Pertussis in children in Bloemfontein, South Africa: A 7-year retrospective review.

BACKGROUND: Pertussis vaccination in the 1950s was associated with a decrease in the incidence of pertussis. A resurgence of pertussis has been documented, mainly in well-resourced countries since the 1990s. The burden of pertussis has not been well described in South Africa (SA). Epidemiological data are important for rational implementation of vaccination strategies. OBJECTIVE: To describe the morbidity and mortality of children with pertussis admitted to public sector hospitals in Bloemfontein, SA. METHODS: A retrospective descriptive hospital-based study of children diagnosed with pertussis by polymerase chain reaction testing from April 2008 to March 2015. RESULTS: One hundred and eighty-three laboratory results confirmed pertussis; 105/183 children (57.4%) were <18 weeks old. Clinical data, available for 154/183 cases (84.2%), showed that 141/154 children (91.6%) were admitted to hospital, of whom one-third required intensive care. Hospital admission was associated with young age (p<0.001). The median hospital stay was 9.0 days (interquartile range 6 - 14.5), and hospital stay was longer for children aged <18 weeks than for those aged ≥18 weeks (p=0.006; 95% confidence interval 1 - 5 days). Of the 154 children, 139 (90.3%) had a cough, which lasted ≤7 days in 110/137 cases (80.3%). The total white cell count was ≥20.0 × 109/L in 58/144 cases (40.3%). Eight children (5.2%) died. CONCLUSIONS: This case series highlights the importance of pertussis as a problem in children. Most children had a history of cough lasting ≤7 days. Young infants were most severely affected, requiring prolonged hospital stay, often with admission to a paediatric intensive care unit.

Clinical Presentation of Infants Hospitalised with Pertussis

Background. Despite the widespread use of pertussis vaccine; there has been a resurgence of pertussis cases in developed and developing countries. South Africa lacks data regarding clinical presentation and healthcare impact of pertussis.Objectives. To describe the clinical presentation and healthcare impact in hospitalised infants with confirmed pertussis.Methods. This was a retrospective cohort study; conducted in Bloemfontein between April 2008 and September 2012. Infants with laboratory-confirmed pertussis (group 1; N=102); were compared with infants with a negative pertussis result (group 2; N=104) and infants with a lower respiratory tract infection of unspecified aetiology (group 3; N=104). The following data were extracted from the clinical records: demographics; presenting symptoms; paediatric intensive care unit (PICU) admission; length of stay in the general ward and PICU; overall hospital stay and outcome.Results. There were no significant demographic differences between the groups. A larger percentage of infants in group 1 (n=41; 40%) required PICU admission compared with group 2 (n=37; 36%) and group 3 (n=20; 19%). The median PICU stay of group 1 was longer (11 days) compared with group 2 (6 days) and group 3 (5 days). The presence of cough and post-tussive vomiting was significantly higher in group 1 than groups 2 and 3. There was no significant difference in mortality between the groups. Conclusion. Pertussis results in significant morbidity in infants. Measures to identify and manage this vaccine-preventable disease should be considered at a national level

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.

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.

Ethionamide-Induced Hypothyroidism in Children

Ethionamide is a second-line anti-tuberculosis drug used in the management of drug-resistant tuberculosis. Hypothyroidism is reported to be a rare adverse effect. A retrospective descriptive study was done of all children started on treatment for multidrug-resistant tuberculosis from 2006-2009; who received ethionamide as part of their drug regimen. Information collected included age; weight; human immunodeficiency virus (HIV) status; ethionamide dose and thyroid function tests. Seven of 13 (54) children developed hypothyroidism and received thyroxine for the duration of ethionamide treatment. Thyroid function returned to normal within two months of completion of tuberculosis treatment in six of the seven children (one lost to follow-up). Ethionamide-induced hypothyroidism is more common in this small number of patients than previously reported. The results warrant further studies to confirm these findings and elucidate possible reasons