A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfillment of the requirements for the degree of Master of Science in Epidemiology in the field of Epidemiology & Biostatistics January 2014 / Studies have shown an increased risk of mortality amongst adults with invasive pneumococcal disease (IPD) with certain serotypes but there are no data from South Africa. We aimed to determine the association between serotypes and in-hospital mortality among adults aged 15 years and older with IPD in South Africa. Methods IPD cases were identified through the GERMS-SA national laboratory-based surveillance programme. Patient data from 25 enhanced surveillance sites from 2003-2008 (pre-pneumococcal conjugate vaccine introduction) with available data on serotype and in-hospital outcome were used. We assessed the association between the 20 most common serotypes and mortality among patients ≥15 years of age using univariate and multivariable logistic regression models. Results From January 2003 through December 2008, there were 3953 cases of IPD amongst adults older than 15 years of age meeting the study inclusion criteria. Amongst the 20 commonest serotypes, the incidence of serotypes 4, 19A, 23F and 18C increased significantly, and serotypes 1, 25 and 5 decreased significantly from 2003 to 2008. Serotype 1 was the commonest serotype overall (16%, 651/3953), followed by serotype 19A (11%, 443/3953) and serotype 4 (7%, 289/3953). The case-fatality ratio (CFR) was 55% (641/1166) for meningitis and 23% (576/2484) for bacteremia (p<0.001). Serotype 19F had the highest CFR of 48% (100/207), followed by 39% (99/252) for serotype 23F and 38% (246/651) for serotype 1. On multivariable analysis, factors independently associated with mortality were disease caused by serotypes 1 (OR 1.93, 95% CI 1.05–3.53) and 19F (OR 2.89, 95% CI 1.38–6.06) compared to serotype 4; increasing age (25-44 years, OR 1.75, 95% CI 1.03–2.95; 45-64 years, OR 3.56, 95% CI 2.00–6.35; ≥65 years, OR 5.17, 95% CI 1.89–14.14; compared to 15-24 years); living in provinces with intermediate (OR 1.65, 95% CI 1.16–2.35) or high poverty rates (OR 1.72, 95% CI 1.02–2.92) compared to provinces with low poverty rates; having meningitis (OR 4.07, 95% CI 2.98–5.55) compared to bacteremia; prior antibiotic treatment in the last two months (OR 3.93, 95% CI 2.50–6.20); inappropriate antibiotic treatment (OR 2.37, 95% CI 1.74–3.22) and positive HIV status (OR 1.69, 95% CI 1.04–2.75). Conclusion Serotypes associated with increased mortality are included in the 10-and-13-valent pneumococcal conjugate vaccine and may be expected to become less common in adults as a result of indirect effects following routine immunization in infants. HIV-infected adults experience increased mortality and the more widespread availability of antiretroviral therapy is likely to substantially improve the quality of life of HIV-infected individuals in terms of physical and mental health and decrease the incidence of IPD and therefore mortality.

No description available.

M.Med. (Diagnostic Radiology), Faculty of Health Sciences, University of the Witwatersrand, 2011 / Pneumocystis jirovecci pneumonia (PJP) in HIV/AIDS is a significant opportunistic infection. As CD4 counts decrease, so does specificity of chest X-ray (CXR). AIM: To determine the proportion of bronchoscopically proven PJP in HIV infected adults, CD4 counts, CXR signs and compare PJP to TB. METHODS: The proportion of bronchoscopically proven PJP and co-infection was determined. Sensitivity and specificity of CXR for the diagnosis of PJP and TB, and frequency of CXR signs were determined. RESULTS: PJP was present in 26.6% and co-infection 19%. Median CD4 (13 cell/mm3) was significantly lower for PJP patients (p = 0.0089). CXR sensitivity for PJP was 33% and specificity was 100%. Bilateral, multilobar and diffuse disease, bronchopneumonia, nodules and cavitation overlapped for PJP and TB. Unilateral and unilobar disease indicated TB over PJP. Effusions and lymphadenpopathy were not seen with PJP. CONCLUSION: PJP makes up a quarter of indeterminate diagnoses in HIV infected adults. Sensitivity of diagnosis on CXR is low. The CXR diagnosis of TB is made more confidently, but is overcalled. In patients with low CD4 levels, a diagnosis of PJP should be considered as important as TB.

Thesis (M.Sc. in Microbiol.) -- Mahidol University, 1970.

MSc (MED) RESEARCH REPORT UNIVERSITY OF THE WITWATERSRAND, JOHANNESBURG. / The research report represents a study to determine the prevalence of antibiotic-resistance of pneumococcal and their scrotypes in Maputo, Mozambique in children under 5 years of age, who were admitted with pneumonia in the Paediatric Unit at the Hospital Central de Maputo. The children included in the study were from suburbs surrounding central Maputo. [Abbreviated Abstract. Open document to view full version] / AC2017

Thesis (Ph. D.)--University of Wisconsin, 1947. / Typescript (carbon copy). eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves 127-145).

Thesis (doctoral)--Lund University, 1995. / Added t.p. with thesis statement inserted.

Thesis (doctoral)--Lund University, 1995. / Added t.p. with thesis statement inserted.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2007. / Härtill 4 uppsatser.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2006. / Härtill 5 uppsatser.