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Clinical and microbiological characterisation of invasive enteric pathogens in a South African population: the interaction with HIVKeddy, Karen Helena January 2017 (has links)
A Thesis Submitted to the School of Public Health,
Faculty of Health Sciences,
University of the Witwatersrand,
in fulfilment of the requirements for the degree of Doctor of Philosophy
Johannesburg, South Africa 2016. / Introduction
Human immunodeficiency virus (HIV) has been associated with invasive enteric infections in
HIV-infected patients, since it was first described in the 1980s. In South Africa, HIV remains
an important health challenge, despite the introduction of antiretroviral therapy (ART) in
2003. In association with this, is an ongoing problem of invasive enteric infections, including
those due to Shigella and Salmonella, including Salmonella enterica serovar Typhi
(Salmonella Typhi). There are few South African data available as to the incidence of
invasive disease due to these pathogens and how these data may contrast with the
presentation and outcome in HIV-uninfected patients. The associated risk factors for
mortality due to invasive enteric pathogens and whether there has been a response with ART
as an intervention also needs further elucidation.
Aims
This work was undertaken to better describe the burden of invasive enteric infections
(Shigella, nontyphoidal Salmonella and Salmonella Typhi) in association with HIV, define
risk factors for mortality and establish whether the introduction of ART has impacted on
disease burdens due to these pathogens.
Methods
Laboratory-based surveillance for enteric pathogens was initiated in 2003. Basic
demographic details (age and gender) were collected on all patients where possible. In 25
hospital sites in all nine provinces, additional clinical information was collected by trained
surveillance officers, including HIV status, data reflecting severity of illness, other immune
suppressive conditions, antimicrobial and antiretroviral usage and outcome (survival versus
death). Laboratories were requested to transport all isolates to the Centre for Enteric Diseases
(CED) at the National Institute for Communicable Diseases of the National Health
Laboratory Service (NHLS) in Johannesburg for further characterisation, including
serotyping, antimicrobial susceptibility testing and molecular typing where relevant (whether
isolates could respectively be classified as Salmonella Typhimurium ST313 and Salmonella
Typhi H58). Additional cases were sought through audits of the Central Data Warehouse
(CDW) of the NHLS.
Annual incidence rates were calculated according to published estimates of population by age
group by the Actuarial Society of South Africa for the Department of Statistics of the South
African government. Analyses were specifically directed at invasive shigellosis, Salmonella
meningitis, typhoid fever in South Africa and nontyphoidal salmonellosis in Gauteng
Province, South Africa. Data were recorded in an Access database and analysed using chisquared
test to establish differences between HIV-infected and uninfected individuals and
univariate and multivariate analysis to compare risk factors for mortality. Data in the number
of patients accessing ART were derived through audits of the CDW, by using the numbers of
patients on whom viral loads were done annually as a proxy.
Results
Between 2003 and 2013, a total of 10111 invasive enteric isolates were received by CED. For
patients for whom sex was recorded, 3283/6244 (52.6%) of patients presenting with invasive
enteric infections were male; invasive disease was predominantly observed in children less
than five years of age (1605/6131; 26.2%) and those who were aged between 25 and 54 years
(3186/6131; 52.0%), with the exception of typhoid fever where the major burden was in
patients aged 5 to 14 years (302/855; 35.3%).
KH Keddy 81-11384 PhD
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More HIV-infected adult women were observed with invasive shigellosis (P=0.002) and with
typhoid fever compared with adult men (P=0.009). Adults aged ≥ 15 years were more likely
to die than children aged < 15 years (invasive shigellosis, odds ratio [OR]=3.2, 95%
confidence interval [CI]=1.6 – 6.6, P=0.001; Salmonella meningitis, OR=3.7, 95% CI=1.7 –
8.1, P=0.001; typhoid fever, OR=3.7, 95% CI=1.1 – 14.9, P=0.03; invasive nontyphoidal
salmonellosis, OR=2.0, 95% CI=1.6 – 2.5, P<0.001).
HIV-infected patients had a significantly higher risk of mortality compared with HIVuninfected
patients (invasive shigellosis, OR=4.1, 95% CI=1.5 – 11.8, P=0.008; Salmonella
meningitis OR=5.3, 95% CI=1.4-20.0, P=0.013; typhoid fever, OR=11.3, 95% CI=3.0 – 42.4,
P<0.001; invasive nontyphoidal salmonellosis OR=2.5, 95% CI=1.7 – 3.5, P<0.001). In all
patients, severity of illness was the most significant factor contributing to mortality (invasive
shigellosis, OR=22.9, 95% CI=2.7 – 194.2, P=0.004; Salmonella meningitis OR=21.6, 95%
CI=3.5 – 133.3, P=0.01; typhoid fever, OR=10.8, 95% CI=2.9 – 39.5, P<0.001; invasive
nontyphoidal salmonellosis OR=5.4, 95% CI=3.6 – 8.1, P<0.001). Between 2003 and 2013,
ART was significantly associated with decreasing incidence rates of invasive nontyphoidal
salmonellosis in adults aged 25 - 49 years (R=-0.92; P<0.001), but not in children (R=-0.50;
P=0.14).
