Pub Date : 2025-03-28eCollection Date: 2025-01-01DOI: 10.7196/AJTCCM.2025.v31i1.3165
U Lalla, R Raine
{"title":"Intensive care unit models in pandemics and beyond: Striking the balance between efficiency, ethics and equity.","authors":"U Lalla, R Raine","doi":"10.7196/AJTCCM.2025.v31i1.3165","DOIUrl":"10.7196/AJTCCM.2025.v31i1.3165","url":null,"abstract":"","PeriodicalId":52847,"journal":{"name":"African Journal of Thoracic and Critical Care Medicine","volume":"31 1","pages":"e3165"},"PeriodicalIF":0.0,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12009503/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144045975","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":"Depemokimab in eosinophilic asthma - a new era in biological therapy?","authors":"S Pillay","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":52847,"journal":{"name":"African Journal of Thoracic and Critical Care Medicine","volume":"31 1","pages":"42"},"PeriodicalIF":0.0,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144028259","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}
Pub Date : 2024-12-11eCollection Date: 2024-01-01DOI: 10.7196/AJTCCM.2024.v30i4.1832
R Morar, I Sinclair, C Feldman
Background: Chitotriosidase is a chitinase enzyme that is expressed selectively through activated macrophages in humans. Increased activity of chitotriosidase in both bronchoalveolar lavage samples and serum of patients with sarcoidosis has been reported. It has been proposed that chitotriosidase could be used as a potential biomarker for diagnosis, monitoring and prognosis in sarcoidosis patients. However, no studies in a South African (SA) cohort have evaluated this potential role.
Objectives: To analyse serum chitotriosidase activity in treated and untreated sarcoidosis patients, healthy controls and patients with tuberculosis (TB). Sarcoidosis and TB are two diseases of differing aetiology that may be clinically difficult to distinguish between in the SA setting, which is a high-burden area for TB. We hoped to determine whether chitotriosidase activity levels could help differentiate the one disease from the other.
Methods: Serum chitotriosidase activity was measured in an SA cohort of treated and untreated sarcoidosis patients and compared with controls. In addition, activity in sarcoidosis patients was compared with that in TB patients. Overall, chitotriosidase activity was assayed in the serum of 12 biopsy-proven sarcoidosis patients before treatment, 9 sarcoidosis patients after at least a month's treatment, 10 patients with confirmed pulmonary and/or disseminated TB before treatment, and 12 healthy controls. Plasma chitotriosidase activity was assayed as previously described using 4-methylumbelliferyl-β-D-N,N',N″-triacetylchitotriose as a substrate.
Results: Significantly higher serum chitotriosidase activity was observed in sarcoidosis patients, both untreated and treated, compared with controls (p<0.05). Sarcoidosis patients had higher chitotriosidase levels than TB patients, but this difference was not significant. While chitotriosidase activity was lower in patients with TB than in those with sarcoidosis, levels were elevated compared with controls.
Conclusion: Chitotriosidase activity in patients with sarcoidosis was greater than in those with TB, and also greater compared with controls. The increased chitotriosidase activity in sarcoidosis suggests that this enzyme may be involved in the disease pathogenesis. Further investigation is required to validate these findings.
Study synopsis: What the study adds. Serum chitotriosidase activity in South African sarcoidosis and tuberculosis (TB) patients was evaluated. The study adds to the research assessing the significance of serum chitotriosidase in patients with sarcoidosis and TB.Implications of the findings. Chitotriosidase enzyme activity could potentially serve as a biomarker of possible diagnostic and/or prognostic value in patients with sarcoidosis.
