year-old man developed both conditions, triggered by Salmonella typhi infection. Diagnosis was supported by Heinz bodies and blister cells on blood smear. Methylene blue and high-dose ascorbic acid were relatively contraindicated because of ongoing haemolysis and renal dysfunction.

Contribution: This case highlights the importance of considering methaemoglobinaemia in G6PD deficiency during infections and adapting treatment when standard therapies are unsuitable.

Background: Carbapenem-resistant Enterobacterales (CRE) pose a critical threat to public health, marked by limited therapeutic options, high mortality rates and significant pressure on healthcare systems. Despite the growing global burden, our region remains under-represented in national surveillance efforts, with a notable absence of local data.

Objectives: This study aims to describe the epidemiological, clinical and microbiological characteristics, as well as patient outcomes, of CRE bacteraemia at Universitas Academic Hospital in Bloemfontein, South Africa, over a 5-year period.

Method: A retrospective file review was performed for all adult in-patients with confirmed CRE bacteraemia admitted between 2019 and 2023. Data collected included patient demographics, comorbidities and clinical data pertaining to admission, microbial characteristics and clinical outcomes.

Results: Ninety-four episodes of CRE bacteraemia were identified in 88 patients. Prior antibiotic exposure was present in 90.9%, while 79.5% had comorbidities and 61.4% acute renal impairment. Klebsiella pneumoniae (84%) and Enterobacter cloacae (9.6%) were the predominant organisms cultured, with oxacillinase-48 (OXA-48) (78.4%) and New Delhi metallo-β-lactamase (NDM) (6.7%) being the most common carbapenemase genes detected. Only 13.8% of OXA-48-positive episodes received recommended first-line antibiotics. In-hospital mortality reached 56.8%, with immunosuppressive therapy significantly associated with death (p = 0.0165).

Conclusion: Mortality in our setting was substantially higher than national and international reports. Suboptimal treatment and limited access to effective antimicrobials likely contributed to these poor outcomes.

Contribution: This is the first outcome-focused CRE study in this region, highlighting an urgent need for improved diagnostic capacity, antimicrobial access and targeted intervention strategies in under-resourced healthcare settings.

Background: High-risk alpha human papillomaviruses (HPVs) are associated with cervical cancer (CC).

Objectives: This study investigated the prevalence and genotype distribution of HPV among women living with and without HIV in Limpopo province, South Africa.

Method: The prevalence of HPV was determined in 450 participants who self-reported to be living with HIV or not. Total DNA was extracted from cervical specimens and amplified through a double-nested polymerase chain reaction (PCR) approach targeting a fragment of the L1 gene. A product from any of the nested PCRs was considered positive for the presence of HPV DNA. The first nested PCR products (~450 base pairs [bp]) were sequenced on an Illumina MiniSeq. Sequence reads of acceptable quality were analysed for viral genotypes.

Results: Human papillomavirus was detected in 32.7% of the study participants and was significantly higher at 52.21% (p = 0.00) among women living with HIV (WLWH) as compared to those not living with HIV. Overall, high-risk (hr) HPV 45 was the predominant genotype (16.7%). However, low-risk (lr) HPV 81 (18.8%) and hr-HPV 56 (25.0%) were more common among women living with and without HIV, respectively. Multiple infections and hr-HPV genotypes were more common among WLWH.

Conclusion: A relatively high prevalence of HPV was detected in the cervical specimens from the study population. Women living with HIV were the most infected group. The data suggest that WLWH should be prioritised for HPV screening and vaccination.

Contribution: This study contributes to the knowledge of HPV in Limpopo province, a region with scarce data on HPV epidemiology.

Background: The coronavirus disease 2019 (COVID-19) is caused by a novel beta coronavirus (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]). The Omicron variant was first identified in November 2021 in multiple countries, including South Africa. The authors aimed to assess chest radiographs to ascertain whether unique radiographic manifestations were related to this variant.

Objectives: The primary objective was to identify key chest X-ray findings in the South African paediatric population testing positive for SARS-CoV-2 during the Omicron era. The secondary objective was to help differentiate between Omicron chest X-ray findings and published findings regarding all preceding variants.

Method: A retrospective cohort review was conducted at three main healthcare academic centres, in which 94 paediatric chest X-rays were assessed by three consultant radiologists to identify key imaging findings.

