Southern African Journal of Infectious Diseases最新文献

Background: HIV advance disease and tuberculosis (TB) are still frequent in Gabon.

Objectives: This study described the clinical and radiological features of bacteriologically confirmed TB among hospitalised persons living with HIV (PLHIV) and in-hospital death-associated factors.

Methods: Patients older than 18 years old, with a diagnosis of TB between 2021 and 2022, were prospectively included. Sociodemographic, clinical, radiological data, CD4 cell count, ART, lenght of hospital stay and mortality were recorded and analyzed. Factors associated with patient death were investigated.

Results: Overall, 94 (54.7%) of 172 hospitalised PLHIV had TB. Their median age was 37 (32-42) years, 67.0% were females, 47.9% were on ART and 85.0% were in the advanced disease stage. Overall, 52 (55.3%) PLHIV had isolated pulmonary TB, 13 (13.8%) had extra-pulmonary forms, mainly neuromeningeal and lymph node forms, 25(26.6%) had a disseminated TB that involved pulmonary lesions and 4 (4.3%) had an extra-pulmonary disseminated TB. The median CD4 count was 83 (54-128) cells/µL. It was lower in the group of deceased participants (p = 0.04). The case fatality rate was 26.0% (n = 24). Mortality associated factors were length of hospital stay below 10 days (odds ratio [OR] = 3.9 [1.06-14.3], p = 0.04) and CD4 < 200 cells/mm³ (p = 0.01). A trend was also observed for males (OR = 2.11 [0.81-5.5], p = 0.062) and age above 45 years (OR = 2.68 [0.92-7.78], p = 0.07).

Conclusion: HIV-TB coinfection and extra-pulmonary forms are still frequent in immunocompromised PLHIV. The in-hospital mortality is high, probably because of late diagnosis.

Contribution: This study highlights the need of integrated early HIV and TB diagnosis and management in highly endemic settings to improve coinfected patient outcome.

The association of tuberculosis (TB) with the mining industry is well known in South Africa. This may well be true for gold mining and silica exposure. However, a description of the pathophysiological link between coal mining and TB is not clearly detailed in the literature with many articles citing associations rather than direct causality. A focused intervention of active case-finding and treatment in coal mines in South Africa resulted in a dramatic reduction in the incidence of TB of more than 70% compared to historical figures and substantially below the national incidence as well.

Contribution: We suggest that the risk of acquiring or reactivating TB is not solely attributable to coal exposure itself. Instead, socioeconomic factors, such as poor working and living conditions around mines and comorbid illnesses, likely play a more significant role, as the principal drivers of the disease and therefore, these factors, alongside active screening for TB should receive more attention.

Background: Healthcare-associated infections (HAIs) result in a significant burden on the healthcare sector. Investigations into their epidemiology and possible routes of transmission are important to enable interventions that protect patients and staff. Radiology devices are known to be colonised by microbial organisms that may act as fomites for infection. However, there is a lack of relevant data from the South African setting.

Objectives: The study aimed to determine deficiencies in infection control practices and the microbial colonisation rates and resistance profiles of devices within a radiology department.

Method: A cross-sectional, single-centre study was conducted in a radiology department in Johannesburg, South Africa. An infection prevention and control (IPC) audit was performed, and 143 swabs were collected. Swabs were cultured according to standard microbiological techniques, and focused antimicrobial resistance testing was performed.

Results: Infection prevention and control practices did not align with manufacturer recommendations. A total of 29 positive swabs were obtained (20.3%). Of these, 93.1% (n = 27) were considered commensals, while 6.9% (n = 2) were considered pathogens. No significant antimicrobial resistance mechanisms were detected.

Conclusion: The detection of pathogenic organisms demonstrates the possibility of microbial transmission between patients within the department. Infection control practices are noncompliant and require improvement to mitigate this risk. The threat of microbial dissemination remains.

Contribution: This study demonstrates the prevalence of microbes in a South African radiology department, underscoring the risk of microbial dissemination because of inadequate decontamination practices between patients.

Background: Coronavirus disease 2019 (COVID-19) was recognised as a global pandemic in 2019, yet the exact number of infections is still unclear. In addition, there is limited research on post-mortem antibody testing.

Objectives: This study sought to evaluate the use of the SureScreen COVID-19 immunoglobulin (Ig) G and IgM Rapid Test Cassette in deceased individuals by comparing it to the gold-standard antibody tests in South Africa, and to identify the most appropriate antibody testing method for post-mortem samples.