{"title":"Serum chitotriosidase activity in South African patients with sarcoidosis and tuberculosis.","authors":"R Morar, I Sinclair, C Feldman","doi":"10.7196/AJTCCM.2024.v30i4.1832","DOIUrl":"10.7196/AJTCCM.2024.v30i4.1832","url":null,"abstract":"<p><strong>Background: </strong>Chitotriosidase is a chitinase enzyme that is expressed selectively through activated macrophages in humans. Increased activity of chitotriosidase in both bronchoalveolar lavage samples and serum of patients with sarcoidosis has been reported. It has been proposed that chitotriosidase could be used as a potential biomarker for diagnosis, monitoring and prognosis in sarcoidosis patients. However, no studies in a South African (SA) cohort have evaluated this potential role.</p><p><strong>Objectives: </strong>To analyse serum chitotriosidase activity in treated and untreated sarcoidosis patients, healthy controls and patients with tuberculosis (TB). Sarcoidosis and TB are two diseases of differing aetiology that may be clinically difficult to distinguish between in the SA setting, which is a high-burden area for TB. We hoped to determine whether chitotriosidase activity levels could help differentiate the one disease from the other.</p><p><strong>Methods: </strong>Serum chitotriosidase activity was measured in an SA cohort of treated and untreated sarcoidosis patients and compared with controls. In addition, activity in sarcoidosis patients was compared with that in TB patients. Overall, chitotriosidase activity was assayed in the serum of 12 biopsy-proven sarcoidosis patients before treatment, 9 sarcoidosis patients after at least a month's treatment, 10 patients with confirmed pulmonary and/or disseminated TB before treatment, and 12 healthy controls. Plasma chitotriosidase activity was assayed as previously described using 4-methylumbelliferyl-β-D-N,N',N″-triacetylchitotriose as a substrate.</p><p><strong>Results: </strong>Significantly higher serum chitotriosidase activity was observed in sarcoidosis patients, both untreated and treated, compared with controls (p<0.05). Sarcoidosis patients had higher chitotriosidase levels than TB patients, but this difference was not significant. While chitotriosidase activity was lower in patients with TB than in those with sarcoidosis, levels were elevated compared with controls.</p><p><strong>Conclusion: </strong>Chitotriosidase activity in patients with sarcoidosis was greater than in those with TB, and also greater compared with controls. The increased chitotriosidase activity in sarcoidosis suggests that this enzyme may be involved in the disease pathogenesis. Further investigation is required to validate these findings.</p><p><strong>Study synopsis: </strong><b>What the study adds.</b> Serum chitotriosidase activity in South African sarcoidosis and tuberculosis (TB) patients was evaluated. The study adds to the research assessing the significance of serum chitotriosidase in patients with sarcoidosis and TB.<b>Implications of the findings.</b> Chitotriosidase enzyme activity could potentially serve as a biomarker of possible diagnostic and/or prognostic value in patients with sarcoidosis.</p>","PeriodicalId":52847,"journal":{"name":"African Journal of Thoracic and Critical Care Medicine","volume":"30 4","pages":"e1832"},"PeriodicalIF":0.0,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11874180/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143558610","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}
Pub Date : 2024-12-11eCollection Date: 2024-01-01DOI: 10.7196/AJTCCM.2024.v30i4.1617
C Schmidt, P S Nyasulu, I Fwemba, U Lalla, B W Allwood, A Parker, J J Taljaard, L N Sigwadhi, J L Tamuzi, A E Zemlin, R T Erasmus, C F N Koegelenberg
<p><strong>Background: </strong>Hospital-acquired infection (HAI) in patients with COVID-19 admitted to the intensive care unit (ICU) is associated with increased mortality. The 'cytokine storm' associated with COVID-19 leads to extreme elevation of inflammatory biomarkers, including C-reactive protein (CRP). Procalcitonin (PCT) has been shown to be more discriminative than CRP in distinguishing HAI from other inflammatory processes.</p><p><strong>Objectives: </strong>To investigate the utility of PCT in detecting HAI in patients with severe COVID-19.