OpenUCT :: Browsing by Department "Division of Dermatology"

Browsing by Department "Division of Dermatology"

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Open Access
The 52 and 60 kD Ro/SS-A : antigens where are they? : do anti-Ro/SS-A autoantibodies cause cutaneous disease?
(1998) Yell, Jennifer Anne
Systemic lupus erythematosus, considered a multifactorial autoimmune disease, is a disease affecting many systems, with associated immunological abnormalities. It has a striking diversity of clinical patterns, pathologies and prognoses. Genetic factors determine the inherited baseline, on which environmental, hormonal and infectious triggers act to produce autoantibodies. Ro antibodies have been considered pathogenic in subacute cutaneous and neonatal lupus erythematosus. I affinity-purified antibodies to the 52 kD Ro from immunised rabbits (whole 52 kD protein) and human sera (using two immunodominant regions of the protein). I affinity-purified antibodies to the 60 kD Ro from immunised rabbits (whole 60 kD protein) and human sera (using two immunodominant regions of the protein, as well as the total "native" protein). Using these purified antibodies, with immunofluorescence on normal neonatal human keratinocytes, I showed that the 52 kD Ro is mainly cytoplasmic and the 60 kD Ro is mostly nuclear, with some fine cytoplasmic staining. I looked at the capacity of these purified antibodies to penetrate living keratinocytes under various conditions (hormones, drugs and vitamins). No antibody penetration was found, although one whole serum gave low levels of intracellular fluorescence. I studied the putative membrane translocation of 52 kD and 60 kD Ro under conditions of stress (UV A or UVB with or without hormones, drugs, vitamins and heat shock). I could not identify translocation of the 52 or 60 kD antigens with purified antibodies, although some whole sera showed fluorescence. I can find no evidence that antibodies directed against the 52 and 60 kD Ro antigens cause cutaneous disease.
Open Access
The aetiology and pathogenesis of tropical ulcer
(1988) Adriaans, Beverley; Hay, roderick J; Drasar, Bohumil S
Tropical ulcer is a very specific form of cutaneous ulceration. It occurs worldwide in most tropical and a number of subtropical areas. The disease occurs mainly in older children and young adults with children under the age of 5 and adults over 45 years rarely being affected. Ulcers occur most commonly on the lower leg but may occur on the upper limb. Although most ulcers normally heal slowly over many weeks or months, some ulcers may recur. Recognised complications include squamous cell carcinoma, gangrene and osteitis, although these are rare. A number of authors have reported on the disease and suggested diet, trauma and infection as aetiological factors for this condition. This survey was thus conducted to assess as many of these factors as possible. The study took place in 5 tropical areas, namely Zambia, Gambia, southern India, Fiji and Papua New Guinea. Consultations took place at hospitals, rural clinics, health centres and villages. Although many authors have suggested that the disease is related to malnutrition, few have objectively assessed the nutritional status of the patients and compared it with controls. Those studies which included objective assessments were limited to small areas and only investigated specific parameters. In order to investigate the immune response of the host to an anaerobic infection, the antibody levels to the organisms isolated from the ulcers were measured by an ELISA test. The local host response to an infection with a Fusobacterium species was assessed by the number of antibody secreting B-lymphocytes at the site of the ulcers. These parameters may play a role in the localisation of the ulcers and account for recurrent infections.
