Acute liver failure (ALF) describes a clinical syndrome resulting from severe liver damage and extensive loss of functional parenchymal liver mass triggered by various factors. Early recognition and initiation of specific therapy may improve outcomes and reduce the need for liver transplantation, a treatment modality not universally available in resource constraint areas. There is paucity of data describing this syndrome in Sub-Saharan Africa in children. Objective This study aims to retrospectively review and determine the clinical presentation, aetiology, complications & outcome of ALF in children admitted at the Red Cross War Memorial Children's Hospital (RCWMCH). Methods All records of children from 0 to 13 years admitted at the RCWMCH over the period from January 2005 to December 2016 with ALF were retrospectively reviewed, after obtaining ethical approval. Patients with pre-existing evidence of chronic liver disease were excluded. Demographic variables as well as clinical presentation and investigations were captured, with determination of outcomes at 3 weeks and 6 weeks of diagnosis. Results Study included 24 children., 16 females (66.7%) and 8 males (33.3%). Median Age was 15 months, with interquartile range from 5 to 28 months. Diarrhoea, jaundice, respiratory distress, hepatomegaly and encephalopathy were common clinical features. Aetiology was infection in 37.5 % of cases (n=9, 2 of whom had autoimmune hepatitis comorbidity) and hepatitis A was most common infectious cause (n=4, 44%). Causes were indeterminate in 29.2%. Two patients had autoimmune hepatitis without co-morbidity; Reye syndrome 12.5% and 17% had miscellaneous causes. Transaminases were raised to thousands in viral causes of hepatitis, with a low C reactive protein. INR >4 and Total Bilirubin>210umol/L were associated with death outcome (p=0.04 and p=0.03 respectively. Conclusion Viral hepatitis A is the leading infective cause of acute liver failure in this study cohort and 29.2% of cases were indeterminable. INR >4 and Bilirubin > 210umol/l were predictors of poor outcome. Follow up study is recommended to better understand clinical spectrum and outcomes of children with acute liver failure in this low resource setting.

MSc (Microbiology) / Department of Microbiology / BACKGROUND: Human norovirus (NoV) is the etiological agent associated with acute gastroenteritis (AGE) in both children and adults worldwide. Children of <5 years of age, the elderly and individuals suffering from chronic diseases are potentially at high risk of NoV-associated illness. High morbidity and mortality rate associated with NoV have been reported worldwide. In children under the age of 5 years about 1.8 million death cases have been reported in developing countries alone. Despite the fact that the virus is affecting people of all age groups, there is lack of data to elucidate the importance and the role of NoV in children of the age above 5 years and adults. OBJECTIVE: To characterize human norovirus in patients with diarrhoea in rural communities of Vhembe district, Limpopo province. MATERIALS AND METHODS : From August 2017 to October 2018, outpatient between 5 and 68 years of age from rural communities of Vhembe district, Limpopo province were recruited for this study. A total of n=80 stool samples were collected from patients with diarrhoea and were kept at 4˚C throughout the transportation to the laboratory and refrigerated at - 20˚C prior to RNA extraction. Stool samples were tested for norovirus using the RIDA©GENE NOROVIRUS I & II real-time RT-PCR. The RNA extracts tested positive for norovirus were subjected to RT-PCR amplification. The RT-PCR products of the amplified fragments were sequenced, and phylogenetic trees were constructed by the neighbor-joining method using MEGA 7 software. RESULTS: NoV was detected in 13(16%) out of 80 stool samples collected, of which 6 (46%) strains belonged to norovirus GII and 7 (54%) strains to norovirus GI. A total of 5 genotypes were detected (GII.Pg, GII.1, GII.2, GII.4 Sydney 2012). The phylogenetic analysis revealed circulation of NoV genotypes with considerable diversity. CONCLUSION: This study illustrates NoV prevalence and substantial genetic diversity in patients above 5 years of age living in rural communities of Vhembe district, Limpopo province. Continued systematic surveillance to evaluate norovirus association with diarrhoea is needed to have a full picture on the epidemiology and disease burden in people of all the age groups. / NRF