</p><p><strong>Methods: </strong>Clinical and laboratory data from all patients admitted to a dedicated ICU with confirmed severe COVID-19 from 1 April 2020 to 31 August 2020 were prospectively captured. HAI was confirmed by serial PCT and CRP measurements, as well as microbiological data (positive microbiological cultures in clinical context). Data from patients who were on antibiotics on ICU admission, had a positive culture for a presumed pathogen during the first 48 hours of ICU admission, or already had suspected or proven HAI on admission were excluded. Optimal cut-offs with the highest sensitivity and specificity were determined. The discriminative power of PCT was assessed for each outcome, using receiver operating characteristic (ROC) analysis describing the area under the curve. Similarly, negative predictive values (NPVs) and positive predictive values (PPVs) were determined. The sensitivity and specificity for different PCT cut-off levels were calculated.</p><p><strong>Results: </strong>Of 92 patients, 35 had confirmed HAI, which was significantly associated with mechanical ventilation (p<0.001) and mortality (p<0.001). ROC analysis demonstrated that a threshold PCT level of 0.22 μg/L resulted in 97% sensitivity and 40% specificity for predicting HAI. Similarly, sensitivity and specificity for CRP were 91.4% and 38.6%, respectively, when the CRP level was 133 mg/L. In patients with a PCT level <0.25 μg/L, the NPV was 92%, whereas for PCT levels >1.00 μg/L, the PPV was >50%. For PCT levels >40 μg/L, the PPV was 100%.</p><p><strong>Conclusion: </strong>During HAI, PCT levels >1.00 μg/L had a moderate PPV of 52%, whereas levels <0.26 μg/L ruled out HAI with an NPV of 92%. With increased PCT values, the PPV rose to 100%, making it a better biomarker than CRP.</p><p><strong>Study synopsis: </strong><b>What the study adds.</b> During an episode of hospital-acquired infection (HAI) in patients with severe COVID-19, procalcitonin (PCT) levels >1.00 μg/L had a moderate positive predictive value (PPV) of 52%, whereas levels <0.26 μg/L had a negative predictive value (NPV) of 92% for proven HAI. For PCT levels >40 μg/L, the PPV was 100%.<b>Implications of the findings.</b> At levels <0.26 μg/L, PCT had an NPV >90%. This 'rule-out' characteristic of PCT may be especially valuable in scenarios of diagnostic equipoise with regard to the presence of bacterial co-infection. Clinicians should take care to
{"title":"The utility of procalcitonin as a biomarker of hospital-acquired infection in severe COVID-19.","authors":"C Schmidt, P S Nyasulu, I Fwemba, U Lalla, B W Allwood, A Parker, J J Taljaard, L N Sigwadhi, J L Tamuzi, A E Zemlin, R T Erasmus, C F N Koegelenberg","doi":"10.7196/AJTCCM.2024.v30i4.1617","DOIUrl":"10.7196/AJTCCM.2024.v30i4.1617","url":null,"abstract":"<p><strong>Background: </strong>Hospital-acquired infection (HAI) in patients with COVID-19 admitted to the intensive care unit (ICU) is associated with increased mortality. The 'cytokine storm' associated with COVID-19 leads to extreme elevation of inflammatory biomarkers, including C-reactive protein (CRP). Procalcitonin (PCT) has been shown to be more discriminative than CRP in distinguishing HAI from other inflammatory processes.</p><p><strong>Objectives: </strong>To investigate the utility of PCT in detecting HAI in patients with severe COVID-19.</p><p><strong>Methods: </strong>Clinical and laboratory data from all patients admitted to a dedicated ICU with confirmed severe COVID-19 from 1 April 2020 to 31 August 2020 were prospectively captured. HAI was confirmed by serial PCT and CRP measurements, as well as microbiological data (positive microbiological cultures in clinical context). Data from patients who were on antibiotics on ICU admission, had a positive culture for a presumed pathogen during the first 48 hours of ICU admission, or already had suspected or proven HAI on admission were excluded. Optimal cut-offs with the highest sensitivity and specificity were determined. The discriminative power of PCT was assessed for each outcome, using receiver operating characteristic (ROC) analysis describing the area under the curve. Similarly, negative predictive values (NPVs) and positive predictive values (PPVs) were determined. The sensitivity and specificity for different PCT cut-off levels were calculated.</p><p><strong>Results: </strong>Of 92 patients, 35 had confirmed HAI, which was significantly associated with mechanical ventilation (p<0.001) and mortality (p<0.001). ROC analysis demonstrated that a threshold PCT level of 0.22 μg/L resulted in 97% sensitivity and 40% specificity for predicting HAI. Similarly, sensitivity and specificity for CRP were 91.4% and 38.6%, respectively, when the CRP level was 133 mg/L. In patients with a PCT level <0.25 μg/L, the NPV was 92%, whereas for PCT levels >1.00 μg/L, the PPV was >50%. For PCT levels >40 μg/L, the PPV was 100%.