Recommendations for the treatment and prevention of malaria: Update for the 2015 season in South Africa

Notified malaria cases in South Africa (SA) decreased significantly over the past 14 years, from over 60 000 in the 1999/2000 malaria season to less than 13 000 in 2013/2014. However, the past two seasons have seen increases in both local and imported cases. Mozambique contributes the highest number of imported cases in SA. This update provides recommendations for malaria treatment and prevention (in travellers and residents) for 2015

The COVID-19 crisis in South Africa : protecting the vulnerable

As of 3 July 2020, global cases of COVID-19 surpassed 10 million with over half a million deaths in more than 210 countries. South Africa (SA) too reached a milestone last week, recording a total of 100 000 laboratory-confirmed cases and 2 500 deaths since March (as of 7 July 2020, total number of positive cases 215 855, total number of deaths 3 502). The epidemic’s epicentre in the Western Cape, where a major surge has resulted in record hospital bed occupancy rates, is quickly being surpassed by Gauteng in the number of new cases. Similar trends in case numbers are being reported in Eastern Cape Province, stretching valiant healthcare workers in all three provinces. The remaining provinces are likely to follow suit.http://www.samj.org.zaam2021Veterinary Tropical Disease

ASSAf Statement on the Implications of the Novel Coronavirus (SARS-CoV-2; COVID-19) in South Africa

Academy of Science of South Africa (ASSAf), (2020). ASSAf Statement on the Implications of the Novel Coronavirus (SARS-CoV-2; COVID-19) in South Africa, 2 March 2020 [Online] Available at: http://hdl.handle.net/20.500.11911/151ASSAf & Department of Science and Innovatio

Case management of malaria : treatment and chemoprophylaxis

Malaria case management is a vital component of programmatic strategies for malaria control and elimination. Malaria case management encompasses prompt and effective treatment to minimise morbidity and mortality, reduce transmission and prevent the emergence and spread of antimalarial drug resistance. Malaria is an acute illness that may progress rapidly to severe disease and death, especially in non-immune populations, if not diagnosed early and promptly treated with effective drugs. In this article, the focus is on malaria case management, addressing treatment, monitoring for parasite drug resistance, and the impact of drug resistance on treatment policies; it concludes with chemoprophylaxis and treatment strategies for malaria elimination in South Africa.http://www.samj.org.zaam2013ay201

Crimean-Congo haemorrhagic fever presenting with undiagnosed chronic myeloid leukaemia

A patient with Crimean-Congo haemorrhagic fever (CCHF) presented with a high white cell count and splenomegaly. Underlying chronic myeloid leukaemia was diagnosed. The management of this complex case was difficult, and the patient demised. This case illustrates that in patients with an acute febrile illness with haemorrhage, a thorough history and examination, as well as a high index of suspicion for concurrent conditions, is important.http://www.tandfonline.com/loi/ojid20am2018Veterinary Tropical Disease

Utility of forensic detection of rabies virus in decomposed exhumed dog carcasses

This report describes four suspected rabies cases in domestic dogs that were involved in human exposures. In all these cases, the animals were buried for substantial times before rabies testing was performed. Animal rabies is endemic in South Africa and domestic dogs are the main vector for transmission to humans. Diagnosis of rabies in humans is complicated, and diagnosis in the animal vector can provide circumstantial evidence to support clinical diagnosis of rabies in humans. The gold standard diagnostic method, fluorescent antibody test (FAT), only delivers reliable results when performed on fresh brain material and therefore decomposed samples are rarely submitted for diagnostic testing. Severely decomposed brain material was tested for the presence of rabies virus genomic material using a quantitative real-time reverse transcription polymerase chain reaction (q-real-time RT-PCR) assay when conventional molecular methods were unsuccessful. This may be a useful tool in the investigation of cases where the opportunity to sample the suspected animals post mortem was forfeited and which would not be possible with conventional testing methodologies because of the decomposition of the material.The National Research Foundation (NRF) (South Africa) grant number UID 66187 and 78566.http://www.jsava.co.zaam201

Utility of forensic detection of rabies virus in decomposed exhumed dog carcasses

