Carbapenem-resistant Enterobacteriaceae have been increasingly reported throughout the world. The... more Carbapenem-resistant Enterobacteriaceae have been increasingly reported throughout the world. The first South African report of a New Delhi metallo-beta-lactamase was from Gauteng in August 2011. Despite maintaining a high degree of vigilance, the first such case was seen in KwaZulu-Natal almost a year later. Other cases have been unable to confirm a definite link to any other affected areas; this is the first case in South Africa showing this direct epidemiological link.
Pan drug-resistant Serratia marcescens: An emerging threat To the Editor: The five most frequentl... more Pan drug-resistant Serratia marcescens: An emerging threat To the Editor: The five most frequently reported organisms isolated from blood cultures worldwide are Klebsiella pneumoniae, Escherichia coli, Staphylococcus aureus, Pseudomonas aeruginosa and Enterococcus species. [1,2] The emergence of carbapenem resistance has seriously compromised treatment options for organisms such as K. pneumoniae, E. coli and other Enterobacteriaceae such as Enterobacter species and Serratia marcescens. Colistin and tigecycline are last-resort therapeutic options for these carbapenem-resistant Enterobacteriaceae. [3] We have observed an increase in the number of carbapenemresistant S. marcescens isolates in blood cultures in our laboratory in the KwaZulu-Natal (KZN) region, South Africa, which is particularly worrisome, given that Serratia species are inherently resistant to colistin. During 2017, S. marcescens was the 6th most common isolate in blood cultures. Of the 572 Enterobacteriaceae isolated from blood cultures, S. marcescens was the 3rd most common after E. coli and K. pneumo niae, accounting for 11% (63/572) of isolates. Ten S. marces cens isolates were carbapenem resistant; 7 of these were also resistant to tigecycline, thus making them pan drug resistant. All the carbapenemresistant S. marcescens isolates carried the New Delhi metallo-betalactamase 1 (NDM1) gene. Unlike other reports of S. marcescens bacteraemia, these isolates were from several different hospitals across KZN and were not linked to an outbreak. [4,5] The emergence of pan drug-resistant S. marcescens in blood cultures in this region creates a challenge for the management of patients admitted to hospitals and intensive care units. Implementation of antimicrobial stewardship and strict infection control practices is imperative to prevent further dissemination of this formidable pathogen.
Diabetes mellitus is reported to predispose women to vaginal candidiasis and hence patients atten... more Diabetes mellitus is reported to predispose women to vaginal candidiasis and hence patients attending busy diabetic clinics are often treated empirically with antifungal agents for genital symptoms. To investigate the etiology of vaginal infections in diabetic women and to determine appropriateness of empiric antifungal therapy for symptomatic women. Prospective study performed on consecutive patients attending two diabetic clinics. Diabetic clinics serving developing communities belonging to two ethnic groups. Two hundred and one women (101 African and 100 Indian) comprising 90 women with symptoms of pruritus vulvae and/or vaginal discharge and 111 asymptomatic women. Candidiasis (50% vs. 24%; P = 0.012) and bacterial vaginosis (28% vs. 8%; P = 0.017) occurred significantly more frequently in symptomatic African women compared to asymptomatic African women. Among Indian women bacterial vaginosis (28% vs. 5%; P = 0.026) occurred more frequently in symptomatic women. The prevalence o...
South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde, 1993
Two hundred and three diabetic women (89 with and 114 without genital symptoms) were examined for... more Two hundred and three diabetic women (89 with and 114 without genital symptoms) were examined for the presence of yeasts and Trichomonas vaginalis. Yeasts were isolated from the vaginas of 35.5% of patients and were more common in the symptomatic group (48.0%) than the asymptomatic group (25.4%; P < 0.05). Candida albicans was isolated from 12.8% of all patients and showed a significant association with pruritus vulvae (P < 0.05). A significant association was also shown between the presence of yeasts in the rectum and in the vagina. C. glabrata (Torulopsis glabrata) was the commonest yeast species isolated (50.0%), with C. albicans the next most frequent (36.1%). T. vaginalis infection was present in 14.3% of all subjects.