Conclusion
Decreasing incidence rates of invasive nontyphoidal salmonellosis and shigellosis suggest
that ART is having an impact on opportunistic enteric disease in HIV. Further work is
necessary however, to fully understand the associations between age, sex and invasive enteric
pathogens. Specifically, this work would include typhoid fever, Shigella transmission from
child to adult carer, development of invasive enteric infections in HIV-exposed children and
whether the decreasing incidence rates can be sustained. Moving forward, an understanding
of invasive enteric infections in the HIV-uninfected patient may assist in targeting severity of
illness as a risk factor for mortality. / MT2017
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Burden of respiratory disease among paediatric patients infected with HIV/AIDSDa Cunha, Natalia Cristina Picarra 19 January 2012 (has links)
HIV is a prominent infection in society and its health implications are seen in the
paediatric wards daily. Despite its multi-system effect on the body, it particularly
results in many respiratory infections. Effective understanding of the disease profile
and management of patients with HIV relies on correct statistics and proper use of
resources.
Since the introduction of anti-retrovirals in 2004 in South Africa, the impact of
HIV/AIDS on respiratory disease needs to be re-evaluated. The purpose of the study
is to understand the disease profile of children with HIV/AIDS with regard to the
presence of respiratory conditions with which they present, the need for chest
physiotherapy and their health status.
Of the 125 patients recruited in this study 55% were boys, average age was 20.55
months (SD= 23.64), average length of hospital stay of 2 ½ weeks (mean=18.76,
SD=19.19), 80% discharged and 9.6% died. The most common respiratory
conditions presented included bacterial pneumonia (66.4%), tuberculosis (48%) and
pneumocystis jirovecii pneumonia (23.2%). The least common condition was
lymphoid interstitial pneumonitis (4.8%). Two thirds of the children (68.8%)
presented with a high burden of disease. Physiotherapy treatment was indicated for
96% of the patients mainly due to excess secretions and poor air entry. About forty
percent (40.8%) of children were taking anti-retrovirals with an average length of use
of 9.81 months (SD=11.61). Three out of four (75%) mothers were not involved in a
PMTCT program. The analysis of immune status revealed a mean CD4 percentage
17.33% (SD=10.96), CD4 absolute 631.36 cell/mm3 (SD=610.36) and viral load 2.6
million copies /ml (SD=9.08 million copies/ml).
A higher burden of disease was related to the use of anti-retrovirals, a lower
immunity, female patients, longer length of hospital stay and incidences of mortality
occuring at later periods of hospital stay. Results of this study highlight the characteristics of respiratory disease burden
among children with HIV in a South African setting in a post HAART era.
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Factors Influencing Clinical Outcomes on Patients on Highly Active Antiretroviral Treatment (HAART) at Vryburg District Hospital, Northwest Province in South Africa.Botokeyande, J. B. Bosoko January 2010 (has links)
Thesis M. Med.(Family Medicine))--University of Limpopo (Medunsa Campus), 2010. / Background
The use of HAART in HIV/AIDS patients has been recognised worldwide to improve the quality of life and survival prospects. Neverthess, factors such as WHO clinical stage III-IV, CD4< 200, VL> 100,000, anaemia, blood transfusion, malnutrition, male gender, intravenous drug use, drug toxicity, HAART experienced by patients, hospitalization, older age and depression have been reported to be associated with negative outcomes whereas, in contrast, white ethnicity, adherence > 90%, antiretroviral naïve subjects, longer period of viral suppression, younger age, and female gender have been reported to be associated with positive clinical outcomes.
Methods
The researcher conducted a descriptive retrospective study of 78 systematically selected patients who initiated HAART during the period of 5 June 2007 to 5 December 2008. Data regarding demographics, nutritional status, patients’ opportunistic infections, patients’ use of ARV drugs and HAART regimens, side effects and adverse events, baseline and follow up measurements of CD4 cell count, VL, ALT and Hb were collected at initiation, 6 and 12 months of HAART and analysed, utilizing descriptive statistics.
Results
Of the 78 patients recruited for the study, 60 (77%) were females and 18 (23%) males, 77 (98.8%) black and 1 (1.2%) coloured. The majority of patients belonged to the two age-groups 26-35 years (35.9%), and 36-45 (37.2%). The majority of patients [73/78 (93.4%)] were unemployed and residents of Vryburg town. Nutritionally, 17/78 (21.8%) patients were underweight. Clinically, 79.4% were classified as WHO clinical stage III - IV. The mean weight improved in both sex at 6 and 12 months of HAART respectively, from 57.5kg (SD 8.0) to 63.0kg (SD 13.0) and 65.2kg (SD 4.5) for males.
