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Trans: Issue 18 Editorial
Andrew Murphie, Adrian Mackenzie, Mitchell Whitelaw
Fibreculture Journal , 2011,
Abstract: It is now perhaps a commonplace that digital, networked and informational media are extremely transient. They diversify in form and function at a dizzying rate. At the same time, they transit and fuse “social” and “natural” differences in a manner which reconfigures all the worlds involved. It is also perhaps a commonplace to suggest that some established powers have found it difficult to come to grips with this (although this is perhaps beginning to change). For many, from seriously challenged newspaper proprietors to established media disciplines, it might be time to pause for breath, if only for a moment—to regroup and adapt established practices and ideas, to count the survivors from among the old media worlds of just a few years ago.While occasionally sympathetic, this issue of the Fibreculture Journal questions this approach. If we pause for breath, it is to take in the new air. This issue draws on the accelerated evolutions of media forms and processes, the microrevolutions in the social (and even the natural sciences) that dynamic media foster, even the way in which “new” media lead us to reconsider the diversity of “old” media species. Summed up simply here under the sign/event of the “trans,” this issue catalyzes new concepts, accounts of and suggestions for new practices for working with all these processes.
Epidemiology of Staphylococcus aureus Bacteraemia at a Tertiary Children’s Hospital in Cape Town, South Africa
Reené Naidoo, James Nuttall, Andrew Whitelaw, Brian Eley
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0078396
Abstract: 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.
Bacterial Disease and Antimicrobial Susceptibility Patterns in HIV-Infected, Hospitalized Children: A Retrospective Cohort Study
Heather B. Jaspan, Lyen C. Huang, Mark F. Cotton, Andrew Whitelaw, Landon Myer
PLOS ONE , 2008, DOI: 10.1371/journal.pone.0003260
Abstract: Background Serious bacterial infections are a major source of morbidity and mortality in HIV-infected children. The spectrum of disease is wide, and responsible organisms vary according to setting. The use of antibiotic prophylaxis and the emergence of multi-drug resistant bacteria necessitate examination of responsible organisms and their antibiotic susceptibility. Methodology/Principal Findings A retrospective cohort study of all HIV-positive pediatric admissions at an urban public sector hospital in Cape Town between January 2002 and June 2006 was conducted. Children between the ages of one month and nine years with laboratory confirmed HIV status, serious bacterial infection, and a hospital length of stay of 5 days or more, were eligible for inclusion. Organisms isolated from blood, urine, and cerebral spinal fluid cultures and their antimicrobial susceptibility were examined, and compared according to timing of isolation to distinguish nosocomial versus community-acquired. One hundred and forty-one children were identified (median age 1.2 years), 39% of whom were on antiretrovirals started before or during this hospitalization. Bacterial infections involved all organ systems, however pneumonia was most common (67%). S. pneumoniae and S. aureus were the most common gram positive and K. pneumoniae was the most common gram negative organism. K pneumoniae isolates were resistant to many first and second line antibiotics, and were all considered nosocomial. All S. aureus isolates were methicillin resistant, some of which were community-acquired. Conclusions/Significance Bacterial infections are an important source of co-morbidity in HIV-infected children in resource-limited settings. Clinicians should have a low threshold to initiate antibiotics in children requiring hospitalization. Broad-spectrum antibiotics should be used judiciously. Clinicians caring for HIV-infected children should be cognizant of the most common organisms affecting such children, and of their local antimicrobial susceptibilities, when treating empirically for serious bacterial infections.
