Self-reported beta-lactam allergy in government and private hospitals in Cape Town, South Africa

BACKGROUND

Up to a quarter of inpatients in high-income countries (HICs) self-report beta-lactam allergy (BLA), which if incorrect,increases the use of alternative antibiotics, worsening individual health outcomes and driving bacterial resistance. In HICs, up to 95% ofself-reported BLAs are incorrect. The epidemiology of BLA in low- and middle-income African countries is unknown.

OBJECTIVES

To describe the epidemiology and de-labelling outcomes of self-reported BLA in hospitalised South African (SA) patients.

METHODS

Point-prevalence surveys were conducted at seven hospitals (adult, paediatric, government and privately funded, district andtertiary level) in Cape Town, SA, between April 2019 and June 2021. Ward prescription records and in-person interviews were conductedto identify and risk-stratify BLA patients using the validated PEN-FAST tool. De-labelling was attempted at the tertiary allergy clinic atGroote Schuur Hospital.

RESULTS

A total of 1 486 hospital inpatients were surveyed (1 166 adults and 320 children). Only 48 patients (3.2%) self-reported a BLA,with a higher rate in private than in government-funded hospitals (6.3% v. 2.8%; p=0.014). Using the PEN-FAST tool, only 10.4% (n=5/48)of self-reported BLA patients were classified as high risk for true penicillin hypersensitivity. Antibiotics were prescribed to 70.8% (n=34/48)of self-reported BLA patients, with 64.7% (n=22/34) receiving a beta-lactam. Despite three attempts to contact patients for de-labelling atthe allergy clinic, only 3/36 underwent in vivo testing, with no positive results, and 1 patient proceeded to a negative oral challenge.

CONCLUSION

Unlike HICs, self-reported BLA is low among inpatients in SA. The majority of those who self-reported BLA were low risk fortype 1 hypersensitivity, but outpatient de-labelling efforts were largely unsuccessful.

Application of European standards for health and quality control of game meat on game ranches in South Africa

The health and quality compliance of game carcasses (n = 295) intended for the South African export market and aspiring to comply with the strict hygiene requirements of the European Union were compared with game carcasses (n = 330) available for the local market and currently not subjected to meat safety legislation. Samples were collected in similar seasons and geographical areas in South Africa from 2006 to 2009. Aerobic plate counts (APC) of the heart blood verified that both groups possessed similar ante mortem bacterial status. For health compliance APC, tests for Escherichia coli, Salmonella spp. and Staphylococcus aureus were performed on the carcasses. Surfaces of the local carcasses were swabbed using the European Enviro-biotrace sponge technique at 3 and 72 h post mortem. Unskinned but eviscerated export carcasses in the abattoir were skinned and sampled by incision using a cork borer 72h post mortem . Temperature andpHreadings were recorded at 3 and 72 h post mortem from the longissimus dorsi muscle and the readings at 3 h differed (P = 0.035). Temperatures at 72 h were lower for export than local carcasses (P 0.001) because of earlier introduction and maintenance of the cold chain. The pH readings also differed between groups at 3 and 72 h (P0.001). APC results for the local group exceeded the maximum permissible count (105). S. aureus results showed differences (P 0.001), with readings from the local group being higher. The same tendency was exhibited for E. coli (P = 0.008). Imposition of hygiene guidelines for game ranchers producing meat for the local market is therefore recommended.

An investigation of the effects of secondary processing on Mycobacterium spp. in naturally infected game meat and organs

The risk for humans to contract bovine tuberculosis through the consumption of undercooked game meat as well as biltong (traditionally dried game meat) is a concern. The survival potential of Mycobacterium bovis during the cooking and drying processes was researched in a preceding study on beef and the positive results compelled the authors to investigate the results with a similar preliminary study on game meat. Muscular, lymphatic and visceral tissues from skin test positive African buffalo (Syncerus caffer) and greater kudu (Tragelaphus strepsiceros) with tuberculous lesions were collected from the Hluhluwe iMfolozi Park during the park's culling programme. The different tissues were exposed to cooking and the muscular tissue to the drying process prior to culture. All acid-fast isolates were analysed by polymerase chain reaction for the presence of Mycobacterium bovis. All tissues were found negative for Mycobacterium bovis but non-tuberculous mycobacteria were isolated from kidney, liver, heart and lymph nodes. The results showed that these processes will kill Mycobacterium bovis but the unexpected recovery of non-tuberculous mycobacteria suggests possible survival and resistance characteristics of these strains which might be of veterinary public health interest.

