The united airway - allergy and beyond

The concept of a 'united airway' became popular to link allergic rhinitis and asthma in many individuals who had symptoms of both upper and lower airway disease. Because of the common epithelium that runs all the way down the airway it is not surprising that in many individuals allergens trigger inflammation in both sites. However, the mere fact that some individuals have both symptoms of rhinitis and lower airway pathology does not mean the condition has an atopic basis. Since the airway has a limited number of ways of expressing symptoms, namely runny, sneezy, itchy and blocked nose, as well as cough or wheeze, these symptoms may also be produced in individuals who have quite a long list of other disease states. Although these are less common, healthcare workers will have to consider at some time that symptoms may be from primary ciliary dyskinesia, immune deficiency (primary or secondary), cystic fibrosis, Samter's triad or even recurrent viral airway infections. This article explores these conditions, suggesting their pathophysiology and symptom base. A clear message, to think of one of these conditions if symptoms do not have an allergy base and do not respond to first-line therapy, is expressed.http://www.allergysa.org/journal.htmam2013ay201

Meningococcal infections in hospitalised patients in Pretoria

We report on 13 patients diagnosed with meningococcal infections in patients attending state-owned hospitals serving an indigent population in Pretoria in 2009. The case fatality rate was 27%. Ceftriaxone was the main antibiotic (9 out of 13 patients) for therapy. Five isolates (39%) were serogroup B and 4 (31%) serogroup W135. Most isolates (12/13) were fully susceptible to penicillin (MIC range 0.016 - 0.047 μg/ml). A single isolate was intermediately resistant to penicillin (MIC, 0.125 μg/ml) while all isolates were uniformly susceptible to ceftriaxone, ciprofloxacin and rifampicin. This pattern reveals a shift in serogroups with an increase of serogroup B disease in the Pretoria region, and the need for ongoing monitoring of antimicrobial susceptibility profiles and the value of ceftriaxone for favourable therapeutic outcome.http://www.samj.org.z

HIV-related bronchiectasis in children : an emerging spectre in high tuberculosis burden areas

BACKGROUND: Human immunodeficiency virus (HIV) infected children have an eleven-fold risk of acute lower respiratory tract infection. This places HIV-infected children at risk of airway destruction and bronchiectasis. OBJECTIVE: To study predisposing factors for the development of bronchiectasis in a developing world setting. METHODS: Children with HIV-related bronchiectasis aged 6–14 years were enrolled. Data were collected on demographics, induced sputum for tuberculosis, respiratory viruses (respiratory syncytial virus), influenza A and B, parainfluenza 1–3, adenovirus and cytomegalovirus), bacteriology and cytokines. Spirometry was performed. Blood samples were obtained for HIV staging, immunoglobulins, immunoCAP®-specific immunoglobulin E (IgE) for common foods and aeroallergens and cytokines. RESULTS: In all, 35 patients were enrolled in the study. Of 161 sputum samples, the predominant organisms cultured were Haemophilus influenzae and parainfluenzae (49%). The median forced expiratory volume in 1 second of all patients was 53%. Interleukin-8 was the predominant cytokine in sputum and serum. The median IgE level was 770 kU/l; however, this did not seem to be related to atopy; 36% were exposed to environmental tobacco smoke, with no correlation between and CD4 count. CONCLUSION: Children with HIV-related bronchiectasis are diagnosed after the age of 6 years and suffer significant morbidity. Immune stimulation mechanisms in these children are intact despite the level of immunosuppression.This study was funded by the Research Development Program Fund of the University of Pretoria awarded to RM.http://www.theunion.org/about-the-journal/about-the-journal.htm

Disagreement between common measures of asthma control in children

BACKGROUND: Asthma is a worldwide problem. It cannot be prevented or cured, but it is possible, at least in principle, to control asthma with modern management. Control usually is assessed by history of symptoms, physical examination, and measurement of lung function. A practical problem is that these measures of control may not be in agreement. The aim of this study was to describe agreement among different measures of asthma control in children. METHODS: A prospective sequential sample of children aged 4 to 11 years with atopic asthma attending a routine follow-up evaluation were studied. Patients were assessed with the following four steps: (1) fraction of exhaled nitric oxide (F ENO ), (2) spirometry, (3) Childhood Asthma Control Test (cACT), and (4) conventional clinical assessment by a pediatrician. The outcome for each test was coded as controlled or uncontrolled asthma. Agreement among measures was examined by cross-tabulation and k statistics. RESULTS: Eighty children were enrolled, and nine were excluded. Mean F ENO in pediatricianjudged uncontrolled asthma was double that of controlled asthma (37 parts per billion vs 15 parts per billion, P , .005). There was disagreement among measures of control. Spirometric indices revealed some correlation, but of the unrelated comparisons, those that agreed with each other most often (69%) were clinical assessment by the pediatrician and the cACT. Worst agreement was noted for F ENO and cACT (49.3%). CONCLUSION: Overall, different measures to assess control of asthma showed a lack of agreement for all comparisons in this study.Division of Pulmonology Research Fund, Department of Paediatrics, University of Pretoriahttp://journal.publications.chestnet.orghb201

