Browsing by Author "Cotton M.F."
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- ItemA case of congenital measles during the 2010 South African epidemic(2011) Dramowski A.; Bekker A.; Kirsten G.; Marais B.J.; Rabie H.; Cotton M.F.Congenital measles is a well recognised but uncommon transplacental infection in the post-vaccine era. A 4-day-old infant is described who presented with uncomplicated congenital measles during the 2010 South African measles outbreak. Clinicians working in regions affected by measles outbreaks should be mindful of waning vaccine-induced measles immunity where infections among pregnant women may result in a resurgence of congenital measles. © W. S. Maney & Son Ltd 2011.
- ItemA proposed comprehensive classification of tuberculosis disease severity in children(2012) Wiseman C.A.; Gie R.P.; Starke J.R.; Schaaf H.S.; Donald P.R.; Cotton M.F.; Hesseling A.C.Background: Tuberculosis (TB) in children has conventionally been classified as pulmonary TB (PTB) and extrapulmonary TB (EPTB) disease, including disseminated TB (TB meningitis and miliary disease). There is no existing approach that comprehensively characterizes the spectrum and severity of pediatric TB. This limits accurate classification of patients and comparison across cohorts. Aims: To develop a classification of pediatric TB that reflects the spectrum and severity of clinical disease better than currently available approaches. Methods: We propose a framework for the standard classification of TB disease severity in children. From a literature search, the following sources of information were used: clinical data, bacteriologic, histopathologic, and imaging data (including information from chest radiography, computerized tomography, and bronchoscopy). Each individual disease entity was systematically considered. Based on the extent and the presence of complications, each entity was then classified as "severe" or "nonsevere." As an initial application, we compared the proposed classification with the convention (PTB, EPTB) in a cohort of HIV-infected and-uninfected infants with culture-confirmed TB. Agreement between the 2 systems was poor. Conclusions: The proposed comprehensive disease classification system may more accurately reflect the clinical TB disease spectrum in children, is relevant to clinical management, and may be valuable to inform research on diagnostic tools and TB treatment strategies in children. Prospective studies are required to evaluate this approach in representative pediatric populations, correlating TB disease severity with diagnostic yield, treatment response, and application in existing and novel treatment strategies. © 2012 by Lippincott Williams & Wilkins.
- ItemAn HIV-infected infant with Bacille Calmette-Guérin disease, recurrent and multidrug-resistant tuberculosis complicated by acute cor pulmonale and hepatitis while on antiretroviral therapy(2007) van Montfrans J.M.; Rabie H.; Schaaf H.S.; Hesseling A.C.; Cotton M.F.; Shipton S.E.; Victor T.We describe the management of an HIV-infected infant with multisystem disease. The infant presented with severe disease at 3 months of age. Initiation of antiretroviral therapy (ART) was delayed through initial lack of access, after which she developed immune reconstitution inflammatory syndrome to BCG. At this time she was also infected with Mycobacterium tuberculosis, with a later recurrence due to multidrug-resistant (MDR) tuberculosis (TB). During this episode she presented with acute cor pulmonale, possibly due to a pulmonary embolus and also transaminitis. Although such infants are seen frequently in sub-Saharan Africa, there are few guidelines or case descriptions to assist clinicians.
- ItemAntiretroviral and Antituberculosis therapy in HIV-TB co-infected children(2011) Slogrove, Amy L.; Rabie H.; Cotton M.F.HIV-infected children experience a high burden of tuberculosis. With recent advances in international pediatric HIV treatment guidelines significant numbers of infants and children will require simultaneous treatment for both TB and HIV. This article attempts to concisely outline strategies for effective co-treatment of both infections. Rifamycins, an essential component of short course TB chemotherapy, alter the metabolism of a number of antiretroviral drugs. These interactions and their consequences are considered. Options for antiretroviral therapy and the optimal timing of its initiation in the presence of antituberculosis therapy are discussed. © 2011 Bentham Science Publishers Ltd.