The profile analysis of attempted-suicide patients referred to Pelonomi Hospital for psychological evaluation and treatment from 1 May 2005 to 30 April 2006

<div style="left: 85.1657px; top: 691.884px; font-size: 15px; font-family: sans-serif; transform: scaleX(1.04288);" data-canvas-width="85.51575"><strong>Background.</strong></div><div style="left: 171.176px; top: 691.884px; font-size: 15px; font-family: sans-serif; transform: scaleX(1.0317);" data-canvas-width="300.2243999999999">Suicide is an increasing phenomenon</div><div style="left: 85.1657px; top: 715.224px; font-size: 15px; font-family: sans-serif; transform: scaleX(1.03619);" data-canvas-width="386.49719999999996">worldwide. A suicide occurs every 40 seconds, and there</div><div style="left: 85.1657px; top: 738.564px; font-size: 15px; font-family: sans-serif; transform: scaleX(1.02775);" data-canvas-width="386.43539999999996">is 1 attempt every 1 to 3 seconds. By 2020, these figures</div><div style="left: 85.1657px; top: 761.904px; font-size: 15px; font-family: sans-serif; transform: scaleX(0.996047);" data-canvas-width="386.4663">may have doubled. No accurate statistics regarding the</div><div style="left: 85.1657px; top: 785.244px; font-size: 15px; font-family: sans-serif; transform: scaleX(1.03893);" data-canvas-width="386.4817499999999">occurrence of attempted suicide (or non-fatal suicidal</div><div style="left: 85.1657px; top: 808.584px; font-size: 15px; font-family: sans-serif; transform: scaleX(1.04742);" data-canvas-width="386.49719999999996">behaviour) in South Africa exist, because there has been</div><div style="left: 85.1657px; top: 831.924px; font-size: 15px; font-family: sans-serif; transform: scaleX(1.01198);" data-canvas-width="194.2991999999999">no systematic data collection.</div><div style="left: 85.1657px; top: 831.924px; font-size: 15px; font-family: sans-serif; transform: scaleX(1.01198);" data-canvas-width="194.2991999999999"> </div><div style="left: 85.1657px; top: 869.424px; font-size: 15px; font-family: sans-serif; transform: scaleX(1.00734);" data-canvas-width="25.1835"><strong>Aim</strong></div><div style="left: 110.581px; top: 869.424px; font-size: 15px; font-family: sans-serif; transform: scaleX(1.05263);" data-canvas-width="361.05105000000003">. The aim of the study was to determine the profile of</div><div style="left: 85.1657px; top: 892.764px; font-size: 15px; font-family: sans-serif; transform: scaleX(1.01698);" data-canvas-width="386.4508499999998">patients who had attempted suicide and were referred</div><div style="left: 85.1657px; top: 916.104px; font-size: 15px; font-family: sans-serif; transform: scaleX(1.053);" data-canvas-width="386.45084999999995">to Pelonomi Hospital, Bloemfontein, for psychological</div><div style="left: 85.1657px; top: 939.444px; font-size: 15px; font-family: sans-serif; transform: scaleX(1.09463);" data-canvas-width="386.4045000000001">evaluation and treatment during the period 1 May 2005</div><div style="left: 85.1657px; top: 962.784px; font-size: 15px; font-family: sans-serif; transform: scaleX(1.16187);" data-canvas-width="120.83444999999996">to 30 April 2006.</div><div style="left: 85.1657px; top: 1000.28px; font-size: 15px; font-family: sans-serif; transform: scaleX(1.09453);" data-canvas-width="55.82085">Method.</div><div style="left: 141.218px; top: 1000.28px; font-size: 15px; font-family: sans-serif; transform: scaleX(1.00434);" data-canvas-width="330.4291499999999">A descriptive, retrospective study was conducted.</div><div style="left: 85.1657px; top: 1023.62px; font-size: 15px; font-family: sans-serif; transform: scaleX(1.0197);" data-canvas-width="386.4663">The study population comprised 258 attempted-suicide</div><div style="left: 85.1657px; top: 1046.96px; font-size: 15px; font-family: sans-serif; transform: scaleX(1.0063);" data-canvas-width="386.41994999999986">patients referred to Pelonomi Hospital for psychological</div><div style="left: 85.1657px; top: 1070.3px; font-size: 15px; font-family: sans-serif; transform: scaleX(0.995928);" data-canvas-width="386.41995000000003">evaluation and treatment. A data form was compiled to</div><div style="left: 85.1657px; top: 1093.64px; font-size: 15px; font-family: sans-serif; transform: scaleX(1.03619);" data-canvas-width="386.49719999999996">transfer the relevant information from patients’ clinical</div><div style="left: 85.1657px; top: 1116.98px; font-size: 15px; font-family: sans-serif; transform: scaleX(1.00065);" data-canvas-width="30.019349999999992">files.