</p><p><strong>Conclusion: </strong>During HAI, PCT levels >1.00 μg/L had a moderate PPV of 52%, whereas levels <0.26 μg/L ruled out HAI with an NPV of 92%. With increased PCT values, the PPV rose to 100%, making it a better biomarker than CRP.</p><p><strong>Study synopsis: </strong><b>What the study adds.</b> During an episode of hospital-acquired infection (HAI) in patients with severe COVID-19, procalcitonin (PCT) levels >1.00 μg/L had a moderate positive predictive value (PPV) of 52%, whereas levels <0.26 μg/L had a negative predictive value (NPV) of 92% for proven HAI. For PCT levels >40 μg/L, the PPV was 100%.<b>Implications of the findings.</b> At levels <0.26 μg/L, PCT had an NPV >90%. This 'rule-out' characteristic of PCT may be especially valuable in scenarios of diagnostic equipoise with regard to the presence of bacterial co-infection. Clinicians should take care to","PeriodicalId":52847,"journal":{"name":"African Journal of Thoracic and Critical Care Medicine","volume":"30 4","pages":"e1617"},"PeriodicalIF":0.0,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11878409/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143558614","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}
Pub Date : 2024-12-11eCollection Date: 2024-01-01DOI: 10.7196/AJTCCM.2024.v30i4.2884
Pierre Goussard, Ernst Eber
{"title":"What is the main cause of childhood non-cystic fibrosis bronchiectasis in the developing world - should pulmonary tuberculosis be the number one accused?","authors":"Pierre Goussard, Ernst Eber","doi":"10.7196/AJTCCM.2024.v30i4.2884","DOIUrl":"10.7196/AJTCCM.2024.v30i4.2884","url":null,"abstract":"","PeriodicalId":52847,"journal":{"name":"African Journal of Thoracic and Critical Care Medicine","volume":"30 4","pages":"e2884"},"PeriodicalIF":0.0,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11874178/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143558716","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}
Pub Date : 2024-12-11eCollection Date: 2024-01-01DOI: 10.7196/AJTCCM.2024.v30i4.1899
P Juggernath, K Mopeli, R Masekela, Z Dangor, A Goga, D M Gray, C Verwey
<p><strong>Background: </strong>Bronchiectasis, a chronic suppurative lung condition, is a largely neglected disease, especially in low- to middle-income countries (LMICs), from which there is a paucity of data. Post-infectious causes are more common in LMICs, while in high-income countries, inborn errors of immunity (IEIs), recurrent aspiration, primary ciliary dyskinesia (PCD) and cystic fibrosis are more common. Children living with HIV (CLWH), especially those who are untreated, are at increased risk of bronchiectasis. Data on risk factors, diagnosis and follow-up of children with bronchiectasis are required to inform clinical practice and policy.</p><p><strong>Objectives: </strong>To describe the demographics, medical history, aetiology, clinical characteristics and results of special investigations in children with bronchiectasis.</p><p><strong>Methods: </strong>We undertook a retrospective descriptive study of children aged <16 years with chest computed tomography (CT) scan-confirmed bronchiectasis in Johannesburg, South Africa, over a 10-year period. Demographics, medical history, aetiology, clinical characteristics and results of special investigations were described and compared according to HIV status.</p><p><strong>Results: </strong>A total of 91 participants (51% male, 98% black African) with a median (interquartile range) age of 7 (3 - 12) years were included in the study. Compared with HIV-uninfected children, CLWH were older at presentation (median 10 (6 - 13) years v. 4 (3 - 9) years; p<0.01), and more likely to be stunted (p<.01), to have clubbing (p<0.01) and hepatosplenomegaly (p=0.03), and to have multilobar involvement on the chest CT scan (p<0.01). All children had a cause identified, and the majority (86%) of these were presumed to be post-infectious, based on a previous history of a severe lower respiratory tract infection. This group included all 38 CLWH. Only a small proportion of the participants had IEIs, secondary immune deficiencies or PCD.</p><p><strong>Conclusion: </strong>A post-infectious cause for bronchiectasis was the most common aetiology described in children from an LMIC in Africa, especially CLWH. With improved access to diagnostic techniques, the aetiology of bronchiectasis in LMICs is likely to change.