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A W Sturm

Publications and source records attributed to A W Sturm.

At least 55 records · Page 3Linked to original sources
PubMed1998

Typhoid fever complicated by acute renal failure and hepatitis: case reports and review.

Four cases of typhoid fever complicated by both acute oliguric renal failure and hepatitis are presented. Two patients had type II hepatitis according to criteria proposed by Khosla et al. (30) with hepatomegaly, hyperbilirubinaemia and markedly elevated asparate transaminase (AST); the others had type III hepatitis, characterized clinically and biochemically by profound jaundice, hepatomegaly, hepatic encephalopathy (one case only), hyperbilirubinemia and markedly elevated serum AST. Renal biopsy was not performed in any of our patients. However, a combination of proteinuria and abnormal urinary sediments containing red cell casts and granular casts, as noted in these patients, is considered highly suggestive of glomerulonephritis. Although isolated renal failure and hepatitis with hepatomegaly and deranged liver enzyme values have been reported previously in typhoid fever, their occurrence simultaneously in the same patient in distinctly rare, having been reported only twice in the English language literature.

Acute Kidney Injury↗
PubMed1998

Pregnant women as a reservoir of undetected sexually transmitted diseases in rural South Africa: implications for disease control.

OBJECTIVES: This study was undertaken to determine the prevalence of sexually transmitted diseases (STDs) in pregnant women in rural South Africa and to determine the value of using abnormal urogenital symptoms to identify infected women. METHODS: This was a cross-sectional study of 327 patients attending prenatal clinics. RESULTS: Of the 271 women with complete data, 141 (52%) had at least 1 STD and 49 (18%) had more than 1. Abnormal symptoms were common (n = 225; 83%), but associations were weak, and the positive predictive value of different symptoms for infection ranged from 2% to 54%. CONCLUSIONS: Most STDs in rural South African women remain undetected and untreated. As the scope for laboratory diagnosis in resource-poor settings is limited, presumptive treatment of pregnant women and their partners may be a cost-effective option to reduce transmission of STDs and HIV infection.

Adult↗
PubMed1997

An outbreak of Shiga bacillus dysentery in KwaZulu/Natal, South Africa.

An outbreak of Shiga bacillus (Shigella dysenteriae type 1) infection has been detected for the first time in South Africa. Forty-eight cases of this epidemic that presented to a referral hospital were clinically evaluated. Patients presented with dysentery from all age groups and 16 (33%) were admitted to hospital. There were two geographical regions where 32 (67%) of the patients resided. The isolates were demonstrated to be pathogenic by in vitro testing for invasion and toxin production, and were found to be resistant to first line antibiotics that have been used for the treatment of shigellosis i.e. ampicillin, cotrimoxazole, tetracycline and chloramphenicol. However, they were susceptible to nalidixic acid, ceftriaxone and ciprofloxacin. Urgent, public health measures are needed to prevent further spread of this epidemic.

Adolescent↗
PubMed1997

Nosocomial transmission of Shigella dysenteriae type 1.

An outbreak of dysentery due to Shigella dysenteriae type 1 occurred in a chronic care psychiatric institution in Durban, South Africa. Of the 10 patients who developed dysentery, 4 (40%) died. S. dysenteriae type 1 was isolated from stool samples from two of the four patients tested and ribotyping showed that these isolates were identical but differed from other community acquired strains. The isolates were resistant to ampicillin, chloramphenicol, tetracycline and co-trimoxazole. Infection control measures including isolation, cohort nursing and strict hand disinfection resulted in rapid control of the outbreak.

Adult↗
PubMed1997

Molecular epidemiology and transmission dynamics of Mycobacterium tuberculosis in rural Africa.

The relative contribution of reactivated and recently acquired tuberculosis to the disease burden in developing countries is unknown, as are the settings within which most transmission occurs. In an attempt to answer these questions, we combined molecular techniques (restriction fragment length polymorphism analysis) and conventional epidemiology (risk factor analysis and contact tracing) to study 246 consecutive cases of smear-positive tuberculosis in rural South Africa. We estimate that 29-43% of the cases were recently acquired, as they were clustered. We were unable to identify firm transmission links between 73% of clustered cases. Our findings suggest that most smear-positive tuberculosis in rural Africa is both recently acquired and casually transmitted. Tuberculosis control may depend more on promoting early presentation, rapid diagnosis and vaccine development than on chemotherapy.