</div><div style="left: 85.1657px; top: 1116.98px; font-size: 15px; font-family: sans-serif; transform: scaleX(1.00065);" data-canvas-width="30.019349999999992"> </div><div style="left: 85.1657px; top: 1154.48px; font-size: 15px; font-family: sans-serif; transform: scaleX(0.839862);" data-canvas-width="41.9931"><strong>Results</strong></div><div style="left: 127.391px; top: 1154.48px; font-size: 15px; font-family: sans-serif; transform: scaleX(1.0274);" data-canvas-width="344.17965000000004">. The majority of patients were female (68.9%). The</div><div style="left: 85.1657px; top: 1177.82px; font-size: 15px; font-family: sans-serif; transform: scaleX(0.995888);" data-canvas-width="386.4045000000001">median age was 22 years. The most common method</div><div style="left: 85.1657px; top: 1201.16px; font-size: 15px; font-family: sans-serif; transform: scaleX(0.985726);" data-canvas-width="386.40449999999987">used in suicide attempts was drug overdose (66%) – mostly</div><div style="left: 85.1657px; top: 1224.5px; font-size: 15px; font-family: sans-serif; transform: scaleX(1.00373);" data-canvas-width="386.43539999999985">antidepressants (19.7%)) and analgesics (8.2%). More</div><div style="left: 85.1657px; top: 1247.84px; font-size: 15px; font-family: sans-serif; transform: scaleX(1.02012);" data-canvas-width="299.91539999999986">females than males overdosed on drugs (</div><div style="left: 385.328px; top: 1247.84px; font-size: 15px; font-family: sans-serif;">p</div><div style="left: 394.212px; top: 1247.84px; font-size: 15px; font-family: sans-serif; transform: scaleX(1.10578);" data-canvas-width="77.4045">=0.0103).</div><div style="left: 85.1657px; top: 1271.18px; font-size: 15px; font-family: sans-serif; transform: scaleX(1.03329);" data-canvas-width="386.4508499999999">The main precipitating factors included problematic</div><div style="left: 85.1657px; top: 1294.52px; font-size: 15px; font-family: sans-serif; transform: scaleX(1.07956);" data-canvas-width="386.4817500000003">relationships (55.4%), financial problems (22.9%),<div style="left: 533.984px; top: 382.042px; font-size: 15px; font-family: sans-serif; transform: scaleX(1.03058);" data-canvas-width="386.4662999999999">psychiatric problems (22.1%), arguments (19.8%), abuse</div><div style="left: 533.984px; top: 405.382px; font-size: 15px; font-family: sans-serif; transform: scaleX(1.00441);" data-canvas-width="381.6767999999998">(emotional, sexual, physical – 18.2%), low self-esteem/</div><div style="left: 533.984px; top: 428.721px; font-size: 15px; font-family: sans-serif; transform: scaleX(1.04346);" data-canvas-width="386.0800499999998">worthlessness/hopelessness/humiliation (16.7%), and</div><div style="left: 533.984px; top: 452.061px; font-size: 15px; font-family: sans-serif; transform: scaleX(1.02182);" data-canvas-width="185.97164999999993">recent life changes (13.2%).</div><div style="left: 533.984px; top: 452.061px; font-size: 15px; font-family: sans-serif; transform: scaleX(1.02182);" data-canvas-width="185.97164999999993"> </div><div style="left: 533.984px; top: 489.561px; font-size: 15px; font-family: sans-serif; transform: scaleX(1.00927);" data-canvas-width="77.71349999999998"><strong>Conclusion.</strong></div><div style="left: 611.93px; top: 489.561px; font-size: 15px; font-family: sans-serif; transform: scaleX(0.976479);" data-canvas-width="308.56739999999996">The aim of the study was to determine the</div><div style="left: 533.984px; top: 512.901px; font-size: 15px; font-family: sans-serif; transform: scaleX(1.00638);" data-canvas-width="386.45084999999995">profile of patients who had attempted suicide. Possible</div><div style="left: 533.984px; top: 536.242px; font-size: 15px; font-family: sans-serif; transform: scaleX(1.00381);" data-canvas-width="386.4663">factors associated with suicide attempts in our sample</div><div style="left: 533.984px; top: 559.581px; font-size: 15px; font-family: sans-serif; transform: scaleX(1.01706);" data-canvas-width="386.48174999999986">were identified and summarised in the form of a screening</div><div style="left: 533.984px; top: 582.922px; font-size: 15px; font-family: sans-serif; transform: scaleX(1.04169);" data-canvas-width="386.46630000000005">checklist. The value of the checklist is that it can be used</div><div style="left: 533.984px; top: 606.261px; font-size: 15px; font-family: sans-serif; transform: scaleX(1.05018);" data-canvas-width="386.46629999999993">as a screening method to identify possible suicide risk in</div><div style="left: 533.984px; top: 629.602px; font-size: 15px; font-family: sans-serif; transform: scaleX(1.00481);" data-canvas-width="55.26465">patients.</div></div>