- ItemAntiretroviral drugs for preventing mother-to-child transmission of HIV: A review of potential effects on HIV-exposed but uninfected children(2011) Heidari S.; Mofenson L.; Cotton M.F.; Marlink R.; Cahn P.; Katabira E.The provision of antiretroviral drugs for the prevention of mother-to-child HIV transmission has been rising sharply in low- and middle-income countries. Changes to the World Health Organization guidelines support further extension of these programs. The result will be a greatly expanded population of HIV-exposed but uninfected children with substantial exposure to antiretroviral drugs, both in utero and while breastfeeding. There are limited data on possible toxicities in this burgeoning population, and the large number of confounding factors limits any conclusions. Although the evidence on birth defects and mitochondrial toxicity remains equivocal, considerable data link protease inhibitors to preterm delivery and low birth-weight. Transient hematologic toxicities are also likely. The drug impact later in life is an open question. Larger and longer cohort studies are necessary to properly balance the risks and benefits of large-scale infant exposure to antiretroviral agents. © 2011 by Lippincott Williams & Wilkins.
- ItemAntiretroviral therapy in children with tuberculosis: Progress toward defining the issues(2010) Cotton M.F.; Rabie H.; Van Zyl G.U.[No abstract available]
- ItemBacteremia in human immunodeficiency virus-infected children in Cape Town, South Africa(2011) Le Roux D.M.; Cotton M.F.; Le Roux S.M.; Whitelaw A.; Lombard C.J.; Zar H.J.Bacteremia contributes to morbidity of HIV-infected children. In a randomized controlled trial evaluating trimethoprim-sulfamethoxazole (TMP-SMX) prophylaxis, 47 bacteremias were detected. The incidence rate of bacteremia increased in the first 3 months after starting combination antiretroviral therapy (cART), but decreased by 74% once children were established on cART for more than 3 months. Children should be prioritized for early cART. Copyright © 2011 by Lippincott Williams & Wilkins.
- ItemBacteriologically confirmed tuberculosis in HIV-infected infants: Disease spectrum and survival(2011) Wiseman C.A.; Schaaf H.S.; Cotton M.F.; Gie R.P.; Jennings T.; Whitelaw A.; Roux P.; Hesseling A.C.BACKGROUND: The human immunodeficiency virus (HIV) has resulted in epidemiological shifts with an emergence of tuberculosis (TB) amongst HIV-infected women and infants. There are limited data on the TB disease spectrum and outcome amongst HIV-infected infants. OBJECTIVES: We describe the clinical characteristics, treatment and survival of HIV-infected infants with culture-confirmed TB. METHODS: This retrospective hospital-based study from Cape Town, South Africa, used routine laboratory-based surveillance among infants diagnosed with culture-confirmed TB from 1 January 2004 to 31 December 2006. Folder and chest radiographic review were completed and vitality status established. TB was classified as pulmonary, extra-pulmonary or disseminated disease. RESULTS: Of 52 infants, 37 (71.1%) had pulmonary, 2 (3.9%) extra-pulmonary only, 7 (13.5%) pulmonary and extra-pulmonary and 6 (11.5%) disseminated TB. Forty-six (88.5%) were started anti-tuberculosis therapy; 37 (71.2%) received antiretroviral therapy (ART) and 17 (32.7%) died, 10 (19.2%) of whom never started ART. HIV stage 4 disease was associated with death. TB treatment outcome was poorly documented. CONCLUSIONS: TB is associated with advanced HIV disease and high mortality in HIV-infected infants. Missed opportunities for initiation of ART were frequent. Although the effects of young age, TB disease spectrum and HIV co-infection are difficult to distinguish, our findings support the initiation of early ART in HIV-infected infants with TB. © 2011 The Union.
- ItemCavitation of the Ghon focus in an HIV-infected infant who acquired tuberculosis after the initiation of HAART(2009) Innes S.; Schaaf H.S.; Cotton M.F.Tuberculosis immune reconstitution inflammatory syndrome (IRIS) may present as new or worsening cavitation. We present an HIV-infected infant in whom TB infection and subsequent cavitation of the Ghon focus appeared to coincide with immune reconstitution due to highly active antiretroviral therapy (HAART). TB-IRIS in response to infection that occurs after starting HAART has not previously been described.