</p><p><strong>Study synopsis: </strong><b>What the study adds.</b> In this retrospective descriptive study of children aged <16 years with chest computed tomography scan-confirmed bronchiectasis in Johannesburg, South Africa (SA), over a 10-year period, we report that a post-infectious cause for bronchiectasis was the most commonly described, and that HIV was an important contributor. A large proportion of children with bronchiectasis in low- and middle-income countries such as SA do not benefit from an extensive work-up for the non-infectious causes of bronchiectasis.<b>Implications of the findings.</b> With improved access to diagnostic techniques, including improvements in early diagnosis and access to
{"title":"Bronchiectasis in children in a high HIV and tuberculosis prevalence setting.","authors":"P Juggernath, K Mopeli, R Masekela, Z Dangor, A Goga, D M Gray, C Verwey","doi":"10.7196/AJTCCM.2024.v30i4.1899","DOIUrl":"10.7196/AJTCCM.2024.v30i4.1899","url":null,"abstract":"<p><strong>Background: </strong>Bronchiectasis, a chronic suppurative lung condition, is a largely neglected disease, especially in low- to middle-income countries (LMICs), from which there is a paucity of data. Post-infectious causes are more common in LMICs, while in high-income countries, inborn errors of immunity (IEIs), recurrent aspiration, primary ciliary dyskinesia (PCD) and cystic fibrosis are more common. Children living with HIV (CLWH), especially those who are untreated, are at increased risk of bronchiectasis. Data on risk factors, diagnosis and follow-up of children with bronchiectasis are required to inform clinical practice and policy.</p><p><strong>Objectives: </strong>To describe the demographics, medical history, aetiology, clinical characteristics and results of special investigations in children with bronchiectasis.</p><p><strong>Methods: </strong>We undertook a retrospective descriptive study of children aged <16 years with chest computed tomography (CT) scan-confirmed bronchiectasis in Johannesburg, South Africa, over a 10-year period. Demographics, medical history, aetiology, clinical characteristics and results of special investigations were described and compared according to HIV status.</p><p><strong>Results: </strong>A total of 91 participants (51% male, 98% black African) with a median (interquartile range) age of 7 (3 - 12) years were included in the study. Compared with HIV-uninfected children, CLWH were older at presentation (median 10 (6 - 13) years v. 4 (3 - 9) years; p<0.01), and more likely to be stunted (p<.01), to have clubbing (p<0.01) and hepatosplenomegaly (p=0.03), and to have multilobar involvement on the chest CT scan (p<0.01). All children had a cause identified, and the majority (86%) of these were presumed to be post-infectious, based on a previous history of a severe lower respiratory tract infection. This group included all 38 CLWH. Only a small proportion of the participants had IEIs, secondary immune deficiencies or PCD.</p><p><strong>Conclusion: </strong>A post-infectious cause for bronchiectasis was the most common aetiology described in children from an LMIC in Africa, especially CLWH. With improved access to diagnostic techniques, the aetiology of bronchiectasis in LMICs is likely to change.</p><p><strong>Study synopsis: </strong><b>What the study adds.</b> In this retrospective descriptive study of children aged <16 years with chest computed tomography scan-confirmed bronchiectasis in Johannesburg, South Africa (SA), over a 10-year period, we report that a post-infectious cause for bronchiectasis was the most commonly described, and that HIV was an important contributor. A large proportion of children with bronchiectasis in low- and middle-income countries such as SA do not benefit from an extensive work-up for the non-infectious causes of bronchiectasis.<b>Implications of the findings.</b> With improved access to diagnostic techniques, including improvements in early diagnosis and access to","PeriodicalId":52847,"journal":{"name":"African Journal of Thoracic and Critical Care Medicine","volume":"30 4","pages":"e1899"},"PeriodicalIF":0.0,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11874181/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143558651","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}
Pub Date : 2024-12-11eCollection Date: 2024-01-01DOI: 10.7196/AJTCCM.2024.v30i4.1841
K S Owusu, S Kwarteng-Owusu, N Wireko-Brobby, E Osei, E Abrafi, F A Appiah, A Enimil, J Sylverken, A Owusu-Ofori, D M Gray, D Ansong, H J Zar
