Acute lower respiratory tract infection (ALRI) is a major cause of paediatric morbidity and mortality, annually accounting for approximately 2 million childhood deaths worldwide of which up to 90% resides in the developing world. In 12-39% of ALRI cases no aetiological agent is identified, despite comprehensive investigations, thus suggesting that additional unknown agents may be involved. Since 2001 a number of new viruses have been identified that may account for some of these cases including human metapneumovirus (hMPV), human bocavirus (hBoV), and two new coronaviruses (hCoV) NL63 and HKU1. The contribution of the recently identified respiratory viruses to annual seasonal lower respiratory tract disease in Sub-Saharan Africa where human immunodeficiency virus infections may exacerbate respiratory infections is not fully understood. In addition, the role and disease association of many of these viruses as primary or co-infecting pathogens, as well as the underlying factors that may determine the pathogenesis of these viruses, is not yet well defined. Quantitative multiplex real-time RT-PCR assays were developed and validated for the detection of 13 well recognized and newly identified viral causes of ALRI, including respiratory syncytial virus (RSV), influenza viruses A and B, parainfluenza virus (PIV) types 1, 2, and 3, adenovirus, hMPV, hBoV and hCoV-NL63, -HKU1, -229E, and -OC43. The newly designed assays were subsequently used to facilitate the investigation of the contribution of respiratory viruses in patients requiring hospitalisation or attending outpatient visits in public sector hospitals serving the Pretoria area, South Africa. During 2006, the prevalence of the aforementioned respiratory viruses was determined by investigating the well recognized viruses previously diagnosed by routine immunofluorescence assays (IFA) in 737 respiratory specimens as well as viruses retrospectively detected by multiplex real-time RT-PCR in a sample group of 319 specimens. The epidemiology and disease association of these respiratory viruses in children who were predominantly less than 5 years of age with acute respiratory tract infections was investigated. Specimens were received from 2 public sector hospitals in Pretoria, South Africa. In addition, the disease association of each virus as a single or co-infection in human immunodeficiency virus (HIV) infected/exposed and HIV-uninfected children as well as the role of viral load was investigated. The multiplex assays could detect 2.5-25 recombinant plasmid DNA/RNA (in vitro transcribed) copies/μl, with a co-efficient of variation of less than 3.1%. Validation on 91 known positive respiratory specimens indicated similar specificity to IFA or single-round PCRs used in the initial identification of the viruses. Application of the multiplex assays to IFA negative specimens improved the detection of respiratory viruses by up to 44%. In children less than 5 years of age RSV was identified in 35.1%, followed by PIV 3 (8.3%); adenovirus (5.6%); influenza A (4.2%); hMPV (4.2%); hBoV (3.8%); hCoV-NL63 (1.6%); influenza B (1.0%); and PIV1, PIV2, hCoV-OC43, hCoV-229E, hCoV-HKU1 in less than 1% of cases. Co-infections were more common for the new viruses ranging from 58% of hMPV cases to 84% for hCoV-NL63 relative to 27% of RSV cases. Viruses were most frequently identified in children <1-year. RSV activity peaked in autumn and winter, PIV 3 in spring, while influenza A and B were mostly detected in winter. The observed seasonal distribution of hBoV and hMPV was less defined compared to traditional viruses, with both viruses showing variability over the two years. Comparable hospitalisation rates were observed for RSV, hMPV, PIV 3 and adenovirus, where approximately 60% of infected children were hospitalised. In addition, a high frequency of hospitalisations was observed in patients for both hMPV and hBoV in HIV-infected/exposed children. Co-infections occurred at higher frequencies with the new viruses, were more frequently associated with severe disease and were frequent in HIV-infected/exposed patients. Viral load was associated with severe RSV disease (p=0.014) however no significant association was observed for the new viruses as single infections. However, where hMPV occurred as a co-infection, higher viral loads of either hMPV or co-infecting agents occurred in severe cases. This association was also observed for hBoV. Most cases of hCoV-NL63 and hCoV-OC43 were co-infections in hospitalised patients. The newly developed multiplex assays demonstrates an improved sensitivity and scope of detecting respiratory viruses relative to routine antigen detection assays while the quantitative utility may facilitate investigation of the role of co-infections and viral load in respiratory virus pathogenesis. RSV remains the most significant viral cause of paediatric ALRI in South Africa. Viruses not currently included in routine diagnostic assays collectively contributed to 11% of ALRI cases in children <2-years in South African hospitals. / Dissertation (MSc)--University of Pretoria, 2010. / Medical Virology / unrestricted

