Prospective study of healthcare utilisation and respiratory morbidity due to RSV infection in prematurely born infants

BACKGROUND: A study was undertaken to determine the impact of respiratory syncytial virus (RSV) infection, both in hospital and the community, on healthcare utilisation and respiratory morbidity in prematurely born infants and to identify risk factors for symptomatic RSV infection. METHODS: A hospital and community follow up study was undertaken of 126 infants born before 32 weeks of gestational age. Healthcare utilisation (hospital admissions and general practitioner attendances) in the first year, respiratory morbidity at follow up (wheeze and cough documented by parent completed diary cards), and RSV positive lower respiratory tract infections (LRTIs) were documented. Nasopharyngeal aspirates were obtained for immunofluorescence and culture for RSV whenever the infants had an LRTI, either in the community or in hospital. RESULTS: Forty two infants had an RSV positive LRTI (RSV group), 50 had an RSV negative LRTI (RSV negative LRTI group), and 32 infants had no LRTI (no LRTI group). Compared with the RSV negative LRTI and the no LRTI groups, the RSV group required more admissions (p=0.392, p<0.001) and days in hospital (p=0.049, p=0.006) and had more cough (p=0.05, p=0.038) and wheeze (p=0.003, p=0.003) at follow up. Significant risk factors for symptomatic RSV LRTI were number of siblings (p=0.035) and maternal smoking in pregnancy (p=0.005), for cough were number of siblings (p=0.002) and RSV LRTI (p=0.02), and for wheeze was RSV LRTI (p=0.019). CONCLUSION: RSV infection, even if hospital admission is not required, is associated with increased subsequent respiratory morbidity in prematurely born infants.     

Neonatal pancreatic function in infants born to mothers with gestational and overt diabetes

Neonatal pancreatic function was assessed in infants born to non-diabetic mothers and to mothers with well-controlled gestational diabetes (GD) and overt diabetes (OD) using cord blood C-peptide estimations and the calculation of cord C-peptide/glucose ratios. Exaggerated pancreatic function was present in infants born to mothers with GD. In these infants the increased cord C-peptide values and cord C-peptide/glucose ratios correlated with their increased birth weight ratios. These results could not be explained on the basis of maternal hyperglycaemia and a possible intrinsic difference in pancreatic response between infants born to mothers with GD and those born to mothers with OD is suggested.     

Drug exposure to infants born to mothers taking Elexacaftor,Tezacaftor, and Ivacaftor

Elexacaftor, tezacaftor, ivacaftor (ETI) have been associated with marked clinical improvements in adults with CF, which appears to be associated with increased fertility. However, maternal and fetal effects of therapy continued during pregnancy are not well understood. We collected maternal blood, infant blood, cord blood, and breast milk from 3 mother-infant pairs from women who elected to remain on ETI therapy while pregnant. Our results demonstrated relatively high levels of ETI in cord blood, suggesting placental transfer of these compounds, as well as low levels of ETI in breast milk and infant blood, suggesting further transfer of these compounds to breast-fed infants in the postnatal period. These data underscore the need for larger studies on the effects of modulator surrounding reproduction.     

An evaluation of nine probiotics available in South Africa, August 2003.

BACKGROUND AND OBJECTIVE: Although probiotics are not new, 5 new commercially available products have been launched onto the South African market in the last 2 years. Evaluations of products in the USA and Europe shown poor correlation between label claims and actual contents. We undertook an evaluation of 9 products currently available on the shelves in South Africa. METHODS AND ANALYSIS: An independent laboratory was used. A culture method involving serial dilutions on selective media was used to obtain a colony count per gram for indicated organisma. A non-culture method, denaturing gradient gel electrophoresis (DGGE), was used to determined the organisms present in the products. RESULTS: Disturbingly, we found a relatively poor correlation between the advertised and determined bacterial content. Only 3 of the 9 products tested contained the bacteria indicated on the label and 5 products contained sufficient bacteria for a probiotic effect. The Enterococcus faecium, a potential pathogen and Saccharomyces cerevisiae found in 2 of the products are of concern. CONCLUSION: This evaluation confirms that the contents of several probiotics available in South Africa do not correspond to the label claims. This is of concern as clinical efficacy is dependent on strain specificity and organism numbers. Current regulatory requirements do not address this discrepancy. As such, we recommend that commercially available probiotic products be screened annually and the results of such quality control measures be made available to the Medicines Control Council (MCC).     

