Epidemiology of invasive Haemophilus influenzae infections in Cape Town, South Africa

The full spectrum of invasive Haemophilus influenzae disease has not been documented previously in Africa. This 1-year prospective study was designed to determine the epidemiology of invasive Haemophilus influenzae disease in Cape Town children. During this period, 142 children with invasive disease were hospitalized; 85 (59.9%) presented with meningitis, 35 (24.6%) with pneumonia and 22 (15.5%) with other diseases. No cases of epiglottitis were seen. Sixty per cent of cases were male and 40% female. The median age of the children was 9 months, with a range of 1-144 months, and 65.5% were aged < 12 months. Neurological dysfunction was noted in 40% and 18% of children with meningitis on admission and discharge, respectively. The overall case fatality rate (95% confidence intervals) was 9.2% (4.9-15.7), and for meningitis, pneumonia and septicaemia it was 4.7% (1.2-16.4), 14.3% (4.6-31.8) and 40% (8-78.1), respectively. Serotype b accounted for 86.5% of all cases, 97.3% of cases of meningitis, 71.4% of cases of pneumonia, 50% of cases of septicaemia, all cases of arthritis and cellulitis and none of mastoiditis. The incidence rates (95% confidence intervals) for all invasive type b infections were 169 (122-198) and 47 (39-57) per 100,000 population for children < 1 and < 5 years, respectively. For meningitis the rates were 112 (84-148) and 34 (25-40) per 100,000, respectively. Rates for mixed race and white children were similar, but those for black children were more than double those rates.(ABSTRACT TRUNCATED AT 250 WORDS)

Detection of bacterial antigens in cerebrospinal fluid by a latex agglutination test in 'septic unknown' meningitis and serogroup B meningococcal meningitis

The latex agglutination test (Wellcogen) was evaluated specifically in cases of 'septic unknown' meningitis, with CSF findings characteristic of bacterial meningitis but with no bacterial organisms grown on CSF culture or seen on microscopy after Gram staining. In only 4 (12%) of 33 cases of 'septic unknown' meningitis were antigens identified in the CSF. This kit contains for the first time reagents for the detection of serogroup B Neisseria meningitidis antigens and was also evaluated for this bacteria. Only 6 (27%) of 22 serogroup B N. meningitidis cases were identified.

[So-called oncocytoma of the thyroid (author's transl)]

There were 68 thyroids with oncocytic cell changes among thyroid specimens from 2476 thyroid operations performed between 1969 and 1978. In 12 instances there were merely Hürthle cell nests, in 13 there was an oncocytic carcinoma and in 43 oncocytic adenoma. Thyroidectomy was the preferred treatment for Hürthle-cell carcinoma. Five patients were no longer suitable for radical operation, in one there was a recurrence. If there is a potentially malignant oncocytoma, hemithyroidectomy should be performed and careful follow-up is necessary. There was no recurrence maximally 82 months postoperatively.

Traumatic mediastinal emphysema

The traumatic mediastinal emphysema occurs along with severe combined injuries. A typical feature is the subcutaneous emphysema as well as crackling sounds and frequently a pneumothorax. The radiography of the chest shows air in the mediastinum surrounding the mediastinal structures. The pleura drainage could be done as an emergency performance in cases of pneumothorax. In cases of an increasing subcutaneous and mediastinal emphysema as well as circulatory failure a cervical mediastinotomy should be carried out. The tracheobronchial tree should be examined bronchoscopically for possible ruptures. Esophagus injuries will be detected by the distribution of a contrast fluid. Even a thoracotomy may be necessary.

[Diagnosis and therapy of acute penetrating myocardial injury (author's transl)]

Clinical signs of an acute penetrating wound of the heart not always are clear. Because of hemorrhage and reduced cardiac output during heart tamponade venous pressure not necessarily must be increased. If by pericardiocentesis an aspiration of blood is possible, diagnosis of a penetrating heart wound is of high probability; otherwise there is no diagnostic value of a negative pericardiocentesis. Only in a case of a very small cardiac wound pericardial drainage can be used as a sole therapeutic proceeding; clinical observation is mandatory and an emergency operation at all time must be possible. In most cases immediately thoracotomy with suture of the cardiac wound should be performed. Attention is necessary because of an injury of a coronary artery. Following this principle prognosis is good if the patient is reaching clinical treatment alive. Lethal outcome in 2 of our 12 reported cases in one of them is caused by refusing immediate surgical intervention by the patient himself, in the other by development of ischemic cardiac necrosis involving a papillary muscle after suturing a cardiac wound.