Adult↗
PubMed1997

Over-the-counter availability of antimicrobial agents, self-medication and patterns of resistance in Karachi, Pakistan.

To determine whether the free availability of antimicrobial agents leads to misuse through self-medication, a house-to-house semi-structured interview was held in three different socio-economic areas of Karachi, Pakistan. Of the 2348 households visited, 1342 (57%) participated; this included 9209 individuals. Three hundred and twenty-two (3.5%) had used one or more antimicrobial in the previous 4 weeks, equivalent to 43 agents per 1000 persons per month. The most frequently used agents were amoxycillin (16.7%), co-trimoxazole (15.7%), erythromycin (10.9%), ampicillin/cloxacillin (Ampiclox, 9.1%) and metronidazole (4.5%). Of these, 91.4% were prescribed by a physician, 2.3% were advised by a chemist and 6.3% were used as self-medication. Self-medication increased with socio-economic status. High levels of resistance were found to ampicillin, co-trimoxazole, chloramphenicol and erythromycin. If these high resistance levels are related to the high frequency of antimicrobial use, over-the-counter availability cannot be held responsible. Education of the medical profession seems to be the single most important tool to control misuse of antimicrobial agents. Innovative approaches for continuous medical education are urgently needed.

Adolescent↗
PubMed1997

Typhoid fever and asymptomatic human immunodeficiency virus infection. A report of 10 cases.

Ten patients with asymptomatic human immunodeficiency virus (HIV) infection were treated for typhoid fever at King Edward VIII Hospital, Durban, South Africa, from 1993 through 1995. The mean age was 23.7 years (range, 8-33 years), with a female-to-male ratio of 9 to 1 and mortality and morbidity rates of 20% and 10%, respectively. Common presenting manifestations were fever (100%), relative bradycardia (50%), and diarrhea (40%). With respect to epidemiologic and clinical characteristics, we noted no significant differences among these 10 HIV-positive and 32 HIV-negative patients treated for typhoid fever during the same period. However, we found hepatic dysfunction in the form of an isolated increase in aspartate aminotransferase (p < 0.01) and abnormal urinary findings suggestive of glomerulonephritis (p = 0.01) more frequently in HIV-positive patients.

Adolescent↗
PubMed1997

Iron and virulence of Haemophilus ducreyi in a primate model.

BACKGROUND AND OBJECTIVES: The pathogenesis of chancroid is currently unclear. There are discrepancies between the virulence of Haemophilus ducreyi in the human and animal experiments. Iron availability influences the virulence of many pathogens. The objective of this study was to investigate the role of iron in virulence of H. ducreyi. STUDY DESIGN: Intradermal inoculation of the primate Macaca mulatta was studied as an animal model for pathogenesis of chancroid. This model then was used to study the influence of iron availability on virulence of H. ducreyi. Eleven strains of H. ducreyi with proven avirulence in the rabbit intradermal test and one virulent control strain were used. Two of the strains had been shown to cause ulcers in a human inoculation experiment. Strains were suspended in fluid with different iron compounds before intradermal injection. Other monkeys were treated with injectable iron before inoculation with bacteria suspended. RESULTS: All but one of the test strains produced a chancroid-like ulcer from which H. ducreyi could be isolated. The minimal ulcerative dose was 10(5) cfu. Iron in the injection fluid decreased this dose 10-fold. In animals pretreated with intramuscular iron, the minimal ulcerative dose decreased to 10(4) cfu and all eleven strains became ulcerative. CONCLUSIONS: The availability of iron increases virulence of H. ducreyi. The iron pretreated primate model is useful for the study of virulence factors of H. ducreyi because of its ability to produce lesions with strains that avirulent in other animal models but pathogenic to humans.

Animals↗
PubMed1997

Growth and cultural characteristics of Calymmatobacterium granulomatis--the aetiological agent of granuloma inguinale (Donovanosis).