Despite advances in health promotion through efforts to reduce tobacco smoking, tobacco-related health conditions have continued to be significant. Exposure to secondhand smoke has been identified as a health risk also in addition to infant health risks related to maternal smoking. In contrast, breastfeeding has been found to promote infant health and is strongly encouraged. Despite literature supporting both of these statements, the combined effects of both breastfeeding and maternal smoking on infant wellbeing have not been delineated. Otitis media represents a common health problem among infants and young children. Tobacco exposure has been shown to increase its incidence while breastfeeding has been shown to reduce its occurrence. In the current study, a consecutive sample of all infants less than 5 years of age with otitis media and breastfed for at least 6 months was collected from a busy urban clinic for analysis. A survey tool was administered to those meeting study criteria. Primary analysis examined the odds ratio of developing otitis media among breastfed infants between those whose mothers smoked tobacco and those whose mothers did not. As a result, the association between the protective effects of breastfeeding and the detrimental effects of maternal smoking was evaluated in relation to the development of otitis media. Secondary variables including demographics, family history, past medical and birth history, and secondhand smoke exposure were also assessed. Results failed to demonstrate a significant difference in otitis media between the 2 cohorts in this study, and of the secondary variables, only cranio-facial deformities and/or a family history of these conditions resulted in higher otitis media occurrence. Further study with larger populations with higher tobacco use rates may offer additional insights into this matter.

Abstract Around 3% of pregnant women in Finland have genital Chlamydia trachomatis infection, which can be transmitted from mother to newborn at birth. The risk of transmission has been reported to be 10–70% in vaginal deliveries resulting in conjunctivitis in 10–30% of cases and lower respiratory tract infection in 0–20% of cases. Although usually benign, Chlamydia trachomatis infections in infancy may result in long-term consequences, including conjunctival and corneal scarring, chronic cough and abnormal lung function. Based on the transmission rates published in prior studies, chlamydial conjunctivitis should occur in approximately 200 infants and chlamydial lower respiratory tract infection in 100 infants each year in our country, but in clinical practice we rarely encounter or diagnose infants with Chlamydia trachomatis infections. To investigate the reason for this discrepancy and to improve the recognition of Chlamydia trachomatis-infected infants, we set out to study the risk of vertical transmission of Chlamydia trachomatis in a population-based setting, to describe the typical features of Chlamydia trachomatis infections in infants and to evaluate the occurrence of Chlamydia trachomatis in both neonatal conjunctivitis and lower respiratory tract infections in infants. When studying the probability of vertical transmission of Chlamydia trachomatis a search through two national health registers for 1996–2011 yielded 206 children aged less than four years with a possible Chlamydia trachomatis infection. In a cohort of 933 823 births this represented an occurrence of 0.22 per 1000 live births (95% confidence interval 0.19–0.25). The risk of vertical transmission of Chlamydia trachomatis leading to a symptomatic infection in infancy was 0.8–1.8%. A review of patient charts to evaluate the typical features of Chlamydia trachomatis infections in infants (124/206) revealed that one-third of the infants with chlamydial conjunctivitis (33/124) had spontaneous bloody discharge from the infected eyes. Almost half of the infants with chlamydial lower respiratory tract infection (15/32) had wheezing, but the characteristic staccato cough was not recorded in any of them. The median diagnostic delay from the onset of symptoms was 13 (range 4–374) days for conjunctivitis and 25 (range 10–149) days for lower respiratory tract infection. One neglected child developed bilateral corneal scars due to untreated chlamydial conjunctivitis. To investigate the occurrence of Chlamydia trachomatis in neonatal conjunctivitis, 173 neonates with clinical conjunctivitis at child health clinics were examined prospectively during 2010–2015 and none of the 163 cases tested had chlamydial or gonococcal conjunctivitis (0%; 95% confidence interval 0%–2.2%). Viral conjunctivitis was diagnosed in 8/167 cases (4.8%; 95% confidence interval 2.1%–9.2%) and non-chlamydial bacterial conjunctivitis in 58/160 (36%; 95% confidence interval 29%–44%). To investigate the occurrence of