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INTRODUCTION Despite widespread access to antiretroviral therapy (ART), the burden of advanced HIV disease in South Africa is high. This translates into an increased risk of AIDS-related opportunistic infections, including invasive mycoses. METHODS Using a limited number of non-culture-based diagnostic assays, we aimed to determine the prevalence of invasive mycoses and tuberculosis among hospitalised adults with very advanced HIV (CD4 counts

Background: Occupational crystalline silica dust exposure is associated with an elevated risk of pulmonary tuberculosis (PTB). However, there is less evidence for an association with environmental silica dust exposure. Methods: A cross-sectional study of 310 participants was conducted in an exposed community living within 2 km of gold mine tailings and an unexposed population residing more than 10 km from the nearest gold mine tailing. Chest radiographs (n = 178) were read for PTB, past or current, by three readers. Results: Past or current PTB was radiologically identified in 14.4% (95%CI 9.2&ndash, 21.8) in the exposed and 7.5% (95%CI 2.8&ndash, 18.7) in the unexposed groups. Multivariate logistic regression models suggested that PTB prevalence was independently associated with exposure to second-hand smoke (OR = 8.13, 95%CI 1.16&ndash, 57.22), a lower body mass index (OR = 0.88, 95%CI 0.80&ndash, 0.98), previous diagnosis and treatment of PTB (OR = 8.98, 95%CI 1.98&ndash, 40.34), and exposure to dust in the workplace from sand, construction, and/or mining industries (OR = 10.2, 95%CI 2.10&ndash, 50.11). Conclusion: We found no association between PTB and environmental exposure to gold mine tailing dust. However, workplace silica dust exposure is a significant risk factor for PTB in South Africa, and PTB patients of working age should be screened for silica exposure.

The effects on respiratory health in populations living close to silica-rich gold mine dumps are unknown. This pilot study related respiratory health and exposure to mine dump dust using two measures of exposure: exposure group, based on distance lived from the mine dump&mdash, high (n = 93) (home &lt, 500 m from a mine dump), moderate (n = 133) (500&ndash, 1.5 km), and low (n = 84) (&gt, 15 km, control group), and cumulative exposure index (CEI) derived from exposure group and number of years of residence in each exposure group. Participants were interviewed about respiratory symptoms and had chest X-rays and spirometry. We adjusted for key respiratory confounders. No subject had radiological features of silicosis. The high relative to low exposure group had significantly elevated adjusted odds ratios (aORs) for upper respiratory symptoms (aOR: 2.76, 95% CI: 1.28&ndash, 5.97), chest wheezing (aOR: 3.78, 95% CI: 1.60&ndash, 8.96), and spirometry-diagnosed chronic obstructive pulmonary disease (COPD) (aOR: 8.17, 95%CI: 1.01&ndash, 65.85). These findings were similar for the high relative to medium exposure group, but no significant associations were found for the medium versus low exposure group. Chronic bronchitis and tuberculosis risks did not differ significantly among groups. CEI and exposure group produced similar results. In conclusion, residents residing &lt, 500 m from mine dumps had elevated adverse respiratory health effects.

BackgroundThousands of people living in close proximity to gold mine waste dumps (GMWDs), are exposed to wind-swept, silica-rich dust. The effects on respiratory heath consequent on this exposure are largely unknown.ObjectiveTo examine associations between environmental GMWD dust exposure and respiratory health effects in adults.MethodsThis was a cross-sectional study of 93, 133 and 84 people in high (home 20 km) exposure groups respectively. We calculated a cumulative exposure index (CEI) based on exposure groups and years of residence. Participants were interviewed for respiratory symptoms, had chest X-rays (read by three experienced readers for tuberculosis and silicosis) and spirometry. We used multivariate logistic regression to examine the effect of dust exposure on respiratory health, and multiple linear regression to determine if CEI was associated with% predicted FEV1 and FVC. We adjusted for socioeconomic status, smoking and occupational and biomass fuel exposure.ResultsBeing in the high exposure group versus the low was associated with elevated adjusted odds ratios (aORs) for upper respiratory (aOR: 2.76, 95% CI: 1.28–5.97) and ocular symptoms (aOR: 4.68; 95% CI: 1.87–11.68), chest wheezing (aOR: 3.78; 95% CI: 1.60–8.96) and spirometry-diagnosed COPD (aOR: 8.17; 95% CI: 1.01–65.85). We found similar associations for the high versus medium exposure groups, but no significant associations in the medium relative to the low group. Exposure had no significant effect on the risks of chronic bronchitis and tuberculosis. We found similar significant results for CEI as for the exposure groups analyses. On linear regression, CEI was not associated with% predicted FEV1, but, surprisingly, FVC was positively associated with CEI. No participant had radiological features of silicosis.ConclusionResidents residing