Granuloma inguinale is a chronic destructive granulomatous disease of the genitalia. The clinical diagnosis is often unreliable and the definitive diagnosis is based on the visualisation of 'Donovan bodies' in tissue smears or biopsy specimens. The organism implicated in its aetiology, Calymmatobacterium granulomatis, was reported to have been cultured > 30 years ago, but little is known about the organism because of its fastidious nature and the difficulty in culturing it. Twenty-two biopsy specimens from female patients with clinical and laboratory-confirmed granuloma inguinale were treated with amikacin 10 mg/L and inoculated in a monocyte co-culture system with peripheral blood mononuclear cells (PBMC) from a single donor and autologous sera. The method was subsequently modified by pretreatment of specimens with vancomycin 5 mg/L and metronidazole 10 mg/L in addition to amikacin 10 mg/L for the purpose of decontamination, pooled blood donor PBMC and by the use of heat-inactivated fetal calf serum instead of autologous serum for culture. This modified method was used to culture additional biopsy specimens and genital ulcer scrapings from female and male patients, respectively. All monocyte co-cultures were examined by a rapid Giemsa (RapiDiff) stain and by an indirect immunofluorescence test with immune sera. Representative cultures were examined by transmission electron microscopy. C. granulomatis was successfully isolated in pure culture by the monocyte co-culture system from four biopsy specimens and 14 genital ulcer scrapings. The cultured organisms were visible both intra- and extra-cellularly and were extremely pleomorphic, with characteristic single and biopolar condensation. The numbers of the organisms increased after each passage. All positive cultures showed bright fluorescence when tested with immune sera. Transmission electron microscopy of the cultured bacteria demonstrated a typical gram-negative cell wall consisting of an outer membrane, middle electron opaque layer and an inner plasma membrane. The capsule was thick and electron dense. Numerous electron dense granules were present within the cytoplasm.

Azure Stains↗
PubMed1997

Tampon sampling for diagnosis of bacterial vaginosis: a potentially useful way to detect genital infections?

Genital tract infections are important causes of ill health in developing countries, but diagnosis is difficult. Bacterial vaginosis (BV) was correctly diagnosed by using a vaginal specimen obtained by tampon sampling in 22 of 24 women (91.6%) for whom BV was diagnosed by Gram staining. The yield for other vaginal infections was higher (28% for Trichomonas vaginalis and 32.7% for Candida albicans) than it was for cervical infections (0% for Neisseria gonorrhoeae and 30% for Chlamydia trachomatis). Tampon sampling was acceptable to patients and may facilitate diagnosis of genital infections in developing countries.

Bacterial Infections↗
PubMed1997

Family planning services in developing countries: an opportunity to treat asymptomatic and unrecognised genital tract infections?

OBJECTIVE: To determine the prevalence of asymptomatic and unrecognised genital tract infections among women attending a family planning clinic in rural South Africa. METHODS: 189 consecutive women had genital samples taken to diagnose infection with Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis, Candida albicans, Treponema pallidum, and HIV, and to diagnose bacterial vaginosis. RESULTS: Mean age was 25 years; 155 (82%) were unmarried, 156 (83%) were currently using contraception, and 41 (22%) reported having an STD treated in the preceding 12 months. Although none volunteered abnormal urogenital symptoms, 74 (39%) had at least one elicited by direct questioning. 119 women (63%) had at least one genital infection: N gonorrhoeae (eight; 4%), C trachomatis (14; 8%), T vaginalis (26; 14%), C albicans (56; 30%), active syphilis (15; 8%), HIV (44; 24%), and bacterial vaginosis (29; 15%). 49 women (26%) had multiple infections. Most infections (71; 60%) were asymptomatic. Symptomatic women failed to recognise and report their symptoms, and routine services failed to detect the infections. CONCLUSION: Prevalence of genital tract infection is high among these women, most infections are asymptomatic, and symptomatic infections are frequently not recognised. Women attending family planning clinics in such settings should be screened for syphilis and offered testing for HIV infection. Strategies to detect and treat other genital infections need to be developed.

Adult↗
PubMed1996

Bacterial vaginosis and associated infections in pregnancy.

