Southern African Journal of Infectious Diseases最新文献

Background: A lack of awareness, poor quality of care, and gender inequalities are factors associated with access and utilisation of leprosy services.

Objectives: This study aimed to identify factors affecting community access and utilisation of leprosy services in high-burden districts of Ethiopia.

Method: A community-based cross-sectional study design was utilised and a simple random sampling technique was used to recruit study respondents. One hundred and sixty-one respondents completed the self-administered structured questionnaire. Data were analysed using SPSS version 26. A logistic regression model was used to identify predictors associated with leprosy services. A p-value < 0.05 was considered statistically significant.

Results: More than 75% (n = 123) of study respondents had limited knowledge about leprosy. However, respondents who reside in urban areas were knowledgeable about the disease (adjusted odds ratio [AOR] = 8.2; 95% confidence interval [CI] = 1.6, 42.0). Men were most likely to use health care facilities (AOR [95% CI] = 2.9 [1.2, 7.2]). In addition, those who had better household income were more likely to have examined their family members for leprosy compared to low-income families (AOR [95% CI] = 4.5 [1.6, 12.9]).

Conclusion: General knowledge about leprosy was low in communities. However, persons infected with leprosy who resided in the urban areas had a better understanding of leprosy. Male persons infected with leprosy were more likely to utilise leprosy services.

Contribution: The results of this study provide early insights into the factors associated with leprosy service utilisation to provide community-centred leprosy care.

Background: Delayed or incorrect treatment of meningitis may result in adverse patient outcomes. However, laboratory testing in resource-limited settings is often limited to conventional diagnostic methods. We explored the utility of syndromic molecular assays for diagnosis.

Objectives: We tested cerebrospinal fluid (CSF) specimens collected from patients with clinically suspected meningitis submitted to a tertiary hospital laboratory in January 2021 - May 2021. Primary microbiological analysis (culture, Gram stain and cytochemical analysis) was performed as part of routine testing.

Method: Residual CSF specimens were tested using a bacterial triplex real-time polymerase chain reaction (PCR) assay and a syndromic multi-pathogen real-time PCR assay for the detection of up to 18 bacterial and viral pathogens. Pathogen detection was compared between conventional and molecular assays.

Results: A potential pathogen was detected in 6% (12/188) and 47% (89/188) of specimens on the triplex and the multi-pathogen assay, respectively. Epstein-Barr virus (49/188; 26%), human herpes virus 7 (22/188; 12%), herpes simplex virus 1 (13/188; 7%) and Streptococcus pneumoniae (10/188; 5%) were the leading pathogens detected on the syndromic multi-pathogen PCR. Further, using the multi-pathogen PCR assay, a potential pathogen was detected in 44% (73/166) of the specimens which were negative following routine testing. Overall, combining routine testing and molecular platforms significantly improved pathogen detection (p < 0.001); a potential pathogen was identified in 51% (95/188) of the specimens tested, compared to 12% (22/188) using routine methods alone.

Conclusion: The use of molecular tests improved pathogen detection by 39% when paired with routine methods.

Contribution: Multi-pathogen molecular testing is useful for rapidly diagnosing meningitis cases.

Nocardiosis is a rare opportunistic infection and may be misdiagnosed as tuberculosis in the immunocompromised patient. This case report highlights the importance of doing tissue cultures in immunocompromised individuals to correctly identify Nocardia spp. and initiate appropriate treatment timeously.

Contribution: This case report describes a typical case of disseminated nocardiosis with brain abscesses in an immunocompromised patient who would have typically been treated as disseminated tuberculosis.

Background: Microbiological testing of peritoneal dialysis bags for peritonitis often yields culture-negative results. Culture-negative samples should not exceed > 15% according to the International Society for Peritoneal Dialysis. To reduce this issue, the addition of a blood culture bottle incubation step to the culture process was introduced at the Infection Control Services Laboratory (ICSL) of the National Health Laboratory Services (NHLS).

Objectives: The aim of the study was to ascertain if the change in methodology increased the culture-positivity yield and reduced the culture-negative percentage.

Method: Data from the NHLS Central Data Warehouse (CDW) were analysed to compare the culture-positive results over two periods: June-December 2022 when the non-blood culture (B/C) bottle method was used and January-July 2023 when the B/C bottle method was implemented.

Results: The non-B/C culture method yielded a 23% culture-positivity yield, whereas the B/C bottle-based method yielded a 51% culture-positivity yield. However, the culture-negative yield for the B/C bottle-based method was high at 49%.

