Browsing by Author "Lishman, Juanita"

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    Clinical experience with severe acute respiratory syndrome Coronavirus 2-related illness in children : hospital experience in Cape Town, South Africa
    (Oxford University Press, 2020-11-10) van der Zalm, Marieke M.; Lishman, Juanita; Verhagen, Lilly M.; Redfern, Andrew; Smit, Liezl; Barday, Mikhail; Ruttens, Dries; da Costa, A’ishah; van Jaarsveld, Sandra; Itana, Justina; Schrueder, Neshaad; Van Schalkwyk, Marije; Parker, Noor; Appel, Ilse; Fourie, Barend; Claassen, Mathilda; Workman, Jessica J.; Goussard, Pierre; Van Zyl, Gert; Rabie, Helena
    Background: Children seem relatively protected from serious severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-related disease, but little is known about children living in settings with high tuberculosis and human immunodeficiency virus (HIV) burden. This study reflects clinical data on South African children with SARS-CoV-2. Methods: We collected clinical data of children aged <13 years with laboratory-confirmed SARS-CoV-2 presenting to Tygerberg Hospital, Cape Town, between 17 April and 24 July 2020. Results: One hundred fifty-nine children (median age, 48.0 months [interquartile range {IQR}, 12.0-106.0 months]) were included. Hospitalized children (n = 62), with a median age of 13.5 months (IQR, 1.8-43.5 months) were younger than children not admitted (n = 97; median age, 81.0 months [IQR, 34.5-120.5 months]; P < .01.). Thirty-three of 159 (20.8%) children had preexisting medical conditions. Fifty-one of 62 (82.3%) hospitalized children were symptomatic; lower respiratory tract infection was diagnosed in 21 of 51 (41.2%) children, and in 11 of 16 (68.8%) children <3 months of age. Respiratory support was required in 25 of 51 (49.0%) children; 13 of these (52.0%) were <3 months of age. One child was HIV infected and 11 of 51 (21.2%) were HIV exposed but uninfected, and 7 of 51 (13.7%) children had a recent or new diagnosis of tuberculosis. Conclusions: Children <1 year of age hospitalized with SARS-CoV-2 in Cape Town frequently required respiratory support. Access to oxygen may be limited in some low- and middle-income countries, which could potentially drive morbidity and mortality. HIV infection was uncommon but a relationship between HIV exposure, tuberculosis, and SARS-CoV-2 should be explored.
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    Descriptive study evaluating the management and outcome of infants aged 21-90 days presenting to a paediatric emergency department with a possible serious bacterial infection
    (2019-12) Lishman, Juanita; Redfern, Andrew; Smit, Liezl; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Paediatrics and Child Health.
    Background: Young infants with a possible serious bacterial infection (SBI) are a common presentation to paediatric emergency departments (PEDs). It is often difficult to distinguish clinically between self-limiting viral infections and a SBI. Available evaluation algorithms to assist clinicians are mostly from high income countries. Data to inform clinical practice in low and middle income countries are lacking. Objectives: To determine the period prevalence of SBI and invasive bacterial infection (IBI) and describe current practice in the assessment and management of young infants aged 21-90 days presenting with a possible SBI to a PED in Cape Town, South Africa. Methods: A retrospective cross-sectional review of infants 21-90 days old presenting to the Tygerberg Hospital PED between 1 January 2016 to 31 May 2016. Results: A total of 248 infants 21-90 days were included in the study. Sixty-two patients (25%, 95% CI 20-30) had a SBI and 13 (5.2%, 95% CI 3-8) had an IBI. One hundred and sixty five infants had a possible SBI based on IMCI criteria. The sensitivity of the IMCI criteria in detecting SBI was 82.3% (95% CI 70.5-90.8) and the specificity 38.7% (95% CI 31.7-46.1). More than half (51.2%) of the infants received antibiotics within the 48 hours prior to presentation, of which 33.5% included intramuscular injection of Ceftriaxone. Only 20 (8.0%) patients in this age group were discharged home after initial evaluation. Of the infants who did not have a SBI, 96 (51.9%) received intravenous antibiotics. Conclusion: Period prevalence of SBI and IBI was much higher compared to that published in the literature. Evaluation algorithms to stratify risk of SBI are needed to assist clinicians in diagnosing and managing infants appropriately in low and middle income settings.
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    Short-term outcomes of children with multisystem inflammatory syndrome in children (MIS-C) in South Africa : a prospective cohort study
    (Stellenbosch : Stellenbosch University, 2023-03) Lishman, Juanita; Rabie, Helena; Abraham, Deepthi Raju; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Paediatrics and Child Health.
    ENGLISH SUMMARY: Background: Despite the life-threatening presentation of MISC in children, the overall prognosis is favourable in centers with access to appropriate supportive care. In this study we investigate the short-term outcomes in children with MIS-C in Cape Town, South Africa. Methods: This prospective observational cohort study in children <13 years who fulfilled the World Health Organization (WHO) case definition of MIS-C and were admitted to Tygerberg Hospital in Cape Town between 1 June 2020 and 31 October 2021. Clinical features were recorded at baseline and at followup at cardiology and rheumatology-immunology clinics respectively. Findings: Fifty-three children with a median age of 7.4 years (interquartile range (IQR) 4.2-9.9) MIS-C were included. There was a slight male predominance (30/53; 56,6%) and the majority was of mixed-race (28/53; 52,83%) or black African ancestry (24/53; 45,3%). Fourteen children (14/53; 26,4%) had comorbid disease. The median length of hospital stay was 8 days (IQR 6-10). All children had an echocardiogram performed at baseline of which 39 were abnormal (39/53; 73,6%). The majority had elevated markers of inflammation, lymphopenia, anaemia, renal impairment, hyponatremia, and elevated cardiac enzymes during the acute phase. All children were discharged alive. The median days from discharge to cardiology follow-up was 39 days (IQR 33.5-41.5) and for rheumatology immunology clinic was 70.5 days (IQR 59.5-85.0). Eleven children (11/41; 26,8%) had a persistently abnormal echocardiogram at cardiology follow-up. Systemic inflammation and organ dysfunction resolved in most. Interpretation: Although the short-term outcomes of MIS-C in our cohort were generally good, the cardiac morbidity needs further characterization and follow-up.