OBJECTIVE: To assess the role of bacterial vaginosis (BV) on pregnancy complications in a developing community where mixed cervico-vaginal infections are common. SETTING: The antenatal clinic at King Edward VIII Hospital (KEH), Durban, South Africa, which is a large urban tertiary hospital serving mainly a Black underprivileged population of KwaZulu/Natal. METHODS: Asymptomatic pregnant women < or = 30 weeks gestation were recruited at their first antenatal visit. Clinical data including the sexual history were recorded. Swab specimens were collected from the vagina and endocervix for diagnosing BV, trichomoniasis, candidiasis, gonorrhea and chlamydial infection. Venous blood specimens were tested for antibody to syphilis and human immunodeficiency virus (HIV). All women continued standard antenatal care and hospital records were reviewed following delivery to evaluate pregnancy outcome. RESULTS: BV was found in 52% of the women studied and was the commonest infection diagnosed. Mixed vaginal infections of BV and trichomoniasis were diagnosed in 14%. Only 29% of asymptomatic women did not have any microbiological evidence of a lower genital tract infection. A total of 46% of women studied had poor pregnancy outcome as measured by obstetrical complications, pregnancy loss and/or neonatal morbidity. There was a significant difference in outcome in women with BV (55 of 88) compared to those having infections other than BV (13 of 31), or no infection (5 of 9)-P = 0.005. This difference was for obstetrical complications of preterm delivery, premature rupture of membranes and intrauterine infection, but not for pregnancy losses and neonatal morbidity. CONCLUSIONS: The high prevalence of BV and concomitant lower genital tract infections among asymptomatic pregnant women and the resultant adverse pregnancy outcome associated with BV, confirms reports from developed countries of the need for screening for BV at the initial antenatal clinic visit. Whether pregnancy outcome was worse in the presence of BV and other infections than BV alone could not be determined. Future studies with appropriate interventions are needed to evaluate the unique problems of developing countries.

Adolescent↗
PubMed1996

Ribosomal DNA typing of Haemophilus ducreyi strains: proposal for a novel typing scheme.

Local strains of Haemophilus ducreyi were characterized by ribosomal DNA fingerprinting in order to develop a typing scheme for this organism. Chromosomal DNAs from 30 strains were extracted, and restriction fragments were separated by agarose gel electrophoresis after cleavage with BglII, HindIII, HindII, and BstEII. Of the 30 local strains studied, nine BglII, eight HindIII, six HindII, and five BstEII ribotype patterns were observed. In order to develop a typing scheme, we correlated the ribotype patterns obtained with each of the four enzymes for each strain. By this scheme, 13 ribotypes designated b to n were defined among the local strains. This study demonstrates that there is a diversity of ribotypes among H. ducreyi strains in our area, which emphasizes that there are many strains responsible for chancroid. This novel typing scheme provides a useful tool for further epidemiological studies of chancroid.

Bacterial Typing Techniques↗
PubMed1996

Microbial colonizers in leprosy skin ulcers and intensity of inflammation.

The microflora of 55 patients with leprosy skin ulcers was studied and related to a weighted inflammatory score (IS). The control group consisted of 18 ulcers with different underlying pathology. Leprosy ulcers were characterized by the exclusive presence of two types of branching gram-positive rods; a particular interesting proposal is that Mycobacterium leprae share common antigens with these unusual "leprosy ulcer associated" organisms and group G beta-hemolytic streptococci. In the leprosy group, corynebacteria and branching rods accounted for 97% of gram-positive bacilli and Bacillus species constituted only 3%. In the control group, B. species formed 50% of gram-positive rods; the rest were corynebacteria (p = 0.03). In the leprosy group, one third of the gram-positive bacteria were branching rods; none of them was acid fast. Ten of them were identified as Arcanobacterium haemolyticum, and the remaining 7 could not be identified. The IS of leprosy patients was lower than in the control group. The presence of more than two species of facultative or aerobic gram-negative rods or single species of pyogenic gram-positive cocci correlated with a high IS. The presence of two or more different pyogenic cocci resulted in a lower IS. Further studies into the nature of leprosyunique organisms as well as the inflammation inhibition factors in mixed infections are warranted. It is recommended that management of ulcers should consist of the application of local disinfection and early treatment of episodes of inflammation with a combination of fluoroquinolone and penicillin.

Actinomycetaceae↗