Chlamydia trachomatis in lower respiratory tract infections, 228 infants aged less than six months with lower respiratory tract infection presenting at the paediatric emergency department of Oulu University Hospital were examined prospectively over a period of a complete epidemiological year. One infant (0.4%; 95% confidence interval 0.01%–2.4%) had lower respiratory tract infection caused by Chlamydia trachomatis and another was diagnosed with whooping cough (0.4%; 95% confidence interval 0.01%–2.4%). The majority of the infants with lower respiratory tract infection (203/228) had a respiratory viral infection. It may be concluded that the risk of mother-to-child transmission of Chlamydia trachomatis leading to a clinical illness in the infant in this era of nucleic acid-based diagnostics was less than 2%, which is significantly lower than in earlier studies. The population-based prevalence of neonatal chlamydial conjunctivitis in primary care was less than 2% and that of chlamydial lower respiratory tract infection in a hospital setting less than 2.5%. The long-term prognosis for Chlamydia trachomatis infections in infancy was good. Common respiratory viruses were detected in 5% of the neonatal conjunctivitis cases. / Tiivistelmä Noin 3 %:lla suomalaisista raskaana olevista naisista on klamydian (Chlamydia trachomatis) aiheuttama sukupuolitauti, joka voi tarttua äidistä lapseen synnytyksessä. Tartuntariskin on raportoitu olevan alatiesynnytyksessä noin 10–70 %. Noin 10–30 % tartunnan saaneista lapsista sairastuu silmätulehdukseen ja 0–20 % keuhkokuumeeseen. Vaikka imeväisten klamydiainfektiot ovat useimmiten lieviä tauteja, imeväisiällä sairastettu klamydiainfektio voi aiheuttaa silmän side- ja sarveiskalvon arpeutumista, pitkittynyttä yskää ja keuhkofunktion alenemaa. Aiempien tutkimusten perusteella arvioimme, että Suomessa sairastuu vuosittain noin 200 imeväistä klamydian aiheuttamaan silmätulehdukseen ja noin 100 imeväistä klamydiakeuhkokuumeeseen. Kliininen kokemuksemme on kuitenkin, että kohtaamme klamydiaa sairastavia imeväisiä varsin harvoin. Tämän ongelman ratkaisemiseksi ja klamydiaa sairastavien imeväisten paremmaksi tunnistamiseksi suunnittelimme tutkimuksen, jonka tarkoituksena on selvittää väestöpohjainen riski klamydian tarttumiselle äidistä vastasyntyneeseen, kuvata imeväisten klamydiainfektioiden tyypilliset piirteet sekä selvittää klamydian osuus imeväisten silmätulehduksissa ja alle kuuden kuukauden ikäisten imeväisten alahengitystieinfektioissa. Klamydian sairastaneet lapset poimittiin kahdesta suomalaisesta terveydenhuoltorekisteristä vuosina 1996–2011. Tuona aikana 206 lasta oli sairastanut mahdollisen klamydiainfektion, joten klamydian ilmaantuvuus oli 0,22/1000:tta elävänä syntynyttä kohti (95 % luottamusväli 0,19–0,25). Väestöpohjainen riski äidin sukupuoliklamydian tarttumiselle vastasyntyneeseen niin että lapselle aiheutuu oireinen infektio oli 0,8–1,8 %. Saatavilla olevien potilasasiakirjojen (124/206) perusteella kolmasosalla (33/124) imeväisistä, jotka sairastivat klamydian aiheuttamaa silmätulehdusta, oli oireena spontaani verinen kyynel- tai rähmäerite. Klamydiakeuhkokuumetta sairastavista puolella (15/32) esiintyi hengityksen vinkumista, mutta klamydiakeuhkokuumeelle tyypillistä hakkaavaa yskää (”staccato-yskä”) ei todettu yhdelläkään imeväisellä. Diagnostinen viive oli verrattain pitkä: 13 päivää (vaihteluväli 4–374) silmätulehduksessa ja 25 päivää (vaihteluväli 10–149) keuhkokuumeessa. Yhdelle laiminlyödylle lapselle kehittyi molemminpuoliset sarveiskalvoarvet hoitamattoman klamydiainfektion seurauksena. Vastasyntyneen silmätulehdustutkimukseen rekrytoitiin 173 alle 30 päivän ikäistä lasta Oulun kaupungin lastenneuvoloissa vuosina 2010–2015. Klamydian tai tippurin aiheuttamaa silmätulehdusta ei todettu yhdelläkään 163:sta tutkitusta vauvasta (0 %; 95 % luottamusväli 0 %–2,2 %). Viruksen aiheuttama silmätulehdus todettiin kahdeksalla vauvalla (4,8 %; 95 % luottamusväli 2,1 %–9,2 %) ja jonkin muun bakteerin kuin klamydian aiheuttama silmätulehdus 58:lla vauvalla (36 %; 95 % luottamusväli 29 %–44 %). Imeväisten alahengitystieinfektiotutkimukseen rekrytoitiin 228 alle kuuden kuukauden ikäistä imeväistä yliopistosairaalan lastenpäivystyksessä yhden epidemiologisen vuoden aikana. Klamydian aiheuttama hengitystieinfektio diagnosoitiin yhdellä imeväisellä (0,4 %; 95 % luottamusväli 0,01 %–2,4 %) ja hinkuyskä niin ikään yhdellä (0,4 %; 95 % luottamusväli 0,01 %–2,4 %). Valtaosalla (203/228) alahengitystieinfektio-oireisista imeväisistä oli viruksen aiheuttama infektio. Yhteenvetona voimme todeta, että klamydia tarttui äidistä lapseen alle 2 %:ssa synnytyksistä, mikä on huomattavasti harvinaisempaa kuin aiemmin on luultu. Klamydian aiheuttamien silmätulehdusten esiintyvyys oli alle 2 % ja alahengitystieinfektioiden alle 2,5 % alueemme lapsiväestössä. Klamydian aiheuttamat pitkäaikaishaitat olivat harvinaisia. Tavallisten hengitystievirusten osuus vastasyntyneiden silmätulehduksissa oli 5 %.

