Ampath Laboratories DxINSIGHTS - Issue 6 - February 2024

Introduction

MALARIA: A BRIEF REVIEW OF DIAGNOSIS AND TREATMENT

The malaria burden in South Africa has decreased significantly. However, it is still a disease that poses a significant health risk. Due to the high morbidity and mortality associated with malaria, the infection is a diagnosis that needs to be made urgently. Early and accurate diagnosis and treatment will contribute to the prevention of severe disease with a reduction in the risk of death and end organ damage associated with malaria. The clinical picture of malaria is very nonspecific, hence the diagnosis can easily be missed if not suspected by the treating clinician.

TICK TALK: UNPACKING TICK BITE FEVER IN THE SOUTH AFRICAN CONTEXT

Tick-borne diseases are a considerable public health challenge in numerous regions across the globe, including South Africa. Tick populations are on the rise, and their distribution areas are expanding, along with the diseases they transmit.  South Africa’s diverse climate and rich ecosystems create an ideal environment for tick populations.  The two prevalent spotted fever diseases encountered in South Africa are boutonneuse fever-like tick bite fever, caused by Rickettsia conorii, and African tick bite fever, caused by R. africae.  This article aims to provide an overview of the aetiology, epidemiology, clinical features, diagnosis, treatment and prevention of tick-borne spotted fever diseases endemic to South Africa.

CRIMEAN-CONGO HAEMORRHAGIC FEVER

Crimean-Congo haemorrhagic fever (CCHF) is the most common viral haemorrhagic fever in South Africa. It is an arthropod-borne viral disease that is prevalent throughout Africa, Asia, parts of Europe and the Middle East. Historically, CCHF was first identified as Crimean haemorrhagic fever in 1945 and later found to have the same disease pattern to a disease, Congo virus infection, discovered in 1956. Both viral diseases were concluded to have the same viral agent in 1969 and therefore jointly named Crimean-Congo haemorrhagic fever virus.

A CASE OF UNDIAGNOSED TICK BITE FEVER

A 48-year-old woman from the Northern Cape visited her local general practitioner (GP) with complaints of headache, body aches, night sweats and general weakness which lasted for about 5 days. She is the wife of a local sheep farmer and was assisting with animal health in the preceding two weeks. She reported that she had to remove a number of ticks from her clothing while she was working, but did not recall any bites. The GP decided to perform rickettsia serological testing and prescribed amoxicillin-clavulanic acid for a possible bacterial infection.

A NEGLECTED TROPICAL DISEASE – A CASE STUDY ON EAST AFRICAN TRYPANOSOMIASIS

A 43-year-old South African man presented to a hospital in Lusaka, Zambia, with acute febrile illness. He was a professional hunter and gave the history of being active in the preceding weeks (in July and August 2021) in the Eastern Province of Zambia. He recounted that he had been bitten by tsetse flies. Use of an antimalarial did not lead to resolution of his illness. SARS-CoV-2 testing was negative. Clinicians suspected that the man was suffering from trypanosomiasis.