Browsing by Author "Dlamini, Sipho"
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- ItemOpen AccessEpidemiology of leptospirosis in Groote Schuur Hospital(2021) Mteshana, Ziningi Charity; Dlamini, Sipho; Muloiwa, Rudzani; Naicker, PreneshniBackground The burden of leptospirosis in sub-Saharan Africa remains unclear although it is accepted that this infection is widely spread in this region. The global estimated number of cases is one million with 58 900 deaths attributable to leptospirosis annually. Objective To describe the profile of patients with suspected leptospirosis and to compare their in hospital outcomes. Methods & Material We performed a retrospective study at a tertiary referral hospital in South Africa. All adults with suspected leptospirosis who had a laboratory request for leptospirosis ELISA IgM testing between 2005 and 2015 were included. Clinical and laboratory findings at presentation were correlated with the patient's subsequent clinical course and ELISA IgM status. Results During the study period 223 patients who had ELISA IgM test requests were enrolled. Leptospirosis ELISA IgM was positive in 45 (20%) patients. Enrolled patients had a median age of 38 (IQR 31 – 53) years, 147/223 (66%) were males and 80/223 (36%) were HIV positive. There were 12/45 (27%) HIV-positive patients in the IgM-positive group compared to 68/178 (38%) in the IgM-negative group, p=0.22. Compared to IgM-negative patients, patients with positive IgM were more likely to present with jaundice 37/45 (82%) vs. 82/178 (46%), p <0.01, and acute kidney injury (AKI) 34/45 (76%) vs.102/178(57%), p=0.06. The median length of hospital stay was 13 days (IQR 8-22 days) for IgM-positive compared to 10 days (IQR 6-21 days) in IgM-negative patients, p= 0.10. A total of 11/45 (24%) IgMpositive patients required ICU admission compared to 41/178 (23%) of IgM-negative patients, p=0.84 and the median length of ICU stay was 7 days (IQR 4-11) for IgM-positive compared to 6 days (IQR 3-9.5) for IgM-negative patients, p=0.51. There were 13/45 (29%) IgM-positive patients who needed dialysis compared to 42/178 (24%) of IgM-negative patients, p= 0.46. The mortality rate was 7/45 (16%) in IgM-positive compared to 52/178 (29%) in IgM-negative patients, p=0.07. Conclusion Patients with positive IgM presented predominantly with jaundice and AKI. There was no statistically significant difference in HIV status and outcomes between the two groups of patients
- ItemOpen AccessFactors associated with increased mortality in a predominantly HIV-infected population with Stevens Johnson syndrome and toxic epidermal necrolysis(Public Library of Science, 2014) Knight, Lauren; Muloiwa, Rudzani; Dlamini, Sipho; Lehloenya, Rannakoe JStevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are life-threatening drug reactions with a higher incidence in HIV-infected persons. SJS/TEN are associated with skin and mucosal failure, predisposing to systemic bacterial infection (BSI), a major cause of death. There are limited data on risk factors associated with BSI and and mortality in HIV-infected people with SJS/TEN. METHODS: We conducted a retrospective study of patients admitted to a university hospital with SJS/TEN over a 3 year period. We evaluated their underlying illnesses, eliciting drugs, predictive value of bacterial skin cultures and other factors associated with mortality and BSI in a predominantly HIV-infected population by comparing characteristics of the patients who demised and those who survived. RESULTS: We admitted 86 cases during the study period and 67/86(78%) were HIV-infected. Tuberculosis was the commonest co-morbidity, diagnosed in 12/86(14%) cases. Skin cultures correlated with BSI by the same organism in 7/64(11%) cases and 6/7 were Gram-negative. Two of the 8 cases of Gram-negative BSI had an associated Gram-negative skin culture, although not always the same organism. All 8 fatalities had >30% epidermal detachment, 7 were HIV-infected, 6 died of BSI and 6 had tuberculosis. CONCLUSIONS: Having >30% epidermal detachment in SJS/TEN carries an increased risk of BSI and mortality. Tuberculosis and BSI are associated with higher risk of death in SJS/TEN. Our data suggests there may be an association between Gram-negative BSI and Gram-negative skin infection.