- ItemChildren with human immunodeficiency virus infection admitted to a paediatric intensive care unit in South Africa(2007) Rabie H.; de Boer A.; van den Bos S.; Cotton M.F.; Kling S.; Goussard P.Background: Early data regarding the outcome of human immunodeficiency virus (HIV) - infected children in paediatric intensive care units (PICU) suggested mortality as high as 100%. Recent studies report mortality of 38%. Survival depends on the indication for admission. Objectives: To describe the prevalence, duration of stay, and outcome of HIV-infected patients in a single PICU over a 1-year period. Additional objectives included describing the indications for admission as well as the clinical and laboratory characteristics of HIV-infected infants and children requiring PICU admission. Method: Retrospective chart review of all children with serological proof of HIV admitted to PICU at Tygerberg Children's Hospital from 1 January to 31 December 2003. Results: Of the 465 patients admitted, 47 (10%) were HIV-infected. For HIV-infected children the median age on admission was 4 months. The median duration of stay was 6 days, significantly longer than for the non-HIV group (p = 0.0001). Fifty-seven percent had advanced clinical and immunological disease. Seventeen died in PICU and four shortly afterwards, poor PICU outcome was significantly associated with HIV status (p = 0.001). Lower total lymphocyte count (p = 0.004) and higher gamma globulin level (p = 0.04) were paradoxically the only findings significantly associated with survival. Acute respiratory failure (ARF) accounted for 76% of admissions, including Pneumocystis jiroveci in 38%. Fifty-one percent had evidence of cytomegalovirus infection. Conclusions: HIV-infected children requiring PICU can survive despite the lack of availability of antiretroviral therapy. © The Author [2007]. Published by Oxford University Press. All rights reserved.
- ItemClassification of HIV disease in children - Towards pragmatism?(2005) Cotton M.F.HIV infection is a multisystem disease characterised by progressive immunodeficiency and increasing susceptibility to common and opportunistic pathogens. Progressive disease is characterised by reversible and then permanent end-organ dysfunction due to HIV itself or co-pathogens, and also an increased risk of malignancy. The hallmark of immunodeficiency is CD4+ lymphocyte depletion, although other elements of the immune system are also deranged. Children with HIV are classified according to clinical and immunological criteria. Both systems are useful for individual patient management, and together are more useful than either parameter individually. Classification into mutually exclusive categories allows standardisation of this complex multisystem disease process, facilitating case management and informing the clinician of both the extent of clinical progression and prognosis. Because of the varied prevalence of pathogens in different geographical areas, disease manifestations may differ. Some pathogens, such as Pneumocystis jiroveci and cytomegalovirus (CMV), will cause the same disease manifestations in any location. Others, such as Mycobacterium tuberculosis, are more prevalent in sub-Saharan Africa than elsewhere. A classification system should take cognisance of this variability. Decisions to initiate antiretroviral therapy (ART) or to change therapy because of regimen failure are based on an understanding of disease progression. Lastly, the classification system allows for surveillance, facilitating planning by ministries of health for adequate resources and equitable access to care.
- ItemCommon opportunistic infections in HIV infected infants and children Part 1 - Respiratory infections(2006) Marais B.J.; Rabie H.; Schaaf S.H.; Cotton M.F.The prevention and adequate management of respiratory infections is extremely important when taking care of HIV-infected children. The successful use of HAART can drastically reduce the risk of opportunistic infections, which re-emphasizes the importance of making optimal use of this live giving opportunity, as discussed the previous articles in this series. The final topic to be covered is; "Common opportunistic infections in HIV infected infants and children; Part 2 - non-respiratory infections".
- ItemCommon opportunistic infections in HIV infected infants and children. Part 2: Non-respiratory infections(2007) Rabie H.; Marais B.J.; Van Toorn R.; Nel E.D.; Cotton M.F.Increased susceptibility to infections is the major cause of disease, end organ damage and death in human immunodeficiency virus (HIV)-infected children. This article will focus on prevention, diagnosis and management of the most common and less common severe infections that are specifically associated with HIV-related immune compromise, as well as some aspects relating to immune reconstitution inflammatory syndrome (IRIS).
- ItemConsensus statement on the revised World Health Organization recommendations for BCG vaccination in HIV-infected infants(2008) Hesseling A.C.; Cotton M.F.; Fordham Von Reyn C.; Graham S.M.; Gie R.P.; Hussey G.D.This document outlines the consensus agreement from the Union's BCG Working Group regarding BCG vaccination in HIV-infected infants, in response to recently revised World Health Organization (WHO) guidelines, which make HIV infection in infants a full contraindication to bacille Calmette-Guérin (BCG) vaccination. BCG is one of the most widely given vaccines globally and is safe in immunocompetent individuals. Recent evidence shows that HIV-infected infants who were routinely vaccinated with BCG at birth, when asymptomatic, and who later developed AIDS, are at high risk of developing disseminated BCG disease (estimated incidence 407-1300 per 100000). The document outlines requirements to implement selective BCG vaccination strategies in infants born to HIV-infected women and strategies to reduce the risk of vertical HIV transmission and disseminated BCG disease in infants. © 2008 The Union.
