Journal of the International Association of Providers of AIDS Care, May 18, 2011
Histoplasmosis is an uncommon cause of hepatosplenomegaly in South Africa. A case of immune recon... more Histoplasmosis is an uncommon cause of hepatosplenomegaly in South Africa. A case of immune reconstitution syndrome (IRS) to disseminated histoplasmosis in a patient presented to a tertiary hospital in Kwazulu-Natal, South Africa, is described.
... David C. Ferris a,b, Halima Dawood a, Nombulelo P. Magula a and Umesh G. Lalloo a, aNelson R.... more ... David C. Ferris a,b, Halima Dawood a, Nombulelo P. Magula a and Umesh G. Lalloo a, aNelson R. Mandela School of ... Clinical team: Clarisse Amani-Bosse, Ignace Ayekoe, Gédéon Bédikou, Nacoumba Coulibaly, Christine Danel, Patricia Fassinou, Appolinaire Horo, Ruffin
Setting: Rates of multidrug-resistant tuberculosis (MDR-TB) are currently as high as 7.7% in retr... more Setting: Rates of multidrug-resistant tuberculosis (MDR-TB) are currently as high as 7.7% in retreatment cases in KwaZulu-Natal, South Africa. MDR-TB prevalence is known to be high in patients categorized as treatment failures. Recent reports have questioned the effectiveness of the World Health Organization (WHO) Category II regimen in retreatment TB cases. Objective: To determine whether treatment category predicts susceptibility patterns and outcomes in a hospitalized population of retreatment TB cases. Design: Retrospective cohort of 197 pulmonary retreatment cases. Results: Retreatment cases treated with the standard retreatment regimen had a high in-hospital mortality (19.8%), or poor outcome (26.4%) and a high rate of MDR-TB (16.2%). The 'treatment failure' category predicted resistance, with 57.1% of patients exhibiting any resistance compared to other treatment categories (P = 0.02); 53.8% of patients with any resistance experienced poor outcomes, compared to 16.6% of pan-susceptible cases (P = 0.02). There was a trend towards poor outcome in the treatment failure category (42.9%, P = 0.13). Conclusion: The retreatment category 'treatment failure' is associated with a high prevalence of resistance in an area of high human immunodeficiency virus (HIV) prevalence. The 'treatment failure' category should be used to identify patients who may benefit from alternative regimens using directed, intensified therapy or second-line agents instead of the current standard retreatment regimen.
Summary: Despite the increase of HIV-1-associated Kaposi's sarcoma (KS), little is known abou... more Summary: Despite the increase of HIV-1-associated Kaposi's sarcoma (KS), little is known about HIV-associated KS in the African setting, particularly among women. A descriptive study of the demographic, clinical, immunological and virological features of AIDS-associated KS from KwaZulu-Natal, South Africa was undertaken. Consecutively, recruited patients were clinically staged; CD4/CD8 cell counts, HIV-1 viral loads and clinical parameters were evaluated. Of the 152 patients (77 male and 75 female) 99% were black. Females were significantly younger (P = 0.02) and had poorer disease prognosis (odds ratio [OR] = 2.7, 95% confidence interval [CI] = 1.4-5.4, P = 0.003) and were more likely to have extensive cutaneous KS when compared with males (OR = 3.1, 95% CI = 1.4-6.7, P = 0.003). One-third of patients had coexisting HIV-related disease, most commonly tuberculosis, and these were more frequent in females (56.7 vs. 43.3%). In conclusion, HIV-associated KS in South Africans has an equal female-to-male ratio. Females are younger and have more severe disease than males.
The provision of highly active antiretroviral therapy (HAART) has transformed HIV / AIDS from an ... more The provision of highly active antiretroviral therapy (HAART) has transformed HIV / AIDS from an acute / subacute disease to a controllable chronic disease. HIV-infected individuals now live longer and grow old. Furthermore, a number of older patients become infected later in life and are not aware of their HIV status. The prevalence of HIV infection in individuals older than 55 years is growing and HIV infection can no longer be thought of as a 'young person's disease'.