- ItemOpen AccessImmunological evaluation of HIV-negative invasive fungal disease at Groote Schuur Hospital, Cape Town, South Africa(2019) Onyango, Vonwicks Czelestakov; Peter, Jonathan; Dlamini, SiphoBackground The majority of invasive fungal disease in South African hospitals is HIV-related or associated with another secondary immunodeficiency e.g. haematopoietic stem cell transplant. After excluding secondary immunodeficiency, a detailed immune work-up can lead to a diagnosis of primary immunodeficiency. Objective To detail an appropriate step-wise immunological work-up for a series of patients with invasive fungal diseases and possible underlying primary immune deficiency. Methods Detailed review of all culture- or histologically confirmed cases of invasive fungal disease (IFD) at Groote Schuur Hospital between 2007-2017. Step-wise immunological work-up of IFD patients with no secondary immunodeficiency. Clinical characteristics and step-wise immunological profiles were evaluated. Results Sixty-seven adults with IFD were identified; 72% (48/67) were HIV-related. 8/19 HIVnegative cases were either deceased (4) or lost-to-follow-up (4). Work-up of the remaining 11 cases found five with non-HIV secondary immunodeficiencies (Lupus, liver transplant, endstage renal failure and haematological malignancy). A primary immunodeficiency was suspected in six cases, but 1 case of cutaneous sporotrichosis was excluded; with five cases (4 with disseminated Cryptococcus neoformans and 1 with cerebral aspergillosis) undergoing detailed immune work-up. A case of idiopathic CD4 lymphopenia was diagnosed; but all other cases had no evidence of neutrophil or a cell-mediated immune defect; including investigations of naïve and memory T-cell subsets and cytokine responses to PHA and candida. All cases were noted to have low baseline vaccine responses and Vitamin D deficiency. Conclusion Invasive fungal disease is predominantly associated with HIV and secondary immunodeficiency in South Africa. Known primary immunodeficiencies can be identified with basic immune work-up; but no obvious functional immune defect is evident in the majority of these cases.
- ItemOpen AccessIncidence and distribution of human leptospirosis in the Western Cape Province, South Africa, (2010-2019): a retrospective study(2022) Gizamba, Jacob Mugoya; Odayar, Jasantha; Dlamini, Sipho; Paul, LynthiaBackground Leptospirosis is an emerging zoonotic infection of global importance. Among humans, the infection is associated with varying clinical manifestations ranging from mild selflimiting febrile illness to severe illness mainly characterized by pulmonary hemorrhagic syndrome and acute kidney injury due to Weil's disease. In addition, leptospirosis presents with symptoms that mimic commonly known infections that cause febrile illnesses such as malaria, influenza, hepatitis, yellow fever, and viral hemorrhagic diseases. This has consequently, led to under-estimation of the burden of leptospirosis hence contributing to it neglected status. The burden of leptospirosis is reported to be substantially high in tropical regions and resource limited settings. In Africa, few countries have data and reports on human leptospirosis and research studies are scarce. In South Africa, the infection is an important underreported public health concern however information on the incidence trend and distribution of the infection is lacking. Yet such epidemiological description is essential for effective prevention of the infection. This study aimed at determining the incidence of Human Leptospirosis from 2010 to 2019, and to compare the incidence based on seasonal and demographic factors in Western Cape Province (WCP), South Africa. Methods The study was a retrospective secondary analysis of all data on ELISA IgM tests that were positive for leptospirosis between January 2010 and December 2019 in WCP, South Africa. Data was obtained from the National Health Laboratory Services (NHLS), where all serological tests on serum samples of patients who are clinically suspected to be having a leptospirosis infection are conducted. All leptospirosis positive results were grouped, and the incidence proportion of leptospirosis estimated according to sex, age, season, and year of occurrence. The provincial population sizes were used as the denominator when estimating the incidence and it was expressed as leptospirosis cases per 100,000 population. Negative binomial regression was used to estimate the effect of sex, year of occurrence and season on the incidence of human leptospirosis over the study period. The results were presented as incidence rate ratios (IRR) with 95% confidence intervals (CI). Results A total of 254 cases of human leptospirosis were recorded by the NHLS in the WCP, South Africa between 2010 and 2019. The highest number of cases was recorded in 2015 (42 cases, 16.5%) and lowest in 2012 (9 cases, 3.5%). The incidence of leptospirosis fluctuated widely across all the 10 years with the annual incidence ranging between 0.15 and 0.66 per 100,000 population and an average annual incidence of 0.40 per 100,000 population. The incidence was significantly higher among males compared to females (0.55 and 0.25 per 100,000 population respectively; incidence rate ratio (IRR) 2.2, 95% CI: 1.66,3.03) and the overall male to female ratio was 2.14:1. The average incidence of leptospirosis was highest among the 18-44-year-old age cohort (0.56 cases per 100,000 population), and lowest among the ≤17-year-old age cohort (0.07 cases per 100,000 population). The 18-44 (IRR 8.0, 95% CI: 4.65,15.15) and ≥ 45 (IRR 7.4, 95% CI: 4.17,14.17) age cohorts were more at risk of infection compared to ≤17age cohort. The incidence proportion in fall, summer and spring seasons were slightly higher compared to what was observed in winter season. However, and there was no significant association between season and incidence of leptospirosis. Conclusions The incidence of leptospirosis widely fluctuated between 2010 and 2019, with males and those above 18 years of age substantially at risk of infection. The results show that leptospirosis is an important zoonotic disease within the province and potentially disproportionately affecting males and the productive age demographic groups. These findings emphasize the need to enhance targeted prevention strategies and provoke further investigation on the importance of environmental and socioeconomic factors on the occurrence of leptospirosis within Western Cape Province and South Africa at large.