Conclusion: The change in dialysis bag processing in 2023 led to a more than doubling in culture-positivity yield. However, the culture-negative percentage remained high. As a result, further modifications to the methodology are needed.

Contribution: The study findings illustrate that the addition of the B/C bottle incubation step significantly improved peritoneal dialysis bag culture yields which directly impacts patient management.

Background: Health care for sexually transmitted infections (STIs) is often inadequate, especially for women, because of the asymptomatic nature of many STIs, which can lead to a false sense of health. Thus, there is limited data on the prevalence of STIs in pregnant women in low and middle-income countries.

Objectives: The study aimed to determine the prevalence of STIs in asymptomatic pregnant women attending antenatal Rethabile Community Health Centre, Limpopo, South Africa.

Method: A cross-sectional analysis of asymptomatic pregnant women at Rethabile Community Health Centre between March 2023 and November 2023 was conducted to determine the prevalence of seven STIs, detected from self-collected vaginal swab specimens using HAIN fluoroType STI-multiplex Polymerase Chain Reaction (PCR) test for nine targets covering seven major STIs.

Results: The study found that Ureaplasma urealyticum was the most prevalent pathogen (43%) followed by Chlamydia trachomatis (41%), and Trichomonas vaginalis (10%). The less common pathogens detected were Mycoplasma Genitalium (5%) and Neisseria gonorrhoeae (2%).

Conclusion: High STI prevalence among asymptomatic pregnant women at Rethabile Community Health Centre necessitates diagnostic screening over syndromic management because of a lack of reporting for symptoms.

Contribution: The paper examines the epidemiology of STIs in Limpopo, South Africa, focusing on healthy, asymptomatic populations. It emphasises the need for laboratory screening, particularly in pregnant women, over empiric treatment because of high chances of missing infections.

Background: Laboratory-based molecular assays return cycle threshold (Ct) values for each gene target. There is limited hyperlocal information describing the Ct, age and sex trends during the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) waves in South Africa.

Objectives: To analyse the demographic and Ct value trends of SARS-CoV-2 molecular assays from two South African hospitals.

Method: The Seegene Allplex 2019-nCoV™ results from the first two waves (June-July 2020 and November 2020-January 2021) from two major hospitals in Gauteng, South Africa, were extracted from the laboratory information system. Demographic variables and Ct values were analysed.

Results: Overall, 2391 samples were analysed over two waves. In both waves, more women were tested than men; 68.4% versus 31.2% in the first wave and 59.8% versus 39.7% in the second wave. Differences in Ct values among the age groups were non-significant overall; however, most median Ct values in all age groups were < 30. Men had lower median Ct values in the first wave, but this trend reversed in the second wave (p < 0.001). The first wave had significantly lower mean and median Ct values per gene target (p < 0.001).

Conclusion: Patients tested in the first wave had lower Ct values. All age groups in both waves demonstrated infectivity potential; the demographic analysis agreed with South Africa's coronavirus disease 2019 (COVID-19) epidemiological trends in both waves.

Contribution: Granular insight into the basic demographic variables and Ct trends of SARS-CoV-2 real-time polymerase chain reaction (RT-PCR) results within and between SARS-CoV-2 waves in South Africa.

Background: In tropical and subtropical areas of the world, malaria is still a serious public health concern. Activities related to agricultural development that involve irrigation schemes likely increase the risk of malaria in tropical and sub-Saharan African regions. Ethiopia is a sub-Saharan country where malaria is endemic.

Objectives: The aim of the study was to investigate the determinants related to the persistence of malaria transmission in the Arjo-Didessa sugarcane farm area in southwest Ethiopia.

Method: The study employed a quantitative survey design. Quantitative data were collected from 397 households using structured questionnaires. SPSS Statistics version 26 was used to analyse the data. Z- and Chi-square tests were applied, and the data were analysed using logistic regression.

Results: The determinants that were identified included variation in land use, water management practices, socioeconomic status and knowledge about the use of anti-malaria treatment. These were shown to contribute to increased malaria transmission and the rise in malaria cases in agricultural areas.

Conclusion: The effectiveness of malaria control in agricultural settings can be improved through free access to malaria testing and treatment as well as knowledge about anti-malaria treatment among the residents in agricultural areas.

Contribution: The study revealed key determinants, including the promotion of free access to anti-malaria treatment, which should be considered for the effective management of malaria in agricultural areas.

Background: The complexity of contexts and varied purposes for which biome donation are requested are unknown in South Africa.

