AJTCCM VOL. 30 NO. 3 2024 135

ABSTRACTS

ADULT PULMONOLOGY

The elusive bleeding lung

B Abdool-Gafoor, C Hayward

Melomed Gatesville Private Hospital, Cape Town, South Africa

Corresponding author: B Abdool-Gafoor (bilalgafoor1979@yahoo.co.uk)

Background. Thoracic endometriosis syndrome (TES) is a rare

condition aecting women in their reproductive years, and is oen

misdiagnosed on initial presentation. Of women with TES, 50-80%

have coexisting pelvic endometriosis. The most common clinical

manifestations of TES are catamenial pneumothorax, catamenial

haemothorax, catamenial haemoptysis and lung nodules.

Case presentation. A 29-year-old woman with no known comorbidities

presented with recurrent dyspnoea and pleuritic chest pain. She

was noted to have a right-sided pleural eusion, which was frankly

haemorrhagic on pleural tap. This had previously been treated

as pulmonary tuberculosis without improvement. A history of

dysmenorrhoea and episodic dyspnoea raised the clinical suspicion of

TES. Video-assisted thoracoscopy and laparoscopy were performed,

and biopsies of vascular islands of tissue on the thoracic surface of the

diaphragm conrmed endometriosis.

Conclusion. A high index of clinical suspicion, as well as a

multidisciplinary approach, are imperative in the diagnosis and

management of a patient with TES.

The performance of chest computed

tomography for the detection of

pulmonary hypertension in patients

with post-tuberculosis lung disease

M Almubarek, E H Louw, S Grith-Richards, C Ackermann, NBaines,

Homson, A J K Pecoraro, C F N Koegelenberg, E M Irusen,

BWAllwood

Division of Pulmonology, Department of Medicine, Faculty of Medicine and

Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town,

SouthAfrica

Corresponding author: M Almubarek (marwanalmobark89@gmail.com)

Background. Pulmonary hypertension (PH) aer tuberculosis (TB)

is increasingly recognised as important in settings with a high burden

of TB. e use of computed tomography (CT) scan imaging to assist

with the detection of PH is currently unknown.

Methods. A retrospective study of patients with post-TB lung disease

(PTLD) was conducted from January 2019 to September 2021. Adult

patients with both a chest CT scan and an echocardiogram performed

within 9 months of each other were enrolled. A diagnosis of PH by

echocardiography was made if the right ventricular systolic pressure

(RVSP) was ≥36 mmHg or the peak tricuspid regurgitant jet velocity

(TRVmax) >2.8 m/s. Radiological criteria for PH included pulmonary

artery/ascending aorta (PA/AA) ratio >1, pulmonary artery diameter

(PAD) ≥29 mm (males) males or ≥27 mm (females), and right ventricle/

le ventricle (RV/LV) ratio ≥1.28. Spirometry was also performed.

Results. Of 173 subjects with PTLD, 52 met the inclusion criteria.

Signicant correlations were found between the CT-measured PA/AA

ratio and RVSP (p=0.0083) and TRVmax (p=0.0582), but not between

the CT-measured RV/LV ratio and RVSP (p=0.1729) or TRVmax

(p=0.0749). PAD was also signicantly correlated with RVSP (p=0.0011)

and TRVmax (p=0.0023). e PA/AA ratio identied patients with PH

on echocardiography with a sensitivity of ~100%, specicity of 65% and

positive predictive value of 39%, indicating a high potential for false-

positive diagnosis. e forced vital capacity was 13.7% lower in patients

with PH (p=0.044), but the forced expiratory volume in the 1st second

was not statistically dierent.

Conclusion. A low PA/AA ratio can be used to rule out the diagnosis of

PH in PTLD, but a high PA/AA ratio requires further investigation for PH.

Ascaris exposure and its association

with asthma and atopy in Angolan

adults: Acase- control study

M Arrais, M Delgadinho, C Ginete, L Veiga, W Dias,

JVasconcelos, M Brito

Department of Pulmonology, Hospital Militar Principal/Instituto Superior,

Luanda, Angola; Centro de Investigação em Saúde de Angola (CISA), Caxito,

Bengo, Angola

Corresponding author: M Arrais (mararrais@hotmail.com)

Background. Infection by Ascaris lumbricoides is one of the most

common soil-transmitted infections, especially in sub-Saharan Africa.

Several epidemiological studies have demonstrated that Ascaris

infection is associated with asthma and atopy in endemic regions.

Objectives. To investigate the association between Ascaris infection

and asthma.

