An outbreak of pertussis in Bloemfontein, South Africa, 2008–2009

Background: In April 2008, the first case of pertussis since 1998 was diagnosed in the Free State province. The outbreak that occurred over a 12-month period is described in this article.Method: This is a case series of 18 children diagnosed with pertussis in Bloemfontein, Free State province, between April 2008 and March 2009. The clinical diagnosis was confirmed by means of a Bordetella polymerase chain reaction test done on a nasal swab. Data were collected from every child with a confirmed diagnosis of pertussis.Results: Eighteen cases of pertussis were diagnosed in the 12-month period; 15 in the public sector and three in the private sector. A peak of cases was observed in the autumn and early winter months. Twelve infants were under six months of age and were thus regarded as ”pre-vaccinated”. Fourteen children required admission to hospital, of whom five required intensive care. No deaths occurred. The cost of managing these children was high.Conclusions: Pertussis is not commonly diagnosed in South Africa. Young children are worst affected by the disease. Ongoing surveillance is needed. A vaccination plan to prevent pertussis in South Africa requires consideration

Linezolid-containing regimens for the treatment of drug-resistant tuberculosis in South African children.

BACKGROUND: Treatment options for drug-resistant tuberculosis (DR-TB) are limited. Linezolid has been successfully used to treat DR-TB in adults, but there are few case reports of its use in children for TB. The reported rate of adverse events in adults is high. METHODS: We conducted a retrospective review of children with DR-TB treated with linezolid-containing regimens from February 2007 to March 2012 at two South African hospitals. RESULTS: Seven children (three human immunodeficiency virus [HIV] infected) received a linezolid-containing regimen. All had culture-confirmed DR-TB; five had previously failed second-line anti-tuberculosis treatment. Four children were cured and three were still receiving anti-tuberculosis treatment, but had culture converted. None of the non-HIV-infected children experienced adverse events while receiving linezolid. Three HIV-infected children had adverse events, one of which was life-threatening; linezolid was permanently discontinued in this case. Adverse events included lactic acidosis (n = 1), pancreatitis (n = 2), peripheral neuropathy (n = 1) and asymptomatic bone marrow hypoplasia (n = 1). CONCLUSION: Linezolid-containing regimens can be effective in treating children with DR-TB even after failing second-line treatment. Adverse events should be monitored, especially in combination with medications that have similar adverse effects. Linezolid remains costly, and a reduced dosage and duration may result in fewer adverse events and lower cost

Paediatric chronic suppurative otitis media in the Free State Province: Clinical and audiological features

Background. Chronic suppurative otitis media (CSOM) is a chronic infection of the middle ear cleft. In sub-Saharan Africa >50% of cases occur in children <10 years of age.Objectives. To describe the otological, audiological and bacteriological findings in children with CSOM.Methods. We conducted a prospective study at the Ear, Nose and Throat (ENT) Clinic at Universitas Academic Hospital between August 2009 and December 2010. We included all children with CSOM over this period. Patients underwent ENT and paediatric examination, and were tested for HIV. Pus swabs were taken after an ear toilet for routine microbiology, fungal and Mycobacterium tuberculosis culture. We performed audiological testing after the otorrhoea had resolved.Results. Eighty-six children (113 ears) were included, with a median age of 4.6 years (range 1 - 12 years). The mean duration of otorrhoea was 161.7 weeks (range 4 - 572 weeks). Nine patients (10.5%) presented with coalescent mastoiditis and/or intracranial complications of CSOM. Of the 153 organisms identified, Gram-negative bacteria were present in 93 (82.3%) ears, with 94.8% of these being sensitive to quinolones. Only 1 case of tuberculous otitis media was identified. HIV infection was present in 54.6% of patients tested. There was a hearing loss in 44 (66.7%) of the tested affected ears.Conclusions. There was a long delay between the onset of symptoms and accessing ENT services. Most cases of CSOM were due to quinolone-sensitive Gram-negative aerobes. There was a high prevalence of cholesteatoma, hearing loss and other complications in children in this study

Linezolid-containing regimens for the treatment of drug-resistant tuberculosis in South African children.

Geneeskunde en GesondheidswetenskappePediatrie En KindergesondheidPlease help us populate SUNScholar with the post print version of this article. It can be e-mailed to: [email protected]