Open Access
Bioenergetic Evaluation of Site-specific Keloid and FKN Fibroblasts
(2019) Chalwa, Temwani; Khumalo, Nonhlanhla; Bayat, Ardeshir; Lebeko, Maribanyana
Excessive scarring due to fibrosis from aberrant wound healing can lead to conditions such as Keloids or Folliculitis Keloidalis Nuchae (FKN). These fibroproliferative growths pose therapeutic challenges due to their complex aetiology that has been linked to multiple genetic and environmental factors, with frequent reoccurrence following therapy. Owing to reports on an increase in ATP and Fibroblast Activation Protein-1α production in keloids, the aim of this study was to investigate whether the disease phenotypes were linked to bioenergetic changes at a cellular level in these two conditions. Patient-derived tissue biopsies were used for fibroblast cell culture models, in which cell analysis was carried out to assess phenotype and different parameters of bioenergetic cellular behaviour. In addition to FKN and the intra- and peri-lesional Keloid patient fibroblasts, normal skin and non-hypertrophic (normo-trophic) scar fibroblasts were used as negative controls. The results show statistically significant and variable growth dynamics with increased proliferation and migration in keloid fibroblasts, while FKN fibroblasts showed a statistically significant increase in proliferation but had a similar migration profile to controls. The results further show that there is a statistically significant metabolic switch towards aerobic glycolysis in the fibroblasts from the disease conditions. During functional measurement of mitochondrial parameters, an increase in oxidative phosphorylation was exhibited in the disease conditions indicating their mitochondria were still functional. An increase in basal glycolysis with a concomitant increase in the cellular maximum glycolytic capacity was also demonstrated. Furthermore, protein analysis showed an upregulation in the expression of Fibroblast Activation Protein-1α in fibroblasts from both disease conditions This study begins to give novel insight into the bioenergetics of normal scars and scarring conditions such as FKN and, adds to the knowledge on the heterogeneity of fibroblasts derived from specific lesional sites within Keloids. These findings suggest that Keloids and FKN have a switch to a metabolic phenotype of aerobic glycolysis. This increase in glycolytic flux potentially proposes glycolytic inhibitors as a mechanistic basis for the treatment of these conditions.
Open Access
Blood and virus detection on barber hair clippers
(2019) Spengane, Zandile Namhla Elizabeth; Khumalo, Nonhlanhla; Ngwanya, Mzudumile R
Background: Bleeding from the popular clean-shave ‘chiskop’ haircut was recently reported as prevalent in South Africa (SA), a country with 6.9 million HIV-infected people. Objectives. To investigate the prevalence of barber hair clipper contamination with blood and HIV and hepatitis B viruses. Methods: Fifty barbers from three townships in Cape Town, SA, were invited to participate. One clipper from each barber was collected immediately after it had been used for a cleanshave haircut. Each clipper was rinsed with phosphate-buffered saline and then submerged in viral medium. The polymerase chain reaction (PCR) was used to identify the bloodspecific RNA marker haemoglobin beta (HBB), hepatitis B virus (HBV) and HIV. Results: The clean-shave haircut was the most common haircut requested by clients (78%). Of the clippers collected, 42% were positive for HBB, confirming detection of blood, none were positive for HIV, and 4 (8%) were positive for HBV. Two clippers (clippers 16 and 20) were positive on qualitative HBV PCR. HBV DNA from clipper 16 clustered with genotype A sequences from SA, India, Brazil and Martinique, while clipper 20 clustered with SA genotype D sequences. The clipper 20 sequence was identical to a subtype D sequence (GenBank accession AY233291) from Gauteng, SA. Conclusion: This study confirms that there is significant contamination of barber hair clippers with blood and blood-borne viruses. Hepatitis B was detected with enough DNA copies to pose a risk of transmitting infection. Although HIV was not detected in this small study, the risk of transmission should be quantified. Further studies to investigate barber clipper sterilization practices and whether the clean-shave hairstyle is an independent risk factor for HIV, HBV and hepatitis C virus infections are warranted. Public education on individual clipper ownership (as is the case with a toothbrush) should be advocated for clean-shave and blade-fade haircuts.
Open Access
Cost-effectiveness analysis of introducing HTLV-1 testing in South Africa
(BioMed Central Ltd, 2015) Sykes, Wendy; Coleman, Charl; Beck, Genevieve; Mhlanga, Jabu; Hlela, Carol; Custer, Brian; Murphy, Edward; Vermeulen, Marion
We have previously reported a 2013 cross-sectional study of HTLV prevalence among 46,765 South African blood donors. Confirmed HTLV-1 prevalence was 0.16% in Black donors, 0.02% in both White and Coloured donors and 0% in south Asian donors, for an overall prevalence of 0.062% extrapolated to the current blood donor population. Using these data we estimated the cost effectiveness of potential HTLV screening strategies in preventing transfusion transmitted HTLV-1 infection (TTI). Five blood donor screening strategies were considered: no screening; HTLV testing of every donation; HTLV testing each donor one time only; HTLV testing of new donors only; and universal filter leukodepletion without HTLV testing.
