10 research outputs found
Emerging fluoroquinolone and ketolide resistance in Haemophilus parainfluenzae in South Africa
No full textThis item has no abstract. Follow the links on the page to access the full text.</jats:p
Molecular characterisation of multidrug-resistant <i>Pseudomonas aeruginosa</i> from a private hospital in Durban, South Africa
No full textNative valve endocarditis due to Candida parapsilosis in an adult patient
No full textCandida endocarditis is rare, but associated with a high mortality. The most common species implicated is Candida albicans. The epidemiology of invasive Candida infections is changing, with a predominance of non-albicans species causing invasive disease. We describe a case of Candida parapsilosis endocarditis in an HIV-positive patient with pre-existing mitral valve disease and renal failure on haemodialysis. The patient presented with fever and malaise. Clinical examination revealed pulmonary oedema and severe mitral regurgitation. Blood cultures were positive for C. parapsilosis. β-D-glucan assay levels were elevated. An echocardiogram showed large, friable vegetations on the mitral valve. C. parapsilosis was cultured from the haemodialysis tip and the vegetations. The patient responded well to mitral valve replacement and antifungal therapy. A high index of suspicion and aggressive diagnostic modalities and therapy are essential in patients with candidaemia, to decrease mortality due to this condition.</jats:p
Emerg Infect Dis
No full textCandida auris is an invasive healthcare-associated fungal pathogen. Cases of candidemia, defined as illness in patients with Candida cultured from blood, were detected through national laboratory-based surveillance in South Africa during 2016-2017. We identified viable isolates by using mass spectrometry and sequencing. Among 6,669 cases (5,876 with species identification) from 269 hospitals, 794 (14%) were caused by C. auris. The incidence risk for all candidemia at 133 hospitals was 83.8 (95% CI 81.2-86.4) cases/100,000 admissions. Prior systemic antifungal drug therapy was associated with a 40% increased adjusted odds of C. auris fungemia compared with bloodstream infection caused by other Candida species (adjusted odds ratio 1.4 [95% CI 0.8-2.3]). The crude in-hospital case-fatality ratio did not differ between Candida species and was 45% for C. auris candidemia, compared with 43% for non-C. auris candidemia. C. auris has caused a major epidemiologic shift in candidemia in South Africa
Native valve endocarditis due to Candida parapsilosis in an adult patient
No full textCandida endocarditis is rare, but associated with a high mortality. The most common species implicated is Candida albicans. The epidemiology of invasive Candida infections is changing, with a predominance of non-albicans species causing invasive disease. We describe a case of Candida parapsilosis endocarditis in an HIV-positive patient with pre-existing mitral valve disease and renal failure on haemodialysis. The patient presented with fever and malaise. Clinical examination revealed pulmonary oedema and severe mitral regurgitation. Blood cultures were positive for C. parapsilosis. β-D-glucan assay levels were elevated. An echocardiogram showed large, friable vegetations on the mitral valve. C. parapsilosis was cultured from the haemodialysis tip and the vegetations. The patient responded well to mitral valve replacement and antifungal therapy. A high index of suspicion and aggressive diagnostic modalities and therapy are essential in patients with candidaemia, to decrease mortality due to this condition
Tet(M) Mediates Tetracycline Resistance in Methicillin-Resistant Staphylococcus aureus (MRSA) Clinical Isolates from the Private Hospital Sector in KwaZulu-Natal (KZN), South Africa
No full textTo elucidate the molecular determinants of tetracycline resistance in clinical methicillin-resistant Staphylococcus aureus (MRSA) isolates from the private health sector in KwaZulu-Natal province (KZN), South Africa (SA). Seventy-five clinical MRSA isolates were collected from the private hospital sector in KZN, SA over a one-year period. Susceptibility to antibiotics (tetracycline, doxycycline, minocycline and tigecycline) were determined and tetracycline resistant strains were screened using polymerase chain reaction (PCR) for the presence of four putative tetracycline resistance determinants (tet(K), tet(L), tet(M) and tet(O)). Efflux inhibitors were used to assess the possibility of efflux-mediated resistance.All isolates were mecA gene positive and susceptible to doxycycline, minocycline and tigecycline. Of note, 47 (62.67%) isolates were resistant to tetracycline. Doxycycline exhibited the largest number of intermediate resistance 20 (26.67%) in all the isolates. The tet(M)gene was found in all 47tetracycline-resistant isolates. No tet(L), tet(K) and tet(O) were detected. Efflux inhibitors did not have any significant effect on the sensitivity of tetracycline-resistant isolates suggesting that efflux played a minor role in tetracycline resistance. In conclusion; Tet(M) mainly mediates tetracycline resistance in MRSA in the private health sector in KZN, SA. This report on the prevalence and molecular determinants of tetracycline resistance is the first study on clinical MRSA isolates from the private health sector in SA