Methods. This case-control study was conducted in Luanda, the

capital city of Angola, with 157 patients with asthma followed up

in the

SouthAfrican oracic

Society Congress 2024

Abstracts of the SATS Congress

UCT GSB Academic Conference Centre

V&A Waterfront

Cape Town 22-24 August 2024

136 AJTCCM VOL. 30 NO. 3 2024

ABSTRACTS

outpatient pulmonology clinic at the Military Hospital, and 157 healthy

volunteers. Atopy was dened by positive skin-prick tests (SPTs) and

immunoglobulin G antibodies to A. lumbricoides (anti-Ascaris IgG) were

detected by enzyme-linked immunosorbent assay. Real-time polymerase

chain reaction was used to detect A. lumbricoides in stool samples. Data

were analysed by independent-sample t-tests and χ

or Fisher’s exact tests.

Results. ere were more women than men in the study sample (64.6%),

and the mean (standard deviation) age was 38.4 (13.6) years. One hundred

and six (67.5%) of the cases and 46 (29.3%) of the controls had positive

SPTs for any aeroallergens tested, and the most frequent sensitisations

involved house dust mites. Only 15 participants (4.8%) were infected

with A. lumbricoides; however, 62 (39.5%) of the cases and 40 (25.5%) of

the controls had positive anti-Ascaris IgG. Having anti-Ascaris IgG was

signicantly associated with asthma risk (p=0.006), but not with sex, age,

body mass index, or even atopy.

Conclusion. Exposure to Ascaris was associated with asthma risk among

Angolan adults, but not with atopy. More studies are needed in dierent

regions of Angola to better understand this relationship.

Funding. is work was funded by FCG/LaCaixa and IDI&CA grant

IPL/2023/IPAsthma.

The diagnostic yield of EBUS-TBNA:

A single-centre experience from the

Middle East

S M Bennji, B Jayakrishnan, Z Al-Hashami, R Kausalya,

IAlQarshoubi

Division of Pulmonology and Head and Neck and oracic Program, Sultan

Qaboos Comprehensive Cancer Care and Research Centre, Muscat, Oman

Corresponding author: S M Bennji (saminj12@gmail.com)

Background. e role of endobronchial ultrasound with transbronchial

aspiration (EBUS- TBNA) in diagnosing and staging lung cancer is well

established. It has also been used to diagnose various other types of cancers

and diseases with mediastinal lymphadenopathy, including inammatory

and infective disorders such as sarcoidosis and tuberculosis.

Objectives. To explore the diagnostic yield of EBUS-TBNA in dierent

cancers and its usefulness in molecular analysis during the rst 2 years

aer establishing the service in a new cancer centre in Muscat, Oman.

Methods. Data on all patients who underwent EBUS-TBNA at Sultan

Qaboos Comprehensive Cancer Care and Research Centre from January

2022 to December 2023 were collected retrospectively.

Results. Seventy-ve patients underwent EBUS-TBNA, and 106 lymph

nodes were sampled with a total of 546 passes. e mean (standard

deviation) age was 62.16 (13.3) years, with patients being older (73.43

(9.13) years) in the gastrointestinal group (p=0.010). e mean duration

of the procedure was 40.01 (19.07) minutes, and the mean number of

passes was 7.38 (3.46) per study. e most common sites of puncture were

subcarinal (n=45; 60.0%) and both the right lower paratracheal and the

right interlobar node stations (n=17; 22.7%). e primary sites of cancer

were the lung (n=31; 41.3%), breast (n=10; 13.3%), gastrointestinal tract

(n=7; 9.3%), and other sites combined (n=12; 16%); 4 patients (5.3%)

had lymphoma. Eleven patients (14.7%) had non-malignant disease.

ere were no major complications. Sixty-four patients had an adequate

sample for cytological examination, with an overall diagnostic yield of

85.3%, while 11 (14.7%) required further interventions. e yield based

on primary site was 90.3% for lung, 60% for breast, and 100% each for

gastrointestinal and other cancers (p<0.001). In the 11 patients with non-

malignant conditions, the yield was 100%. In 7 out of 13 requests for

molecular analysis (53.8%), there was sucient material.

Conclusion. EBUS-TBNA is safe, with a high diagnostic yield for both

malignant and benign conditions. However, for molecular analysis the

yield is relatively low

Prediction of pleural metastasis from

machine learning models incorporating

pleural C-reactive protein in two

facilities in Yaoundé Hospital, Cameroon

M E Ngah Komo, C Mbobara, M Massongo, A Kuaban, A Ntyo’o,

EWPefura

Division of Internal Medicine, Faculty of Medicine and Biomedical Sciences,

University of Yaoundé I, Cameroon

Corresponding author: M E Ngah Komo (elisabeth.ngah@fmsb-uy1.cm)

Background. e diagnosis of pleural metastasis is dicult in Cameroon

owing to the poor access to thoracoscopy. We decided to develop machine

learning algorithms integrating pleural C-reactive protein (CRP) and

clinical and biological parameters to predict pleural metastasis.