Tuberculosis is a major public health issue in South Africa and is complicated by the high incide... more Tuberculosis is a major public health issue in South Africa and is complicated by the high incidence of human immunodeficiency virus (HIV). Healthcare spending is focused primarily on antiretroviral therapy to control HIV. Although South Africa has access to anti-TB medication and has a directly observed treatment, short-course (DOTS) program in place, the goal of lowering the incidence of TB in South Africa is hindered by inefficient management of resources at all levels of care and an incompletely implemented DOTS strategy with incomplete TB registers and insufficient laboratory services for diagnosis of tuberculosis. One of the strengths of the South African National Tuberculosis Program is that TB is a notifiable condition. South Africa has adopted the Stop TB Partnership Policy of the three Is: intensified case finding, isoniazid prophylaxis for latent TB, and infection control. Substantial progress has been made in diagnosing and treating MDR- and XDR-TB, but there is still an urgent need for community-based, patient-centered adherence programs that are convenient and acceptable to patients with TB.
Tuberculous meningitis (TBM) is the most frequent manifestation of central nervous system tubercu... more Tuberculous meningitis (TBM) is the most frequent manifestation of central nervous system tuberculosis (TB) and is more common in children than in adults. The diagnosis of TBM in children is difficult because signs and symptoms are vague. Information about drug resistant TB in children is scarce, and there is no published information on drug resistant TBM in children. This is a retrospective review of medical records of children with culture-confirmed multidrug-resistant tuberculous meningitis (MDR-TBM) at King George V Hospital in Durban, South Africa. Between 1992 and 2003, there were 8 children with MDR-TBM; 6 were HIV infected and 2 were HIV negative. Only one child survived. The diagnosis was made posthumously in almost all the children. The changes in the cerebrospinal fluid (CSF) in early TBM can be nonspecific and can change rapidly; therefore, CSF studies should always include culture and susceptibility testing. Factors that contributed to the high mortality were disseminated TB, HIV infection, delay in diagnosis and treatment, the absence of a standardized approach to the management of MDR-TBM and the poor CSF penetration of most MDR-TB drugs. MDR-TB therapy should be considered if there is a history of TB: a MDR-TB contact or a poor clinical response to TB therapy despite adequate adherence to treatment. Early diagnosis is important because TBM in children is often associated with a grave outcome.
Journal of the International Association of Providers of AIDS Care, May 18, 2011
Histoplasmosis is an uncommon cause of hepatosplenomegaly in South Africa. A case of immune recon... more Histoplasmosis is an uncommon cause of hepatosplenomegaly in South Africa. A case of immune reconstitution syndrome (IRS) to disseminated histoplasmosis in a patient presented to a tertiary hospital in Kwazulu-Natal, South Africa, is described.
... David C. Ferris a,b, Halima Dawood a, Nombulelo P. Magula a and Umesh G. Lalloo a, aNelson R.... more ... David C. Ferris a,b, Halima Dawood a, Nombulelo P. Magula a and Umesh G. Lalloo a, aNelson R. Mandela School of ... Clinical team: Clarisse Amani-Bosse, Ignace Ayekoe, Gédéon Bédikou, Nacoumba Coulibaly, Christine Danel, Patricia Fassinou, Appolinaire Horo, Ruffin
Setting: Rates of multidrug-resistant tuberculosis (MDR-TB) are currently as high as 7.7% in retr... more Setting: Rates of multidrug-resistant tuberculosis (MDR-TB) are currently as high as 7.7% in retreatment cases in KwaZulu-Natal, South Africa. MDR-TB prevalence is known to be high in patients categorized as treatment failures. Recent reports have questioned the effectiveness of the World Health Organization (WHO) Category II regimen in retreatment TB cases. Objective: To determine whether treatment category predicts susceptibility patterns and outcomes in a hospitalized population of retreatment TB cases. Design: Retrospective cohort of 197 pulmonary retreatment cases. Results: Retreatment cases treated with the standard retreatment regimen had a high in-hospital mortality (19.8%), or poor outcome (26.4%) and a high rate of MDR-TB (16.2%). The 'treatment failure' category predicted resistance, with 57.1% of patients exhibiting any resistance compared to other treatment categories (P = 0.02); 53.8% of patients with any resistance experienced poor outcomes, compared to 16.6% of pan-susceptible cases (P = 0.02). There was a trend towards poor outcome in the treatment failure category (42.9%, P = 0.13). Conclusion: The retreatment category 'treatment failure' is associated with a high prevalence of resistance in an area of high human immunodeficiency virus (HIV) prevalence. The 'treatment failure' category should be used to identify patients who may benefit from alternative regimens using directed, intensified therapy or second-line agents instead of the current standard retreatment regimen.