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Conclusion
The administration of HAART to patients attending ARV clinic at Vryburg District Hospital was followed by better clinical outcomes in terms of weight gain, correction of anaemia, increase in CD4 and achievement of virological suppression. Female gender, VL > 100,000 copies/ml, Younger age
(< 46 years) and good adherence were found to have positive influence on clinical outcomes.
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A study on Factors associated with non-disclosure of HIV positive status to sexual partners by adult patients attending the VCT clinic at Nhlangano health centre, Swaziland.Legasion, Michael January 2010 (has links)
Thesis (M. Med.(Family Medicine))--University of Limpopo (Medunsa Campus), 2010. / A study on Factors associated with non-disclosure of HIV positive status to sexual partners by adult patients attending the VCT clinic at Nhlangano health centre, Swaziland.
Aim: To describe the factors associated with non-disclosure of known HIV sero-positive status to sexual partners by adult patients attending the VCT clinic at Nhlangano health center, Swaziland.
Design:- Cross-sectional study using questionnaire administered by a trained research assistant.
Setting:- Nhlangano health center VCT clinic, Nhlangano town in the Shiselweni region, Southern Swaziland.
Study population:- All adult patients above the age of 18 years who had undergone HIV testing, who knew their positive HIV status and had follow up visits at the VCT clinic of Nhlangano health centre, from November 2005 (when the centre started rendering VCT service) till the beginning of the data collection, in September, 2008.
Results:-The vast majority (89.1%) disclosed their positive HIV status to their sexual partners and 94.6% believed that letting their sexual partner/s know about their HIV status was very important. In terms of knowing the HIV status of their partners, 55.4% knew the HIV status of all of their sexual partners and 44.6% knew only the status of the regular partner/s. With regard to condom use, 96.7% believed that using condoms helps them to prevent transmission of HIV and 91.3% expected that letting their partners know about their HIV status would help them use condom
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more frequently. Only 53.3% said they would insist on condom use even if their partner is not willing to use.
Conclusion:-
The rate of positive HIV status disclosure to sexual partner found in this study compared to many studies done in other settings is considerably high. This is encouraging especially considering the existing very high prevalence of HIV infection in the country. Despite this though, knowing partner's HIV status was relatively lower. Therefore, people are more likely to share their HIV status with a partner than insist that the partner does the same.
Even though the study was done only amongst patients attending VCT, it is important to note that the majority of the patients had positive attitudes about HIV status disclosure to a partner, and believed in the importance of letting their sexual partner/s know about their HIV status. Patients understood the unethical nature of engaging into sexual intercourse without disclosing their positive HIV status to their partner. It is possible to conclude that factors which contributed to these positive results should be implemented at a larger scale, namely creating awareness, health education, good counseling and follow up of treatment.
Awareness of the importance of condom use in preventing HIV transmission (including the fact that disclosure of HIV status to a partner enhances its better use) was impressively high amongst almost all participants. But it is worrisome that only half of the participants said they would insist on condom use irrespective of their partners’ willingness to use it or not.
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The variables that were found to be independently associated with disclosure to a partner comparing those who disclosed with those who did not were gender, age, marital status, education, number of sexual partners, and stage of the HIV condition.
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Causes of Hospital re-administrations of HIV / AIDS children at Dr George Mukhari hospital during the year 2003Malebye, Manthodi Alina January 2011 (has links)
Thesis (MPH) -- University of Limpopo, 2011. / Introduction
HIV/AIDS is major cause of child mortality and an increase in the number of sick children
presenting to health services worldwide (UNICEF 2008). A significant number of children live
with HIV/AIDS in South Africa. Research indicates that in poor resourced countries, there is
an increase in the prevalence of hospital admissions and re-admissions among HIV infected
children as compared to developed countries. Research data on hospital admissions,
treatment and care of HIV positive children South Africa is limited.
Objectives
This study was therefore initiated to determine the demographic and clinical causes of HIV
positive children admitted and readmitted at the paediatric ward of Dr George Mukhari
Hospital (DGMH), South Africa in the year 2003.
Methods
This was mainly a descriptive quantitative study using medical records of HIV infected
children admitted and readmitted in the paediatric ward of DGMH from 1st January to 31st
December 2003. A full census of all the records of children admitted in the two paediatric
wards was carried out. Descriptive and inferential statistics were used to analyze data.
Results
The study comprised 74 children, 28 (37.8%) female and 48 (62.2%) males. The average
mean of initial admission length of hospital stay was 12.3 days and (SD = 12.1) days. The
different diagnoses were classified in accordance with World Health Organization (WHO)
Clinical Staging of HIV disease for infants and children with established HIV infection.