- ItemCulture-positive tuberculosis in human immunodeficiency virus type 1- infected children(1998) Schaaf H.S.; Geldenduys A.; Gie R.P.; Cotton M.F.Background. Adults infected by HIV have increased susceptibility to Mycobacterium tuberculosis and progress more rapidly to disease. HIV and tuberculosis (TB) coinfection in children has been reported but often lacks bacterial confirmation. We report on the clinical picture, special investigations, clinical course and outcome of 14 children with HIV infection and culture-confirmed TB from a developing country. Methods. The clinical records of all children, from 1992 to 1997, with HIV infection and culture- proved TB were reviewed. Results. Fourteen (10.4%) of 135 children with vertically transmitted HIV infection, 93% <2 years of age, fit the criteria. Nonresolving pneumonia (4) and otorrhoea (6) were common complaints. A Mantoux test was positive (≤15 mm) in 6 of 11 children. Extrapulmonary TB was present in 5 cases. Ear swabs were the source of M. tuberculosis culture in 3. Chest radiographs were abnormal in all with hilar and paratracheal lymphadenopathy present in 7. A source case with pulmonary TB was identified for 10. Susceptibility tests were done on 9 strains of which 1 was drug- resistant. Four children were culture-positive 4 to 10 months after initiation of TB treatment. Mortality was 21% and 3 were lost to follow-up. Conclusions. In HIV-infected children the Mantoux skin test remains useful and culture specimens should be obtained from all sources. Response to treatment is unpredictable, and for this reason repeated cultures should be taken during treatment and a 9-month course of treatment considered.
- ItemCytomorphological patterns of M. bovis BCG and M. tuberculosis on fine needle aspiration biopsies: Does HIV make a difference?(2011) Schubert P.T.; Cotton M.F.; Wright C.A.To determine if fine needle aspiration (FNAB) of mycobacterial lymphadenopathy can differentiate infection with M. bovis BCG (BCG) from M. tuberculosis (TB) and whether HIV status affects discriminatory cytological features. A retrospective study of culture positive, fine needle aspiration biopsies of lymph nodes in children (<13 years) between 2003 and 2008. A total of 77 aspirates were available for evaluation with 67 (87%) patients having known HIV status. BCG occurred at a younger age (6 months), predominantly axillary lymph nodes (90%) compared with TB (5 years and 20% axillary lymph nodes). Amorphous necrosis was only seen in aspirates fromTB lymph nodes, while in HIV negative children with TB, foamy macrophages were absent. OnZN staining there were more organisms in the BCG group and in HIV positive patients the organisms were present in both extra- and intracellular locations, whereas in the HIV negative patients the organisms were predominantly extracellular in location. Demographic and cytomorphologic features that can assist in distinguishing between thetwo mycobacterial species include: age of patient, location of the lymph node, and presence/absence of amorphous necrosis and foamy macrophages on FNAB. However the only reliable method to identify the mycobacterial species is by mycobacterial culture and/orPCR. © 2010 Wiley-Liss, Inc.
- ItemDental abscesses as a cause of 'unexplained' recurrent fever in a 9-year-old boy.(2000) Cotton M.F.; Hayton G.[No abstract available]
- ItemDiagnostic and management challenges for childhood tuberculosis in the era of HIV(2007) Marais B.J.; Graham S.M.; Cotton M.F.; Beyers N.The diagnosis and management of childhood tuberculosis (TB) pose substantial challenges in the era of the human immunodeficiency virus (HIV) epidemic. The highest TB incidences and HIV infection prevalences are recorded in sub-Saharan Africa, and, as a consequence, children in this region bear the greatest burden of TB/HIV infection. The tuberculin skin test (TST), which is the standard marker of Mycobacterium tuberculosis infection in immunocompetent children, has poor sensitivity when used in HIV-infected children. Novel T cell assays may offer higher sensitivity and specificity than the TST, but these tests still fail to make the crucial distinction between latent M. tuberculosis infection and active disease and are limited by cost considerations. Symptom-based diagnostic approaches are less helpful in HIV-infected children, because of the difficulty of differentiating TB-related symptoms from those caused by other HIV-associated conditions. Knowing the HIV infection status of all children with suspected TB is helpful because it improves clinical management. HIV-infected children are at increased risk of developing active disease after TB exposure/infection, which justifies the use of isoniazid preventive therapy once active TB has been excluded. The higher mortality and relapse rates noted among HIV-infected children with active TB who are receiving standard TB treatment highlight the need for further research to define optimal treatment regimens. HIV-infected children should also receive appropriate supportive care, including cotrimoxazole prophylaxis, and antiretroviral therapy, if indicated. Despite the difficulties experienced in resource-limited countries, the management of children with TB/HIV infection could be vastly improved by better implementation of readily available interventions. © 2007 by the Infectious Diseases Society of America. All rights reserved.
