Optimizing Mycobacterial Culture in Smear-Negative,Human Immunodeficiency Virus-Infected Tuberculosis Cases

Introduction

Tuberculosis (TB) is a significant public health problem and the diagnosis in human immunodeficiency virus (HIV)—infected individuals is challenging. The use of mycobacterial culture remains an important complementary tool and optimizing it has important benefits. We sought to determine the effect of an increase in the number of specimens evaluated, addition of nutritional supplementation to the culture medium, sputum appearance and volume on diagnostic yield and time to detection of pulmonary TB among smear-negative, HIV-infected adults.

Methods

In this prospective study conducted at the Tshwane District Hospital and Academic TB Laboratory, Pretoria, South Africa we collected three sputum specimens an hour apart from presumptive TB cases at an antiretroviral treatment site. We analysed specimens from 236 patients. Specimen appearance and volume were recorded. All specimens were processed for culture using both standard and supplemented media.

Results

A single specimen identified 79% of PTB cases using standard media; the second and third specimens added 12.5% and 8.3% respectively. Media supplementation, sputum appearance and specimen volume had no effect on culture yield or contamination rates. The mean time to detection was reduced from 19.8 days in standard cultures to 11.8 days in nutrient supplemented cultures (p = 0.002). For every 1 ml increase in sputum volume, time to detection was decreased by a factor of 0.797 (p = 0.011).

Conclusion

Use of an inexpensive culture supplement substantially reduced time to detection and could contribute to reducing treatment delay among HIV-infected cases.     

Effects of Community-Based Natural Resource Management on Household Welfare in Namibia

Biodiversity conservation, as an environmental goal, is increasingly recognized to be connected to the socioeconomic well-being of local communities. The development of a widespread community-based natural resource management (CBNRM) program in Namibia makes it an ideal location to analyze the connection between conservation and socioeconomic well-being of local communities. Namibia’s CBNRM program involves the formation of communal conservancies within rural communities and previous studies have found it to be successful on both ecological and economic fronts. In order to broaden the understanding of the program’s impact to include social factors, we have conducted a comparative analysis to determine the effects of this program on household welfare outcomes. Data from two rounds of the Namibia Demographic and Health Surveys (2000 and 2006/07) and quasi-experimental statistical methods were used to evaluate changes in various health, education and wealth outcomes of those living in conservancies, relative to non-conservancy comparison groups. Regression results indicate mixed effects of the conservancy program at the household level. The program had positive effects on some health outcome variables, including bednet ownership, which was twice as likely to increase over time in conservancy compared to non-conservancy households. Program impacts were negative for education outcomes, with the proportion of school attendance of conservancy children being 45% less likely to increase over time than non-conservancy children. Wealth outcome results were inconclusive. Our findings highlight the importance of analyzing community conservation programs at a variety of scales when evaluating overall impact, as community-level benefits may not necessarily extend down to the household level (and vice versa).     

Waterlogging responses of Schoenoplectus scirpoides (Schrad) Browning (Cyperaceae)

Waterlogging responses of an emergent freshwater macrophyte, Schoenoplectus scirpoides, were investigated by carrying out laboratory and field experiments. Soil cores containing uniform plants of S. scirpoides were subjected to drained, 1/3 flooded, alternately flooded and drained at weekly intervals, and continuously flooded treatments for 6 months. Mean soil redox potential of the drained soil was 225 ± 29 mV and was significantly lower in the other treatments. Total dry biomass, above‐ground biomass and number of culms in the flooded/drained and flooded treatments were significantly higher than those in the drained and 1/3 flooded treatments. Below‐ground/above‐ground biomass ratios were highest in the drained treatment and significantly lower in the waterlogged treatments. Plant height and the growth rate of culms were least in the drained treatment and significantly higher in the other treatments. Culm specific gravity decreased significantly with increase in soil moisture. In the field study, soil redox potentials were moderately reduced in the inland and streamside sites, while culm elongation rate was significantly higher by 94% in the streamside compared with the inland site. Optimum growth occurred under flooded conditions, suggesting that the species could flourish with increasing water intrusion in estuarine areas, as predicted by global climate change.     

Differential effects of nitrogen and phosphorus enrichment on growth of dwarf Avicennia marina mangroves

The effects of N and P enrichment were investigated on growth and physiological responses of dwarf Avicennia marina mangroves in a hypersaline (58 ± 8 psu) field site in Richards Bay, South Africa. It was hypothesized that at high salinities mangroves allocate more resources to roots than shoots, and that nutrient enrichment with N and P will shift resource allocation to shoots and enhance growth and productivity. In unvegetated areas of the dwarf zone, 1-year-old A. marina seedlings were planted in pots and enriched bimonthly with N, P, N + P, or remained unfertilized (control-C), and growth and morphology of plants were monitored for 2 years. Enrichment with N and N + P shifted resource allocation to shoots from 38% to 55%, and increased dry biomass accumulation by over 500%, compared to the control treatment. In the N and N + P treatments, plant height, number of leaves, leaf chlorophyll content and photosynthesis increased by over 50%, 330%, 30% and 30%, respectively, compared to the C and P treatments. Enrichment with N and N + P increased N concentrations in roots by over 60% (from 1.0 ± 0.1% to 1.6 ± 0.2% of dry mass) and in shoots by over 100% (from 1.3 ± 0.1% to 2.7 ± 02% of dry mass). Plants enriched with P alone were similar to those of the control. This study has demonstrated that dwarf A. marina in Richards Bay is N limited, and that N enrichment shifts resource allocation from roots to shoots and increases growth and productivity.     

