Southern African Journal of Infectious Diseases最新文献

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.

Background: Despite the increased initiation and uptake of antiretroviral therapy (ART) in South Africa, some people living with HIV (PLHIV) who are on ART still have non-suppressed viral load (VL).

Objectives: This study aimed to determine the prevalence of VL non-suppression among adolescents and youth (aged 12 years - 24 years) living with HIV and on ART in South Africa, as well as the factors associated with it.

Method: Data from the 2017 South African national HIV prevalence, incidence, behaviour, and communication survey were analysed. The survey used a multistage-stratified cluster sampling design. A backward stepwise multivariable generalised linear model was used to identify factors associated with VL non-suppression.

Results: The study included 340 participants aged 12 years - 24 years, with a median age of 21 (interquartile range [IQR]: 18-23). The proportion of adolescents and youth living with HIV and on ART with non-suppressed VL was 19.2% (95% confidence interval [CI]: 14.4-25.3). Approximately 60% of the participants were not on ART. The odds of VL non-suppression were significantly higher among youth aged 15 years - 19 years (adjusted odds ratio [AOR] = 1.63 [95% CI: 1.24-2.13], p = 0.001) and aged 20 years - 24 years (AOR = 1.22 [95% CI: 1.06-1.41], p = 0.005) compared to adolescents aged 12 years - 14 years. The odds were significantly lower among individuals of other races (AOR = 0.80 [95% CI: 0.69-0.92], p = 0.003) compared to black African people.

Conclusion: Findings suggest a need for ART education and counselling as part of treatment support. In addition, the promotion of HIV awareness as part of strengthening the HIV treatment and prevention cascade.

Contribution: The article showed the prevalence of VL non-suppression and associated factors among adolescents and youth.

Hydatid disease (cystic echinococcosis) is a neglected zoonosis, often incidentally detected in its late stages. The clinical manifestations depend on the location and dimensions of the cysts, with the liver and lungs frequently affected. This case report describes thrombocytopenia, an unusual haematological complication of hydatid disease. We use this case to highlight the role that platelets play in various parasitic infections and to advocate for further research into the role of platelets in hydatid disease.

Contribution: We draw attention to a less well-known complication of hydatid disease.

Background: Despite compelling evidence of comorbidity between tuberculosis (TB) and depression, little is known about the prevalence and determinants of depression among TB patients in the Free State province in South Africa.

Objectives: This study assessed the prevalence and factors associated with possible depression among new drug susceptible TB patients attending primary health care facilities.

Method: The study followed a cross-sectional design. Trained fieldworkers conducted face-to-face interviews with conveniently selected patients. Depression was assessed using the Patient Health Questionnaire-9. Data were subjected to descriptive and binomial logistic regression analyses.

Results: Out of 208 patients, 46.2% screened positive for possible depression - 22.6%, 18.8%, and 4.8% presenting with mild, moderate, and severe symptoms, respectively. Possible depression odds were three times higher among females than males (adjusted odds ratio [AOR]: 3.0; 95% confidence interval [CI]: 1.25-7.32) and 2.7 times higher among extrapulmonary TB (EPTB) than pulmonary TB patients (95% CI: 1.03-7.21). Longer TB treatment duration was protective (AOR: 0.8; 95% CI: 0.70-0.95) against depression. Among human immunodeficiency virus-positive patients, those on antiretroviral therapy (ART) had 2.5 times higher odds of depression (95% CI: 1.13-5.46) than those who were not.

Conclusion: The results highlight a significant burden of possible depression among new TB patients, particularly among females, EPTB patients, and ART recipients. Longer TB treatment duration may offer some protection against depression symptoms, suggesting a need for enhanced adherence support.

Contribution: The results suggest that strengthening TB and mental health service integration is critical to improving treatment outcomes, overall well-being of TB patients, and the performance of the Free State TB programme.

Background: Moulds and dimorphic fungi are increasingly recognised as pathogens carrying high morbidity and mortality in critically ill and immune-compromised patients. The lack of surveillance data limits our understanding of these infections.

Objectives: To determine the distribution, patient characteristics, risk factors, therapy and treatment outcome in patients with positive mould or dimorphic fungal cultures from sterile sites at a tertiary hospital in central South Africa.