Objectives: The aim of this study was to provide strategic data towards actualisation of whether a stool donor bank may be established as a collaborative between Western Cape Blood Services (WCBS) and the University of Cape Town (UCT).

Method: We designed a cross-sectional, questionnaire-based survey to determine willingness of WCBS blood donors to donate stool specimens for microbiome biobanking. The study was conducted between 01 June 2022 and 01 July 2022 at three WCBS donation centres in Cape Town, South Africa. Anonymous blood donors who met the inclusion criteria were enrolled. Anonymised demographic and interview data were analysed statistically.

Results: Analysis of responses from 209/231 blood donors demonstrated in a logistic regression model that compensation (p < 0.001) and 'societal benefit outweighs inconvenience' beliefs (p = 7.751e-05) were covariates significantly associated with willingness to donate stool. Age was borderline significant at a 5% level (p = 0.0556). Most willing stool donors indicated that donating stool samples would not affect blood donations (140/157, 90%). Factors decreasing willingness to donate were stool collection being unpleasant or embarrassing.

Conclusion: The survey provides strategic data for the establishment of a stool bank and provided an understanding of the underlying determinants regarding becoming potential donors.

Contribution: This is the first report on the perspectives of potential participants in donating samples towards a stool microbiome biobank in South Africa, a necessity for faecal microbiota transplantation (FMT).

Background: There is limited data on diagnoses during hospital stay among children living with HIV(CLHIV) in the antiretroviral and coronavirus disease 2019 (COVID-19) era.

Objectives: The aim of this study was to describe hospital diagnoses and clinical characteristics of CLHIV before and during the COVID-19 pandemic.

Method: A retrospective descriptive cross-sectional study was performed. Clinical and laboratory data were retrieved by reviewing folders and discharge summaries from January 2019 to December 2021. Period A (pre-COVID-19) was defined as the period from January 2019 to March 2020. Period B (During COVID-19) was defined as being from April 2020 to December 2021.

Results: Ninety-six children contributed 215 diagnoses over the study period. The five most common diagnoses were unspecified HIV disease (47/215, 21.9%), tuberculosis (TB) (42/215, 19.5%), pneumonia (13/215, 6.0%), encephalopathy (11/215, 5.1%) and malnutrition (11/215, 5.1%). Median CD4 count was 377 cells/mm (IQR 126, 726) and 8.0% of the children were virally suppressed. Ninety-five per cent of the children had WHO Stage 3 and 4 (95%) disease and 12.5% of children required ICU admission. No child was diagnosed with COVID-19 despite universal screening. Moreover, 81.7% of the children had a social worker referral documented.

Conclusion: Advanced HIV disease (AHD) remains prevalent with TB being the most common diagnosis. There were no cases of COVID-19 recorded in CLHIV.

Contribution: The findings provide a description of the diagnoses of CLHIV in the South African setting prior to and during the COVID-19 pandemic. It highlights the need for more specific documentation of diagnoses to inform better prevention of AHD in children.

Background: Since 2019, the World Health Organization has recommended dolutegravir-containing regimens for HIV in low- and middle-income countries because of its high genetic barriers to resistance, lower drug interactions, fewer side effects, higher viral load (VL) suppression rates and cost-effectiveness compared to efavirenz.

Objectives: This study investigates factors associated with unsuppressed VLs in people living with HIV on tenofovir-lamivudine and dolutegravir (TLD) in South Africa (SA).

Method: A cross-sectional study was conducted between October 2023 and February 2024 at Mamelodi Regional Hospital's Ntshembo Clinic. Participants were people living with HIV aged 18 years and older, more than 6 months on TLD, with either suppressed (≤ 50 copies/mL) or unsuppressed (> 50 copies/mL) VLs.

Results: Significant associations were found between unsuppressed VL and factors such as sex, marital status, occupation and education level. Male participants were less likely to achieve VL suppression than female participants (odds ratio: 0.45, p = 0.0007). Poor antiretroviral therapy adherence was linked to higher unsuppressed VL (p < 0.05). Newly initiated patients had significantly lower suppression rates (p < 0.05). The use of traditional or herbal and religious products was also linked to unsuppressed VL (p < 0.05).

Conclusion: The study highlights the importance of addressing adherence factors to improve VL suppression rates among people living with HIV on TLD.

Contribution: Tailored interventions targeting adherence, especially among newly initiated patients, and addressing the use of traditional or herbal and religious products are warranted to enhance treatment outcomes.