Browsing by Author "Rabie H."

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    A 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.
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    An 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.
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    Antiretroviral 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.
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    Antiretroviral therapy in children with tuberculosis: Progress toward defining the issues
    (2010) Cotton M.F.; Rabie H.; Van Zyl G.U.
    [No abstract available]
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    Attention deficit hyperactivity and oppositional defiance disorder in HIV-infected South African children
    (2010) Zeegers I.; Rabie H.; Swanevelder S.; Edson C.; Cotton M.; van Toorn R.
    Objective: To determine the prevalence of attention deficit-hyperactivity disorder (ADHD) and oppositional defiance disorder (ODD) in HIV-infected South African children. Methods: Swanson, Nolan and Pelham (SNAP-IV) questionnaires were used to determine ADHD and ODD severity and a draw-a-person (DAP) test was used to screen for developmental disorders. Associations between behavioural subtypes, psychological functioning, demographic and health variables were investigated. Results: The SNAP-IV caregiver questionnaires showed a 26% prevalence of ADHD inattentive type; 38% hyperactive type and 24% combined type. The prevalence of ODD was 12% on parent questionnaires and 9.5% on teacher's questionnaires. Conclusions: Parents/caregiver-only SNAP-IV questionnaires indicate a high prevalence of significant ADHD (all subtypes) and ODD in HIV-infected children. No significant differences were found between the severity of HIV disease and the presence of a behavioural disorder. The SNAP IV questionnaires and DAP test may prove valuable screening tools in HIV children with behavioural problems. © The Author [2009]. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org.
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    Caring for our children
    (2007) Marais B.J.; Kangwana B.; Rabie H.; Cotton M.
    [No abstract available]
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    Children 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.
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    Common 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".
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    Common 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).
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    Early antiretroviral treatment reduces risk of bacille Calmette- Guérin immune reconstitution adenitis
    (2011) Rabie H.; Violari A.; Duong T.; Madhi S.A.; Josipovic D.; Innes S.; Dobbels, Els; Lazarus E.; Panchia R.; Babiker A.G.; Gibb D.M.; Cotton M.F.
    SETTING: Two centres in Soweto and Cape Town, South Africa. OBJECTIVE: To assess the effects of timing of initiation of antiretroviral treatment (ART) and other factors on the risk of bacille Calmette-Guérin (BCG) related regional adenitis due to immune reconstitution infl ammatory syndrome (BCG-IRIS) in human immunodefi ciency virus (HIV) infected infants. DESIGN: HIV-infected infants aged 6-12 weeks with CD4 count ≥25% enrolled in the Children with HIV Early Antiretroviral Therapy (CHER) Trial received early (before 12 weeks) or deferred (after immunological or clinical progression) ART; infants with CD4 count <25% all received early ART. All received BCG vaccination after birth. Reactogenicity to BCG was assessed prospectively during routine study follow-up. RESULTS: Of 369 infants, 32 (8.7%) developed BCGIRIS within 6 months of starting ART, 28 (88%) within 2 months after ART initiation. Of the 32 cases, 30 (93.8%) had HIV-1 RNA > 750 000 copies/ml at initiation. Incidence of BCG-IRIS was 10.9 and 54.3 per 100 personyears (py) among infants with CD4 count ≥25% at enrolment receiving early (at median age 7.4 weeks) vs. deferred (23.2 weeks) ART, respectively (HR 0.24, 95%CI 0.11-0.53, P < 0.001). Infants with CD4 count <25% receiving early ART had intermediate incidence (41.7/ 100 py). Low CD4 counts and high HIV-1 RNA at initiation were the strongest independent risk factors for BCG-IRIS. CONCLUSIONS: Early ART initiation before immunological and/or clinical progression substantially reduces the risk of BCG-IRIS regional adenitis. © 2011 The Union.
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    Important HIV-associated conditions in HIV-infected infants and children
    (2007) Rabie H.; Marais B.J.; Van Toorn R.; Nourse P.; Nel E.D.; Goussard P.; Sellers N.; Cotton M.F.
    This article is the last in a series of 6 articles that discussed the management of HIV-infected children in a clinically orientated, practical and concise fashion. The topics covered previously include; 1) Preventing and diagnosing HIV-infection in infants and children, 2) Initiating anti-retroviral therapy in HIV-infected infants and children, 3) Maintaining HIV-infected infants and children on anti-retroviral therapy, 4) Common opportunistic infection in HIV-infected children: Part 1-respiratory infections and 5) Part 2 non-respiratory infections.