Einleitung: Atemwegsinfekte gehören zu den häufigsten Krankheitsbildern in der Allgemeinarztpraxis. Ziel der Erhebung war es, Daten zur Diagnostik und Therapie von Atemwegsinfekten in der hausärztlichen Praxis zu erheben. Methoden: Während einer jeweils eintägigen Hospitation bei 30 Fachärzten für Allgemeinmedizin wurde deren Vorgehensweise bei allen Patienten mit einem akuten Atemwegsinfekt dokumentiert, die im Zeitraum der Beobachtung den Arzt konsultierten. Es erfolgte eine Unterscheidung zwischen Erst- und Folgekontakten. Ergebnisse: Diagnostisch wurden am häufigsten die Auskultation der Lunge und die Inspektion des Mund-Rachen-Raumes durchgeführt. 98,4% der Patienten mit Erstkonsultationen und 62,5% der Patienten mit Folgekonsultationen erhielten eine medikamentöse Verordnung. Im Durchschnitt erhielten erstkonsultierende Patienten 2,1 (+-1,0), Patienten im Folgekontakt 1,3 (+-1,1) Medikamente. Am häufigsten wurden Medikamente aus der Gruppe der Husten- und Erkältungspräparate verordnet (87,1% der Erstkontakte und 52,9% der Folgekontakte). 43,5% der Erstkontakte und 29,9% der Folgekontakte erhielten ein Antibiotikum (37,5% Makrolide, 21,5% Penicilline, 20,8% Doxycyclin als Monosubstanz oder in Kombination mit Expektorantien). Schlussfolgerung: Nahezu alle Patienten erhielten ein Rezept über mindestens ein Medikament. Die erhobenen Daten lassen vermuten, dass sich bei einer höheren Gewichtung der so genannten "Hausmittel" ein deutliches Einsparungspotential böte. Angesichts des hohen Anteils der Antibiotikaverordnungen sollte die entsprechende Indikationsstellung kritisch überdacht werden.

Text in English / Regular exercise has significant physical and psychological health benefits yet, paradoxically, may also have harmful effects. The purpose of this study was to investigate the physical and psychological health risks of distance running, a popular participation sport in South Africa. Structural equation modelling was employed to examine the personality and motivational antecedents of running addiction and its influence, in turn, on self-reported overuse injuries and upper respiratory tract infections in 220 athletic club members. The predictors and physical health effects of customary training load were also assessed. It was found that perfectionistic concerns, Type A behaviour pattern, and task goal orientation had a direct, positive impact on running addiction, which predicted higher running injury scores. In contrast, training workload (Volume × Intensity) was inversely related to injury risk. Neither running addiction nor any training load variables influenced infectious illness susceptibility. The findings of this study indicate that maladaptive perfectionism, Type A behaviour, and achievement goal orientation may be risk factors for running addiction, which may, in turn, contribute to increased injury incidence in South African distance runners. Conversely, heavier training loads may be protective against injury occurrences in this population. The results of this research may help to enhance current understanding of the possible health hazards of distance running. This knowledge may have practical implications for the health and well-being of runners of diverse levels of ability and experience. / Psychology / D.Litt. et Phil. (Psychology)