<p><strong>Background: </strong>Induced sputum (IS) is a sampling technique for obtaining lower airway samples for microbial investigations, including GeneXpert and culture for microbiological confirmation of <i>Mycobacterium tuberculosis</i>.</p><p><strong>Objectives: </strong>To investigate the safety and yield of IS in children admitted to a tertiary hospital in Ghana with presumed pulmonary tuberculosis (PTB).</p><p><strong>Methods: </strong>A prospective cross-sectional study was carried out in children aged 3 months - 14 years at Komfo Anokye Teaching Hospital in Kumasi, Ghana, over the 6-month period January - June 2022. All children with breathing difficulty and other signs of respiratory distress were given respiratory support, and IS samples were obtained when respiratory distress had resolved. One or two IS samples were collected from each child within 48 hours of admission by a trained nurse after at least 4 hours of fasting. Children were monitored during and for 30 minutes after the procedure, with recording of respiratory rate, oxygen saturation, temperature and pulse rate. They were also monitored for any adverse events such as vomiting, wheezing and nosebleeds.</p><p><strong>Results: </strong>A total of 144 children were sampled, with approximately two-thirds sampled a second time. Nearly half of the participants were aged <2 years (49.3%; n=71/144), and the median (interquartile range (IQR)) age was 2.5 (0.9 - 6.8) years. Ninety-eight children (68.1%) tested positive for PTB by Xpert Ultra, with 19/98 (19.4%) being rifampicin resistant; 47/102 (46.1%) were positive by Ziehl-Neelsen staining, and 57/102 (55.9%) were positive by Auramine O staining. Three children (2.1%) had an episode of epistaxis following the procedure. No other adverse events were observed. Measurements before and 30 minutes to 1 hour after the procedure (median (IQR)) were similar: temperature 36.5°C (36.5 - 37.5°C) v. 36.5°C (36.2 - 37.1°C), oxygen saturation 98% (92 - 99%) v. 98% (93 - 99%), pulse rate 120 (106 - 139) v. 125 (112 - 142) bpm, and respiratory rate 38 (30 - 48) v. 33 (30 - 45) cycles per minute.</p><p><strong>Conclusion: </strong>We found sputum induction to be a safe and well-tolerated procedure in the paediatric population, with minimal clinical risk and a high microbiological yield for PTB.</p><p><strong>Study synopsis: </strong><b>What the study adds.</b> This study is the first to provide information on the performance and safety of induced sputum (IS) in Ghanaian children. It shows that IS can be performed safely in this population, despite safety concerns that resulted in its late introduction in the country. In addition, it shows that IS procedures can provide quality sputum samples to improve bacteriological confirmation of pulmonary tuberculosis (PTB) in children with presumed tuberculosis. Lastly, it adds to the existing body of literature showing that with requisite training, sputum induction can be performed in low-income settings
{"title":"Safety and yield of sputum induction for diagnosis of pulmonary tuberculosis in children in a tertiary hospital in Ghana.","authors":"K S Owusu, S Kwarteng-Owusu, N Wireko-Brobby, E Osei, E Abrafi, F A Appiah, A Enimil, J Sylverken, A Owusu-Ofori, D M Gray, D Ansong, H J Zar","doi":"10.7196/AJTCCM.2024.v30i4.1841","DOIUrl":"10.7196/AJTCCM.2024.v30i4.1841","url":null,"abstract":"<p><strong>Background: </strong>Induced sputum (IS) is a sampling technique for obtaining lower airway samples for microbial investigations, including GeneXpert and culture for microbiological confirmation of <i>Mycobacterium tuberculosis</i>.</p><p><strong>Objectives: </strong>To investigate the safety and yield of IS in children admitted to a tertiary hospital in Ghana with presumed pulmonary tuberculosis (PTB).</p><p><strong>Methods: </strong>A prospective cross-sectional study was carried out in children aged 3 months - 14 years at Komfo Anokye Teaching Hospital in Kumasi, Ghana, over the 6-month period January - June 2022. All children with breathing difficulty and other signs of respiratory distress were given respiratory support, and IS samples were obtained when respiratory distress had resolved. One or two IS samples were collected from each child within 48 hours of admission by a trained nurse after at least 4 hours of fasting. Children were monitored during and for 30 minutes after the procedure, with recording of respiratory rate, oxygen saturation, temperature and pulse rate. They were also monitored for any adverse events such as vomiting, wheezing and nosebleeds.