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    Initiating anti-retroviral therapy in HIV-infected infants and children
    (2006) Rabie H.; Marais B.J.; Cotton M.F.
    [No abstract available]
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    Lopinavir exposure is insufficient in children given double doses of lopinavir/ritonavir during rifampicin-based treatment for tuberculosis
    (2011) McIlleron H.; Ren Y.; Nuttall J.; Fairlie L.; Rabie H.; Cotton M.; Eley B.; Meyers T.; Smith P.J.; Merry C.; Maartens G.
    Background: Coadministration of rifampicin dramatically reduces the concentrations of protease inhibitors. A pharmacokinetic study in healthy adults showed that doubling the dose of coformulated lopinavir/ritonavir was able to overcome the inducing effect of rifampicin. We evaluated this strategy in children treated with rifampicin-based antituberculosis therapy attending antiretroviral clinics in South Africa. Methods: Plasma concentrations of lopinavir were measured in children (aged 0.64-2.43 years) established on antituberculosis treatment who commenced antiretroviral therapy comprising double the usual recommended dose of lopinavir/ritonavir oral solution (460/115 mg/m2 twice daily) plus two nucleoside reverse transcriptase inhibitors. Control children (0.57-4.23 years old) without tuberculosis received standard doses of lopinavir/ritonavir (230/57.5 mg/m2 twice daily). Results: Pre-dose lopinavir concentrations were reduced by >80% in children with tuberculosis (median 0.7 mg/l, IQR 0.1-2.0) compared with controls (4.2 mg/l, IQR 3.4-8.1; P<0.001) and were below the minimum recommended concentration of 1 mg/l in 12 of 20 (60%) children with tuberculosis versus 2 of 24 (8%) controls (P<0.001). Conclusions: Double doses of coformulated lopinavir/ritonavir results in inadequate lopinavir concentrations in young children treated concurrently with rifampicin. Suitable regimens are urgently needed for treating young children with HIV-associated tuberculosis. ©2011 International Medical Press.
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    Maintaining infants and children on highly active antiretroviral therapy
    (2006) Rabie H.; Marais B.J.; Cotton M.F.
    [No abstract available]
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    Mass needle stick injury in children from the western cape
    (2006) de Waal N.; Rabie H.; Bester R.; Cotton M.F.
    Illegal dumping of contaminated medical waste occurs commonly in South Africa. There is little information on the management and outcome of the children exposed to and injured by medical waste. On 15 September 1999, 54 children where involved in a mass exposure incident. 44 presented the same evening and 10 following day. Used needles and syringes were discarded on their soccer field. Children gave one another injections and played darts with the discarded needles. Parents were counselled and blood was drawn for HIV and Hepatitis B virus (HBV) serology. All were given HBV vaccination (HBVV). Stat doses of zidovudine (ZDV) and lamivudine (LMV) were given to all with visible wounds or history of percutaneous injury. Younger children were given prophylaxis as we considered their histories unreliable. Further visits were conducted at the community clinic for patient convenience. Children were reviewed at weeks 1 and 3 for drug adherence and side effects. At week 4, the second HBVV was given. At 3 months and 6 months HIV and HBV serology were repeated. 18/44 (40 per cent) had entry wounds. 44/54 (81 per cent) were given antiretroviral treatment (ART). Initial screening for HIV was negative in all, 6 had antibodies to HBV surface antigen, and 2 were HBV surface antigen positive. At week 1 all patients on ART were seen but at week 3 only 30 (55 per cent) attended. 41 (75 per cent) attended at 4 weeks, 8 non-attendees being located by primary healthcare workers. At 3 months, none of the 35 (64 per cent) children had seroconverted for either virus. 44 (81 per cent) attended at 6 months and all serology was negative. All were also Hepatitis C negative. The exposure incident sensitized the community to HIV. Follow up of patients after mass exposure is difficult and time-consuming. Adherence to ART was poor and should be carefully monitored. ZDV was probably adequate for this incident. In a non-mobile community a 3 month visit unnecessary. © 2006 Oxford University Press.
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    Opsoclonus-myoclonus in an HIV-infected child on antiretroviral therapy-possible immune reconstitution inflammatory syndrome
    (2005) van Toorn R.; Rabie H.; Warwick, James M.
