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Biomedical subjects

G Hussey

Publications and source records attributed to G Hussey.

50 records · Page 3Linked to original sources
PubMed1991

Missed opportunities for measles immunisation in selected western Cape hospitals.

Measles is still a major cause of childhood mortality and morbidity in South Africa. The World Health Organisation (WHO) has recently recommended that greater attention be paid to opportunities for immunisation in the curative sector. This study quantified the extent of missed opportunities for measles immunisation in children attending primary, secondary and tertiary level curative hospitals in the western Cape. Exit interviews of 1,068 carers of children aged between 6 and 59 months inclusive showed that 2.4-40.7% of carers had been requested to produce a Road-to-Health card, and that 4.8-43.1% of carers had a card available. The proportion of children with documented evidence of measles immunisation available ranged from 4.8% to 40.0% between facilities. The study demonstrated that a considerable number of potential opportunities to immunise children against measles are currently being missed in children attending hospitals and day hospitals in the western Cape. The study documents the effect of a fragmented approach to health care, and indicates a need for rapid integration of preventive and curative components of health care into a metropolitan-based primary health care service.

Child, Hospitalized↗
PubMed1991

The serodiagnosis of tuberculosis in children: an evaluation of an ELISA test using IgG antibodies to M. tuberculosis, strain H37 RV.

An enzyme-linked immunosorbent assay (ELISA) for detecting serum IgG antibodies to an autoclaved suspension of Mycobacterium tuberculosis H37 RV was evaluated as a diagnostic tool in 132 clinical cases of childhood tuberculosis. The mean (SD) optical density value in these patients was 0.115 (0.122) compared with 0.022 (0.017) in the control group of patients who had non-tuberculous acute respiratory tract infections. Using as a cut-off level the mean of the control plus 2 standard deviations, the test sensitivity was 62% and the specificity was 98% in all the patients with a clinical diagnosis of tuberculosis. In the culture-positive group (n = 35), the sensitivity was 69%. A positive correlation was shown between the optical density levels and increasing age and chronicity of infection but not with respect to tuberculin skin reactivity, nutritional status and the duration of prior therapy. In addition, BCG vaccination (presence of a scar) did not affect the ELISA result. We conclude that this ELISA test is a useful diagnostic test in children.

Adolescent↗
PubMed1991

An outbreak of whooping cough in a highly vaccinated urban community.

In 1950 a whole-cell pertussis vaccine was introduced in Cape Town and was followed by a marked decline in reported whooping cough mortality and morbidity. This resulted in reduced awareness of whooping cough as a clinical problem and, in recent years, no routine diagnostic tests for Bordetella pertussis have been performed. An outbreak of whooping cough occurred in Cape Town between 1 June 1988, and 31 May 1989, with 292 children admitted to hospital for whooping cough during this period (hospital admission rate in children under 5 years of age = 187 per 100,000). In an investigation of 239 children attending four pre-primary schools in the city, the whooping cough attack rate was 33 per cent, while pertussis vaccine coverage was 95 per cent. In the latter part of the outbreak nasopharyngeal swabs and serology were performed in patients presenting to a children's hospital with suspected whooping cough. Bordetella pertussis was isolated from 3 out of 34 (9 per cent) children tested and the first isolate was serotyped as type 1,2,4. Available clinical and laboratory evidence indicated that the organism responsible for the outbreak was Bordetella pertussis. Coverage studies for pertussis vaccine in Cape Town indicated that between 81 and 93 per cent of children were fully immunized by 13 months of age. These findings suggest that, since its introduction, the whole-cell pertussis vaccine produced in South Africa has been highly effective in controlling whooping cough. However, it was not able to prevent a moderate scale outbreak, even in the presence of high vaccination levels.

Child↗
PubMed1991

Miliary tuberculosis in children: a review of 94 cases.

This is a retrospective review of the clinical, radiologic and laboratory features of 94 cases of childhood miliary tuberculosis seen during a 5-year period, 1985 to 1989. A history of Bacillus Calmette-Guérin vaccination was documented in 88% of children. The median age at presentation was 10.5 months, 52% of cases occurring in those younger than 1 year. The presenting symptoms were nonspecific: cough (72%); fever (61%); loss of appetite and weight (40%); and diarrhea and vomiting (33%). The main presenting signs were hepatomegaly (82%), splenomegaly (54%), lymphadenopathy (46%) and pyrexia (39%). Most of the patients were malnourished and anergic. Meningitis occurred in 19% of patients and this was the only significant risk factor identified for mortality, the overall case fatality rate being 14%. The diagnosis in the vast majority was made on the clinical presentation supported by a classic miliary pattern on chest roentgenogram (91% of cases). Mycobacterium tuberculosis was cultured in 33% of cases. In addition a review of hospital admissions from 1981 to 1989 revealed that annually miliary tuberculosis in children and adults accounted for 8.3 and 1.3%, respectively, of all tuberculosis admissions. This study confirms that miliary tuberculosis is a relatively common complication of tuberculosis in young children.

Adolescent↗
PubMed1990

Nosocomial bacteremias in measles.

The purpose of this study was to determine whether nosocomial bacteremias occurred more frequently in patients admitted with severe measles compared with general pediatric admissions. In a retrospective survey of 977 blood culture reports during a 4-year period, 1985 to 1988, the incidence of nosocomial bacteremias in patients with measles was found to be on the average of 3.37/100 admissions/year, approximately 6 times that of general pediatric patients (0.57). Gram-negative organisms (predominantly Klebsiella and Salmonella species) accounted for 86.5% of all isolates from measles patients, with 23% of these being multiply antibiotic-resistant. All the isolates from the general patients were fully susceptible to antibiotics. The duration of hospitalization was more than doubled in both groups of affected patients. The onset of hospital-acquired bacteremias occurred on an average of 11.2 days after admission in the patients with measles and 20.5 days in the general patients. Our findings revealed that nosocomial bacteremias occurred with greater frequency in patients with measles and contributed to the morbidity of these patients.

Adolescent↗
PubMed1987

Laryngeal tuberculosis in childhood.

Laryngeal tuberculosis is an extremely rare condition in childhood, although probably less so in the underdeveloped world. We have described two cases treated concurrently in our wards. The first case showed features of a pharyngopalatotonsillar membrane, an exquisitely painful edematous pharynx and larynx and was initially sputum-negative for acid-fast bacilli. This presentation fits the hematogenous form of disease and stresses that: laryngeal tuberculosis is not confined to cases of far advanced pulmonary tuberculosis; tuberculosis should enter the differential diagnosis of pharyngeal, tonsillar and palatal lesions (especially membranoulcerative lesions); and there is a common association between laryngeal and abdominal tuberculosis. Her treatment included a 1-month course of steroids and to date (12 months after onset) she shows no signs of complications. The edematous form of laryngeal tuberculosis may be yet another indication for the use of steroids in tuberculosis. Our second patient presented with prolonged chest symptoms, initial positive sputum for acid-fast bacilli and localized granulomatous laryngeal disease, features of far advanced "adult" disease and bronchogenic laryngeal spread. Laryngeal tuberculosis usually responds rapidly to antituberculosis chemotherapy. This was clinically and endoscopically confirmed in both our cases.

Antitubercular Agents↗