</p><p><strong>Results: </strong>A total of 144 children were sampled, with approximately two-thirds sampled a second time. Nearly half of the participants were aged <2 years (49.3%; n=71/144), and the median (interquartile range (IQR)) age was 2.5 (0.9 - 6.8) years. Ninety-eight children (68.1%) tested positive for PTB by Xpert Ultra, with 19/98 (19.4%) being rifampicin resistant; 47/102 (46.1%) were positive by Ziehl-Neelsen staining, and 57/102 (55.9%) were positive by Auramine O staining. Three children (2.1%) had an episode of epistaxis following the procedure. No other adverse events were observed. Measurements before and 30 minutes to 1 hour after the procedure (median (IQR)) were similar: temperature 36.5°C (36.5 - 37.5°C) v. 36.5°C (36.2 - 37.1°C), oxygen saturation 98% (92 - 99%) v. 98% (93 - 99%), pulse rate 120 (106 - 139) v. 125 (112 - 142) bpm, and respiratory rate 38 (30 - 48) v. 33 (30 - 45) cycles per minute.</p><p><strong>Conclusion: </strong>We found sputum induction to be a safe and well-tolerated procedure in the paediatric population, with minimal clinical risk and a high microbiological yield for PTB.</p><p><strong>Study synopsis: </strong><b>What the study adds.</b> This study is the first to provide information on the performance and safety of induced sputum (IS) in Ghanaian children. It shows that IS can be performed safely in this population, despite safety concerns that resulted in its late introduction in the country. In addition, it shows that IS procedures can provide quality sputum samples to improve bacteriological confirmation of pulmonary tuberculosis (PTB) in children with presumed tuberculosis. Lastly, it adds to the existing body of literature showing that with requisite training, sputum induction can be performed in low-income settings","PeriodicalId":52847,"journal":{"name":"African Journal of Thoracic and Critical Care Medicine","volume":"30 4","pages":"e1841"},"PeriodicalIF":0.0,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11874176/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143558653","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}
C Jacobs, P Goussard, M Merven, A Gie, S S B Venkatakrishna, S Andronikou
{"title":"Is this airway safe?","authors":"C Jacobs, P Goussard, M Merven, A Gie, S S B Venkatakrishna, S Andronikou","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":52847,"journal":{"name":"African Journal of Thoracic and Critical Care Medicine","volume":"30 4","pages":"176"},"PeriodicalIF":0.0,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11880898/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143568813","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}
Pub Date : 2024-12-11eCollection Date: 2024-01-01DOI: 10.7196/AJTCCM.2024.v30i4.2883
K Mochankana, R Masekela
{"title":"A critical perspective on paediatric pulmonary tuberculosis and diagnostic advancements.","authors":"K Mochankana, R Masekela","doi":"10.7196/AJTCCM.2024.v30i4.2883","DOIUrl":"10.7196/AJTCCM.2024.v30i4.2883","url":null,"abstract":"","PeriodicalId":52847,"journal":{"name":"African Journal of Thoracic and Critical Care Medicine","volume":"30 4","pages":"e2883"},"PeriodicalIF":0.0,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11874177/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143558559","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}
Pub Date : 2024-10-14eCollection Date: 2024-01-01DOI: 10.7196/AJTCCM.2024.v30i3.1128
H Peens-Hough, P Goussard, D Rhode, L van Wyk, J Janson
Background: Bronchiectasis (BE) in children living with HIV (CLWH) remains a significant cause of morbidity and mortality, especially in tuberculosis (TB)-endemic low- and middle-income countries. Treatment modalities for BE in CLWH currently focus mainly on prevention of infections and management of symptoms, while surgical management is indicated for a select group. In contrast, surgical management in non-cystic fibrosis BE is well established.
Objectives: To describe the indications for and complications of surgical resection for BE in CLWH, and to identify variables influencing outcome.
Methods: A retrospective medical records review was conducted of all CLWH aged ≤14 years who underwent surgical resection for BE at Tygerberg Hospital, Cape Town, South Africa, between 1 January 2007 and 30 September 2014. The variables collected included immune status, antiretroviral treatment (ART), previous treatment for TB, operative and postoperative complications, and postoperative symptom relief.
