Reality bites of spider bites : a case report and review of the local epidemiology

Spider bites are a frequent complaint, often prompting patients to seek medical attention. However, the diagnosis of a spider bite is frequently inferred by the patient, and a thorough evaluation subsequently reveals an alternate diagnosis. Gertsch et al demonstrated that of 600 consecutive "spider bite" cases, 80% were incorrectly diagnosed. Alternative diagnoses included bites by arthropods other than spiders, bacterial, viral or fungal infections and malignant tumours. In this study, we describe the case of a patient who was initially misdiagnosed as having been bitten by a spider. Later, the patient was demonstrated to have a spontaneous, soft tissue Staphylococcus aureus infection. We further describe the local epidemiology of cases presenting with spider bites and the subsequent microbiological findings.Discovery Foundation.http://www.sajei.co.za/index.php/SAJEIam201

Biting off more than you can chew : microbiological flora isolated from human and animal bite wounds

BACKGROUND: Bite wounds, from human and animal origin, can lead to significant complications if appropriate therapy is not undertaken timeously. A basic knowledge of the microbiological flora is essential for each clinical setting in order to be able to facilitate appropriate empiric antibiotic therapy. MATERIAL AND METHODS: All patients admitted to the Steve Biko Academic Hospital over a 27-month period with histories of bite wound and taken to theatre for debridement were included in this study. All culture data was collected together with sensitivity profiles for all organisms isolated. RESULTS: In total, 38 patients were included in this study, with 25 sustaining human bite wounds, 11 sustaining dog bites, and only two with snake bites. The most striking finding is the predominance of Streptococcus spp isolated from human bite wounds. Although a relatively rare finding, Salmonella spp was isolated from one of the patients who sustained a snake bite. A surprising fraction of isolates were resistant to Amox-Clav, with only marginally improved sensitivity rates to second generation cephalosporins and fluoroquinolones. CONCLUSIONS: This study emphasises the importance of obtaining microbiological cultures on all patients admitted with bite wounds. This will not only assist in surveillance practices, but also provides the clinician with targeted therapy if the empiric antimicrobial should fail.This study has been approved by the Research Ethics Committee of the University of Pretoria, protocol number 58/2009. No benefits of any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.The Discovery Foundationay2013http://www.charpublications.co.za/C_JournalsORTH.aspam2013ay201

Decreased CD10 Expression in the Bone Marrow Neutrophils of HIV Positive Patients

Background: HIV-1 infection is associated with various quantitative and qualitative changes in haemopoietic cells. Clear distinction between primary myelodysplastic syndrome (MDS) and secondary dysplasia may not always be possible. Adjunctive analyses used in the diagnosis of MDS include cytogenetics and flow cytometry (FCM). Much focus has been placed on establishing FCM guidelines aiding in the diagnosis of MDS, and to distinguish this condition from secondary dysplastic changes. One of the parameters often cited is the CD10 expression on the granulocyte population, as this marker denotes granulocytic maturation.  Aims: To determine the expression level of CD10 on granulocytes in HIV positive patients.  Methods: In total, 117 HIV-1 positive and 29 HIV-1 negative patients were included in this study. Bone marrow aspirate samples were evaluated in terms of morphological abnormality as well as CD10 expression on the granulocytic population.  Results: The average CD10 expression among the HIV-1 positive patients were markedly reduced, at 18.4%, and 113 patients (96.6%) of these patients had expression levels below 50%. Discussion: Disease conditions causing secondary dysplasia, especially HIV-1 infection, is associated with a marked reduction in CD10 expression on the granulocyte population independent from the presence of myelodysplastic features. This marker is therefore of doubtful significance as a diagnostic tool in distinguishing between primary and secondary dysplasia

Microscopy 'AIDS' in diagnosing a febrile infant

A 5-month-old South African girl presented to a casualty department with a short history of fever. General examination did not reveal organomegaly or neck stiffness. In keeping with local guidelines, malaria was excluded on antigen testing and microscopy (thick and thin smear with Giemsa stain). Rickettsia typhi, R. conorii and Coxiella burnetti were also excluded on the basis of serological testing.http://www.sajhivmed.org.z