Isolation of Non-Tuberculous Mycobacteria in Children Investigated for Pulmonary Tuberculosis
Mark Hatherill, Tony Hawkridge, Andrew Whitelaw, Michele Tameris, Hassan Mahomed, Sizulu Moyo, Willem Hanekom, Gregory Hussey
PLOS ONE , 2006, DOI: 10.1371/journal.pone.0000021
Abstract: Objective To evaluate the frequency and clinical significance of non-tuberculous mycobacteria (NTM) isolates among children investigated for pulmonary tuberculosis in a rural South African community. Methods Children were investigated for pulmonary tuberculosis as part of a tuberculosis vaccine surveillance program (2001–2005). The clinical features of children in whom NTM were isolated, from induced sputum or gastric lavage, were compared to those with culture-proven M. tuberculosis. Results Mycobacterial culture demonstrated 114 NTM isolates from 109 of the 1,732 children investigated, a crude yield of 6% (95% CI 5–7). The comparative yield of positive NTM cultures from gastric lavage was 40% (95% CI 31–50), compared to 67% (95% CI 58–76) from induced sputum. 95% of children with NTM isolates were symptomatic. Two children were HIV-infected. By contrast, M. tuberculosis was isolated in 187 children, a crude yield of 11% (95% CI 9–12). Compared to those with culture-proven M. tuberculosis, children with NTM isolates were less likely to demonstrate acid-fast bacilli on direct smear microscopy (OR 0.19; 95% 0.0–0.76). Children with NTM were older (p<0.0001), and more likely to demonstrate constitutional symptoms (p = 0.001), including fever (p = 0.003) and loss of weight or failure to gain weight (p = 0.04), but less likely to demonstrate a strongly positive tuberculin skin test (p<0.0001) or radiological features consistent with pulmonary tuberculosis (p = 0.04). Discussion NTM were isolated in 6% of all children investigated for pulmonary tuberculosis and in more than one third of those with a positive mycobacterial culture. NTM may complicate the diagnosis of PTB in regions that lack capacity for mycobacterial species identification. The association of NTM isolates with constitutional symptoms suggestive of host recognition requires further investigation.
High incidence of antimicrobial resistant organisms including extended spectrum beta-lactamase producing Enterobacteriaceae and methicillin-resistant Staphylococcus aureus in nasopharyngeal and blood isolates of HIV-infected children from Cape Town, South Africa
Mark F Cotton, Elizabeth Wasserman, Juanita Smit, Andrew Whitelaw, Heather J Zar
BMC Infectious Diseases , 2008, DOI: 10.1186/1471-2334-8-40
Abstract: NP swabs were taken at baseline from HIV-infected children enrolled in the study. Standard microbiological techniques were used. Children were grouped according to previous or current exposure to TMP-SMX and whether enrolled to the study during a period of hospitalization. Blood culture results were also recorded within 12 months of baseline.Two hundred and three children, median age 1.8 (Interquartile [IQ]: 0.7–4) years had NP swabs submitted for culture. One hundred and eighty-four (90.7%) had either stage B or C HIV disease. One hundred and forty-one (69.8%) were receiving TMP-SMX and 19 (9.4%) were on antiretroviral therapy. The majority, 168 (82%) had a history of hospitalization and 91 (44.8%) were enrolled during a period of hospitalization. Thirty-two subjects (16.2%) died within 12 months of study entry.One hundred and eighty-one potential pathogens were found in 167 children. The most commonly isolated organisms were Streptococcus pneumoniae (48: 22.2%), Gram-negative respiratory organisms (Haemophilus influenzae and Moraxella catarrhalis) (47: 21.8%), Staphylococcus aureus (44: 20.4%), Enterobacteriaceae 32 (14.8%) and Pseudomonas 5 (2.3%).Resistance to TMP-SMX occurred in > 80% of pathogens except for M. catarrhalis (2: 18.2% of tested organisms). TMP-SMX resistance tended to be higher in those receiving it at baseline (p = 0.065). Carriage of Methicillin resistant S. aureus (MRSA) was significantly associated with being on TMP-SMX at baseline (p = 0.002). Minimal inhibitory concentrations (MIC) to penicillin were determined for 18 S. pneumoniae isolates: 7 (38.9%) were fully sensitive (MIC ≤ 0.06 μg/ml), 9 (50%) had intermediate resistance (MIC 0.12 – 1 μg/ml) and 2 (11.1%) had high level resistance (MIC ≥2 μg/ml). Fifty percent of Enterobacteriaceae produced extended spectrum beta-lactamases (ESBL) (resistant to third generation cephalosporins) and 56% were resistant to gentamicin. Seventy-seven percent of S. aureus were MRSA. Carriage of resistant org
Genetic basis of rifampicin resistance in methicillin-resistant Staphylococcus aureus suggests clonal expansion in hospitals in Cape Town, South Africa
Melissa J Jansen van Rensburg, Andrew C Whitelaw, Brenda G Elisha
BMC Microbiology , 2012, DOI: 10.1186/1471-2180-12-46
