South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde
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Drug resistance is a serious problem in the treatment of tuberculosis and a threat to successful tuberculosis control programmes. Local health workers have expressed concern that the increasing tuberculosis epidemic in the Western Cape is partly attributable to drug resistance. The aim of this study was to determine the prevalence of tuberculosis drug resistance (including multidrug resistance) and to investigate possible relationships between drug resistance and patient demographic characteristics. ⋯ Results from this study indicated that drug resistance is currently not a major problem in the Western Cape, rates comparing favourably with those reported from developed countries and being much lower than those for developing countries. Every effort should therefore be made to maintain the status quo and to prevent the emergence of further resistance. The priority for tuberculosis control in the Western Cape should remain to limit transmission of the disease by reducing the infectious pool through improved cure of (especially) smear-positive cases.
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Comparative Study
Use of saliva as an alternative to serum for HIV screening in Africa.
Saliva has been recommended as a safe and effective alternative to serum for enzyme-linked immunosorbent assay (ELISA) for HIV antibodies in surveillance programmes in developing countries. We evaluated the use of saliva specimens for detection of HIV antibodies using three different commercially available ELISAs. Saliva specimens from 107 patients selected at random from HIV high-risk (38), medium-risk (27) and low-risk (42) areas of the hospital were screened with the Wellcozyme HIV1 + 2 GACELISA VK61 (recommended for use with saliva), Wellcozyme HIV1 + 2 VK54/55 and Wellcozyme HIV-1 recombinant VK56/57. ⋯ For detection of antibodies to HIV in saliva, the Wellcozyme HIV1 + 2 GACELISA VK61 had a sensitivity and a specificity of 98%, the Wellcozyme HIV-1 recombinant VK56/57 a sensitivity and specificity of 96%, and the Wellcozyme HIV1 + 2 VK54/55 a sensitivity of 94% and a specificity of 95%. For detection of antibodies to HIV in serum, the Wellcozyme HIV-1 recombinant VK56/57 had a sensitivity and a specificity of 100%, the Wellcozyme HIV1 + 2 GACELISA VK61 a sensitivity and a specificity of 98%, and the Wellcozyme HIV1 + 2 VK54/55 a sensitivity and a specificity of 96%. This study illustrates that saliva can be used as an alternative to serum for screening for anti-HIV antibodies in African patients.
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A 45-year-old man died 2 months after being bitten on the hand by a dog. He developed the rare but characteristic clinical picture of fulminant septicaemia and peripheral gangrene caused by a Gram-negative bacillus, Capnocytophaga canimorsus, previously known as dysgonic fermenter type 2 (DF-2), which is an occasional commensal in the oral flora of dogs and cats. This disease must be anticipated and dog bites appropriately managed to avoid the mortality associated with infection by this micro-organism. Initial treatment includes appropriate prophylactic antibiotics and debridement, while early exchange transfusion and emergency amputation may be of value in fulminant cases.