Results: Twelve CLWH on ART with symptomatic BE underwent surgical resection. The mean age was 7 years and the mean CD4 count 970 cells/µL. Indications for surgery included recurrent infections, chronic cough and persistent lobar collapse. The most common procedures were left lower lobe lobectomy (42%), left pneumonectomy (17%) and right bilobectomy (17%). Complications were limited to persistent pneumothorax after surgery in one child. There were no deaths. Ten children (83%) showed significant improvement of symptoms at follow-up.
Conclusion: Surgical resection for BE in CLWH can be performed safely with a low complication rate, resulting in significant improvement of symptoms postoperatively.
Study synopsis: What the study adds. Bronchiectasis (BE) in children living with HIV (CLWH) is a significant cause of morbidity and mortality. Current treatment focuses on preventing infections and managing symptoms, while surgical management is rarely considered. A retrospective medical records review of 12 children aged ≤14 years in South Africa found that surgical resection for BE can be performed with a low complication rate, resulting in significant improvement of symptoms postoperatively. Variables influencing outcome include immune status, antiretroviral treatment and previous treatment for tuberculosis.Implications of the findings. This study demonstrates that surgery for BE can be performed safely in CLWH, with significant improvement of respiratory symptoms postoperatively.
{"title":"Surgery for bronchiectasis in children living with HIV: A case series from a low- to middle-income country.","authors":"H Peens-Hough, P Goussard, D Rhode, L van Wyk, J Janson","doi":"10.7196/AJTCCM.2024.v30i3.1128","DOIUrl":"10.7196/AJTCCM.2024.v30i3.1128","url":null,"abstract":"<p><strong>Background: </strong>Bronchiectasis (BE) in children living with HIV (CLWH) remains a significant cause of morbidity and mortality, especially in tuberculosis (TB)-endemic low- and middle-income countries. Treatment modalities for BE in CLWH currently focus mainly on prevention of infections and management of symptoms, while surgical management is indicated for a select group. In contrast, surgical management in non-cystic fibrosis BE is well established.</p><p><strong>Objectives: </strong>To describe the indications for and complications of surgical resection for BE in CLWH, and to identify variables influencing outcome.</p><p><strong>Methods: </strong>A retrospective medical records review was conducted of all CLWH aged ≤14 years who underwent surgical resection for BE at Tygerberg Hospital, Cape Town, South Africa, between 1 January 2007 and 30 September 2014. The variables collected included immune status, antiretroviral treatment (ART), previous treatment for TB, operative and postoperative complications, and postoperative symptom relief.</p><p><strong>Results: </strong>Twelve CLWH on ART with symptomatic BE underwent surgical resection. The mean age was 7 years and the mean CD4 count 970 cells/µL. Indications for surgery included recurrent infections, chronic cough and persistent lobar collapse. The most common procedures were left lower lobe lobectomy (42%), left pneumonectomy (17%) and right bilobectomy (17%). Complications were limited to persistent pneumothorax after surgery in one child. There were no deaths. Ten children (83%) showed significant improvement of symptoms at follow-up.</p><p><strong>Conclusion: </strong>Surgical resection for BE in CLWH can be performed safely with a low complication rate, resulting in significant improvement of symptoms postoperatively.</p><p><strong>Study synopsis: </strong><b>What the study adds.</b> Bronchiectasis (BE) in children living with HIV (CLWH) is a significant cause of morbidity and mortality. Current treatment focuses on preventing infections and managing symptoms, while surgical management is rarely considered. A retrospective medical records review of 12 children aged ≤14 years in South Africa found that surgical resection for BE can be performed with a low complication rate, resulting in significant improvement of symptoms postoperatively. Variables influencing outcome include immune status, antiretroviral treatment and previous treatment for tuberculosis.<b>Implications of the findings.</b> This study demonstrates that surgery for BE can be performed safely in CLWH, with significant improvement of respiratory symptoms postoperatively.</p>","PeriodicalId":52847,"journal":{"name":"African Journal of Thoracic and Critical Care Medicine","volume":"30 3","pages":"e1128"},"PeriodicalIF":0.0,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11629482/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142808429","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}
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