Prophylactic human papillomavirus vaccination against cervical cancer : a summarised resource for clinicians

No abstract available.http://www.sajgo.co.za/index.php/sajg

Allergic rhinitis in South Africa – Update 2014

The SAARWG met on the 8th and 9th February 2014 to discuss and review important concepts in allergic rhinitis diagnosis and management. The theme of that meeting was to lead clinicians through the ideal „Allergy Clinic‟ and the diagnostic facilities that may be offered to patients who present for management at such a clinic. The content of that meeting forms the basis of this update. The main reason for this statement is two-fold. Firstly, patients with allergic diseases require careful examination and secondly, they may need a set of diagnostic modalities. All physicians who see such patients must be knowledgeable of the interpretation of such tests. This review will focus specifically on the clinical tools and diagnostic modalities employed in the management of those conditions.http://reference.sabinet.co.za/sa_epublication/cacihttp://www.allergysa.org/journal.htmhb201

The value of pimecrolimus in improving quality of life of children with severe eczema – an open non-randomised study

BACKGROUND: Atopic eczema is a common skin condition. It has the potential to severely impair quality of life in affected children. Pimecrolimus is currently registered for mild-moderate eczema but in clinical practice children with more severe disease are often treated with this therapy in an attempt to find a safe addition to long-term topical corticosteroid usage. The aim of this study was to test the value of pimecrolimus in improving quality of life in children with severe atopic eczema. METHODS: This a single site, phase 4, non-randomised, open label trial of pimecrolimus use in children aged 4 months to 12 years living with moderate to very severe atopic eczema. The study was conducted at Steve Biko Academic Hospital. Patients with unsatisfactorily controlled disease despite conventional topical therapy, adequate use of emollients, allergen avoidance and non-pharmacological skin hygiene were enrolled. A Parent Index Quality of Life Questionnaire was completed by parents before and three months after using pimecrolimus. RESULTS: A total of 24 patients were recruited, 20 of whom completed the study. Ninety per cent of patients had co-morbid asthma and allergic rhinitis. The Parent Index Quality of Life demonstrated a mean 33% score improvement after the use of pimecrolimus. There was an attendant reduction in cost of therapy to these patients. CONCLUSIONS: Pimecrolimus usage should be extended to patients with more severe atopic eczema as the improvement in quality of life is important and demonstrable

Asthma control - practical suggestions for practicing doctors in family practice

Many surveys of asthma care suggest that only 5% of asthmatics are meeting the ‘Goals of asthma management’ as set out in the Global Initiative for Asthma (GINA) guidelines. Despite the availability of useful asthma therapies and treatment strategies, the morbidity from asthma has remained significant. This review includes practical suggestions on optimal asthma control for the family practitioner

Acute viral bronchiolitis : aetiology and treatment implications in a population that may be HIV co-infected

No abstract available

Outcome of human immunodeficiency virus–exposed and –infected children admitted to a pediatric intensive care unit for respiratory failure

Objective: Acute severe pneumonia with respiratory failure in human immunodeficiency virus-infected and -exposed infants carries a high mortality. Pneumocystis jiroveci is one cause, but other organisms have been suggested to play a role. Our objective is to describe the coinfections and treatment strategies in a cohort of human immunodeficiency virus-infected and -exposed infants with respiratory failure and acute respiratory distress syndrome, in an attempt to improve survival. Design: Prospective intervention study. Setting: Steve Biko Academic Hospital, Pretoria, South Africa. Patients: Human immunodeficiency virus–exposed infants with respiratory failure and acute respiratory distress syndrome were recruited into the study. Interventions: All infants were treated with routine therapy for Pneumocystis jiroveci and bacterial coinfection. However, in addition, all infants received ganciclovir from admission until the cytomegalovirus viral load result was demonstrated to be <log 4. Measurements: Routine investigations included human immunodeficiency virus polymerase chain reaction, cytomegalovirus viral load, blood culture, C-reactive protein, and white cell count. Tracheal aspirates for Pneumocystis jiroveci detection, bacterial culture, tuberculosis culture, and viral identification were performed. Main Results: Sixty-three patients met the recruitment criteria. The mortality rate was 30%. Pneumocystis jiroveci was positive in 33% of infants, while 38% had cytomegalovirus viral load ≥log 4. Only 7.9% of infants had a positive tuberculosis culture. Nineteen deaths occurred, 13 of which had a cytomegalovirus viral load ≥log 4. Bacterial coinfection and CD4 count were not predictors of mortality. Conclusions: A case fatality rate of 30% is achievable if severe pneumonia with respiratory failure and acute respiratory distress syndrome is managed with a combination of antibiotics and ventilation strategies. Cytomegalovirus infection appears to be associated with an increased risk of death in this syndrome. This may, however, be a marker of as yet undefined pathology.http://www.pccmjournal.orghb201