ABSTRACT
Background. GeneXpert MTB/RIF is useful for the diagnosis of pulmonary TB in adults, but there is limited evidence on its usefulness in extrapulmonary TB.Objectives. To investigate the diagnostic accuracy of GeneXpert MTB/RIF in HIV-infected and HIV-uninfected patients with suspected musculoskeletal TB.Methods. A prospective study of patients with suspected musculoskeletal (bone and joint) TB was undertaken. The diagnostic accuracy of GeneXpert MTB/RIF was compared with the reference standards of culture and histopathology.Results. A total of 206 biopsies from 201 patients (23% HIV-infected) were evaluated. The sensitivity and specificity of GeneXpert MTB/RIF was 92.3% (84/91) and 99.1% (114/115), respectively. GeneXpert MTB/RIF detected 8.8% more cases than culture (84/91 (92.3%) v. 76/91 (83.5%), respectively; p=0.069). GeneXpert MTB/RIF also detected all 4 multidrug-resistant TB cases and an additional 2 rifampicin-resistant cases in culture-negative samples. The sensitivity of GeneXpert MTB/RIF in HIV-infected patients was 96.9% (31/32) v. 89.6% (43/48) in HIV-uninfected patients (p=0.225).Conclusion. GeneXpert MTB/RIF is an accurate test for the detection of TB in tissue samples of HIV-infected and HIV-uninfected patients with suspected musculoskeletal TB. A positive GeneXpert MTB/RIF result should be regarded as microbiological confirmation of TB
Subject(s)
Data Accuracy , HIV Infections , Musculoskeletal Diseases , Rifampin , South Africa , Tissue Array Analysis , Tuberculosis, PulmonaryABSTRACT
Background. Routinely collected patient information has the potential to yield valuable information about health systems and population health, but there have been few comprehensive analyses of paediatric admissions at South African (SA) hospitals.Objectives. To investigate trends in hospitalisation and outcomes at Red Cross War Memorial Children's Hospital (RCWMCH), a major referral hospital for children in the Western Cape and SA.Methods. Using routinely collected observational health data from the hospital informatics system, we investigated admissions between 2004 and 2013. Clinical classification software was used to group International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) codes to rank causes during 2008 - 2013, when ICD-10 codes were widely available. Analyses examined trends in medical and surgical admissions over time. Results. There were 215 536 admissions over 10 years of 129 733 patients. Admissions increased by 9.3%, with increases in the general medical wards (5%), medical specialty wards (74%), the burns unit (73%), and the intensive care unit (16%). In contrast, admissions decreased in the trauma unit (21%) and short-stay medical wards (1%). In-hospital mortality decreased by 54% (p-trend <0.001) over 10 years. Diarrhoea and lower-respiratory tract illness were the most common causes for medical admissions, although admissions and deaths due to these conditions decreased between 2008 and 2013, which coincided with the national introduction of related vaccines. Similarly, tuberculosis admissions and deaths decreased over this period. These trends could be owing to a concurrent decrease in HIV comorbidity (p-trend <0.001). Trauma was the most common reason for surgical admission. Conclusion. Paediatric in-hospital mortality decreased consistently over a decade, despite an overall increase in admissions. Pneumonia and diarrhoea admissions decreased markedly over a 6-year period, but remain the most important causes of hospitalisation
ABSTRACT
Background. Pulmonary function tests (PFTs) objectively measure the extent and progression of cystic fibrosis (CF) lung disease. The rate of lung function decline in developing countries has not previously been studied. Aim. To investigate the average annual rates of pulmonary function decline in South African children with CF from 1999 to 2006. Methodology: The medical records and best PFT over 3-monthly intervals of children attending the CF clinic at Red Cross War Memorial Children's Hospital; Cape Town; were retrospectively reviewed and analysed using the mixed model regression method. Results. A total of 1 139 PFT were recorded on 79 patients; with a median (interquartile range) of 14 (6 - 21) PFTs per patient. The mean (standard error) forced expiratory volume in 1 second (FEV1) at age 6 years was estimated at 73.83 (3.34) per cent predicted with an FEV1 decline of 0.23 (0.43)per annum. FEV1 at age 6 was affected by age at CF diagnosis; genotype; and year of birth. Rate of FEV1 decline was significantly affected by Pseudomonas aeruginosa colonisation and genotype. Conclusions. Although FEV1 at age 6 years was low compared with developed countries; the annual rate of FEV1 decline in South African children with CF was minimal; setting the scene for improved survival in this population
Subject(s)
Child , Cystic Fibrosis , Lung DiseasesABSTRACT
Childhood empyema is an important complication of bacterial pneumonia. The incidence of empyema is increasing worldwide. Streptococcus pneumoniae and Staphylococcus aureus are the most common aetiologies in high and low-income countries respectively. The diagnosis is based on clinical; radiographic and pleural fluid examination. Tuberculosis (TB) is an important cause of a pleural effusion in high TB prevalence areas. There is controversy about the optimal treatment for empyema in children. Sepsis should be controlled with antibiotics and drainage of the pleural cavity. Intrapleural fibrinolysis and Video Assisted Thorascopic Surgery (VATS) are modern interventions widely used in high-income countries but mostly unavailable in the developed world. There are however few properly conducted studies that would support one therapeutic approach over the other. Despite this; the clinical outcome of paediatric empyema is usually good regardless of therapeutic approach. This review summarises aetiology; pathogenesis and clinical presentation of childhood empyema and discusses the various treatment modalities with an emphasis on clinical practice in developing countries