Open Access
The Epidermiology of Hairstyle related african hair disdorders, in and Urban Township in South Africa
(2007) Khumalo, Nonhlanhla P; Ehrlich, Rodney; Jessop, S
The hair of indigenous people of Africa varies from the north to the south of the continent. Although the variation in hair colour from light brown to black occurs, the most significant difference is in the curls which are tightest, and spiral, in indigenous sub Saharan Africans. African hair for the purpose of this thesis refers to the latter hair phenotype. The unique morphology of this hair type is associated with specific responses to grooming. In addition hairstyle preferences may be influenced by politics and fashion. Specific scalp disorders have been anecdotally reported to be more prevalent in Africans. These are acne (folliculitis) keloidalis (AKN), central centrifugal cicatricial alopecia (CCCA) and traction alopecia (TA). For many years all these conditions have been suspected to have a causal association with hairstyles. However, preliminary investigation suggested a lack of population studies demonstrating the latter association. In addition the possible influence of the unique African hair follicle on disease pathogenesis had not been determined. The aims of this thesis were to: Present a systematic 1. literature review of published prevalence and incidence data on the above three conditions. 2. Conduct cross sectional studies to investigate the prevalence of AKN, CCCA and TA in a population of school children and adults and the prevalence of different hairstyles, and to describe any associations between hairstyles and disease. 3. Develop and test for reliability a new severity scoring system for TA the commonest of the above conditions [the marginal traction alopecia severity (M-TAS) scoring instrument]. 4. Evaluate the determinants of both TA presence and severity in African females using data from our cross sectional studies in school children and adults.
Open Access
Epidermolysis bullosa in South Africa
(1986) Winship, Ingrid M
Open Access
Genomics study of anti-tuberculosis drug-induced hypersensitivity reactions
(2015) Shebe, Khadija Ahmed; Lehloenya, Rannakoe J; Todd, Gail
Introduction: All first-line anti-tuberculosis drugs can be associated with all phenotypes of cutaneous adverse drug reactions (CADR). Second-line drugs are associated with much poorer outcomes. Thus, identifying the offending drug in poly-pharmacy is difficult. Re -challenge with the drug is the gold standard in identifying the offender, however poses unacceptably high risk of CADR recurrence. Population and drug-specific genomics help identify those susceptible to adverse reactions to a drug facilitating avoidance of the drug. Objective: To investigate the genomic susceptibility in patients with confirmed rifampicin and or isoniazid-associated hypersensitivity reactions using both genome- wide association studies and candidate gene approaches. Methods: A case control study using 14 patients with previous tuberculosis-associated CADR who were re-challenged with first-line anti-tuberculosis drugs and subsequently developed re-challenge reactions to either isoniazid or rifampicin as cases. These were compared with 30 controls who had tolerated rifampicin and isoniazid during the re- challenge process (12 patients, Group 1a) and consecutive patients who had been on TB treatment for at least 12 weeks without developing any adverse drug reaction (1 8 patients, Group 1b) and 200 black South Africans from the general population. HLA genotypes of the samples were determined by SeCore® HLA Sequence based typing (Invitrogen, Life technologies, USA), and potential ambiguities were resolved by sequencing-based typing. Results: We found HLA-B*58:02 (OR=3.6; 95% CI: 1.4-8.99) and HLA-DRB1*09:01 (OR=15.3; 95% CI: 2.1-113.1) to be significantly more prevalent in patients who developed rifampicin and isoniazid-associated CADR as compared to black South African general population. However, we found no significant associations between HLA genotype and rifampicin/isoniazid-associated CADR when we compared the cases to our study controls that had tolerated rifampicin and isoniazid. HLA-B *58.02 was not found to be statistically associated with HIV positive status (p=0.42) and DRESS phenotype ( p= 0.6279). The majority of our cases were black Africans. Approximately 80% of our cases and controls were HIV-infected. DRESS/DIHS was the prevalent phenotype of CADR, accounting for approximately 80% of cases and controls. Discussion: To our knowledge, this is the first study to show an association between HLA-B*58:02 and HLA-DRB1*09:01 alleles and severe cutaneous adverse drugs reactions secondary to rifampicin and isoniazid in an African population. We identify 2 candidate HLA alleles that need confirmation of their association in African patients who develop rifampicin or isoniazid-associated CADR in larger studies. The value of identifying candidate alleles could lead to CADR preventative screening prior to initiating anti-tuberculosis therapy in black South Africans. The HLA-B*58:02 noted in our cases and controls tolerant of the drugs might not be associated with CADR but could be a reflection of the HIV status and control in HIV-TB co-infected persons. Conclusion: HLA-B*58:02 and HLA-DRB1*09:01 may be associated with rifampicin and isoniazid-associated CADR. Alternately HLA-B*58:02 may be associated with HIV status rather than CADR. A sufficiently powered study is needed to confirm this association.
