The aim of this study was to add to the descriptive data pertaining to the epidemiology, presentation, and clinical course of multisystem inflammatory syndrome (MIS) temporally associated with coronavirus disease 2019 in adults and adolescents from low- and middle-income countries. Patients presenting to the adult wards (14 years and older) of three academic hospitals in South Africa, who were diagnosed with MIS between August 1, 2020 and May 31, 2021, were reviewed retrospectively. The presentation, laboratory and radiographic findings, and clinical course are described. Eleven cases of MIS were reported, four in adolescents (14-19 years) and seven in adults (≥19 years). Fever was universal. Gastrointestinal symptoms (90.9%), cardiorespiratory abnormalities (90.9%), and mucocutaneous findings (72.7%) were prominent. Echocardiography in 10/11 patients (90.9%) showed a median left ventricular ejection fraction of 26.3% (interquartile range 21.9-33.6%). All patients required high care admission and 72.7% required inotropic support. Glucocorticoids were initiated in all cases and 72.7% received intravenous immunoglobulin. This constitutes the largest multicentre review of adults and adolescents with MIS in Africa. MIS may be overlooked in resource-limited settings, and heightened suspicion is needed in patients with multi-organ dysfunction, especially where repeated investigations for other aetiologies are negative.

Disseminated Acanthamoeba species infection is likely an underrecognized and underdiagnosed opportunistic infection in patients with advanced human immunodeficiency virus (HIV) disease in South Africa. It presents a unique clinical challenge in that the diagnosis can be difficult to establish and management options are limited in low-resource settings. To our knowledge, there is a paucity of literature to date on the successful use of combination treatment options for patients in low-resource settings without access to miltefosine. We present a case describing the clinical improvement of disseminated Acanthamoeba infection in a patient with advanced HIV using a non-miltefosine-based treatment regimen. The case serves to highlight that Acanthamoeba sp. infection should be considered as a differential diagnosis for nodular and ulcerative cutaneous lesions in patients with advanced HIV in South Africa, and that although there are alternative options for combination treatment in countries without access to miltefosine, efforts should be made to advocate for better access to miltefosine for the treatment of acanthamoebiasis in South Africa.

Background: There is a paucity of information on the burden of Klebsiella pneumoniae invasive disease (KPn-ID) in Africa. We conducted a multicentre, observational study on the clinical and microbiological epidemiology of KPn-ID in hospitalized adults in South Africa, focusing on clinical outcomes and KPn susceptibility profiles. Methods: Surveillance for culture-confirmed KPn from blood and CSF was undertaken from 15 May 2023 to 14 May 2024. Phenotypic antimicrobial susceptibility was analysed, and the presence of carbapenemases was assessed with a lateral flow assay test. Results: We enrolled 524 of 617 individuals with KPn-ID. The median age was 48 (IQR: 35–61) years, and 84.4% (442/524) were presumed healthcare-associated infections. Comorbidities included HIV (26.9%; 141/524) and diabetes mellitus (16.4%; 86/524). There was a high prevalence of carbapenem resistance (55.0%; 288/524), with the OXA-48 carbapenemase detected in 71.5% (181/253), and OXA-48 and NDM co-detected in 20.9% (53/253) of tested isolates. Colistin resistance was detected in 7.6% (19/251) of tested isolates. The in-hospital case fatality risk (CFR) was 56.5% (296/524). Urethral catheterization [adjusted odds ratio (aOR) 3.30; 95% CI: 1.51–7.23] and an admission quick sepsis-related organ failure assessment score of 1 to 3 (aOR 2.14; 95% CI: 1.25–3.68) were independently associated with in-hospital death. Achieving source control was associated with lower odds of death (aOR 0.18; 95% CI: 0.10–0.30). Conclusions: We observed a high prevalence of MDR and high CFR in adults with KPn-ID. These data show the urgent need for strategies to mitigate KPn-ID in settings such as ours.

Klebsiella pneumoniae is a leading cause of nosocomial infections, neonatal sepsis, and childhood mortality worldwide. A drastic rise in antibiotic-resistant isolates poses an urgent threat to humanity, and the World Health Organization (WHO) has classified this as a critical-priority antimicrobial-resistant (AMR) pathogen. Recent advancements in developing vaccines against Klebsiella pneumoniae have highlighted the lack of standardized assays to evaluate immunogenicity, complicating comparison among different vaccines under development and the establishment of a serological threshold of risk reduction (SToRR). Here, we describe the development of a ten-plex multiplex assay to measure IgG against capsular polysaccharides (K2, K25, K102, K149), O antigens (O1v1, O1v2, O2v1, O2v2 and O5), and a conserved protein (MrkA). A standard curve was established by pooling human sera from naturally exposed subjects and then calibrated in terms of Relative Luminex Units/mL. The assay was fully characterized in terms of specificity, precision, linearity, and repeatability. This immunoassay demonstrates performance suitable for future clinical trials, as well as to perform sero-epidemiological studies to gain insights into naturally occurring immunity, potentially contributing to the establishment of a serological threshold of risk reduction against Klebsiella pneumoniae.

Introduction: Hydatid disease in the South African setting remains an important differential diagnosis in many appropriate clinical presentations, such as splenomegaly. Splenic hydatid disease in pregnancy is a rare and complex disease to manage. Patient presentation: In this case report we describe a case of isolated splenic hydatid disease in an HIV-positive woman presenting in her third trimester of pregnancy. Management and outcome: A multidisciplinary team consisting of specialists from the high-risk maternity unit, hepatobiliary surgery and infectious diseases planned the management of the patient, which included pre-operative albendazole and elective caesarean section with assisted forceps delivery at 36 weeks’ gestation. An elective splenectomy in the post-partum period was planned for definitive management. Conclusion: Our aim is to highlight the unique treatment challenges of hydatid disease in pregnancy and the need for a multidisciplinary team approach when managing complex cases of hydatid disease.