Browsing by Author "Lehloenya, Rannakoe"

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    Open Access
    Drug-associated adverse events and their relationship with outcomes in patients receiving treatment for extensively drug-resistant tuberculosis in South Africa
    (Public Library of Science, 2013) Shean, Karen; Streicher, Elizabeth; Pieterson, Elize; Symons, Greg; van Zyl Smit, Richard; Theron, Grant; Lehloenya, Rannakoe; Padanilam, Xavier; Wilcox, Paul; Victor, Tommie C; van Helden Paul; Groubusch Martin; Warren, Robin; Badri, Motasim; Dheda, Keertan
    BACKGROUND: Treatment-related outcomes in patients with extensively drug-resistant tuberculosis (XDR-TB) are poor. However, data about the type, frequency and severity of presumed drug-associated adverse events (AEs) and their association with treatment-related outcomes in patients with XDR-TB are scarce. METHODS: Case records of 115 South-African XDR-TB patients were retrospectively reviewed by a trained researcher. AEs were estimated and graded according to severity [grade 0 = none; grade 1-2 = mild to moderate; and grade 3-5 = severe (drug stopped, life-threatening or death)]. FINDINGS: 161 AEs were experienced by 67/115(58%) patients: 23/67(34%) required modification of treatment, the offending drug was discontinued in 19/67(28%), reactions were life-threatening in 2/67(3.0%), and 6/67(9.0%) died. ∼50% of the patients were still on treatment at the time of data capture. Sputum culture-conversion was less likely in those with severe (grade 3-5) vs. grade 0-2 AEs [2/27(7%) vs. 24/88(27%); p = 0.02]. The type, frequency and severity of AEs was similar in HIV-infected and uninfected patients. Capreomycin, which was empirically administered in most cases, was withdrawn in 14/104(14%) patients, implicated in (14/34) 41% of the total drug withdrawals, and was associated with all 6 deaths in the severe AE group (renal failure in five patients and hypokalemia in one patient). CONCLUSION: Drug-associated AEs occur commonly with XDR-TB treatment, are often severe, frequently interrupt therapy, and negatively impact on culture conversion outcomes. These preliminary data inform on the need for standardised strategies (including pre-treatment counselling, early detection, monitoring, and follow-up) and less toxic drugs to optimally manage patients with XDR-TB.
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    Incidence of anxiety and depression in a predominantly HIV-infected population with severe adverse drug reactions
    (BioMed Central Ltd, 2014) Zitha, Eddy; Chiliza, Bonga; Muloiwa, Rudzani; Lehloenya, Rannakoe
    Little is known on the short-term or medium-term psychological and psychiatric sequelae following Stevens Johnson syndrome (SJS), toxic epidermal necrolysis (TEN) and drug reaction with eosinophilia and systemic symptoms (DRESS). Based on this we did a prospective study designed to assess anxiety and depression in patients with severe cutaneous adverse drug reactions by indicating higher Hospital anxiety and depression scale (HADS).
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    Patients with severe cutaneous adverse drug reactions have extremely high hair cortisol concentrations that do not correlate with presence of depression.
    (2024) Zitha, Eddy; Lehloenya, Rannakoe; Khumalo, Nala ; Peter, Jonny
    Background: Hair cortisol concentrations (HCC) +/- DHEA, a depression and stress biomarker has not been studied in severe cutaneous adverse drug reactions (SCAR). Objective: To determine DHEA/HCC correlation with SCAR-associated depression and compare the ratio with published values. Methods: Depression was assessed using M.I.N.I. and DHEA/HCC measured in epidermal necrolysis (EN) and DRESS patients at a South African tertiary hospital. PubMed search was conducted for publications documenting DHEA/HCC. Results: 22/37 participants enrolled were depressed, significantly higher in EN than DRESS. HCC, DHEA or DHEA/HCC were not different between SCAR; depressed versus non-depressed; and presence versus absence of suicidal ideation. DHEA/HCC was unaffected by HIV or TB status. HCC was high in all SCAR patients, regardless of gender. HCC in SCAR was extremely high compared to published healthy controls [309.33 (28.9 - 1835.7) vs. 46.1 (17.7 - 153.2), p = <0.01]; depressed subjects [1349.67 (SD 1935.59) vs. 7.26 (SD 0.47), p = <0.01] and depressed HIV positive males [1479.61 (SD 2313.74) vs. 18.02 (SD 9.37), p =0.0003]. Conclusions: HCC was high and sustained in SCAR irrespective of HIV, TB, or depression status. No association existed between DHEA/HCC ratio and depression. Sustained high cortisol levels potentially impact long-term SCAR-associated outcomes.
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    Patients with severe cutaneous adverse drug reactions have extremely high hair cortisol concentrations that do not correlate with presence of depression.
    (2024) Zitha, Eddy; Lehloenya, Rannakoe; Khumalo Nala &; Peter, Jonny
    Background: Hair cortisol concentrations (HCC) +/- DHEA, a depression and stress biomarker has not been studied in severe cutaneous adverse drug reactions (SCAR). Objective: To determine DHEA/HCC correlation with SCAR-associated depression and compare the ratio with published values. Methods: Depression was assessed using M.I.N.I. and DHEA/HCC measured in epidermal necrolysis (EN) and DRESS patients at a South African tertiary hospital. PubMed search was conducted for publications documenting DHEA/HCC. Results: 22/37 participants enrolled were depressed, significantly higher in EN than DRESS. HCC, DHEA or DHEA/HCC were not different between SCAR; depressed versus non-depressed; and presence versus absence of suicidal ideation. DHEA/HCC was unaffected by HIV or TB status. HCC was high in all SCAR patients, regardless of gender. HCC in SCAR was extremely high compared to published healthy controls [309.33 (28.9 - 1835.7) vs. 46.1 (17.7 - 153.2), p = <0.01]; depressed subjects [1349.67 (SD 1935.59) vs. 7.26 (SD 0.47), p = <0.01] and depressed HIV positive males [1479.61 (SD 2313.74) vs. 18.02 (SD 9.37), p =0.0003]. Conclusions: HCC was high and sustained in SCAR irrespective of HIV, TB, or depression status. No association existed between DHEA/HCC ratio and depression. Sustained high cortisol levels potentially impact long-term SCAR-associated outcomes.