Summary: Despite the increase of HIV-1-associated Kaposi's sarcoma (KS), little is known abou... more Summary: Despite the increase of HIV-1-associated Kaposi's sarcoma (KS), little is known about HIV-associated KS in the African setting, particularly among women. A descriptive study of the demographic, clinical, immunological and virological features of AIDS-associated KS from KwaZulu-Natal, South Africa was undertaken. Consecutively, recruited patients were clinically staged; CD4/CD8 cell counts, HIV-1 viral loads and clinical parameters were evaluated. Of the 152 patients (77 male and 75 female) 99% were black. Females were significantly younger (P = 0.02) and had poorer disease prognosis (odds ratio [OR] = 2.7, 95% confidence interval [CI] = 1.4-5.4, P = 0.003) and were more likely to have extensive cutaneous KS when compared with males (OR = 3.1, 95% CI = 1.4-6.7, P = 0.003). One-third of patients had coexisting HIV-related disease, most commonly tuberculosis, and these were more frequent in females (56.7 vs. 43.3%). In conclusion, HIV-associated KS in South Africans has an equal female-to-male ratio. Females are younger and have more severe disease than males.
The provision of highly active antiretroviral therapy (HAART) has transformed HIV / AIDS from an ... more The provision of highly active antiretroviral therapy (HAART) has transformed HIV / AIDS from an acute / subacute disease to a controllable chronic disease. HIV-infected individuals now live longer and grow old. Furthermore, a number of older patients become infected later in life and are not aware of their HIV status. The prevalence of HIV infection in individuals older than 55 years is growing and HIV infection can no longer be thought of as a 'young person's disease'.
Tuberculosis is a major public health issue in South Africa and is complicated by the high incide... more Tuberculosis is a major public health issue in South Africa and is complicated by the high incidence of human immunodeficiency virus (HIV). Healthcare spending is focused primarily on antiretroviral therapy to control HIV. Although South Africa has access to anti-TB medication and has a directly observed treatment, short-course (DOTS) program in place, the goal of lowering the incidence of TB in South Africa is hindered by inefficient management of resources at all levels of care and an incompletely implemented DOTS strategy with incomplete TB registers and insufficient laboratory services for diagnosis of tuberculosis. One of the strengths of the South African National Tuberculosis Program is that TB is a notifiable condition. South Africa has adopted the Stop TB Partnership Policy of the three Is: intensified case finding, isoniazid prophylaxis for latent TB, and infection control. Substantial progress has been made in diagnosing and treating MDR- and XDR-TB, but there is still an urgent need for community-based, patient-centered adherence programs that are convenient and acceptable to patients with TB.
Tuberculous meningitis (TBM) is the most frequent manifestation of central nervous system tubercu... more Tuberculous meningitis (TBM) is the most frequent manifestation of central nervous system tuberculosis (TB) and is more common in children than in adults. The diagnosis of TBM in children is difficult because signs and symptoms are vague. Information about drug resistant TB in children is scarce, and there is no published information on drug resistant TBM in children. This is a retrospective review of medical records of children with culture-confirmed multidrug-resistant tuberculous meningitis (MDR-TBM) at King George V Hospital in Durban, South Africa. Between 1992 and 2003, there were 8 children with MDR-TBM; 6 were HIV infected and 2 were HIV negative. Only one child survived. The diagnosis was made posthumously in almost all the children. The changes in the cerebrospinal fluid (CSF) in early TBM can be nonspecific and can change rapidly; therefore, CSF studies should always include culture and susceptibility testing. Factors that contributed to the high mortality were disseminated TB, HIV infection, delay in diagnosis and treatment, the absence of a standardized approach to the management of MDR-TBM and the poor CSF penetration of most MDR-TB drugs. MDR-TB therapy should be considered if there is a history of TB: a MDR-TB contact or a poor clinical response to TB therapy despite adequate adherence to treatment. Early diagnosis is important because TBM in children is often associated with a grave outcome.
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