Staphylococcus aureus bacteraemia cases at Helen Joseph Hospital.

Background: Staphylococcus aureus bacteraemia (SAB) is associated with a high mortality. Data on SAB cases in South Africa (SA) are limited. Objectives: This study aimed to establish the demographic profile, risk factors and complications of patients with SAB in a tertiary inpatient setting. Method: We conducted a retrospective record review of inpatients above the age of 13 with SAB from October 2015 to November 2022 at Helen Jospeh Hospital (HJH) in Gauteng, SA. Results: A total of 126 patients with SAB were reviewed. The case fatality ratio among these patients was 20.6% (95% confidence interval [CI]: 13.9-28.8); this was similar for methicillin-sensitive S. aureus and methicillin-resistant S. aureus (p = 0.154). Almost half (49.2%) were community acquired, and these were chiefly associated with skin and soft tissue infections (45.2%), while most healthcare-associated community-acquired infections (18.3%) and nosocomial-related infections (32.5%) were associated with short-term venous catheterisation (40.6%). The most common risk factors for acquiring a SAB were prior hospitalisation in the last 90 days (27.8%), the presence of an invasive device (26.2%) and receipt of haemodialysis (15.1%). Having hypertension (adjusted odds ratio: 5.55 [95% CI: 1.31-23.55]) and being recently hospitalised (adjusted odds ratio: 11.88 [95% CI: 1.84-26.99]) were associated with statistically significant increased odds of death. Conclusion: SAB-associated all-cause mortality remains high in a middle-income tertiary hospital setting, albeit with a case fatality ratio comparable to that seen in high-income countries. Contribution: Our study suggests that acceptable outcomes are achievable in tertiary middle-income settings provided there is access to resources including infectious diseases consultation, echocardiograms and basic infection control practices.

Removal of Intraorbital Foreign Body by Transnasal Endoscopic Approach Removal of Intraorbital Foreign Body by Transnasal Endoscopic Approach.

Foreign bodies in the intra-orbital area are a rare occurrence. It can be metallic or non-metallic. Intra-orbital foreign bodies can present with a variety of complications depending upon its size and location. We report a case of intra-orbital foreign body which was successfully removed by trans-nasal endoscopic approach.A 12 year old boy with an intra-orbital wooden foreign body in the medial extra-conal space was presented three days post trauma. He had normal visual acuity but there was painful restriction of eye movement. Foreign body was removed and pus drained by trans-nasal endoscopic approach. Post operatively he gradually regained his eye movements. Post operatively patient had complete recovery of eye movements. Traditionally intra-orbital foreign bodies were removed by external approach. With advancement in technology medial intra-orbital foreign bodies can be removed by trans-nasal endoscopic approaches.

Endoscopic Optic Nerve Decompression for Direct Traumatic Optic Neuropathy : Our 10 Years Experience.

Traumatic optic neuropathy (TON) can be classified into direct or indirect types. Direct optic injury usually results from optic nerve avulsion ,laceration or compression by fracture, fracture segment impingement or a resultant hematoma. Indirect optic injury is caused by increased intracanalicular pressure resulting in ischemia and disruption of neurofeedback channels. The prognosis of TON is usually quite poor. To date, no standardized treatment protocol has been developed for TON. In this study we are assessing the visual improvement in patients with direct TON who underwent endoscopic optic nerve decompression in the last 10 years. A retrospective study of 32 cases of optic nerve decompression for direct TON in the last 10 years. Preoperative and postoperative visual assessment were done and followed up for 3 months. There was complete improvement in vision in 17% of patients when optic nerve decompression was done within 72 h of trauma; whereas 31% cases had only partial improvement when done between 3 and 7 days. And there was no improvement when done after 7 days. Endoscopic optic nerve decompression is a minimally invasive surgery for direct traumatic optic neuropathy; with minimal or no complications when done by an experienced ENT surgeon. Other important prognostic factors include timing of surgery and preoperative visual status.

Multiple opportunistic infections (pulmonary tuberculosis, Mycobacterium avium complex and parvovirus B19) in a single patient.

INTRODUCTION: HIV infection is a common disease in the South African population. The virus can lead to the development of many opportunistic infections. This case study examines co-infection with three opportunistic infections and the need for clinical suspicion of infections in our HIV population. PATIENT PRESENTATION: A 36-year-old unemployed female residing in Soweto, Johannesburg, presented at Chris Hani Baragwanath Hospital (CHBAH). She was HIV positive, defaulting treatment, with no other comorbidities. She presented to CHBAH with general body weakness, diarrhoea, cough and constitutional symptoms; clinically she appeared pale and chronically ill. A differential diagnosis was made of multiple infections co-inhabiting the patient. MANAGEMENT AND OUTCOME: The patient had blood, sputum, radiological and invasive bone marrow aspiration, and trephine biopsies completed. The investigations revealed that she was co-infected with Mycobacterium tuberculosis (MTB), Mycobacterium avium complex (MAC) and parvovirus B19. The TB and disseminated MAC infection were managed with rifampicin, isoniazid, ethambutol, pyrazinamide and azithromycin, and reinitiation of antiretroviral (ARV) treatment was planned on further follow-up of the ARV drug resistance test. The parvovirus B19 infection was managed with immunoglobulins (Polygam) and steroids (prednisone). She was discharged successfully for further follow-up. CONCLUSION: A thorough history, clinical examination and subsequent targeted investigations are vital to arriving at the correct diagnosis or diagnoses. The case presented above serves to illustrate how three life-threatening opportunistic infections (OIs), all with differing treatments, may present in a single patient. Clinicians caring for immunosuppressed patients need to remain vigilant for the presence of multiple OIs occurring simultaneously.

Role of Endoscopic Internal Maxillary Artery Ligation in Intractable Idiopathic Epistaxis.

The protocols for managing intractable idiopathic epistaxis have evolved with advances in endoscopic techniques. Transnasal endoscopic sphenopalatine artery ligation (TESPAL) has been the treatment of choice for idiopathic intractable epistaxis. If TESPAL fails, transantral ligation of internal maxillary artery (IMA) used to be the dictum along with radiological interventions. Here we discuss about the role of endoscopic IMA ligation in cases of failed TESPALs. Retrospective study at a tertiary hospital was performed. 28 cases of intractable idiopathic epistaxis underwent TESPAL in our institution of which 2 cases had rebleed. We also had two referred cases of failed TESPALS. Of this 4 patients, three patients underwent endoscopic IMA ligation and one patient underwent selective embolisation. All the patients who underwent endoscopic IMA ligation for failed TESPAL had no further episodes of epistaxis. One patient who underwent selective embolization also had no further episodes of bleed but had transient facial pain and trismus. When TESPAL fails, endoscopic IMA ligation can be considered as an alternative procedure before resorting to embolization.