International Journal of Infectious Diseases, 2014
Background: Dengue is the most important arthropod-borne viral disease in the world. Since dengue... more Background: Dengue is the most important arthropod-borne viral disease in the world. Since dengue clinical manifestations are similar to those of many other febrile syndromes, the availability of dengue-specific laboratory tests is useful for appropriate management of patients. Dengue is endemoepidemic inMartinique, a French Caribbean island. The island has experienced epidemics caused by DENV-2/DENV-4 in2005, DENV-2 in2007, DENV-1/DENV-4 in2010 and DENV-2/DENV-4 in2013. In our virology unit, RT-PCR (Hemi-nested protocol from Lanciotti et al., J Clin Microbiol 1992) is systematically run for patients consulting at hospital facilities with acute febrile disease and admitted until day 8 of fever onset. This technique is considered as the gold standard but it is time consuming and at high risk of contamination. Moreover there is a need for standardized dengue RT-PCR with internal controls. Methods & Materials: In the present study, we evaluated the performance of three commercialdengue real-time PCR kits (Simplexa TM Dengue PCR assay: Focus Diagnostic, RealStar® Dengue RT-PCR kit 1.0: Altona Diagnostics, Geno-Sen's Dengue 1-4 Real-time PCR kit: Genome Diagnostics Pvt) using 162 samples positive with the hemi-nested RT-PCR (46 DENV-1, 37 DENV-2, 33 DENV-3, and 46 DENV-4). In addition, 70 negative serum specimens were used to evaluate specificity. All three kits included an internal control. RNA extraction was performed using the NucliSens easyMAG® (BioMérieux). Results: Geno-Sen's, RealStar®, and Simplexa TM tests were positive in 138 (85.1%), 135 (83.3%), and 151 (93.2%) samples, respectively. The sensitivity of Simplexa TM was significantly higher than Geno-Sen's (Chi 2, p = 0.009) and RealStar® (p = 0.005). Compared to the in-place reference RT-PCR, the specificity was 100% for Geno-Sen's and Simplexa TM and 98% for Real Star.According to dengue genotypes, the sensitivity was for DENV-1 (91%, 78% and 96%), for DENV-2 (89%, 87%, and 92%) for DENV-3 (91%, 91%, 91%), for DENV-4 (72%, 80% and 94%) by Geno-Sen's, Real Star® and Simplexa TM kits respectively. Simplexa is the only kit providing genotyping of virus. Conclusion: The good performance of the Simplexa TM Dengue PCR assay at the detection and genotyping level in combination with an automated extraction is suitable for diagnosis during dengue outbreaks in tropical areas.
Journal of infection in developing countries, Jan 24, 2016
There is a dearth of surveillance data on clinical Campylobacter in South Africa, particularly in... more There is a dearth of surveillance data on clinical Campylobacter in South Africa, particularly in the private healthcare environment. We investigated the prevalence of resistance to first-line antibiotics used to treat campylobacterioses in clinical Campylobacter isolates from a private pathology laboratory. Identification of the Campylobacter specific genes were confirmed by PCR. Minimum inhibitory concentrations were determined using the broth micro-dilution method against macrolides (erythromycin, azithromycin), fluoroquinolones (ciprofloxacin, gatifloxacin) and tetracycline. Seventy-two Campylobacter isolates were identified by PCR, with 54 (75%) being classified as C. jejuni and 18 (25%) as C. coli. Of these, 11 (20.4%) C. jejuni and six (33.3%) C. coli strains were resistant to ciprofloxacin and three (7.41%) C. jejuni and three (16.7%) C. coli strains were resistant to gatifloxacin. The number of C. jejuni strains resistant to erythromycin and azithromycin was 17 (31.5%) and ...
Microbial drug resistance (Larchmont, N.Y.), Jan 20, 2018
This study investigated the molecular mechanisms of resistance to carbapenems and cephalosporins ... more This study investigated the molecular mechanisms of resistance to carbapenems and cephalosporins in 24 consecutive, multidrug-resistant Acinetobacter baumannii (MDRAB) isolates collected between January and April 2015 by a private sector laboratory in Durban, South Africa. All isolates were resistant to all carbapenems tested. bla and bla genes were found in 23 isolates, while bla, bla, and bla were absent in all isolates. The most prevalent extended-spectrum β-lactamase was TEM-116 (92%). bla was present in 83.3% of isolates, of which two were new variants with three and five amino acid differences compared to Acinetobacter-derived cephalosporinase (ADC)-1, the first at positions 64E → K, 341N → T, and 342R → G and the second at positions 24G → D, 167S → P, 283R → F, 341N → T, and 342R → G, respectively. All isolates were negative for bla, bla, bla, bla, bla, and bla. Metallo-β-lactamase IMP and VIM were absent in all isolates, and NDM-1 was present in 1 isolate. ISAba1 was located...