An investigation of the occurrence of SV40 antibodies in South Africa.

We developed an enzyme-linked immunosorbent assay (ELISA) for the detection of antibodies to simian virus 40 (SV40) in human serum. We then used the ELISA to test for anti-SV40 antibodies in healthy individuals and patients suffering from cancer and renal diseases. The aim of the study was to determine the presence of antibodies against SV40 in sera of individuals who received the South African poliovirus vaccines from 1958 to the present. Detecting such antibodies could give an indication of whether any of the poliovirus vaccines used in South Africa were ever contaminated with the SV40 or not. A total of 5/164 samples were repeatedly positive for SV40 antibodies by the ELISA. Four of the samples were from the healthy population group and the remaining 1 (1/64) was from the patient group. An SV40 antibody-blocking assay and a Western blot were used as additional confirmation for the SV40 antibodies, whereas the Western blot assay developed a single common band on all 5 samples.     

Mortality in a cohort of children born to HIV-1 infected women from Durban, South Africa.

OBJECTIVES: To describe mortality in a cohort of infants with vertically transmitted HIV-1 infection. PATIENTS AND METHODS: Children of HIV-1 infected women were followed up from birth and a record was made at each visit of growth, development and all illnesses. Details surrounding death were obtained from hospital records. RESULTS: The final cohort comprised 48 infected and 93 uninfected children; there were 25 deaths, 17 of which (35%) were regarded as being HIV-related. The mean age at death of HIV-related cases was 10.1 months (range 1-48 months), with 83% of HIV-related deaths occurring before the age of 10 months. The commonest diagnoses at the time of death were diarrhoea, pneumonia, failure to thrive and severe thrush. These findings, together with neurological abnormalities, often presaged rapid deterioration and death. CONCLUSIONS: Mortality among children with vertically acquired HIV infection is high in the first year of life. Death in these subjects was due to the common causes of morbidity and mortality among all children in developing countries. A combination of diarrhoea, pneumonia, failure to thrive, and neurological abnormalities should alert one to the possibility of rapidly progressive disease and death.     

Scalp ringworm among Black children in South Africa and the occurrence of Trichophyton yaoundei.

The prevalence of tinea capitis among 153 children who were selected by overt signs of scalp infestation from among 658 Black schoolchildren, was studied in two rural areas of the Transvaal. In both areas (Eastern and Northern Transvaal), Trichophyton violaceum was the predominant dermatophyte species which was isolated. Microsporum audouinii was isolated in both areas from a total of 4 children, but M. canis was the cause of only 1 infection, and that was in the Eastern Transvaal. Five infections caused by T. yaoundei, all of which occurred in the Northern Transvaal, were recorded. They are the first documented cases of endothrix scalp ringworm caused by this species in South Africa.     

Tick-bite fever in South Africa. The occurrence of severe cases on the Witwatersrand

Tick-bite fever, the variety of tick typhus occurring in southern Africa, is caused by Rickettsia conori var. pijperi and is transmitted by hard or ixodid ticks. It is usually a mild disease, especially in children and young adults, but in middle-aged and elderly patients (and sometimes in young adults) it may assume a severe form. This is characterized by high fever, severe headache, delirium, stupor and occasionally coma, and a profuse maculopapular rash which becomes haemorrhagic and is associated with petechiae in the skin and later, but rarely, by the development of gangrene of the fingers and toes. During these severe attacks the central nervous system may be involved and marked disorders of liver and kidney function sometimes lead to kidney failure and the need for treatment and dialysis in an intensive care unit. Three illustrative cases are described in which diagnosis was delayed. One patient died; 2 patients responded to administration of tetracycline. The danger of allowing tick-infested dogs onto one's bed is stressed. Infections transmitted by dog ticks tend to be more severe than those acquired via ticks from the bushveld, possibly because they so often occur in middle-aged and elderly patients. Serological tests have recently indicated that there are antigenic differences between 'suburban' and 'bushveld' strains; these clearly require further study.