- ItemOpen AccessManagement of cryptoccocal meningitis in resource-limited settings: A systematic review(2009) Sloan, Derek; Dlamini, Sipho; Dedicoat, MartinCryptococcal meningitis (CM) remains a serious cause of mortality and morbidity in individuals infected with the human immunodeficiency virus (HIV). The optimal treatment of CM is unknown. We conducted a systematic review to determine the best treatment for CM with an emphasis on resource-poor settings. Six studies met the inclusion criteria; none was found that compared amphotericin B with fluconazole. From the available evidence, it is not possible to determine which treatment is superior for CM.
- ItemOpen AccessPatterns of Detectable Viral Load in a cohort of HIV-infected adolescents on antiretroviral therapy(2018) Sher, Rebecca Yael Nthabiseng; Muloiwa, Rudzani; Dlamini, SiphoBackground Despite improved treatment and access to care, adolescent AIDS deaths are decreasing more slowly than in any other age group. There is lack of longitudinal data around adolescent adherence and the dynamics of viraemia over time. We aimed to describe patterns of detectable viral load in a cohort of adolescents attending an antiretroviral clinic in Cape Town, South Africa. Methods We conducted a retrospective cohort study of all patients on ART aged 10-19 years. Participants were included if they underwent at least two HIV viral load (VL) measurements and attended the Groote Schuur Hospital HIV Clinic for at least 24 months between 2002 and 2016. The primary outcome was two consecutive VL >100 copies/ml, in line with the lower limit of detection of assays in use over the follow-up period. Results Of 482 screened subjects, 327 met inclusion criteria. Most subjects were vertically infected (n= 314; 96%), and 170 (52%) were male. Overall, 203 episodes of confirmed detectable VL involving 159 (49% [95% CI 43%–54%]) subjects were experienced during the follow-up period. A total of 111 (34%) subjects never experienced detectable VL, while 16 (5%) never suppressed throughout the follow-up period. Median age at first detectable VL was 14 (IQR 11-16) years. Of the 159 subjects who experienced detectable VL, 102 (64%) re-suppressed, of which 38 (37%) had a subsequent detectable VL. Six subjects had genotyped resistance to protease inhibitors. Four of these never suppressed, while two suppressed on salvage regimens. Total follow-up time was 1723 person years (PY), of which 880 (51%) were contributed by the 159 subjects who experienced detectable VL. Overall time with detectable VL was 370 PY. This comprised 22% of total follow-up time, but 42% of the follow-up time contributed by those who experienced detectable VL. The rate of detectable VL was 11.8 (95% CI 10.3–13.5) episodes per 100 PY. The risk increased by 24% for each year of increasing age (RR 1.24 [95% CI 1.17-1.31]; p< 0.0001). Neither prevalence, duration nor rate of detectable VL was influenced by gender. Conclusion Detectable VL was seen in nearly half of adolescents, with the rate increasing with age. Viraemia was not a static process, and adolescents moved in and out of this state as adolescence progressed. Further study is warranted to correlate these findings with risks and clinical outcomes.