Humans are occasionally inadvertently infected with dirofilariae, the zoonotic nematodes. We repo... more Humans are occasionally inadvertently infected with dirofilariae, the zoonotic nematodes. We report two cases of human dirofilariasis in South Africa, an area apparently non-endemic for this infection. Dirofilariasis is frequently misdiagnosed, so increased awareness of this entity in areas that are non-endemic is essential for prevention of inappropriate investigations and invasive therapy.
International Journal of Infectious Diseases, 2014
Background: Dengue is the most important arthropod-borne viral disease in the world. Since dengue... more Background: Dengue is the most important arthropod-borne viral disease in the world. Since dengue clinical manifestations are similar to those of many other febrile syndromes, the availability of dengue-specific laboratory tests is useful for appropriate management of patients. Dengue is endemoepidemic inMartinique, a French Caribbean island. The island has experienced epidemics caused by DENV-2/DENV-4 in2005, DENV-2 in2007, DENV-1/DENV-4 in2010 and DENV-2/DENV-4 in2013. In our virology unit, RT-PCR (Hemi-nested protocol from Lanciotti et al., J Clin Microbiol 1992) is systematically run for patients consulting at hospital facilities with acute febrile disease and admitted until day 8 of fever onset. This technique is considered as the gold standard but it is time consuming and at high risk of contamination. Moreover there is a need for standardized dengue RT-PCR with internal controls.
A case of Candida parapsilosis endocarditis observed 16 months after BMT is reported. The patient... more A case of Candida parapsilosis endocarditis observed 16 months after BMT is reported. The patient, a 35-year-old female with CML, suffered from Candida parapsilosis fungemia on day +22 after BMT. In spite of treatment with amphotericin B, fluconazole and catheter withdrawal, the same yeast was isolated &amp;amp;gt; 1 year later from a vegetation on an old rheumatic mitral valve. Although the patient remained in complete cytogenetical and hematological remission, in vitro tests showed reduced phagocytic and chemotactic capacity of neutrophils and monocytes. This case stresses the need of prolonged therapy for patients with candidemia after BMT.
King Edward VIII Hospital, Musgrave, Background In a pilot study performed in eight mosques in th... more King Edward VIII Hospital, Musgrave, Background In a pilot study performed in eight mosques in the Durban area, it was South Africa found that the prevalence of tinea pedis et unguium in the adult Muslim male population regularly attending mosques was higher than in the nonMuslim male population. The aims Correspondence of the present study were: (i) to determine the prevalence of tinea pedis et unguium in the Noufal Raboobee, MBChB (Natal), FFDerm (SA) adult Muslim male population regularly attending mosques; (ii) to investigate the role of PO Box 50822 mosque carpets and ablution areas in the spread of infection; and (iii) to develop Musgrave 4062 strategies to combat the infection.
Diagnostic Microbiology and Infectious Disease, 2014
We describe 4 patients infected with NDM-1 Enterobacter cloacae, Citrobacter freundii, and Serrat... more We describe 4 patients infected with NDM-1 Enterobacter cloacae, Citrobacter freundii, and Serratia marcescens from South Africa that co-produced SHV-12, CTX-M-3, and CTX-M-15 and were positive for qnrS, qnrA, aac(6&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;)-Ib-cr, rmtF, rmtC, and armA. Plasmids belonged to IncN, IncA/C replicon types with ccdAB and vagC/D addiction factors. Local and imported cases of NDM-producing bacteria co-exist within South Africa.