Method: Between May 2021 and February 2023, fifty cases, with suspected COVID-19 infection during their lifetime, were recruited from Tygerberg Mortuary and Salt River Mortuary, after obtaining informed consent from their next-of-kin. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was confirmed through antemortem positive COVID-19 polymerase chain reaction (PCR) (PCP) tests in 39 participants. Blood samples were collected during autopsies in serum separator tubes, which yielded better separation when centrifuged immediately after collection. The SureScreen test was performed alongside Roche Diagnostics Elecsys Anti-SARS-CoV-2 and Abbott Architect SARS-CoV-2 IgG assays.

Results: Among the confirmed PCP cases, Elecsys demonstrated the highest sensitivity (97.1%) followed by SureScreen IgG (82.1%). In a logistic regression analysis, PCP confirmation was significantly associated with the SureScreen IgG results (p < 0.05).

Conclusion: Overall, Roche's Elecsys had the highest yield of positive results on our cohort of post-mortem serum samples, followed by SureScreen, and finally, Abbott's Architect assay.

Contribution: These results suggest that the SureScreen test has potential as a screening tool in mortuary settings, with Roche's Elecsys assay recommended for diagnostic confirmation.

Background: Before coronavirus disease 2019 (COVID-19), global health was improving, with declining mortality trends. The pandemic disrupted this progress, increasing mortality in South Africa between April 2020 and March 2022. Pre-pandemic data establishes a baseline for assessing COVID-19's impact on all-cause mortality.

Objectives: This study examines changes in hospital-based mortality trends in a Gauteng hospital complex from April 2018 to March 2022, addressing the scarcity of such studies during the COVID-19 era.

Method: A retrospective review of 7815 deaths from April 2018 to March 2022 was conducted. Chi-squared tests were used to analyse deaths by age group and gender, with correlations reported.

Results: Mortality rates rose from 3.2% in 2018-2019, peaked at 5.1% in 2020-2021, and declined to 4.2% in 2021-2022. Patients aged 15 years-64 years had the highest death rates, with an increase among those over 65. Male deaths exceeded female deaths, with the smallest difference observed in 2020-2021. Leading causes of death included diseases of the circulatory and respiratory systems, neoplasms, digestive system diseases, and infectious and parasitic diseases.

Conclusion: The study highlights COVID-19's impact on mortality, showing variations by year, age, gender, and disease.

Contribution: Excess non-COVID-19 deaths likely stemmed from disrupted healthcare services. These findings underscore the need for ongoing monitoring of hospital mortality to identify pandemic-related service disruptions and guide interventions to strengthen healthcare services, improve access to care, and enhance referral systems during unexpected disasters.

Background: Studying the microbial profile and their antibiotic resistance in paediatric appendicitis is essential for tracking susceptibility, guiding treatment choices and ensuring effectiveness. Understanding variations in therapies can improve outcomes and reduce complications. Despite its importance, limited research has been conducted in South Africa on microbial profiles and antibiotic resistance in paediatric appendicitis.

Objectives: To identify bacteria cultured from pus specimens obtained from paediatric patients with acute appendicitis and determine their antibiotic susceptibility.

Method: This was a prospective case series of children aged 13 years and younger, who had appendectomies for acute appendicitis. Data were collected via REDCap and analysed using R software. Pus swabs were obtained for microscopy, culture and sensitivity of organisms isolated.

Results: The study comprised 20 patients, of whom 12 (60%) were male. Most cases (n = 17; 85%) were complicated appendicitis. Escherichia coli was the most prevalent bacterial species isolated, accounting for 60% of cases, while no bacterial growth was observed in 30% of cases. All the isolates (100%) were susceptible to cefepime, gentamicin, amikacin, ertapenem, imipenem and meropenem, while high sensitivity rates of 92.9% were found for ciprofloxacin, ceftazidime and piperacillin-tazobactam. Short-term complications (predominantly surgical site infections) were present in 6 patients (30%).

Conclusion: Escherichia coli was the most common bacterium in paediatric acute appendicitis, with all isolates sensitive to ciprofloxacin.

Contribution: Regional monitoring and research are useful to adapt protocols and combat increasing antibiotic resistance.

Background: Inappropriate prescribing of antibiotics is a global problem. We assessed the prescribing patterns of antibiotics in three public primary healthcare centres (PHCCs) in Maseru, Lesotho.

Objectives: A cross-sectional point prevalence survey was employed using patients' prescription booklets from October 2022 to December 2022.

Method: Antibiotics were categorised according to the World Health Organization (WHO) AWaRe classification and assessed by Defined Daily Dose (DDD)/100 outpatients/day to measure relative consumption of each antibiotic as a percentage of total consumption, Access-to-Watch index (AW-I) and Amoxicillin Index (A-I).