Open Access
Health risks of the clean-shave chiskop haircut
(2013) Khumalo, Nonhlanhla P; Gantsho, Nomphelo; Gumedze, Freedom; Mthebe, Thami
The clean-shave haircut known locally as the chiskop is rare among females but popular with black South African men, who are also predisposed to folliculitis keloidalis nuchae (FKN) (keloids on the back of the head). During a previous study, participants described an unexpected symptom of haircut-associated bleeding. As this is not a widely recognised entity, we conducted the present study at an HIV clinic servicing the same population, with the objective of comparing the prevalences of haircut-associated bleeding and FKN in 390 HIV-positive subjects with published data for Langa (Western Cape, South Africa). The results for HIV-positive participants were similar to the population data, but in both groups the prevalence of haircut-associated bleeding (24.5% v. 32%; p =0.17) was much higher than that of FKN (10.2% v. 10.5%), suggesting that the hairstyle increases the risk of bleeding even in people with healthy scalps without folliculitis. This study does not (and was not intended to) prove a higher HIV prevalence in chiskop wearers or in FKN sufferers, but it confirms a history of haircut-associated bleeding in at least a quarter of our male study participants. The risk of transmission of blood-borne infection via haircuts is likely to be low, but requires formal quantification. Public education on adequate sterilisation of barber equipment between haircuts and promotion of individual hair-clipper ownership for chiskop clients should not be delayed. Depilatory creams formulated for African hair offer a non-mechanical means of achieving clean-shave hairstyles.
Open Access
Human T cell lymphotropic virus type 1- associated infective dermatitis in KwaZulu Natal, South Africa
(BioMed Central Ltd, 2013) Hlela, Carol; Graham, Natalie; Bhigjee, Ahmed; Taylor, Graham; Khumalo, Nonhlanhla; Mosam, Anisa
BACKGROUND: The Human T cell lymphotropic virus type 1 (HTLV-1)-associated infective dermatitis (IDH), is a chronic relapsing dermatitis which usually presents in children older than 2years. A total of 300 cases have been reported worldwide (Latin America, the Caribbean and only 5 from Senegal). Neither IDH, nor its complications have been reported from the rest of Africa. We aimed to examine the clinical and aetiological characteristics of IDH in a cohort of South African children. METHODS: Attendees at the dermatology clinic at King Edward VIII Hospital, Durban underwent clinical examination. After obtaining consent those suspected of IDH had specimens taken for blood counts, immunoglobulins, serum protein electrophoresis, viral studies (including genotyping), skin swabs and stool examinations. RESULTS: Nineteen of 60 suspected cases recruited over 3years met the diagnostic criteria for IDH. The male-to-female ratio was 1:2; mean age 8years (range 0.7 to 15). Dermatitis mostly affected the scalp (78.9%) and axilla (73.7%); fewer children had nasal crusting (47.4%). Mean Ig A, IgG and IgM were raised, at 3.52g/l, 22.6g/l and 1.38g/l, respectively. The median CD4 cell count was 1958 cells/mm3. Viral genotyping of all tested samples were positive for the Cosmopolitan, Subtype A (HTLV-1a). CONCLUSIONS: IDH is a distinct entity which also affects South Africans. Our patients were older at presentation and the majority did not present with nasal crusting as has been described in other countries.