American Journal of Respiratory and Critical Care Medicine, 2010
Rationale: Current tools for the rapid diagnosis of tuberculous meningitis (TBM) are suboptimal. ... more Rationale: Current tools for the rapid diagnosis of tuberculous meningitis (TBM) are suboptimal. We evaluated the clinical utility of a quantitative RD-1 IFN-g T-cell enzyme-linked immunospot (ELISPOT) assay (T-SPOT.TB), using cerebrospinal fluid cells for the rapid immunodiagnosis of TBM. Objectives: To evaluate the diagnostic utility of the RD1 antigenspecific ELISPOT assay for the diagnosis of tuberculous meningitis. Methods: The ELISPOT assay was evaluated in 150 patients with suspected TBM who were categorized as definite-TBM, probable-TBM, and non-TBM. Culture or polymerase chain reaction positivity for Mycobacerium tuberculosis served as the reference standard. To determine the diagnostic value of the ELISPOT assay, a clinical prediction rule was derived from baseline clinical and laboratory parameters using a multivariable regression model. Measurements and Main Results: A total of 140 patients (81% HIVinfected; median CD4 count, 160 cells/mm 3 ) were included in the final analysis. When comparing the definite-TBM (n 5 38) and non-TBM groups (n 5 48), the ELISPOT assay (cut point of >228 spot-forming cells per 1 million mononuclear cells) was a useful rule-in test: sensitivity 58% (95% confidence interval [CI], 41-74); specificity 94% (95% CI, 83-99). However, ELISPOT outcomes improved when other rapid tests were concurrently used to exclude bacterial (Gram stain) and cryptococcal meningitis (latex-agglutination test) within the non-TBM group. Using this approach, the ELISPOT assay (cut point of >46 spot-forming cells) was an excellent rule-in test: sensitivity 82% (95% CI, 66-92); specificity 100% (95% CI, 78-100); positive predictive value, 100% (95% CI, 89-100); negative predictive value, 68% (95% CI, 45-86); area under the curve, 0.90. The ELISPOT assay had incremental diagnostic value compared with the clinical prediction rule. Conclusions: The RD-1 ELISPOT assay, using cerebrospinal fluid mononuclear cells and in conjunction with other rapid confirmatory tests (Gram stain and cryptococcal latex-agglutination test), is an accurate rapid rule-in test for TBM in a TB and HIV endemic setting.
Carbapenem-resistant Enterobacteriaceae have been increasingly reported throughout the world. The... more Carbapenem-resistant Enterobacteriaceae have been increasingly reported throughout the world. The first South African report of a New Delhi metallo-beta-lactamase was from Gauteng in August 2011. Despite maintaining a high degree of vigilance, the first such case was seen in KwaZulu-Natal almost a year later. Other cases have been unable to confirm a definite link to any other affected areas; this is the first case in South Africa showing this direct epidemiological link.
Pan drug-resistant Serratia marcescens: An emerging threat To the Editor: The five most frequentl... more Pan drug-resistant Serratia marcescens: An emerging threat To the Editor: The five most frequently reported organisms isolated from blood cultures worldwide are Klebsiella pneumoniae, Escherichia coli, Staphylococcus aureus, Pseudomonas aeruginosa and Enterococcus species. [1,2] The emergence of carbapenem resistance has seriously compromised treatment options for organisms such as K. pneumoniae, E. coli and other Enterobacteriaceae such as Enterobacter species and Serratia marcescens. Colistin and tigecycline are last-resort therapeutic options for these carbapenem-resistant Enterobacteriaceae. [3] We have observed an increase in the number of carbapenemresistant S. marcescens isolates in blood cultures in our laboratory in the KwaZulu-Natal (KZN) region, South Africa, which is particularly worrisome, given that Serratia species are inherently resistant to colistin. During 2017, S. marcescens was the 6th most common isolate in blood cultures. Of the 572 Enterobacteriaceae isolated from blood cultures, S. marcescens was the 3rd most common after E. coli and K. pneumo niae, accounting for 11% (63/572) of isolates. Ten S. marces cens isolates were carbapenem resistant; 7 of these were also resistant to tigecycline, thus making them pan drug resistant. All the carbapenemresistant S. marcescens isolates carried the New Delhi metallo-betalactamase 1 (NDM1) gene. Unlike other reports of S. marcescens bacteraemia, these isolates were from several different hospitals across KZN and were not linked to an outbreak. [4,5] The emergence of pan drug-resistant S. marcescens in blood cultures in this region creates a challenge for the management of patients admitted to hospitals and intensive care units. Implementation of antimicrobial stewardship and strict infection control practices is imperative to prevent further dissemination of this formidable pathogen.