Habitat preferences and seasonal activity of the Microstigmatidae from Ngome State Forest, South Africa (Arachnida: Araneae)

As part of the South African National Survey of Arachnida (SANSA) inventories are underway to determine the arachnid biodiversity of various biomes. Asurvey of groundliving spiders was conducted over a year period (1992-1993) at Ngome State Forest, KwaZulu-Natal, South Africa. Spiders were collected with 180 pitfall traps from five different habitat types ranging from indigenous forest to a pine plantation and grassland. A total of 186 specimens of the rare Mygalomorphae family Microstigmatidae were sampled, representing 2 % of the total spider fauna collected during the study. Two species, Microstigmata longipes (Lawrence) and M. zuluensis (Lawrence), occur sympatrically. Both species were more active in the indigenous forest, and were absent or present in low numbers in the open grass and pine plantation. Microstigmata zuluensis was slightly more abundant (59 % of total) and was recorded from three of the five habitats, while M. longipes (41 %) was found in four of the habitat types. Both species were active throughout the year with the lowest numbers recorded in winter (June to August). The males of M. longipes peaked in November while those of M. zuluensis peaked in April.

A check list of the spider fauna of the Western Soutpansberg, South Africa (Arachnida: Araneae)

By virtue of its geological history and geographical location the Soutpansberg constitutes a refuge for a high diversity of organisms. The Western Soutpansberg forms part of the Savanna Biome and is presently the area with the highest concentration of Natural Heritage Sites in South Africa. A unique private initiative is under way to improve its national and international conservation status in a bid to conserve the mountain. A checklist of the spider species of the Western Soutpansberg collected over a five-year period is presented. Forty-six families, represented by 109 genera and 127 species have been collected. Of the species collected, 81 (64 %) were wandering spiders and 46 (36 %) web builders. The Thomisidae have the highest number of species (15) followed by the Araneidae and the Salticidae with 10 species each. Ninety-six genera are represented by a single species. Ninety six percent of the species collected are new records for the area. This survey is the first for the area and forms part of the South African National Survey of Arachnida (SANSA).

Bio-accumulation of selected metals in African sharptooth catfish Clarias gariepinus from the lower Olifants River, Mpumalanga, South Africa

The level of metal (Cr, Cu, Mn, Ni, Pb and Zn) bio- accumulation in tissues (muscle, gill, kidney, liver and gonads) and bile of the African catfish Clarias gariepinus, from the lower Olifants River was investigated. These metals were detected in all the tissues as well as in the bile, with the highest concentration found in either the gills, liver or gonadal tissue. The lowest concentration was usually detected in the muscle tissue. Although statistic comparisons revealed no significant differences between the localities, fish from the Selati River (Locality 1) generally had higher metal levels than fish from the localities along the Olifants River inside the Kruger National Park. The higher levels in the fish from the Selati River may be attributed to anthropogenic activities resulting in point and/or diffuse sources of metal pollution. These sources should be identified and reduced.

The effect of copper on the blood chemistry of Clarias gariepinus (Clariidae)

Environmental stressors, both natural and humanly induced, could cause changes in cellular function which alter the physiology of organ systems in fish. The need to comprehend and predict the condition which stress metals will pose on fish, and extrapolate the effect of pollutants from laboratory to population levels, have forced scientists to search for physiological and biochemical indicators of health and sublethal toxicant effects. Hematological evaluation of fish blood provides valuable facts concerning the physiological response of fish to changes in the external environment. Furthermore, hematological variables are well known for their clinical value in prognosis and diagnosis. Sublethal responses after exposure to toxicants can be determined by commonly applied techniques. Measurements for a number of hematological and carbohydrate metabolic variables were recorded at winter and summer temperatures after fish, acclimated for 3 months to experimental conditions, were exposed to sublethal concentrations of copper for 96 hr in a continuous-flow experimental system. Controls were run at the same time to establish essential baseline hematological values. Fish were exposed to the mean copper concentration as was found in the Olifants River, Kruger National Park, during summer (0.05 +/- 0.032 mg liter-1) and winter (0.085 +/- 0.032 mg liter-1) to establish the effect thereof on the variables mentioned. The results proved that the concentration of copper in the river exerts a physiological effect on Clarias gariepinus at 21 +/- 1 and 28 +/- 1 degrees C which manifests in changed blood chemistry. Pathological conditions, such as erythrocytopenia, leucocytosis, hyperglycemia, and hyperprotonemia, are evident. The fish physiologically adapted to the environmental change, which does not necessarily reflect a state of normality.