Open Access
Kaposi's sarcoma: Genetic subtypes and clinical correlation in a South African population
(2017) Isaacs, Thuraya; Todd, Gail; Katz, Arieh A
Human herpes virus 8 (HHV8) is the aetiological agent of all forms of Kaposi's sarcoma (KS). Seven major subtypes (A, B, C, D, E, F, Z) based on genetic variability of open reading frame (ORF)-K1, have been identified. Numerous studies point to differing tumorigenic and pathogenic properties of the HHV8 subtypes. The study objective was to determine the prevalence of the HHV8 subtypes in a cohort of clinical and histologically confirmed KS in Cape Town, South Africa, and analyse associations between the different subtypes, clinico- epidemiological forms and clinical presentation of KS. The clinical data was prospectively collected and recorded on a body diagram and with photographs. Demographic data was retrospectively collected from clinical records. Tissue biopsies were taken for ORF-K1 subtyping. Out of a cohort of 103, eighty six patients were subtyped; 81 AIDS (aquired immune deficiency syndrome)-KS and 5 African endemic. Subtype A5 (42/86) and B2 (16/86) predominated. B1, B3, A1 and A4 subtypes were identified in 10/86, 9/86, 4/86 and 1/86 patients respectively. A5, B1, B2 and B3 were found in African blacks and individuals of mixed ancestry, while subtypes A1 and A4 are found only in whites and individuals of mixed ancestry. Subtype A5 was associated with >10 KS lesions at presentation in the AIDS-cohort (32/38, p=0,050), but not in the African endemic patients (2/4, p=0,600). Subtypes A1 and A4 were less likely to be associated with poor risk tumour extension (p=0,031) and A1 was associated with lower likelihood of lower limb involvement (p=0,004).
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Lettuce allergy: allergies in the workplace
(2005) Gottschalk, Gavin; Todd, Gail
A casual worker in a vegetable-packing plant developed hand and forearm eczema soon after commencing work in the lettuce-packing section. Despite a negative standard battery, targeted patch testing revealed lettuce as the offending agent; this highlights the need to use the patient's own materials identified from an appropriate risk assessment of the workplace in cases of suspected allergy. Development of her eczema may have been facilitated by chronic exposure to water, emphasizing the need for workers to have access to gloves, and education about their correct use.
Open Access
“Next generation sequencing identifies mutations in GNPTG gene as a cause of familial form of scleroderma-like disease”
(BioMed Central, 2017-12-29) Arowolo, Afolake T; Adeola, Henry A; Khumalo, Nonhlanhla P
A letter to the editor making some recommendations on the article entitled “Next generation sequencing identifies mutations in GNPTG gene as a cause of familial form of scleroderma-like disease”.
Open Access
Omics-based molecular techniques in oral pathology centred cancer: prospect and challenges in Africa
(BioMed Central, 2017-06-05) Adeola, Henry A; Soyele, Olujide O; Adefuye, Anthonio O; Jimoh, Sikiru A; Butali, Azeez
Background: The completion of the human genome project and the accomplished milestones in the human proteome project; as well as the progress made so far in computational bioinformatics and “big data” processing have contributed immensely to individualized/personalized medicine in the developed world. Main body: At the dawn of precision medicine, various omics-based therapies and bioengineering can now be applied accurately for the diagnosis, prognosis, treatment, and risk stratifcation of cancer in a manner that was hitherto not thought possible. The widespread introduction of genomics and other omics-based approaches into the postgraduate training curriculum of diverse medical and dental specialties, including pathology has improved the profciency of practitioners in the use of novel molecular signatures in patient management. In addition, intricate details about disease disparity among diferent human populations are beginning to emerge. This would facilitate the use of tailor-made novel theranostic methods based on emerging molecular evidences. Conclusion: In this review, we examined the challenges and prospects of using currently available omics-based technologies vis-à-vis oral pathology as well as prompt cancer diagnosis and treatment in a resource limited setting.