Factors Associated with Nursing Home Placement of All Patients Admitted for Inpatient Rehabilitation in Singapore Community Hospitals from 1996 to 2005: A Disease Stratified Analysis

Objectives

To (1) identify social and rehabilitation predictors of nursing home placement, (2) investigate the association between effectiveness and efficiency in rehabilitation and nursing home placement of patients admitted for inpatient rehabilitation from 1996 to 2005 by disease in Singapore.

Design

National data were retrospectively extracted from medical records of community hospital.

Data Sources

There were 12,506 first admissions for rehabilitation in four community hospitals. Of which, 8,594 (90.3%) patients were discharged home and 924 (9.7%) patients were discharged to a nursing home. Other discharge destinations such as sheltered home (n = 37), other community hospital (n = 31), death in community hospital (n = 12), acute hospital (n = 1,182) and discharge against doctor’s advice (n = 24) were excluded.

Outcome Measure

Nursing home placement.

Results

Those who were discharged to nursing home had 33% lower median rehabilitation effectiveness and 29% lower median rehabilitation efficiency compared to those who were discharged to nursing homes. Patients discharged to nursing homes were significantly older (mean age: 77 vs. 73 years), had lower mean Bathel Index scores (40 vs. 48), a longer median length of stay (40 vs. 33 days) and a longer time to rehabilitation (19 vs. 15 days), had a higher proportion without a caregiver (28 vs. 7%), being single (21 vs. 7%) and had dementia (23 vs. 10%). Patients admitted for lower limb amputation or falls had an increased odds of being discharged to a nursing home by 175% (p<0.001) and 65% (p = 0.043) respectively compared to stroke patients.

Conclusions

In our study, the odds of nursing home placement was found to be increased in Chinese, males, single or widowed or separated/divorced, patients in high subsidy wards for hospital care, patients with dementia, without caregivers, lower functional scores at admission, lower rehabilitation effectiveness or efficiency at discharge and primary diagnosis groups such as fractures, lower limb amputation and falls in comparison to strokes.     

Epidemiology of Staphylococcus aureus Bacteraemia at a Tertiary Children’s Hospital in Cape Town,South Africa

Background

Staphylococcus aureus is an important pathogen in paediatric patients with bloodstream infections. The epidemiology of S. aureus bacteraemia, however, has not been well documented in children in South Africa.

Methods

A retrospective study was conducted at a children’s hospital in Cape Town, South Africa, to investigate the epidemiology of S. aureus bacteraemia from 2007-2011. The incidence, clinical presentation, risk factors, management and outcomes of methicillin sensitive S. aureus (MSSA) and methicillin resistant S. aureus (MRSA) bacteraemia were compared.

Results

Over the five year study period, 365 episodes of S. aureus bacteraemia were identified. The annual incidence was 3.28 cases per 1000 hospital admissions. MRSA was responsible for 26% of S. aureus bacteraemia and 72% of nosocomial infections. Only six possible cases of community-acquired MRSA infections were described. MSSA bacteraemia was more likely to present as pulmonary and bone or joint infections, while bacteraemia without a source was the most common presentation with MRSA.  Infants, children with malnutrition, and residents of long-term care facilities were at highest risk for MRSA bacteraemia. The overall case fatality rate for S. aureus bacteraemia was 8.8% over five years, with MRSA being the only significant risk factor for mortality.

Conclusion

The incidence of S. aureus bacteraemia and MRSA bacteraemia in children has remained stable over the past five years. MRSA is a predominantly nosocomial pathogen in children with S. aureus bacteraemia in Cape Town, South Africa.     

Structural and functional characterization of peptides derived from the carboxy‐terminal region of a defensin from the tick Ornithodoros savignyi

Tick defensins may serve as templates for the development of multifunctional peptides. The purpose of this study was to evaluate shorter peptides derived from tick defensin isoform 2 (OsDef2) in terms of their antibacterial, antioxidant, and cytotoxic activities. We compared the structural and functional properties of a synthetic peptide derived from the carboxy‐terminal of the parent peptide (Os) to that of an analogue in which the three cysteine residues were omitted (Os–C). Here, we report that both peptides were bactericidal (MBC values ranging from 0.94–15 µg/ml) to both Gram‐positive and Gram‐negative bacteria, whereas the parent peptide only exhibited Gram‐positive antibacterial activity. The Os peptide was found to be two‐fold more active than Os–C against three of the four tested bacteria but equally active against Staphylococcus aureus. Os showed rapid killing kinetics against both Escherichia coli and Bacillus subtilis, whereas Os–C took longer, suggesting different modes of action. Scanning electron microscopy showed that in contrast to melittin for which blebbing of bacterial surfaces was observed, cells exposed to either peptide appeared flattened and empty. Circular dichroism data indicated that in a membrane‐mimicking environment, the cysteine‐containing peptide has a higher α‐helical content. Both peptides were found to be non‐toxic to mammalian cells. Moreover, the peptides displayed potent antioxidant activity and were 12 times more active than melittin. Multifunctional peptides hold potential for a wide range of clinical applications and further investigation into their mode of antibacterial and antioxidant properties is therefore warranted. Copyright © 2013 European Peptide Society and John Wiley & Sons, Ltd.