Abstract: Between July 2007 and June 2011, the prevalence of rifampicin-resistant MRSA in hospitals in Cape Town ranged from 39.7% to 46.4%. Based on the results of the aforementioned study, nine ST612-MRSA-IV isolates, the rifampicin-resistant ST5-MRSA-I isolate, and two rifampicin-susceptible MRSA isolates were investigated. Four previously described ST612-MRSA-IV isolates, including two each from South Africa and Australia, were also included.The ST5-MRSA-I isolate carried a single mutational change, H481Y, commonly associated with high-level rifampicin resistance. All ST612-MRSA-IV isolates carried an uncommon double amino acid substitution in RpoB, H481N, I527M, whilst one of the Australian ST612-MRSA-IV isolates carried an additional mutation within rpoB, representing a novel rpoB genotype: H481N, I527M, K579R. All ST612-MRSA-IV isolates also shared a unique silent single nucleotide polymorphism (SNP) within rpoB.That local ST612-MRSA-IV isolates described here share an uncommon rpoB genotype and a unique silent SNP suggests this clone may have undergone clonal expansion in hospitals in Cape Town. Further, the data suggest that these isolates may be related to rifampicin-resistant ST612-MRSA-IV previously described in South Africa and Australia.It has long been acknowledged that antimicrobial use drives the emergence of resistant pathogens [1]. Currently in South Africa, rifampicin is used primarily for the treatment of tuberculosis, although it is also sometimes used in combination therapies to treat Staphylococcus aureus infections. A national antimicrobial susceptibility surveillance study carried out in South Africa between 2005 and 2006 showed that 52.8% of MRSA isolates from public diagnostic laboratories were rifampicin-resistant [2]. Regional studies carried out between 2001 and 2006 in public hospitals in the Kwa-Zulu Natal and Gauteng provinces of South Africa reported that 63 - 100% of MRSA isolates were rifampicin-resistant [3,4]. Given South Africa's high i
Art Against Information: Case Studies in Data Practice
Mitchell Whitelaw
Fibreculture Journal , 2008,
Abstract: This article makes a critical analysis of new media art working with data interfaces and visualisation – data practice or data art. Pursuing the distinction between information and data, it is demonstrated that data art often turns away from information in an attempt to present the data itself. In the process, data art constructs figures of data as unmediated, immanent, material and underdetermined. A critical analysis of these figures underpins reflections on the wider significance and potential of such data practices.
The TOBY Study. Whole body hypothermia for the treatment of perinatal asphyxial encephalopathy: A randomised controlled trial
Dennis Azzopardi, Peter Brocklehurst, David Edwards, Henry Halliday, Malcolm Levene, Marianne Thoresen, Andrew Whitelaw, The TOBY Study Group
BMC Pediatrics , 2008, DOI: 10.1186/1471-2431-8-17
Abstract: Studies in adult and newborn animals have shown that a reduction of body temperature of 3–4°C after cerebral insults is associated with improved histological and behavioural outcome. Pilot studies in infants with encephalopathy of head cooling combined with mild whole body hypothermia and of moderate whole body cooling to 33.5°C have been reported. No complications were noted but the group sizes were too small to evaluate benefit.TOBY is a multi-centre, prospective, randomised study of term infants after perinatal asphyxia comparing those allocated to "intensive care plus total body cooling for 72 hours" with those allocated to "intensive care without cooling".Full-term infants will be randomised within 6 hours of birth to either a control group with the rectal temperature kept at 37 +/- 0.2°C or to whole body cooling, with rectal temperature kept at 33–34°C for 72 hours. Term infants showing signs of moderate or severe encephalopathy +/- seizures have their eligibility confirmed by cerebral function monitoring. Outcomes will be assessed at 18 months of age using neurological and neurodevelopmental testing methods.At least 236 infants would be needed to demonstrate a 30% reduction in the relative risk of mortality or serious disability at 18 months.Recruitment was ahead of target by seven months and approvals were obtained allowing recruitment to continue to the end of the planned recruitment phase. 325 infants were recruited.Combined rate of mortality and severe neurodevelopmental impairment in survivors at 18 months of age. Neurodevelopmental impairment will be defined as any of:? Bayley mental developmental scale score less than 70? Gross Motor Function Classification System Levels III – V? Bilateral cortical visual impairmentsCurrent Controlled Trials ISRCTN89547571This is a multicentre prospective randomised controlled trial to determine whether a reduction of body temperature by 3–4°C following perinatal asphyxia improves survival without neurodevelopmental di