Spread of Plasmid-Encoded NDM-1 and GES-5 Carbapenemases among Extensively Drug-Resistant and Pandrug-Resistant Clinical Enterobacteriaceae in Durban, South Africa
No full textABSTRACT
Whole-genome sequence analyses revealed the presence of
bla
NDM-1
(
n
= 31),
bla
GES-5
(
n
= 8),
bla
OXA-232
(
n
= 1), or
bla
NDM-5
(
n
= 1) in extensively drug-resistant and pandrug-resistant
Enterobacteriaceae
organisms isolated from in-patients in 10 private hospitals (2012 to 2013) in Durban, South Africa. Two novel NDM-1-encoding plasmids from
Klebsiella pneumoniae
were circularized by PacBio sequencing. In p19-10_01 [IncFIB(K); 223.434 bp],
bla
NDM-1
was part of a Tn
1548
-like structure (16.276 bp) delineated by IS
26
. The multireplicon plasmid p18-43_01 [IncR_1/IncFIB(pB171)/IncFII(Yp); 212.326 bp] shared an 80-kb region with p19-10_01, not including the
bla
NDM-1
-containing region. The two plasmids were used as references for tracing NDM-1-encoding plasmids in the other genome assemblies. The p19-10_01 sequence was detected in
K. pneumoniae
(
n
= 7) only, whereas p18-43_01 was tracked to
K. pneumoniae
(
n
= 4),
Klebsiella michiganensis
(
n
= 1),
Serratia marcescens
(
n
= 11),
Enterobacter
spp. (
n
= 7), and
Citrobacter freundii
(
n
= 1), revealing horizontal spread of this
bla
NDM-1
-bearing plasmid structure. Global phylogeny showed clustering of the
K. pneumoniae
(18/20) isolates together with closely related carbapenemase-negative ST101 isolates from other geographical origins. The South African isolates were divided into three phylogenetic subbranches, where each group had distinct resistance and replicon profiles, carrying either p19-10_01, p18-10_01, or pCHE-A1 (8,201 bp). The latter plasmid carried
bla
GES-5
and
aacA4
within an integron mobilization unit. Our findings imply independent plasmid acquisition followed by local dissemination. Additionally, we detected
bla
OXA-232
carried by pPKPN4 in
K. pneumoniae
(ST14) and
bla
NDM-5
contained by a pNDM-MGR194-like genetic structure in
Escherichia coli
(ST167), adding even more complexity to the multilayer molecular mechanisms behind nosocomial spread of carbapenem-resistant
Enterobacteriaceae
in Durban, South Africa.
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First detection of human dirofilariasis in South Africa
No full textHumans are occasionally inadvertently infected with dirofilariae, the zoonotic nematodes. We report two cases of human dirofilariasis in South Africa, an area apparently non-endemic for this infection. Dirofilariasis is frequently misdiagnosed, so increased awareness of this entity in areas that are non-endemic is essential for prevention of inappropriate investigations and invasive therapy
Invasive Pneumococcal Disease in Neonates Prior to Pneumococcal Conjugate Vaccine Use in South Africa: 2003–2008
No full textEpidemiologic shift in Candidemia driven by Candida auris, South Africa, 2016–2017
No full textCandida auris is an invasive healthcare-associated fungal pathogen. Cases of candidemia, defined as illness in patients with Candida cultured from blood, were detected through national laboratory-based surveillance in South Africa during 2016–2017. We identified viable isolates by using mass spectrometry and sequencing. Among 6,669 cases (5,876 with species identification) from 269 hospitals, 794 (14%) were caused by C. auris. The incidence risk for all candidemia at 133 hospitals was 83.8 (95% CI 81.2–86.4) cases/100,000 admissions. Prior systemic antifungal drug therapy was associated with a 40% increased adjusted odds of C. auris fungemia compared with bloodstream infection caused by other Candida species (adjusted odds ratio 1.4 [95% CI 0.8–2.3]). The crude in-hospital case-fatality ratio did not differ between Candida species and was 45% for C. auris candidemia, compared with 43% for non–C. auris candidemia. C. auris has caused a major epidemiologic shift in candidemia in South Africa.http://wwwnc.cdc.gov/eidam2020School of Health Systems and Public Health (SHSPH