Results: Of the 624 participants (median age 35 [interquartile range {IQR}: 45-26] years), 71.5% (n = 446) were female. Overall mean (standard deviation [s.d.]) antibiotic consumption was 1.48 (0.13) DDD/100 outpatients/day, with PHCC-1 at 1.64, PHCC-2 at 1.33 and PHCC-3 at 1.47 DDD/100 outpatients/day. The median (IQR) AW-I was 4.64 (3.42-9.45) and the A-I was 1.41 (0.87-1.95). The most frequently prescribed Access group antibiotics included amoxicillin (PHCC-2: 45.9%, overall 1.33 DDD/100 outpatients/day; PHCC-3: 24.5%, 1.47 DDD/100 outpatients/day, and PHCC-1: 23.2%, 1.64 DDD/100 outpatients/day) and doxycycline (PHCC-3: 29.9%, 1.47 DDD/100 outpatients/day, 24.1%, PHCC-2: 1.33 DDD/100 outpatients/day). Erythromycin was the most prescribed Watch group antibiotic for all PHCCs.

Conclusion: High consumption of Access-group antibiotics was observed. The Watch group's antibiotic use, particularly erythromycin, requires the implementation of stewardship programmes. Results may be a baseline for establishing antibiotic stewardship in Lesotho's PHCCs.

Contribution: Our study addressed the scarcity of data on antibiotic prescribing patterns in PHCCs in Lesotho using the AWaRe classification system recommended for monitoring antibiotic prescribing and promoting rational use.

This case report details haemorrhagic cystitis in a 49-year-old female with chronic lymphocytic leukaemia (CLL), recurrent haematuria and detected BK polyomavirus (BKPyV) and adenovirus (HAdV) in urine. During chemotherapy cycles, quantitative polymerase chain reaction (PCR) assays found high HAdV load, similar to a HAdV-B2 genotype 78, a rare genotype that is closely related to HAdV-11.

Contribution: Viral interactions reveal immune system vulnerabilities.

Fungal endocarditis is rare, challenging to diagnose and treat and associated with high mortality. We describe a case of Fusarium solani endocarditis in a patient with Ebstein's anomaly with a favourable outcome.

Contribution: We emphasise that surgical intervention with source control of the infective vegetation is still the mainstay of treatment and highlight the importance of submitting infected source material for histology, culture and molecular testing to identify the causative organism.

Background: Carbapenem-resistant Enterobacterales (CRE) are associated with significant morbidity and mortality. Carbapenem-resistant Enterobacterales colonisation is an important prerequisite for infection, and its surveillance is crucial to reduce spread. However, data from South Africa are limited.

Objectives: We aimed to determine CRE colonisation prevalence, the incidence of subsequent CRE infections and the risk factors associated with each.

Method: We retrospectively reviewed hospital records from 686 patients admitted to a medical high-care ward at a tertiary hospital in Gauteng, South Africa, between October 2019 and May 2022. Patients were grouped by CRE colonisation status on arrival and discharge. Data on comorbidities, indwelling devices and antibiotic exposure were collected.

Results: The prevalence of CRE colonisation was 12.4% (95% confidence interval [CI]: 10.1-15.1), with Klebsiella pneumoniae (81.2%) being the most common CRE isolated and OXA-48-like enzymes (94.5%) being the most frequent carbapenemase detected. Risk factors for CRE colonisation on the univariate analysis included exposure to antibiotics (odds ratio [OR]: 2.21; 95% CI: 0.98-4.96, P = 0.048) and presence of a central venous line (OR: 6.33; 95% CI: 1.78-22.46, P = 0.001). Of patients colonised with a CRE, 21.2% subsequently developed a culture-positive infection within 180 days from the initial colonisation result and the majority within 30 days. These infections were mostly CREs (OR: 4.0, 95% CI: 1.3-12.7), and where the infections were CREs, the causative CRE organism and carbapenemase subtype were identical in each case.

Conclusion: Our study documented higher CRE prevalence rates than those previously reported from South Africa. Given the association between CRE colonisation and subsequent infection, urgent measures are required to reduce CRE colonisation rates. As the organism and carbapenemase detected in the initial colonisation and subsequent CRE infection were closely related, knowledge of prior CRE colonisation may assist clinicians with antibiotic choice if patients present with an infection within 30 days of CRE colonisation.

Contribution: This study reports higher CRE colonization rates in South Africa than previously documented, highlighting the urgent need to reduce colonization. The close genetic link between CRE colonization and subsequent infection suggests that knowledge of prior colonization can guide clinicians in selecting effective antibiotics, particularly for infections occurring within 30 days. These findings support targeted interventions to address the rising CRE threat.