African Journal of Thoracic and Critical Care Medicine

S L Ngaka

S F Mokati

R Masekela

Bronchoscopy in children: A review of services in sub-Saharan Africa

儿童支气管镜检查：撒哈拉以南非洲地区服务综述

Background. Bronchiectasis, a chronic suppurative lung condition, is a largely neglected disease, especially in low- to middle-income countries (LMICs), from which there is a paucity of data. Post-infectious causes are more common in LMICs, while in high-income countries, inborn errors of immunity (IEIs), recurrent aspiration, primary ciliary dyskinesia (PCD) and cystic fibrosis are more common. Children living with HIV (CLWH), especially those who are untreated, are at increased risk of bronchiectasis. Data on risk factors, diagnosis and follow-up of children with bronchiectasis are required to inform clinical practice and policy. Objectives. To describe the demographics, medical history, aetiology, clinical characteristics and results of special investigations in children with bronchiectasis. Methods. We undertook a retrospective descriptive study of children aged &lt;16 years with chest computed tomography (CT) scan-confirmed bronchiectasis in Johannesburg, South Africa, over a 10-year period. Demographics, medical history, aetiology, clinical characteristics and results of special investigations were described and compared according to HIV status. Results. A total of 91 participants (51% male, 98% black African) with a median (interquartile range) age of 7 (3 - 12) years were included in the study. Compared with HIV-uninfected children, CLWH were older at presentation (median 10 (6 - 13) years v. 4 (3 - 9) years; p&lt;0.01), and more likely to be stunted (p&lt;0.01), to have clubbing (p&lt;0.01) and hepatosplenomegaly (p=0.03), and to have multilobar involvement on the chest CT scan (p&lt;0.01). All children had a cause identified, and the majority (86%) of these were presumed to be post-infectious, based on a previous history of a severe lower respiratory tract infection. This group included all 38 CLWH. Only a small proportion of the participants had IEIs, secondary immune deficiencies or PCD. Conclusion. A post-infectious cause for bronchiectasis was the most common aetiology described in children from an LMIC in Africa, especially CLWH. With improved access to diagnostic techniques, the aetiology of bronchiectasis in LMICs is likely to change.

P Juggernath

K Mopeli

Z Dangor

A Goga

D M Gray

C Verwey

Bronchiectasis in children in a high HIV and tuberculosis prevalence setting

高艾滋病和结核病流行地区儿童的支气管扩张症

C Jacobs

P Goussard

M Merven

A Gie

S S B Venkatakrishna

S Andronikou

Is this airway safe?

这条气道安全吗？

Background. Chitotriosidase is a chitinase enzyme that is expressed selectively through activated macrophages in humans. Increased activity of chitotriosidase in both bronchoalveolar lavage samples and serum of patients with sarcoidosis has been reported. It has been proposed that chitotriosidase could be used as a potential biomarker for diagnosis, monitoring and prognosis in sarcoidosis patients. However, no studies in a South African (SA) cohort have evaluated this potential role. Objectives. To analyse serum chitotriosidase activity in treated and untreated sarcoidosis patients, healthy controls and patients with tuberculosis (TB). Sarcoidosis and TB are two diseases of differing aetiology that may be clinically difficult to distinguish between in the SA setting, which is a high-burden area for TB. We hoped to determine whether chitotriosidase activity levels could help differentiate the one disease from the other. Methods. Serum chitotriosidase activity was measured in an SA cohort of treated and untreated sarcoidosis patients and compared with controls. In addition, activity in sarcoidosis patients was compared with that in TB patients. Overall, chitotriosidase activity was assayed in the serum of 12 biopsy-proven sarcoidosis patients before treatment, 9 sarcoidosis patients after at least a month’s treatment, 10 patients with confirmed pulmonary and/or disseminated TB before treatment, and 12 healthy controls. Plasma chitotriosidase activity was assayed as previously described using 4-methylumbelliferyl-β-D-N,Nʹ,N′′-triacetylchitotriose as a substrate. Results. Significantly higher serum chitotriosidase activity was observed in sarcoidosis patients, both untreated and treated, compared with controls (p&lt;0.05). Sarcoidosis patients had higher chitotriosidase levels than TB patients, but this difference was not significant. While chitotriosidase activity was lower in patients with TB than in those with sarcoidosis, levels were elevated compared with controls. Conclusion. Chitotriosidase activity in patients with sarcoidosis was greater than in those with TB, and also greater compared with controls. The increased chitotriosidase activity in sarcoidosis suggests that this enzyme may be involved in the disease pathogenesis. Further investigation is required to validate these findings.