Diabetes mellitus is reported to predispose women to vaginal candidiasis and hence patients atten... more Diabetes mellitus is reported to predispose women to vaginal candidiasis and hence patients attending busy diabetic clinics are often treated empirically with antifungal agents for genital symptoms. To investigate the etiology of vaginal infections in diabetic women and to determine appropriateness of empiric antifungal therapy for symptomatic women. Prospective study performed on consecutive patients attending two diabetic clinics. Diabetic clinics serving developing communities belonging to two ethnic groups. Two hundred and one women (101 African and 100 Indian) comprising 90 women with symptoms of pruritus vulvae and/or vaginal discharge and 111 asymptomatic women. Candidiasis (50% vs. 24%; P = 0.012) and bacterial vaginosis (28% vs. 8%; P = 0.017) occurred significantly more frequently in symptomatic African women compared to asymptomatic African women. Among Indian women bacterial vaginosis (28% vs. 5%; P = 0.026) occurred more frequently in symptomatic women. The prevalence o...
South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde, 1993
Two hundred and three diabetic women (89 with and 114 without genital symptoms) were examined for... more Two hundred and three diabetic women (89 with and 114 without genital symptoms) were examined for the presence of yeasts and Trichomonas vaginalis. Yeasts were isolated from the vaginas of 35.5% of patients and were more common in the symptomatic group (48.0%) than the asymptomatic group (25.4%; P < 0.05). Candida albicans was isolated from 12.8% of all patients and showed a significant association with pruritus vulvae (P < 0.05). A significant association was also shown between the presence of yeasts in the rectum and in the vagina. C. glabrata (Torulopsis glabrata) was the commonest yeast species isolated (50.0%), with C. albicans the next most frequent (36.1%). T. vaginalis infection was present in 14.3% of all subjects.
International Journal of Infectious Diseases, 2014
Background: Dengue is the most important arthropod-borne viral disease in the world. Since dengue... more Background: Dengue is the most important arthropod-borne viral disease in the world. Since dengue clinical manifestations are similar to those of many other febrile syndromes, the availability of dengue-specific laboratory tests is useful for appropriate management of patients. Dengue is endemoepidemic inMartinique, a French Caribbean island. The island has experienced epidemics caused by DENV-2/DENV-4 in2005, DENV-2 in2007, DENV-1/DENV-4 in2010 and DENV-2/DENV-4 in2013. In our virology unit, RT-PCR (Hemi-nested protocol from Lanciotti et al., J Clin Microbiol 1992) is systematically run for patients consulting at hospital facilities with acute febrile disease and admitted until day 8 of fever onset. This technique is considered as the gold standard but it is time consuming and at high risk of contamination. Moreover there is a need for standardized dengue RT-PCR with internal controls. Methods & Materials: In the present study, we evaluated the performance of three commercialdengue real-time PCR kits (Simplexa TM Dengue PCR assay: Focus Diagnostic, RealStar® Dengue RT-PCR kit 1.0: Altona Diagnostics, Geno-Sen's Dengue 1-4 Real-time PCR kit: Genome Diagnostics Pvt) using 162 samples positive with the hemi-nested RT-PCR (46 DENV-1, 37 DENV-2, 33 DENV-3, and 46 DENV-4). In addition, 70 negative serum specimens were used to evaluate specificity. All three kits included an internal control. RNA extraction was performed using the NucliSens easyMAG® (BioMérieux). Results: Geno-Sen's, RealStar®, and Simplexa TM tests were positive in 138 (85.1%), 135 (83.3%), and 151 (93.2%) samples, respectively. The sensitivity of Simplexa TM was significantly higher than Geno-Sen's (Chi 2, p = 0.009) and RealStar® (p = 0.005). Compared to the in-place reference RT-PCR, the specificity was 100% for Geno-Sen's and Simplexa TM and 98% for Real Star.According to dengue genotypes, the sensitivity was for DENV-1 (91%, 78% and 96%), for DENV-2 (89%, 87%, and 92%) for DENV-3 (91%, 91%, 91%), for DENV-4 (72%, 80% and 94%) by Geno-Sen's, Real Star® and Simplexa TM kits respectively. Simplexa is the only kit providing genotyping of virus. Conclusion: The good performance of the Simplexa TM Dengue PCR assay at the detection and genotyping level in combination with an automated extraction is suitable for diagnosis during dengue outbreaks in tropical areas.