This report describes four suspected rabies cases in domestic dogs that were involved in human exposures. In all these cases, the animals were buried for substantial times before rabies testing was performed. Animal rabies is endemic in South Africa and domestic dogs are the main vector for transmission to humans. Diagnosis of rabies in humans is complicated, and diagnosis in the animal vector can provide circumstantial evidence to support clinical diagnosis of rabies in humans. The gold standard diagnostic method, fluorescent antibody test (FAT), only delivers reliable results when performed on fresh brain material and therefore decomposed samples are rarely submitted for diagnostic testing. Severely decomposed brain material was tested for the presence of rabies virus genomic material using a quantitative real-time reverse transcription polymerase chain reaction (q-real-time RT-PCR) assay when conventional molecular methods were unsuccessful. This may be a useful tool in the investigation of cases where the opportunity to sample the suspected animals post mortem was forfeited and which would not be possible with conventional testing methodologies because of the decomposition of the material.The National Research Foundation (NRF) (South Africa) grant number UID 66187 and 78566.http://www.jsava.co.zaam201

Maintaining focus on administering effective malaria treatment during the COVID-19 pandemic

As September marks the start of the malaria season in South Africa (SA), it is essential that healthcare professionals consider both COVID19 and malaria when a patient who lives in or has recently travelled to a malaria area presents with acute febrile illness. Early diagnosis of malaria by either a rapid diagnostic test or microscopy enables prompt treatment with the effective antimalarial, artemether-lumefantrine, preventing progression to severe disease and death. Intravenous artesunate is the preferred treatment for severe malaria in both children and adults. Adding single low-dose primaquine to standard treatment is recommended in endemic areas to block onward transmission. Use of the highly effective artemisinin-based therapies should be limited to the treatment of confirmed malaria infections, as there is no clinical evidence that these antimalarials can prevent or treat COVID-19. Routine malaria case management services must be sustained, in spite of COVID-19, to treat malaria effectively and support SA’s malaria elimination efforts.http://www.samj.org.zadm2022Family MedicineSchool of Health Systems and Public Health (SHSPH)UP Centre for Sustainable Malaria Control (UP CSMC)Veterinary Tropical Disease

First report of an imported case of haemorrhagic fever with renal syndrome in South Africa

Haemorrhagic fever with renal syndrome (HFRS) is caused by hantavirus infection. Hantaviruses are not endemic to South Africa, and we report the first detection of an imported case of HFRS in the country. The case involved a traveller from Croatia who presented to a Johannesburg hospital with an acute febrile illness with renal dysfunction. The patient reported visiting rurally located horse stables in Croatia before falling ill, and that a worker in the stables with similar illness was diagnosed with HFRS. Given the exposure history and clinical findings of the case, a clinical diagnosis of HFRS was made and confirmed by laboratory testing.The NICD, a division of the National Health Laboratory Service.http://www.samj.org.zadm2022Medical Virolog

Human rabies associated with domestic cat exposures in South Africa, 1983–2018

Rabies is a fatal encephalitic disease caused by lyssaviruses belonging to the family Rhabdoviridae. At the time of this report, a total of 16 species of lyssaviruses, which included the prototype rabies virus (RABV), and 2 related but unclassified bat lyssaviruses, Taiwan and Kothalati, had been recognised by the International Committee on Taxonomy of Viruses (ICTV 2019). Globally RABV, also referred to as ‘classic rabies’, circulates in natural transmission cycles involving domestic dogs and various wildlife species. In the Americas, RABV is found in certain insectivorous and haematophagous bat species (Banyard et al. 2013). The public health burden of rabies is, however, very closely related to the occurrence of the disease in domestic dogs; thus, human cases of rabies are mostly reported from areas where dog rabies is uncontrolled (Hampson et al. 2015). An annual estimation of 59 000 human deaths occur worldwide with 95% of rabies cases occurring in Africa and Asia (Hampson et al. 2015). In South Africa, RABV circulates both in domestic animals and wildlife cycles, involving the canid and mongoose variants of the virus (Nel, Thomson & Von Teichman 1993). The urban cycle involves domestic dogs reported from various locations in the country, but particularly from the KwaZulu-Natal, Eastern Cape, Limpopo and Mpumalanga provinces (Cohen et al. 2007; Zulu, Sabeta & Nel 2009). Sylvatic cycles of the canid variant RABV in bat-eared foxes and black-backed jackal (Zulu et al. 2009) and the mongoose variant RABV in certain species of mongoose occur in South Africa (Van Zyl, Markotter & Nel 2010). Apart from the reservoir species, canid and mongoose RABV infections are reported in an array of domestic and wildlife species in the country, with these animals primarily serving as dead-end hosts (Sabeta et al. 2018). Laboratory-confirmed human rabies cases in South Africa are predominantly dogmediated, and seven cases of rabies linked to other domestic species and wildlife have been reported (Weyer et al. 2011).http://www.jsava.co.zaam2020Medical VirologyVeterinary Tropical Disease