Out of a total of 581 initial admissions, 74 (12.7%) children were readmitted. The mean
interval days between the discharge date and readmission date was 9.8 days (SD = 7.0 days)
and 94.6% of the readmissions occurred within the first two weeks of discharge date.
Second readmission decreased by 75.3% as only 18 patients were readmitted. A further
95.9% decrease in the third readmission was noted with only 3 patients getting readmitted.
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The commonest causes of admission with HIV were broncho-pneumonia, gastro-enteritis,
vomitting, oral thrush, immunosuppression with symptoms like fever,cough, respiratory
distress. Causes of readmissions were broncho-pneumonia, oral thrush, diarrhoea,
vomitting, immunosuppression, pulmonary tuberculosis, wasting and failure to thrive,
dehydration associated with symptoms like fever, cough, respiratory distress and upper
respiratory distress.
Conclusion
The rate of readmission was (12.7%) and majority of the readmitted children were in the 0-
2-year age group. The study results show a high prevalence of diseases of the respiratory
system with a high frequency of broncho-pneumonia and a high prevalence of diseases of
the digestive system with a high frequency of gastro-enteritis.
The average mean of the initial hospital admission stay was 12.3 days, which was
significantly higher than other studies previously conducted. The probable reason for a long
hospital stay could be the high prevalence of co-infections among the children admitted.
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Disclosure of HIV infection by caregivers to children with HIV/AIDS in Thamaga Primary Hospital - Botswana : Reasons and experiencesMotshome, Paul Oteng January 2011 (has links)
Thesis (MPH) -- University of Limpopo, 2011. / Introduction
With the increased availability of the life-saving ARVs in most Sub-Saharan Africa more HIV -infected children are surviving into their adolescent years and beyond
hence giving rise to the question of whether the caregiver should disclose or not disclose the child's HIV diagnosis to child. Little is known of the reasons and
experiences that motive or hinder caregivers from disclosing the HIV diagnosis to
the child.
Study Aim and objectives
This was aimed at identifying caregivers' reasons for HIV diagnosis disclosure and non-disclosure to HIV-infected children under their care. The study also explores
their experience with process of HIV diagnosis disclosure and non-disclosure to the
child.
Study methodology
Using qualitative descriptive research approach, twenty (20) caregivers of HIV¬infected children aged between 6 - 16 years receiving ART at Thamaga Primary
Hospital IDee with unknown HIV diagnosis disclo~ure status were ~.ubjected to audio-taped in-depth interviews for data capturing. Thematic content analysis was
used for data analysis using, Nvivo8 software and 16 themes with their sub categories were identified.
Findings
Both caregivers of disclosed and non-disclosed HIV-infected children perceived disclosure as a good thing to do with majority of the caregivers (60%) having
disclosed. Reasons for telling the children their HIV diagnosis were that the child had the right to know his/her status; caregiver tired of keeping child HIV diagnosis a
secret; the caregiver's believe that disclosure will improve the child's ART adherence and finally some caregivers felt the child had reached the right age or maturity for
disclosure. Non-disclosing caregivers felt that health care workers should assist them in doing disclosure and identified the reasons for non-disclosure as the child
being too young and not asking questions about their illness; fear that disclosure might hurt the child psychologically; fear that the child might not keep their HIV
diagnosis a secret leading to discrimination in the community while some caregivers lack of knowledge on how to disclose. Non-disclosing caregivers managed
disclosure by not telling the child the truth about their diagnosis and using threats to coerce them to take their ARV drugs.
Conclusions and recommendations
The decision to disclosure or not to disclose the HIV diagnosis to a child by a caregiver is influenced by a number of reasons and their experiences. Caregivers of
HIV-infected children need to be assisted by a health care provider when disclosing to the child and further assessment should be made in making disclosure part of the
holistic management of an HIV -infected child.
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HIV-1 patient assessment and treatment : from multitest to co-receptor (CCR5) gene polymorphism : from Rgp160 immunization to highly active antiretroviral treatment (HAART) /Bratt, Göran, January 1900 (has links)
Diss. (sammanfattning) Stockholm : Karol. inst. / Härtill 7 uppsatser.
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Slow progression in HIV-1 infection : a clinical, virological and immunological study /Broström, Christina, January 1900 (has links)
Diss. (sammanfattning) Stockholm : Karol. inst. / Härtill 6 uppsatser.
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Impact of sepsis and HIV-1 infection on neutrophil radical production, lipids and lipoproteins /Åkerlund, Börje, January 1900 (has links)
Diss. (sammanfattning) Stockholm : Karol. inst. / Härtill 7 uppsatser.
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HIV-1 variability in relation to host defence mechanisms and disease outcome /Jansson, Marianne, January 1900 (has links)
Diss. (sammanfattning) Stockholm : Karol. inst. / Härtill 7 uppsatser.
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