Microscopy 'AIDS' in diagnosing a febrile infant

A 5-month-old South African girl presented to a casualty department with a short history of fever. General examination did not reveal organomegaly or neck stiffness. In keeping with local guidelines, malaria was excluded on antigen testing and microscopy (thick and thin smear with Giemsa stain). Rickettsia typhi, R. conorii and Coxiella burnetti were also excluded on the basis of serological testing.http://www.sajhivmed.org.z

Human papillomavirus (HPV) vaccines

Human papillomavirus (HPV) infection has been estimated to cause 270 000 deaths worldwide annually from cervical cancer and approximately 80% of these occur in resource-poor countries.1 In South Africa, cervical cancer is the second most common malignancy among women, with the highest rate among black women aged 66 - 69 years.2 With the development of prophylactic HPV vaccines there are prospects of significant reduction in morbidity and mortality due to HPV infection and its complications.http://www.cmej.org.za/index.php/cme

Combination vaccines in the South African setting

The number of vaccines available and included as part of the national immunization schedules, has increased significantly over the past few decades. This impacts on patient/parent compliance and creates a challenge for health care providers for implementation of schedules necessitating training and infrastructure improvements. Use of combination rather than component vaccines offers advantages for compliance by single dose administration of various antigens, reducing stock costing as well as reducing cost of additional health care visits. Combination vaccines are often significantly more expensive than individual constituent vaccines. Concerns regarding an increased incidence of adverse events with use of combination vaccines have not been confirmed and rates may seem high as the adverse events seem to mimic the sum total of adverse event rates for each individual antigen used but may in fact be lower. Manufacturers typically advise against interchanging use of vaccine products. Despite this, health authorities advocate use of an alternative vaccine where the original vaccine in not available, to ensure continuity of vaccination. A notable exception is the acellular pertussis vaccine. Partly, because no serological correlates of immunity exist, but also a general lack of convincing follow up studies has prompted the recommendation for manufacturer fidelity for at least the first 3 vaccine doses. According to the South African Medicines Formulary, a variety of vaccines are available in South Africa. Although a large number are available in the private sector, the only true combination vaccine included in the current state EPI, modified in 2009, is the DTaP-IPV/Hib vaccine (Diphtheria, Tetanus, acellular Pertussis, inactivated Poliomyelitis virus and Haemophilus influenzae type b). There are many reasons justifying the use of combination vaccines rather that the individual constituent formulations. Implementation of use in the South African setting at this point is still limited, but may offer an exciting avenue of expanding the antigen repertoire without impacting on side-effects, efficacy or complexity of scheduling.http://www.elsevier.com/locate/vaccin

Fresh-frozen plasma use in a South African tertiary hospital

Despite available guidelines on indications for fresh-frozen plasma (FFP) transfusion, inappropriate use is increasing worldwide. We evaluated FFP administration to patients admitted to the Steve Biko Academic Hospital over 4 months, including indications for use and completeness of requisition forms. Transfusions were considered inappropriate for 39.5% of units administered. Of request forms submitted, only 22% had sufficient information for the blood transfusion services of the indication for transfusion. Transfusion with FFP is a medical intervention that carries risks and should be undertaken with care. Although this study was conducted in one centre, it is evident that clinicians’ lack of knowledge of the indications for administration of FFP is widespread. Intervention is necessary to improve patient outcomes and reduce expenditure.S Afr Med J 2012;102(6):366-36

Patient with protracted abdominal pain

Actinomycosis is very often misdiagnosed as typically, the associated laboratory and radiological findings are nonspecific. Therefore, clinicians should always have a high index of suspicion in cases in which there is a chronic, indolent development of a mass lesion with sinus tracts, that progresses through the tissue planes, and which relapses following short courses of antibiotics. Early diagnosis may prevent invasive investigations and radical surgical procedures as the patient can then simply be treated with oral penicillin.http://www.sajei.co.za/index.php/SAJEIam2014ay201