Objectives. To determine the performances of machine learning models

in the prediction of pleural metastasis.

Methods. is was a cross-sectional study of 302 patients aged ≥16 years

presenting with non-purulent pleural eusion, conducted in two hospitals

in Yaoundé. Data were collected using a self-administered questionnaire.

We tested four models of classification (Random Forest, Gradient

Boosting, Neuronal Network and Logistic Regression) to determine the

performances of machine learning models in the prediction of pleural

metastasis using the R Soware Python Scikit-learn package.

Results. Of the participants, 57.9% were male and 42.1% were female. e

median age (25th-75th percentile) was 47 (44-48) years. Forty-eight

(15.9%) of the patients had pleural metastasis. Among the cases of non-

metastatic pleural eusion, we found 44 cases (59.3%) of tuberculosis

and 35 cases (24.8%) of chronic nonspecic pleurisy. e determinants

of pleural metastasis were age, male gender, primary cancers identied,

and pleural CRP and pleural protein levels. Aer comparison of the

performances of the four machine learning models, we selected the

Logistic Regression model, which had an area under the receiver

operating curve score of 0.80 and the best curb during cross-validation.

Neuronal Network ranked second in terms of performance.

Conclusion. Logistic Regression was the machine learning model with the

best prediction score for pleural metastasis, followed by Neuronal Network.

Factors aecting the establishment

and provision of an outpatient

pulmonary rehabilitation programme:

Perspectives of physiotherapists

working in the Cape Metropole,

SouthAfrica

L Labuschagne, A Lupton-Smith, P Gretschel, I du Plessis

Division of Physiotherapy, Department of Health and Rehabilitation Sciences,

Faculty of Health Sciences, University of Cape Town, SouthAfrica; Department

of Physiotherapy, Groote Schuur Hospital, Western Cape Department of Health

and Wellness, Western Cape, SouthAfrica

Corresponding author: L Labuschagne (lisaphysiosa@gmail.com)

AJTCCM VOL. 30 NO. 3 2024 137

ABSTRACTS

Background. Chronic respiratory diseases (CRDs) are a signicant

global health problem. Although extensive evidence shows pulmonary

rehabilitation (PR) to be an important tool in CRD management, the

uptake and implementation of PR remains a challenge.

Objectives. To explore the factors affecting the establishment and

provision of outpatient PR programmes (PRPs) from the perspective

of physiotherapists working in the Cape Metropole, Cape Town,

SouthAfrica.

Methods. An exploratory qualitative descriptive design was used,

whereby data were generated following semistructured interviews

with six physiotherapists in the Cape Metropole, who had attempted to

provide PRPs to adults. A thematic analysis of the data then took place,

with the data being analysed and interpreted through the theoretical

lens of the Social Cognitive eory (SCT).

Results. ree themes emerged following analysis of the data from these

six interviews: ‘One size does not t all’, ‘Sustained and driven by internal

factors and external sources of support’, and ‘Common barriers with

diering impacts’. e participants’ ability to establish and implement

PR was determined by how they enacted their self-ecacy to navigate

barriers and mobilise facilitators in their practice contexts.

Conclusion. The need to promote self-efficacy and behavioural

capability among physiotherapists in overcoming the barriers to

provision of PRPs was emphasised.

Management outcomes of acute

pulmonary embolism at Dr George

Mukhari Academic Hospital, Pretoria,

SouthAfrica

M K Mahlangu, M J Mpe

Department of Internal Medicine, School of Medicine, Sefako Makgatho Health

Sciences University, Pretoria, SouthAfrica

Corresponding author: M K Mahlangu (drkennymahlangu@gmail.com)

Objectives. To describe the management and outcomes of patients with

pulmonary embolism (PE) admitted to the medical wards of a university

hospital in Pretoria, SouthAfrica (SA). e outcome of interest was in-

hospital mortality attributable to PE.

Methods. is was a retrospective analysis of case records of patients

admitted to the medical wards with a conrmed diagnosis of PE during

a 3-year study period (January 2017-December 2019).

Results. A total of 141 medical patients admitted during the study period

were conrmed as having PE by computed tomography pulmonary

angiograms. e mean (standard deviation) age of the cohort was

48.6 (15.2) years. HIV was considered a risk factor in 38% of the cases.

e commonest presenting symptom was acute breathlessness. Just

over 40% of the patients (n=57) needed care in a high-dependency

unit (HDU), with 7 (4.9%) managed in an intensive care unit (ICU)

and the remainder in standard medical wards. Treatment consisted

of standard parenteral anticoagulation, followed by an oral vitaminK

antagonist. None of the patients received any interventional therapies

outside of standard medical care. Eleven patients (7.8%) died as a

result of the PE: 1 patient in the ICU and 10 in the HDU. ere was no

statistically signicant association between the following variables and

the risk of death: presence of right ventricular dysfunction, presence of

comorbidities, PE size, gender, or age below or above 60 years. Hospital

stay was statistically signicantly longer among survivors.