- ItemDiagnostic dilemmas in abdominal tuberculosis in children(2001) Saczek K.B.; Schaaf H.S.; Voss M.; Cotton M.F.; Moore S.W.The authors review 45 pediatric patients with intra-abdominal tuberculosis (ATB) treated between May 1990 and April 1998. The diagnosis was confirmed histologically or by positive culture for Mycobacterium tuberculosis. Clinical presentation was with an abdominal mass (12), subacute obstruction (11), ascites (5), mass and ascites (4), peritonitis (4), and 9 unusual presentations. Mantoux tests were positive in 68% of patients tested. There were radiologic features suggestive of pulmonary TB in 29 patients (64%); abnormal abdominal radiographs were recorded in 21 (47%). Lymphadenopathy was noted on abdominal ultrasound in 23 of 30 patients (77%) and on computed tomography scan in a further 3 of 8 patients investigated. Ascitic fluid adenosine deaminase (ADA) levels were greater than 30 IU/1 in 3 of 4 patients (75%), suggesting ATB. All 28 patients screened for human immunodeficiency virus were negative. A surgical procedure was performed in 39 patients, 29 (74%) had an elective diagnostic laparotomy for tissue diagnosis. One (3.4%) developed a postoperative intra-abdominal abscess. Ten (26%) presented with complications requiring surgical intervention including perforated viscus, segmental bowel resection, strictureplasty, adhesiolysis, or ileostomy. One of the latter died due to sepsis after having complications of persistent intestinal obstruction and cecal perforation. The authors recommend an aggressive approach to patients with suspected ATB in order to obtain an early definitive diagnosis, prevent complications, and reduce morbidity and mortality. They emphasize the importance of tissue diagnosis and confirmation by culture.
- ItemDisseminated bacille Calmette-Guérin disease in HIV-infected South African infants(2009) Hesseling A.C.; Johnson L.F.; Jaspan H.; Cotton M.F.; Whitelaw A.; Schaaf H.S.; Fine P.E.M.; Eley B.S.; Marais B.J.; Nuttall J.; Beyers N.; Godfrey-Faussett P.Objective: To determine the population-based incidence of disseminated bacille Calmette-Guérin (BCG) disease in HIV-infected infants (aged ≤ 1 year) in a setting with a high burden of tuberculosis and HIV infection coupled with a well-functioning programme for the prevention of HIV infection in infants. Methods: The numerator, or number of new cases of disseminated BCG disease, was derived from multicentre surveillance data collected prospectively on infants with a confirmed HIV infection during 2004-2006. The denominator, or total number of HIV-infected infants who were BCG-vaccinated, was derived from population-based estimates of the number of live infants and from reported maternal HIV infection prevalence, vertical HIV transmission rates and BCG vaccination rates. Findings: The estimated incidences of disseminated BCG disease per 100 000 BCG-vaccinated, HIV-infected infants were as follows: 778 (95% confidence interval, CI: 361-1319) in 2004 (vertical HIV transmission rate: 10.4%); 1300 (95% CI: 587-2290) in 2005 (transmission rate: 6.1%); and 1013 (95% CI: 377-1895) in 2006 (transmission rate: 5.4%). The pooled incidence over the study period was 992 (95% CI: 567-1495) per 100 000. Conclusion: Multicentre surveillance data showed that the risk of disseminated BCG disease in HIV-infected infants is considerably higher than previously estimated, although likely to be under-estimated. There is an urgent need for data on the risk-benefit ratio of BCG vaccination in HIV-infected infants to inform decision-making in settings where HIV infection and tuberculosis burdens are high. Safe and effective tuberculosis prevention strategies are needed for HIV-infected infants.
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