Introduction We aimed to obtain an in-depth understanding on recent antimicrobial resistance trends and molecular epidemiology trends of S . aureus bacteraemia (SAB). METHODS: Thirteen academic centres in South Africa were included from June 2010 until July 2012. S . aureus susceptibility testing was performed on the MicroScan Walkaway. Real-time PCR using the LightCycler 480 II was done for mec A and nuc . SCC mec and spa -typing were finalized with conventional PCR. We selected one isolate per common spa type per province for multilocus sequence typing (MLST). RESULTS: S . aureus from 2709 patients were included, and 1231 (46%) were resistant to methicillin, with a significant decline over the three-year period (p-value = 0.003). Geographical distribution of MRSA was significantly higher in Gauteng compared to the other provinces (P

Introduction Hospital-associated methicillin-resistant S. aureus (HA-MRSA) remains a significant cause of morbidity and mortality worldwide. We conducted a study to determine risk factors for HA-MRSA in order to inform control strategies in South Africa. Methods We used surveillance data collected from five tertiary hospitals in Gauteng and Western Cape provinces during 2014 for analysis. A case of HA-MRSA was defined as isolation of MRSA from a blood culture 48 hours after admission and/or if the patient was hospitalised in the six months prior to the current culture. Multivariable logistic regression modelling was used to determine risk factors for HA-MRSA. Results Of the 9971 patients with positive blood cultures, 7.7% (772) had S. aureus bacteraemia (SAB). The overall prevalence of MRSA among those with SAB was 30.9% (231/747; 95% confidence interval [CI] 27.6%– 34.3%). HA-MRSA infections accounted for 28.3% of patients with SAB (207/731; 95% CI 25.1%– 31.7%). Burns (adjusted odds ratio [aOR] 12.7; 95% CI 4.7–34.4), age ≤1 month (aOR 8.7; 95% CI 3.0–24.6), residency at a long-term care facility (aOR 5.2; 95% CI, 1.5–17.4), antibiotic use within two months of the current SAB episode (aOR 5.1; 95% CI 2.8–9.1), hospital stay of 13 days or more (aOR 2.8; 95% CI 1.3–5.6) and mechanical ventilation (aOR 2.2; 95% CI 1.07–4.6), were independent risk factors for HA-MRSA infection. Conclusion The prevalence of MRSA remains high in South African tertiary public hospitals. Several identified risk factors of HA-MRSA infections should be considered when instituting infection and prevention strategies in public-sector hospitals, including intensifying the implementation of antimicrobial stewardship programmes. There is an urgent need to strengthen infection prevention and control in burn wards, neonatal wards, and intensive care units which house mechanically ventilated patients.

Introduction Meningitis is a major cause of mortality in southern Africa. We aimed to describe the aetiologies and frequencies of laboratory-confirmed fungal and bacterial meningitis among adults in a South African province with an 11% HIV prevalence, over 4 years. Methods We conducted a retrospective, observational study of secondary laboratory data, extracted on all cerebrospinal fluid (CSF) specimens submitted to public-sector laboratories in Gauteng province from 2009 through 2012. We calculated cause-specific incidence rates in the general and HIV-infected populations and used Poisson regression to determine if trends were significant. Results We identified 11,891 (10.7%) incident cases of meningitis from 110,885 CSF specimens. Cryptococcal meningitis, tuberculous meningitis and pneumococcal meningitis accounted for 62.3% (n = 7,406), 24.6% (n = 2,928) and 10.1% (n = 1,197) of cases over the four-year period. The overall incidence (cases per 100,000 persons) of cryptococcal meningitis declined by 23% from 24.4 in 2009 to 18.7 in 2012 (p