Open Access
Primary cutaneous malignancies in the Northern Cape Province of South Africa: A retrospective histopathological review
(2018) York, Katherine; Khumalo, Nonhlanhla P; Dlova, Ncoza; Mosam, Anisa
Background: Excessive sun exposure and high human immunodeficiency virus prevalence increase skin cancer risk in South Africa. Objective: To describe the nature and extent of skin cancers presenting in public and private health sectors of the Northern Cape Province. Methods: A retrospective analysis of histologically-confirmed new primary cutaneous malignancies from 1/1/2008 to 31/12/2012 was conducted using public and private health sector databases. Types, quantity and distribution of common invasive malignancies by population group, age, gender, anatomical site and health sector were explored. One-year cumulative incidence was calculated and logistic regression models were used to analyse incidence and melanoma thickness trends. Results: 4270 biopsies (14 cutaneous malignancies) were identified. Most common were Squamous Cell Carcinoma (SCC), Basal Cell Carcinoma (BCC), Kaposi Sarcoma (KS), Cutaneous Malignant Melanoma (CMM) and Basosquamous carcinoma. The odds of a White male developing SCC increased by 8% each year (OR: 1.08; CI: 1.01-1.15; p-value: 0.022) whilst the odds of a Black male developing SCC and KS decreased by 9% (OR: 0.91; CI: 0.84-0.99; p-value: 0.033) and 18% (OR: 0.82; CI: 0.70-0.97; p-value: 0.022) each year, respectively. SCC and CMM were diagnosed at more advanced stages within public versus private sectors. CMM is being detected earlier, as indicated by low stage depth increasing by 72% annually (OR: 1.72; 95% CI: 1.04-3.01; p-value: 0.042). Conclusion: Results suggest that reported skin cancer patterns are changing. There is a need for further research and equitable appropriation of financial resources and effort toward developing primary skin cancer prevention initiatives in South Africa.
Open Access
Pyoderma gangrenosum : the Groote Schuur Hospital experience, 1970-1990
(1991) Lawrence, Pat
Open Access
Regional clinical registry data show increased incidence of cutaneous melanoma in Cape Town
(2008) Jessop, S J; Stubbings, H; Sayed, A R; Duncan-Smith, J; Jordaan, H F; Schneider, J W
Cutaneous melanoma is a skin tumour that continues to result in a high mortality rate, particularly in the case of thick tumours and those that are deeply invasive histologically. It occurs in all populations but is most common in fair-skinned individuals, especially those with skin types 1 and 2 that tan poorly or not at all. There is epidemiological evidence for the pathogenetic role of ultraviolet light, particularly intense childhood exposure, although the relationship is complex. Genetic factors also play a role, as exemplified by families with both atypical naevi and melanoma. The rising incidence of melanoma, noted initially in countries with high levels of UV light, appears to be levelling off or decreasing in some areas. The pattern of these trends is inconsistent, with even European countries showing great variation. An epidemiological study performed in Cape Town from 1990 to 1995 demonstrated an incidence of melanoma of 24.4 per 100 000 white people per annum. We conducted a methodologically identical study in the same geographical area after a 10-year interval, to identify whether there is a trend in the incidence of melanoma in this area.