Method: All moulds or dimorphic fungi cultured from sterile specimens from 1 July 2014 to 30 June 2017 were identified retrospectively. Laboratory and clinical records were reviewed. Information collected included gender and age, type of specimen collected for investigation, specific fungi isolated, underlying conditions, other contributing risk factors, treatment and outcome of the patients.

Results: Forty-eight patient records were analysed. Male and female patients were equally distributed. The mean age was 40.5 years (range 7-78 years). Aspergillus spp. were most commonly isolated. The most common underlying condition was HIV infection, followed by haematological conditions. Twenty-six (54.2%) patients received treatment involving antifungal therapy alone (n = 19; 73.1%), surgery alone (n = 5; 19.2%) or a combined medical and surgical approach (n = 2; 7.7%). Twenty-two (45.8%) patients received no treatment. The overall mortality rate was 25.0% (n = 12).

Conclusion: The diagnosis of fungal infections remains challenging. In the current study, moulds and dimorphic fungi were isolated from at-risk patients' specimens. Despite treatment with appropriate antifungal agents, the associated mortality rate was high.

Contribution: This study contributes to the growing body of knowledge on these potentially life-threatening infections.

Diphtheria is a life-threatening respiratory tract infection that causes outbreaks in susceptible populations. Between April and May 2018, an outbreak of diphtheria occurred in the eThekwini district. A school-based outbreak vaccination response was initiated to target vulnerable children and adolescents.

Contribution: This study adds to the limited data describing a school-based vaccination in an outbreak response and highlights successes and challenges. School-based outbreak vaccination response can rapidly increase vaccine coverage; however, additional community engagement may be required in vaccine-hesitant populations.

Background: Comparisons of the characteristics of individuals hospitalised with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or seasonal influenza in low-to middle-income countries with high human immunodeficiency virus (HIV) prevalence are limited.

Objectives: Determine the epidemiological differences with those hospitalised with influenza or SARS-CoV-2 infection.

Method: We investigated hospitalised individuals ≥18 years of age testing positive for seasonal influenza (2016-2019) or SARS-CoV-2 (2020-2021). We used random effects multivariable logistic regression, controlling for clustering by site, to evaluate differences among adults hospitalised with influenza or SARS-CoV-2 infection.

Results: Compared to individuals with influenza, individuals with SARS-CoV-2 infection were more likely to be diabetic (adjusted odds ratio [aOR]: 1.70, 95% confidence interval [CI]: 1.11-2.61) or die in hospital (aOR: 2.57, 95% CI: 1.61-4.12). Additionally, those with SARS-CoV-2 infection were less likely to be living with HIV (not immunosuppressed) (aOR: 0.50, 95% CI: 0.34-0.73) or living with HIV (immunosuppressed) (aOR: 0.27, 95% CI: 0.18-0.39) compared to not living with HIV and less likely to be asthmatic (aOR: 0.21, 95% CI: 0.13-0.33) rather than those living with influenza.

Conclusion: Individuals hospitalised with SARS-CoV-2 had different characteristics to individuals hospitalised with influenza before the coronavirus disease 2019 (COVID-19) pandemic. Risk factors should be considered in health management especially as we move into an era of co-circulation of SARS-CoV-2 and influenza pathogens.

Contribution: Identifying groups at high risk of severe disease could help to better monitor, prevent and control SARS-CoV-2 or influenza severe disease.

In this opinion paper, the author reflects on a transformative experience attending an antimicrobial stewardship workshop that shifted their perception of the looming crisis of antimicrobial resistance. The author emphasises the critical need for greater awareness and education at all levels of society, from healthcare professionals to the general population, to truly comprehend the severity of this issue. Drawing parallels between antimicrobial resistance and more recognised threats such as cancer, the author advocates for a multidisciplinary approach and heightened emphasis on education to foster responsible antimicrobial use. They propose practical strategies, including integrating stewardship principles into medical education and advocating for preventive measures such as vaccination. Ultimately, this paper urges individuals to embrace their roles as stewards of antimicrobials and to seize the opportunity to effect change for the betterment of humanity.

Contribution: This opinion paper emphasises the urgent need for greater awareness and education on antimicrobial stewardship. It underscores the importance of multidisciplinary collaboration and proposes practical strategies, particularly in healthcare education. These insights align with the journal's scope of advancing healthcare education, policy, and addressing global health challenges regarding infectious diseases.