Journal of infection in developing countries, Jan 24, 2016
There is a dearth of surveillance data on clinical Campylobacter in South Africa, particularly in... more There is a dearth of surveillance data on clinical Campylobacter in South Africa, particularly in the private healthcare environment. We investigated the prevalence of resistance to first-line antibiotics used to treat campylobacterioses in clinical Campylobacter isolates from a private pathology laboratory. Identification of the Campylobacter specific genes were confirmed by PCR. Minimum inhibitory concentrations were determined using the broth micro-dilution method against macrolides (erythromycin, azithromycin), fluoroquinolones (ciprofloxacin, gatifloxacin) and tetracycline. Seventy-two Campylobacter isolates were identified by PCR, with 54 (75%) being classified as C. jejuni and 18 (25%) as C. coli. Of these, 11 (20.4%) C. jejuni and six (33.3%) C. coli strains were resistant to ciprofloxacin and three (7.41%) C. jejuni and three (16.7%) C. coli strains were resistant to gatifloxacin. The number of C. jejuni strains resistant to erythromycin and azithromycin was 17 (31.5%) and ...
Microbial drug resistance (Larchmont, N.Y.), Jan 20, 2018
This study investigated the molecular mechanisms of resistance to carbapenems and cephalosporins ... more This study investigated the molecular mechanisms of resistance to carbapenems and cephalosporins in 24 consecutive, multidrug-resistant Acinetobacter baumannii (MDRAB) isolates collected between January and April 2015 by a private sector laboratory in Durban, South Africa. All isolates were resistant to all carbapenems tested. bla and bla genes were found in 23 isolates, while bla, bla, and bla were absent in all isolates. The most prevalent extended-spectrum β-lactamase was TEM-116 (92%). bla was present in 83.3% of isolates, of which two were new variants with three and five amino acid differences compared to Acinetobacter-derived cephalosporinase (ADC)-1, the first at positions 64E → K, 341N → T, and 342R → G and the second at positions 24G → D, 167S → P, 283R → F, 341N → T, and 342R → G, respectively. All isolates were negative for bla, bla, bla, bla, bla, and bla. Metallo-β-lactamase IMP and VIM were absent in all isolates, and NDM-1 was present in 1 isolate. ISAba1 was located...
Humans are occasionally inadvertently infected with dirofilariae, the zoonotic nematodes. We repo... more Humans are occasionally inadvertently infected with dirofilariae, the zoonotic nematodes. We report two cases of human dirofilariasis in South Africa, an area apparently non-endemic for this infection. Dirofilariasis is frequently misdiagnosed, so increased awareness of this entity in areas that are non-endemic is essential for prevention of inappropriate investigations and invasive therapy.
International Journal of Infectious Diseases, 2014
Background: Dengue is the most important arthropod-borne viral disease in the world. Since dengue... more Background: Dengue is the most important arthropod-borne viral disease in the world. Since dengue clinical manifestations are similar to those of many other febrile syndromes, the availability of dengue-specific laboratory tests is useful for appropriate management of patients. Dengue is endemoepidemic inMartinique, a French Caribbean island. The island has experienced epidemics caused by DENV-2/DENV-4 in2005, DENV-2 in2007, DENV-1/DENV-4 in2010 and DENV-2/DENV-4 in2013. In our virology unit, RT-PCR (Hemi-nested protocol from Lanciotti et al., J Clin Microbiol 1992) is systematically run for patients consulting at hospital facilities with acute febrile disease and admitted until day 8 of fever onset. This technique is considered as the gold standard but it is time consuming and at high risk of contamination. Moreover there is a need for standardized dengue RT-PCR with internal controls.