R Morar

I Sinclair

C Feldman

Serum chitotriosidase activity in South African patients with sarcoidosis and tuberculosis

南非结节病和结核病患者血清几丁质三糖苷酶活性研究

Background. Hospital-acquired infection (HAI) in patients with COVID-19 admitted to the intensive care unit (ICU) is associated with increased mortality. The ‘cytokine storm’ associated with COVID-19 leads to extreme elevation of inflammatory biomarkers, including C-reactive protein (CRP). Procalcitonin (PCT) has been shown to be more discriminative than CRP in distinguishing HAI from other inflammatory processes. Objectives. To investigate the utility of PCT in detecting HAI in patients with severe COVID-19. Methods. Clinical and laboratory data from all patients admitted to a dedicated ICU with confirmed severe COVID-19 from 1 April 2020 to 31 August 2020 were prospectively captured. HAI was confirmed by serial PCT and CRP measurements, as well as microbiological data (positive microbiological cultures in clinical context). Data from patients who were on antibiotics on ICU admission, had a positive culture for a presumed pathogen during the first 48 hours of ICU admission, or already had suspected or proven HAI on admission were excluded. Optimal cut-offs with the highest sensitivity and specificity were determined. The discriminative power of PCT was assessed for each outcome, using receiver operating characteristic (ROC) analysis describing the area under the curve. Similarly, negative predictive values (NPVs) and positive predictive values (PPVs) were determined. The sensitivity and specificity for different PCT cut-off levels were calculated. Results. Of 92 patients, 35 had confirmed HAI, which was significantly associated with mechanical ventilation (p&lt;0.001) and mortality (p&lt;0.001). ROC analysis demonstrated that a threshold PCT level of 0.22 μg/L resulted in 97% sensitivity and 40% specificity for predicting HAI. Similarly, sensitivity and specificity for CRP were 91.4% and 38.6%, respectively, when the CRP level was 133 mg/L. In patients with a PCT level &lt;0.25 μg/L, the NPV was 92%, whereas for PCT levels &gt;1.00 μg/L, the PPV was &gt;50%. For PCT levels &gt;40 μg/L, the PPV was 100%. Conclusion. During HAI, PCT levels &gt;1.00 μg/L had a moderate PPV of 52%, whereas levels &lt;0.26 μg/L ruled out HAI with an NPV of 92%. With increased PCT values, the PPV rose to 100%, making it a better biomarker than CRP.

C Schmidt

P S Nyasulu

I Fwemba

U Lalla

B W Allwood

A Parker

J J Taljaard

L N Sigwadhi

J L Tamuzi

A E Zemlin

R T Erasmus

C F N Koegelenberg

The utility of procalcitonin as a biomarker of hospital-acquired infection in severe COVID-19

严重COVID-19中降钙素原作为医院获得性感染生物标志物的应用

K Mochankana

A critical perspective on paediatric pulmonary tuberculosis and diagnostic advancements

儿科肺结核及其诊断进展的批判性视角

Publication Information	Publisher: South African Medical Association，Publishing cycle: ，Journal Type: journal，Open Access Journals: Yes
Basic data	Year of publication: 2018，Proportion of original research papers: 0.00%，Self Citation Rate:N.A.， Gold OA Rate: 0.00%
Journal Fees	$Details
Average review cycle	24 weeks

African Journal of Thoracic and Critical Care Medicine

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Bronchoscopy in children: A review of services in sub-Saharan Africa

Bronchiectasis in children in a high HIV and tuberculosis prevalence setting

Is this airway safe?

Serum chitotriosidase activity in South African patients with sarcoidosis and tuberculosis

The utility of procalcitonin as a biomarker of hospital-acquired infection in severe COVID-19

Bronchiectasis in children in a high HIV and tuberculosis prevalence setting

Is this airway safe?

Serum chitotriosidase activity in South African patients with sarcoidosis and tuberculosis

The utility of procalcitonin as a biomarker of hospital-acquired infection in severe COVID-19

A critical perspective on paediatric pulmonary tuberculosis and diagnostic advancements

ISSN	2617-0191, 2617-0205
h-index	5