Conclusions. In-hospital mortality in our cohort was elevated in

comparison with recent reports from other countries, but much lower

than reports from SA. HIV infection was a reasonably important risk

factor for PE.

In-hospital management and outcomes

of acute exacerbations of chronic

obstructive pulmonary disease at a

tertiary hospital in Pretoria, SouthAfrica

N P Mlongo, K Kalidas, M J Mpe

Division of Respiratory Medicine, Department of Internal Medicine, School of

Medicine, Sefako Makgatho Health Sciences University, Pretoria, SouthAfrica

Corresponding author: N P Mlongo (nipmhlongo@yahoo.com)

Background. Chronic obstructive pulmonary disease (COPD) is a

signicant cause of ill-health and mortality throughout the world.

Objectives. To describe the management and outcomes of patients

admitted to medical wards with an acute exacerbation of COPD.

Methods. is was a cross-sectional study of a cohort of medical patients

who met the inclusion criteria.

Results. A total of 97 patients were studied. e mean age was 64.6 years,

and the majority (73.2%) were male. Over 70% (73.2%) were current

tobacco users, with 26% having >40 pack-years of use. irty-eight

patients (39.1%) had had at least one previous exacerbation requiring

hospitalisation during the past 12 months. More than 75% (79.4%) of the

are-ups were deemed infective in origin. One patient had a pulmonary

embolus as a precipitant. Seven patients required admission to high care.

Eighteen patients (18.5%) died as a result of the exacerbation. ere was

no association between the presence of comorbid disease, a previous

episode of exacerbation or gender and poor outcome. ere were no

signicant dierences between survivors and non-survivors with regard

to age, mean pack-years or admission biochemical abnormalities.

Survivors had a signicantly longer hospital stay (p<0.001).

Conclusion. COPD exacerbations in this study led to signicant loss

of life, even though an association between poor outcome and factors

traditionally associated with increased mortality could not be found.

is nding suggests that all are-ups of the disease carry a potential

for poor outcome, regardless of the presence or absence of known risk

factors for poor outcome.

Accuracy of AI-driven computer-aided

detection to identify cavitary disease

as a marker of infectious tuberculosis

during community-based active

case-ﬁnding

A J Scott, S V Kik, T Perumal, P Gina, M Masikati, S Jaumdally,

SOelofse, L Kühn, J Swanepoel, M Ruhwald, A Esmail, K Dheda

Centre for Lung Infection and Immunity, Division of Pulmonology, Department

of Medicine and University of Cape Town Lung Institute, Cape Town,

SouthAfrica; Centre for the Study of Antimicrobial Resistance, SouthAfrican

Medical Research Council, Cape Town, SouthAfrica

Corresponding author: K Dheda (keertan.dheda@uct.ac.za)

Background. The infectiousness of individuals with tuberculosis

(TB) residing in the community who do not self-report to healthcare

facilities remains poorly deﬁned.

138 AJTCCM VOL. 30 NO. 3 2024

ABSTRACTS

Objectives. To determine whether computer-aided detection (CAD)

could accurately identify cavitary disease (proxy for infectiousness)

during community-based active case-ﬁnding (ACF) for TB.

Methods. Participants with microbiologically conﬁrmed TB (sputum

Xpert Ultra and/or culture positivity), recruited from two community-

based ACF studies in SouthAfrica (XACT-3 and XACT- 19), underwent

point-of-care (POC) chest radiography analysed by CAD (qXR v4.0) and

two expert human readers. All participants underwent positron emission

tomography-computed tomography (PET-CT) scanning. e accuracy

of CAD in detecting cavitary disease was compared with that of PET-CT

(radiological reference standard; presence of cavitation plus SUVmax >2.5

suggesting metabolically active cavitary disease was used as a proxy for

probable infectiousness).

Results. A total of 1 455 participants were enrolled, of whom 112

(7.7%) had microbiologically conﬁrmed TB (n=54/112 (48.2%) were

asymptomatic). Chest radiographs and PET-CT scans were available

in 82.1% (n=92/112); 61/92 (66.3%) had cavitary disease on PET-CT

(median SUVmax 5.4). At the developer-recommended cavity threshold,

CAD sensitivity and speciﬁcity were 60.7% (95% condence interval (CI)

47.3-72.9) and 84.6% (95% CI65.1-95.6), respectively. Compared with

human readers, CAD had statistically similar sensitivity (60.7% (95%

CI47.3-72.9) v. 66.7% (95% CI52.5-78.9)), speciