Thesis (M Med(Family Medicine)) -- University of Limpopo, 2010. / BACKGROUND AND OBJECTIVE Tuberculosis remains an important curable disease particularly in the developing world. One third of the world's population is infected with T8 and new infections are occurring at a rate of about one per second(Tuberculosis Wikipedia Encyclopedia 2009).The distribution globally is not uniform with eighty percent of cases in Africa and Asia(Tuberculosis Wikipedia Encyclopedia 2009). Treatment is challenging because it requires compliance to long courses of multiple antibiotics. WHO highlights the global failure of health service providers to deal with the burden of tuberculosis (Fourie et aI1999). The researcher observed that socio-economic factors, political and intrapersonal aspects associated with T8 infection might as well be important to the treatment outcome. It was therefore important to explore factors that could be associated with treatment outcomes in the prison environment where the full impact of these factors could be found. This study was conducted at Potchefstroom prison in North Westprovince of South Africa. METHODS A quantitative cross-sectional study was done. A record review of all T8 patients in Potchefstroom prison who initiated their treatment in 2007 and ending their treatment up to 2010 was conducted. Data was recorded on data collection sheet and results were then analyzed. Descriptive analysis was done to provide frequencies, mean and standard deviation. Measures of association between characteristics and treatment outcome using odds ratio was done. RESULTS 202 T8 patients in this prison had T8 during the period covered by the study. The age group distribution of the patients shows that majority, 142(70.3%) belong to the age group 21- 37 years while those aged 38 - 53 years was 48(23.8%) and their mean age was 33.7yrs. There were 197(97.5%) male and 4(2.0%) female and 1 (0.5%) no records. Of these, therewere 92(45.5%) patients cured 4 (2%) death, 1 (0.5%) treatment failure and 102 recorded as other outcomes belonging to the transferred and treatment interruption cluster. Factors compared with these outcomes were, age, gender, initial body weight, level of education, treatment initiation time, regimen type, social support, co morbidities, smoking, application of DOT ant the type of T8. Factors that were significantly associated with favorable outcomes were occasional visits providing some social support (39.4%, OR 3.78, 95% CI1.25-11.54), DOT application (37.4%, OR 3.99, 95% CI 2.35-11.23), young age (32.6% OR 3.14, 95% CI 2.1-5.3) and Regimen 1 (34.0%, OR 1.5, 95% CI0.11-12.61) Social habits like smoking were significantly higher in patients with other treatment outcome(OR=1.56, 95% CI=1.92 to 2.05), other factors found to be aligned to negative outcomes but lacking statistical significance were extra-pulmonary tuberculosis, non application of DOT, regimens other than regimen 1, and lack of social visits. Factors like co-morbidity and gender were found not to be significantly associated with any treatment outcome because there was no point of difference in the association of different grouping in these categories with particular outcome. CONCLUSION Many factors could be associated with treatment outcomes to some varying degree, but only significant factors explored in this study were considered important. Factors that were ultimately identified as important in determining treatment outcome were age, smoking status, social support, DOT and regimen type. These were factors that were found to be contributory to the pathology of TB in many other studies and which are amenable to interventions that would improve the outcomes.

STUDY OBJECTIVES: An analysis of IgG subclasses and allotypes in children with pulmonary Tuberculosis (PTB) in the Western Cape. DESIGN: Consecutive children under 15 years of age with microbiological proven PTB over an 8 month period- November 1993 to July 1994. SETTING: Teaching Hospitals in Cape Town. PATIENTS: Thirty-five cases were selected from 99 consecutive cases that were Mycobacterium tuberculosis positive, 15 of which were of Mixed and 20 were of Black Ancestry. CONTROL GROUP: Sera were selected from 224 Black Ancestry (59 children and 165 adults) and 211 Mixed Ancestry (67 children and 144 adults) that had no evidence for active tuberculosis or a history of previous TB diagnosis. MEASUREMENTS AND RESULTS: IgG subclasses, total IgG,and five allotypes: Glm(a), Glm(f), G2m(n), G3m(bl), G3m(gl) were determined by ELISA techniques. In the Mixed ancestry group the Glm(f) (p= 0.01), G2m(n) (p= 0.04) and G3m(gl) (p=0.001) allotypes were less frequently found in children with proven PTB. In the Black Ancestry subjects the G3m(g 1) allotype was significantly less common than in the control group (p < 0.001). CONCLUSIONS: Because allotypes are inherited in a Mendelian fashion, the observed association of childhood PTB and certain allotypes strengthens the hypothesis that a genetic susceptibility exists to acquiring TB.

No description available.

South Africa is one of the high burden countries for TB in Sub Sahara in Africa with Mpumalanga as one of the provinces with a high burden of disease. Data available on tuberculosis in Msukaligwa indicate the following: Cure Rate 40%; Smear conversion at the end of intensive phase 35% and Defaulter Rate 27.5%. The problem of TB is made worse by the twin epidemic of HIV, with a prevalence of 38.9% in our district -the highest among the 3 districts in the province. Retreatment TB carries the risk of developing TB drug resistance with severe consequences for the patient and the population. Understanding the characteristics of these patients will help in designing interventions to prevent the problem, promote a high cure rate for patients with TB in our health care system and reduce to minimum the burden of re-treatment pulmonary TB on our health care facilities and community. One critical precondition for Retreatment TB is non adherence to TB treatment. Factors responsible for non adherence could be classified as individual patient factors; Co-morbid conditions; Health system; treatment related and Community factors. The outcomes of Retreatment TB could be, cure, and death and failure of treatment leading to drug resistance. The Setting of this study is the 58-bedded TB hospital in Ermelo. The Aim of the study was to describe the occurrence, characteristics and management outcome of Retreatment Pulmonary Tuberculosis in patients in the Ermelo TB hospital. The specific Objectives were to describe the socio-demographic, behavioural and clinical factors related to recurrence of the TB in patients; to determine the contribution of non adherence to treatment on recurrence of TB in the study population; to identify the prevalence of resistance to TB medication among patients with Retreatment TB ; to identify treatment outcomes in patients who have been followed up for the duration of Retreatment TB and finally to make recommendations to the Department of Health, Mpumalanga towards minimizing Retreatment TB and improving the overall TB programme. The Study design is cross sectional and descriptive; the study population comprised of patients admitted with TB at Ermelo TB hospital aged 15 years and older between 1 January 2005 and 31 December 2007.No specific probability sampling was applied in the selection of the patients. Data Collection involved visits to the TB hospital during the period and extracting the relevant information from the patient medical records and the TB register using a predesigned data collection form. Data analysis was done by the statistician from the Centre for Statistical Consultation, University of Stellenbosch. Being a descriptive study, the data analysis expresses the prevalence of various factors associated with retreatment TB. This study met the Ethical approval of the University of Stellenbosch as well as the Research Ethics Committee of the Department of Health & Social Services, Mpumalanga. Findings All the three hundred and eighty eight patient records with retreatment TB forming 19.6% of TB patients admitted between 2005 and 2007 were reviewed. The distributions of the patients were: males 66%; mean age of 41.4 years; females 34%; mean age 35.3 years. They were mostly unemployed; primary education 93%; unmarried 43% and married 34%.Retreatment TB was diagnosed with sputum smear microscopy in 71% with bacilli load of 3+ in 45%.The sources of referral to TB hospital were: public hospital 71 %; private doctors 2%. 74% of the patients have had TB 1-3 years before the episode under study. Retreatment TB categories were: after treatment completed 69%; default 19%; after cure 8% and treatment failure 4%. 98% of patients tested had +ve HIV status; the median CD4 cell count was 106 cells/µl at the time of retreatment; very few (5%) were on ART. Drug resistance to primary TB drugs was as follows: Rifampicin 16%; Isoniazid 29%; Ethambutol 19% and Streptomycin 23%. The treatment outcomes for those whom data were available were: successful 49.1%, death 23.8%; treatment default 22.9%. MDR-TB complicated 3.3% of the patients. Conclusion: Majority of the retreatment TB patients were males with an average age of 41years and unemployed. More than two thirds of the patient had completed TB treatment previously and default on treatment accounted for less than one quarter of retreatment categories. The process of care was better in terms of diagnosis of TB with sputum smear. Improvement in the documentation of key factors like smoking, alcohol, drug use among patients and co-morbidity as well as counselling and testing for HIV and provision of ARTs is required. Treatment outcomes with regards to successful outcome need to be monitored and improved upon.

Thesis (MTech (Radiography (Nuclear Medicine)))--Cape Peninsula University of Technology, 2010 / Radioactively labelled red blood cells (RBC) are used in various nuclear medicine studies. In order to obtain accurate results when performing these studies, it is of paramount importance that a good binding of the radioactivity (Tc-99m) with the red blood cells is ensured. The literature indicates that certain drugs can influence red cell membrane properties and biochemistry. These drugs can potentially influence the binding of radionuclides to cells. Antibiotics may possibly alter the labelling efficiency of Tc-99m RBC. Due to the high incidence of tuberculosis (TB) in South Africa, many patients receive anti-TB medication, and therefore the influence of these drugs on the labelling efficiencies of Tc-99m RBC was studied.

ABSTRACT Introduction Circulating levels, and the ex vivo production, of the chemokines CCL3, CCL4, CCL5, CXCL8 and CXCL12 (known to play an important role in the pathogenesis of either human immunodeficiency virus type 1 (HIV-1) or tuberculosis (TB)) were examined in the context of both single infections with HIV-1 or Mycobacterium tuberculosis (Mtb) and coinfection with both organisms. We hypothesised that CCL3L1 gene copy number (known to affect CCL3 production, associated with susceptibility to and disease progression of HIV-1) would be associated with mother-to-child transmission (MTCT) of HIV-1, and that the IL8-251T→A single nucleotide polymorphism (SNP) (associated with enhanced CXCL8 production and susceptibility to TB in African Americans) would be highly represented in the South African Black population. Methods Samples used included (i) plasma, DNA samples and cell culture supernatants from control, HIV-1, TB and HIV-1/TB groups, (ii) DNA samples from mothers and their infants (grouped as HIV-1 exposed-uninfected, infected in utero, or infected intrapartum), and (iii) DNA samples from a populationbased study cohort. Chemokines were quantified by enzyme-linked immunosorbent assay (ELISA), CCL3L1 gene copy numbers were determined by real-time polymerase chain reaction (PCR), and a real-time PCR method was developed for identification of the IL8-251T→A SNP. DNA sequencing was used for confirmation. Results We found reduced ex vivo chemokine production in response to phytohaemagglutinin (PHA) together with increased plasma levels of chemokines in HIV-1 and TB patients. In contrast to that seen in Caucasians (median CCL3L1 copy number of 2), in Black individuals (median CCL3L1 copy number of 5) circulating levels of CCL3 did not correlate with CCL3L1 gene copy number; in addition, a high proportion of Black individuals were found to have CCL3L1 copy numbers below their population-specific median. Using MTCT as a model for studying HIV-1 transmission, infants who became infected with HIV-1 had significantly reduced CCL3L1 gene copy numbers. IL8-251A allele frequencies were found to be 0.41 for Caucasian groups, and 0.85 for Black groups; due to study limitations, the possible association of IL8-251T→A with TB susceptibility could not be addressed. Discussion The increased plasma levels of chemokines seen in HIV-1 and TB, likely due to chronic immune activation in vivo, may result in T cell anergy which in turn might be the cause of reduced PHA-stimulated ex vivo chemokine production. Our results suggest that Black South Africans may be at particularly high risk for acquiring HIV-1 (at least with respect to CCL3L1 gene copy number), and further imply the presence of other genetic polymorphisms which may influence plasma CCL3 levels. In addition, the high IL8-251A allele frequency (if indeed associated with TB in South African populations) in Black individuals suggests a greater risk for infection with Mtb. It will be important, in larger studies, to gain a more in-depth understanding of the relationships between host genotype and chemokine production phenotype, and to relate these measures to infection outcomes. Conclusions Together, these results highlight the importance of gaining an understanding of the effects of host genotype on the development of innate and acquired immunity to HIV-1 and TB, which will be key in the design of efficient therapies and prevention strategies.

Thesis (M.Med.(Paediatrics), Faculty of Health Sciences, University of the Witwatersrand, 2009 / Background In settings with a high burden of tuberculosis, children with unrecognised culture-confirmed pulmonary tuberculosis (PTB) may be discharged from hospital before mycobacterial culture results are available; in these cases clinical improvement may have been due to successful treatment of an intercurrent viral or bacterial co-infection. Aim To estimate the burden of tuberculosis in children who were enrolled in a double-blind, placebo-controlled pneumococcal conjugate vaccine (PCV) trial, and to probe for the presence of pneumococcal co-infection in trial participants who had a hospital-based diagnosis of PTB. Methods A retrospective case-finding strategy was adopted in order to define the tuberculosis case load amongst 39 836 children that had been enrolled in a PCV efficacy trial in Soweto, Gauteng Province. The trial follow-up period was 5.3 years. Children with a hospital-based diagnosis of tuberculosis were categorised by strength of evidence for the disease, HIV status and PCV vaccination status. Incidence rates and risk ratio assessments were conducted using standard statistical methods. Results Four-hundred and ninety-two episodes of tuberculosis arose amongst 425 of the 39 836 PCV Study participants. Tuberculosis incidence was 1067 per 100 000 children (95% Confidence Interval [CI], 968 – 1173), with the greatest burden observed amongst HIV-infected children (10 633 per 100 000 children [95% CI, 9411 – 11 969]; Risk Ratio [RR] 27.5 [95% CI, 22.6 – 33.5], P<0.001). The burden of PTB in the cohort was 982 cases per 100 000 children (95% CI, 887 – 1084): 9895 per 100 000 (95% CI, 8718 – 11 187) in the HIV-infected children and 352 per 100 000 (95% CI 294 – 417) in the HIV-uninfected children (RR 28.1; 95% CI, 22.9 – 34.6), P<0.001. PCV recipients exhibited a 44 percent (95% CI, 11 – 65), P=0.010, reduction in incident culture-confirmed PTB compared to placebo recipients; this apparent reduction was demonstrated chiefly in PCV-vaccinated HIV-infected children (RR 0.53; 95% CI, 0.31 – 0.90) compared to HIV-infected placebo recipients, P=0.017. Conclusions A high burden of tuberculosis is carried by children under 5.3 years in the study setting, with HIV-infected children bearing the brunt of the morbidity. Pneumococcal co-infections are common in the context of hospitalised PTB in the study setting.

O presente trabalho estuda alguns aspectos epidemiológicos da tuberculose pulmonar na Casa de Detenção de São Paulo, Brasil, durante o período de 1976 a 1980. São analisados dados relativos à prevalência e incidência da infecção tuberculosa, busca de casos pelo método bacteriológico e taxa de transmissibilidade da infecção. Os resultados mostram elevadas taxas de prevalência e incidência de infecção e de casos de tuberculose naquele Estabelecimento Penal, caracterizando população exposta a um alto risco de infecção e de adoecimento por tuberculose. / This paper presents some epidemiological aspects of pulmonary tuberculosis in a state prision of S.Paulo, Brazi1, from 1976 to 1980. Data concerning both the prevalence and incidence of tuberculosis infection, case finding by the bacteriological method and infectivity rate are analysed. Results show high rates of prevalence and incidence of infection as well as of active cases in that institution, characterizing this population as one being exposed to a high risk of infection and of developing tuberculosis.

O presente trabalho estuda alguns aspectos epidemiológicos da tuberculose pulmonar na Casa de Detenção de São Paulo, Brasil, durante o período de 1976 a 1980. São analisados dados relativos à prevalência e incidência da infecção tuberculosa, busca de casos pelo método bacteriológico e taxa de transmissibilidade da infecção. Os resultados mostram elevadas taxas de prevalência e incidência de infecção e de casos de tuberculose naquele Estabelecimento Penal, caracterizando população exposta a um alto risco de infecção e de adoecimento por tuberculose. / This paper presents some epidemiological aspects of pulmonary tuberculosis in a state prision of S.Paulo, Brazi1, from 1976 to 1980. Data concerning both the prevalence and incidence of tuberculosis infection, case finding by the bacteriological method and infectivity rate are analysed. Results show high rates of prevalence and incidence of infection as well as of active cases in that institution, characterizing this population as one being exposed to a high risk of infection and of developing tuberculosis.

Thesis (M Med.(Family Medicine))--University of Limpopo, 2010. / OBJECTIVE: In order to obtain optimal results using sputum smear microscopy for acid-fast bacilli (AFB) detection in the diagnosis of pulmonary tuberculosis (PTB), good quality sputum with an adequate volume of at least 5.0ml is required. An inadequate amount of sputum sample may result cases of active PTB being missed. This study was aimed at showing that a single sputum sample of at least 5.0ml would lower the chances of missing active PTB cases, and increase sputum smear positivity by microscopy thus enabling prompt treatment of PTB, and restricting its transmission. METHODS: An analytical cross sectional study was carried out at Dr George Mukhari Hospital in Pretoria, South Africa. Two sputum samples, one of 5.0ml and the other with 2.0ml were collected from each adult patient suspected of having active PTB. Sputum collection was supervised and patients were given instructions on how to enhance sputum expectoration. Sputum samples were processed using the N-acetyl-L-cysteine (NaLc-NaOH) method and stained with Auramine O. Sputum analysis was done with the aid of fluorescence microscopy. Following microscopy, both the 2.0ml and 5.0ml specimens were sent for culture using the Middlebrook broth medium, and culture results were available after 6-8 weeks. Using the culture results as gold standard, the yield through microscopy of the 2.0ml specimen versus the 5.0ml specimen for each patient were compared and analysed. RESULTS: A Total of 330 sputum samples were analysed of which 77 were found to be culture positive. A sensitivity of 76.6% and specificity of 99.6% was obtained for AFB test in the 5.0ml specimens; while in the 2.0ml samples the sensitivity was 75.3%, with a specificity of 99.2%. The difference in the smear positivity rate of 76.6% obtained using the 5.0ml sputum specimen compared to the 75.3% obtained using the 2.0ml specimen from patients suspected of having TB in this study was statistically insignificant – ascribable to the small sample size. CONCLUSION: In this study, the volume of sputum collected did not determine a better AFB test yield in the diagnosis of pulmonary tuberculosis in patients suspected of having TB.