Improved detection of Pneumocystis jirovecii in upper and lower respiratory tract specimens from children with suspected pneumocystis pneumonia using real-time PCR: a prospective study
Catherine M Samuel, Andrew Whitelaw, Craig Corcoran, Brenda Morrow, Nei-Yuan Hsiao, Marco Zampoli, Heather J Zar
BMC Infectious Diseases , 2011, DOI: 10.1186/1471-2334-11-329
Abstract: Children hospitalised at an academic hospital with suspected PCP were prospectively enrolled. An upper respiratory sample (nasopharyngeal aspirate, NPA) and a lower respiratory sample (induced sputum, IS or bronchoalveolar lavage, BAL) were submitted for real-time PCR and direct IF for the detection of Pneumocystis jirovecii. A control group of children with viral lower respiratory tract infections were investigated with PCR for PCP.202 children (median age 3.3 [inter-quartile range, IQR 2.2 - 4.6] months) were enrolled. The overall detection rate by PCR was higher than by IF [180/349 (52%) vs. 26/349 (7%) respectively; p < 0.0001]. PCR detected more infections compared to IF in lower respiratory tract samples [93/166 (56%) vs. 22/166 (13%); p < 0.0001] and in NPAs [87/183 (48%) vs. 4/183 (2%); p < 0.0001]. Detection rates by PCR on upper (87/183; 48%) compared with lower respiratory tract samples (93/166; 56%) were similar (OR, 0.71; 95% CI, 0.46 - 1.11). Only 2/30 (6.6%) controls were PCR positive.Real-time PCR is more sensitive than IF for the detection of P. jirovecii in children with PCP. NPA samples may be used for diagnostic purposes when PCR is utilised. Wider implementation of PCR on NPA samples is warranted for diagnosing PCP in children.Pneumocystis pneumonia (PCP), caused by Pneumocystis jirovecii, is an important opportunistic infection in HIV-infected children [1,2]. The incidence of PCP in developed countries has declined since the introduction of highly active anti-retroviral therapy and use of chemoprophylaxis. However, PCP remains a major cause of hospitalization and mortality in HIV-infected children in low or middle income countries, [1,3-5] with reported incidence rates of 10 - 49%, [1,3,6] and in-hospital case-fatality rates of 20 - 63% [1,3,4,6]. Apart from HIV infection, there are other factors that predispose children to developing PCP including malnutrition, other immune deficiencies or HIV exposure. Untreated, the case fatality rate in chi
Culture-confirmed childhood tuberculosis in Cape Town, South Africa: a review of 596 cases
H Simon Schaaf, Ben J Marais, Andrew Whitelaw, Anneke C Hesseling, Brian Eley, Gregory D Hussey, Peter R Donald
BMC Infectious Diseases , 2007, DOI: 10.1186/1471-2334-7-140
Abstract: Cultures of Mycobacterium tuberculosis from children less than 13 years of age at Tygerberg and Red Cross Children's Hospitals, Cape Town, South Africa, were collected from March 2003 through February 2005. Folder review and chest radiography were performed and drug susceptibility tests done.Of 596 children (median age 31 months), 330 (55.4%) were males. Of all children, 281 (47.1%) were HIV-uninfected, 133 (22.3%) HIV-infected and 182 (30.5%) not tested. Contact with infectious tuberculosis adults was recorded in 295 (49.5%) children. Missed opportunities for chemoprophylaxis were present in 117/182 (64.3%) children less than 5 years of age.Extrathoracic TB was less common in HIV-infected than in HIV-uninfected children (49/133 vs. 156/281; odds ratio 0.50, 95% confidence interval 0.32–0.78). Alveolar opacification (84/126 vs. 128/274; OR 1.85, 95%CI 1.08–3.19) and cavitation (33/126 vs. 44/274; OR 2.28, 95%CI 1.44–3.63) were more common in HIV-infected than in HIV-uninfected children. Microscopy for acid-fast bacilli on gastric aspirates and sputum was positive in 29/142 (20.4%) and 40/125 (32.0%) children, respectively. Sixty-seven of 592 (11.3%) children's isolates showed resistance to isoniazid and/or rifampicin; 43 (7.3%) were isoniazid-monoresistant, 2 (0.3%) rifampicin-monoresistant and 22 (3.7%) multidrug-resistant. Death in 41 children (6.9%) was more common in HIV-infected children and very young infants.HIV infection and missed opportunities for chemoprophylaxis were common in children with culture-confirmed TB. With cavitating disease and sputum or gastric aspirates positive for acid-fast bacilli, children may be infectious. Transmission of drug-resistant TB is high in this setting.In recent years there has been increasing recognition of the significant contribution of childhood tuberculosis (TB) to the global burden of TB [1,2]. This increased international awareness is evidenced by the recent publication of childhood TB guidance for National TB Progra
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