A case of Candida parapsilosis endocarditis observed 16 months after BMT is reported. The patient... more A case of Candida parapsilosis endocarditis observed 16 months after BMT is reported. The patient, a 35-year-old female with CML, suffered from Candida parapsilosis fungemia on day +22 after BMT. In spite of treatment with amphotericin B, fluconazole and catheter withdrawal, the same yeast was isolated &amp;amp;gt; 1 year later from a vegetation on an old rheumatic mitral valve. Although the patient remained in complete cytogenetical and hematological remission, in vitro tests showed reduced phagocytic and chemotactic capacity of neutrophils and monocytes. This case stresses the need of prolonged therapy for patients with candidemia after BMT.
King Edward VIII Hospital, Musgrave, Background In a pilot study performed in eight mosques in th... more King Edward VIII Hospital, Musgrave, Background In a pilot study performed in eight mosques in the Durban area, it was South Africa found that the prevalence of tinea pedis et unguium in the adult Muslim male population regularly attending mosques was higher than in the nonMuslim male population. The aims Correspondence of the present study were: (i) to determine the prevalence of tinea pedis et unguium in the Noufal Raboobee, MBChB (Natal), FFDerm (SA) adult Muslim male population regularly attending mosques; (ii) to investigate the role of PO Box 50822 mosque carpets and ablution areas in the spread of infection; and (iii) to develop Musgrave 4062 strategies to combat the infection.
Diagnostic Microbiology and Infectious Disease, 2014
We describe 4 patients infected with NDM-1 Enterobacter cloacae, Citrobacter freundii, and Serrat... more We describe 4 patients infected with NDM-1 Enterobacter cloacae, Citrobacter freundii, and Serratia marcescens from South Africa that co-produced SHV-12, CTX-M-3, and CTX-M-15 and were positive for qnrS, qnrA, aac(6&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;)-Ib-cr, rmtF, rmtC, and armA. Plasmids belonged to IncN, IncA/C replicon types with ccdAB and vagC/D addiction factors. Local and imported cases of NDM-producing bacteria co-exist within South Africa.
American Journal of Respiratory and Critical Care Medicine, 2010
Rationale: Current tools for the rapid diagnosis of tuberculous meningitis (TBM) are suboptimal. ... more Rationale: Current tools for the rapid diagnosis of tuberculous meningitis (TBM) are suboptimal. We evaluated the clinical utility of a quantitative RD-1 IFN-g T-cell enzyme-linked immunospot (ELISPOT) assay (T-SPOT.TB), using cerebrospinal fluid cells for the rapid immunodiagnosis of TBM. Objectives: To evaluate the diagnostic utility of the RD1 antigenspecific ELISPOT assay for the diagnosis of tuberculous meningitis. Methods: The ELISPOT assay was evaluated in 150 patients with suspected TBM who were categorized as definite-TBM, probable-TBM, and non-TBM. Culture or polymerase chain reaction positivity for Mycobacerium tuberculosis served as the reference standard. To determine the diagnostic value of the ELISPOT assay, a clinical prediction rule was derived from baseline clinical and laboratory parameters using a multivariable regression model. Measurements and Main Results: A total of 140 patients (81% HIVinfected; median CD4 count, 160 cells/mm 3 ) were included in the final analysis. When comparing the definite-TBM (n 5 38) and non-TBM groups (n 5 48), the ELISPOT assay (cut point of >228 spot-forming cells per 1 million mononuclear cells) was a useful rule-in test: sensitivity 58% (95% confidence interval [CI], 41-74); specificity 94% (95% CI, 83-99). However, ELISPOT outcomes improved when other rapid tests were concurrently used to exclude bacterial (Gram stain) and cryptococcal meningitis (latex-agglutination test) within the non-TBM group. Using this approach, the ELISPOT assay (cut point of >46 spot-forming cells) was an excellent rule-in test: sensitivity 82% (95% CI, 66-92); specificity 100% (95% CI, 78-100); positive predictive value, 100% (95% CI, 89-100); negative predictive value, 68% (95% CI, 45-86); area under the curve, 0.90. The ELISPOT assay had incremental diagnostic value compared with the clinical prediction rule. Conclusions: The RD-1 ELISPOT assay, using cerebrospinal fluid mononuclear cells and in conjunction with other rapid confirmatory tests (Gram stain and cryptococcal latex-agglutination test), is an accurate rapid rule-in test for TBM in a TB and HIV endemic setting.
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