Open Access
Relevance of a positive latex specific IgE result in a non medical occupational setting
(2011) Motsepe, Didintle Christine; Todd, Gail
Background: In 2007, three patients from Impregnated Web Technology (IWT) factory were referred to Groote Schuur occupational clinic with contact dermatitis. The IWT factory manufactures sanding and grinding discs, traditionally a low latex exposure industry. Workers at this factory were introduced to latex gloves in 2004 to protect their hands for various reasons. One of the patient was referred with raised latex specific IgE. Our preliminary diagnosis was irritant contact dermatitis. The dermatitis cleared after avoiding latex gloves. The other two were referred with negative latex specific IgE. One was subsequently diagnosed of fiberglass dermatitis confirmed with histology and the other with urticaria based on the history. Because of the perception that skin problems equate to latex allergy we decided to study the relevance of a positive latex specific IgE in a nonmedical setting. Objective: The objective of this study is to determine the prevalence and relevance of latex sensitization at this traditionally a low latex exposure factory. It also aimed to increase awareness of latex exposure and provide recommendations for preventing and managing latex allergies. Methods: A cross sectional study of the workers on duty was conducted at the IWT factory over 2 days. There were no exclusion criteria. Ethics approval was obtained. Workers who volunteered were asked to sign informed consent and answer 3 questionnaires. Questioned asked were related to glove use at work and at home. They were also examined by the investigator and had a blood sample taken for total IgE and latex specific IgE measurement. Results: There were 160 workers on the factory floor over the study period. Only 81 workers volunteered giving a response rate of 51 %. The point prevalence of latex sensitization was 16 %(13/81). There was a significant relationship between workers who had skin signs and wore glove, however there was no association between glove usage and total and latex specific IgE. A raised latex specific IgE was associated with permanent employment. Conclusion: The prevalence of elevated latex specific IgE amongst workers at IWT factory was high, in the range of that reported of medical personnel, suggesting a source of latex exposure in the work place. The reasons for glove use amongst the workers revealed an appropriate use of natural rubber latex gloves with unnecessary latex exposure. Although we could not link the high prevalence of latex specific IgE to the use of gloves, subgroup analysis with larger numbers of workers may expose an association suggested by a higher prevalence in permanent workers. We suggest the use of more appropriate gloves selected for the protection needed. A latex specific IgE test should be performed only for workers with strong suspicion of latex sensitization, not simply skin signs and symptoms.
Open Access
Stevens Johnson Syndrome and toxic epidermal necrolysis: maternal and foetal outcomes in twenty-two consecutive pregnant HIV infected women
(Public Library of Science, 2015) Knight, Lauren; Todd, Gail; Muloiwa, Rudzani; Matjila, Mushi; Lehloenya, Rannakoe J
Introduction Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) form a spectrum of a rare and life-threatening cutaneous drug reaction. SJS/TEN in pregnancy poses largely unknown risk factors and outcomes for both the mother and foetus compared to the general population. METHODS: We conducted a study of consecutive pregnant women admitted to single tertiary referral centre in South Africa with SJS/TEN over a 3 year period. They were all managed by the same medical team using the same protocols. We evaluated their underlying illnesses, offending drugs and the course of pregnancy and outcomes to determine factors influencing maternal and foetal outcomes. RESULTS: We identified twenty-two women who developed SJS/TEN while pregnant, all of them HIV-infected. Their median age was 29 years. The majority 16/22 (73%) had SJS, the milder variant of the disease affecting < 10% body surface area. Nevirapine was the offending drug in 21/22 (95%) cases. All 22 of the mothers survived with 3/22 (14%) developing postpartum sepsis. Pregnancy outcomes were known in 18/22 women and 9/18 (50%) babies were delivered by caesarean section. There were 2 foetal deaths at 21 and 31 weeks respectively and both were associated with post-partum sepsis. Postnatal complications occurred in 5 cases, 3 involving the respiratory system and the other two being low birth weight deliveries. Eight placentae and one foetus were sent for histology and none showed macroscopic or microscopic features of SJS/TEN. On follow-up, only 12/20 children were tested for HIV at 6 weeks post-delivery and none of them were HIV-infected. All had received prophylactic ARVs including nevirapine. CONCLUSIONS: TEN, the severe form of the disease, was associated with poorer foetal outcomes. SJS/TEN-associated mortality is not increased in HIV-infected pregnant women. Maternal SJS/TEN does not seem to commonly manifest in the foetus.
Open Access
Studies in symptomatic porphyria in the African
(1969) Shanley, Brian Christopher