Results: Ground-glass opacities were more common among infants (45.4%) than children (20%) and adolescents (20%; p = 0.001). Peribronchial thickening was high in all age groups: 97.7% in infants, 87.5% in children and 70% in adolescents (p = 0.019). Consolidation was seen in 28.6% of infants, 19.1% of children and 33.3% of adolescents (p = 0.065). Diffuse disease (involving all lobes) was seen in 54.5% of infants, 52.5% of children and 10% of adolescents (p = 0.033).

Conclusion: Infants had the most chest X-ray findings, with peribronchial thickening followed by ground-glass opacities being the most common.

Contribution: The findings suggest difference neither between Omicron and preceding waves nor between this study and previously published data.

The authors describe a rare case of uterine infection occurring in the postpartum period, following an otherwise uneventful antenatal and peripartum course in a patient who delivered at 36 weeks of gestation. Originally from rural Eastern Cape with livestock exposure, her case emphasises accurate diagnosis in patients from rural areas presenting with respiratory symptoms, including zoonotic infections as causative organisms.

Contribution: This case underscores the importance of identifying uncommon infections in unusual anatomical sites and atypical settings, enabling early intervention to prevent severe complications.

Background: There are few studies of long coronavirus disease (COVID) in low- and middle-income countries.

Objectives: This study investigated long-term pulmonary manifestations of long COVID among adults in Johannesburg, South Africa.

Method: This was a respiratory sub-study of a larger long COVID investigation. Cases with self-reported long COVID symptoms were recruited into four cohorts: prior asymptomatic infection, mild to moderate infection, hospitalised for severe infection and vaccinated prior to infection. Cases with respiratory comorbidity and/or well-characterised exposure to certain conditions (e.g. cigarette smoking) were excluded. Demographics, clinical features, spirometry, six-minute walk test (6MWT) and high-resolution computerised tomographic (HRCT) scan of the chest were recorded.

Results: Of the 171 patients interviewed from the initial study, 36 with appropriate inclusion criteria were recruited a median of 2.1 years following their acute COVID-19 illness. Accordingly, the incidence of long COVID was 21.1% (36/171 patients) for the group as a whole and 5.9% (3/51), 25.0% (14/56), 37.8% (17/45) and 10.5% (2/19) for cohorts 1-4, respectively (p = 0.001). The major symptoms were tiredness and/or fatigue, shortness of breath and cough. Overall, 33 patients had abnormal 6MWT results, and 10 had abnormalities on spirometry; obstructive pattern in five, restrictive in three and mixed in two. Seven patients (six of whom were previously hospitalised) had probable/possible abnormalities compatible with long COVID on HRCT scan (p = 0.045).

Conclusion: This study documented respiratory abnormalities in patients as long as 2 years after prior SARS-CoV-2 infection, especially among those with severe prior infection.

Contribution: This was among the first studies comprehensively documenting pulmonary abnormalities in patients with long COVID in South Africa.

Background: Among hospital-born babies, infections account for 4% - 56% of deaths in the neonatal period, with bloodstream infections being up to 20 times more frequent in low- and middle-income countries (LMICs). The cleansing of infants with chlorhexidine (without emollient) has been the standard of care in Grey's Hospital Neonatal Intensive Care Unit (NICU) for over a decade.

Objectives: This study evaluated the impact of adding an emollient to chlorhexidine on the prevalence of microbiologically confirmed infections.

Method: A retrospective observational cohort study of all microbiologically confirmed bloodstream infections in the neonatal unit before (01 June 2022 to 30 November 2022) and after (01 December 2022 to 31 May 2023) the implementation of the quality improvement project was conducted. The rates of microbiologically confirmed infections were compared between the two periods.

Results: There was a total number of 2741 positive blood cultures over the study period with a significant reduction in positive cultures in the intervention group (46.1% vs. 27%, p < 0.001) but no significant reduction in the proportion of different organisms (Gram-positive, Gram-negative, and fungal isolates) in the two groups (p = 0.58) Gram-positive organisms accounted for most infections in the pre- and post-intervention study groups. There was no significant reduction in the rate of sepsis-associated mortality (p = 0.20).

Conclusion: Further research evaluating the response in larger study populations is needed.

Contribution: Although there was no significant reduction in sepsis-associated mortality, cleansing infants using chlorhexidine with an emollient may reduce bloodstream infections in this vulnerable population in LMICs.