    The exact immunopathogenesis and neuroanatomical localization of opsoclonus-myoclonus ataxia syndrome remains unclear. We describe a 1 year 9 month old girl who, shortly after commencement of highly active antiretroviral therapy developed opsoclonus-myoclonus syndrome and subsequently died of disseminated cytomegalovirus infection. We postulate on the etiological factors that may have played a role in the disease pathogenesis of the patient's opsoclonus-myoclonus ataxia. Immune reconstitution inflammatory syndrome was considered the most likely because of the initial CD4 depletion and the onset of symptoms shortly after initiation of antiretroviral therapy. Single photon emission computed tomography (SPECT) proved helpful by localizing the area of dysfunction to the cerebellar vermis. © 2005 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved.
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    Oseltamivir use in low-birth weight infants during the 2009 nH1N1 influenza a outbreak in the Western Cape, South Africa
    (2012) Holgate S.L.; Bekker A.; Rabie H.; Cotton M.F.
    Before vaccination against nH1N1 influenza was available in South Africa our hospital experienced an outbreak of nH1N1 infection on the maternal and neonatal platform. Oseltamivir was administered to nine low birth weight infants, five for therapy and four for prophylaxis. The median gestational age was 31 (27-37) weeks and the birth weight was 1660 (720-2360) g. Respiratory function improved in those with confirmed disease and none receiving prophylaxis developed worsening respiratory symptoms. One neonate receiving prophylaxis developed self-limiting conjunctivitis; another succumbed from necrotizing enterocolitis (NEC) three days post completion of oseltamivir treatment. A causal relationship between oseltamivir and NEC, although unlikely, cannot be confirmed or excluded. © The Author [2011]. Published by Oxford University Press. All rights reserved.
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    Paediatric antiretroviral drug targets
    (2011) Slogrove, Amy L.; Rabie H.; Cotton M.
    Introduction: HIV-1 infection is a major problem for children in lower income countries. The benefit of early antiretroviral (ARV) therapy started within 12 weeks of life is well documented. Although the development of new drug classes give alternative options for highly treatment experienced patients there is inadequate pharmacokinetic knowledge regarding the already established ARV classes in infants and children. Also, there are many practical challenges to administering these agents to children. Method and Results: The challenges of current widely available treatment regimens in the light of new vertical transmission prevention guidelines are discussed. The dynamic physiological changes affecting pharmacokinetics in infancy and childhood are reviewed. New antiretroviral drugs in the established drug classes are presented. The new drug classes of entry inhibitors (including co-receptor binding inhibitors and fusion inhibitors), integrase inhibitors and other novel drug classes under development are described and relevant pediatric studies are reviewed. Work on novel drug delivery systems with potential to enhance adherence, improve drug exposure and reduce side-effects are discussed. Conclusion: The established benefits of ARV therapy in children of all ages can be enhanced by appropriate pharmacokinetic data on established antiretroviral agents and child-friendly drug formulations. Besides new suppressive treatment options in treatment experienced patients with multi-class resistant virus the new drug classes provide potential for novel means of disease modification and reduction of vertical transmission. Novel drug classes and delivery systems in development provide potential for further reduction in vertical transmission of HIV, rapid virological suppression and improved neurological outcomes in children and adults. © 2011 Bentham Science Publishers Ltd.
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    Paradoxical tuberculosis associated immune reconstitution inflammatory syndrome presenting with chylous ascites and chylothorax in a HIV-1 infected child
    (2010) Rabie H.; Lomp A.; Goussard P.; Nel E.; Cotton M.
    We present a case of tuberculosis (TB) paradoxical immune reconstitution inflammatory syndrome (IRIS) complicated by chylous ascites and chylothorax in a HIV-infected child. There are few descriptions of TB IRIS in children. This case extends the clinical spectrum of TB IRIS. © The Author [2010]. Published by Oxford University Press. All rights reserved.
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    Pediatric and adolescent imported malaria in Cape Town.
    (2009) Gray T.C.; Cooke M.L.; Rabie H.; Kidd M.; Cotton M.F.
    We reviewed 42 cases of pediatric and adolescent imported malaria in Cape Town. Patients were predominantly new and returned immigrants from other African countries. Rapid diagnosis occurred in most cases. Eleven of 42 (26%) had severe malaria. Management issues included delay to and inappropriate treatment, inadequate monitoring for hypoglycemia, and under notification to health authorities.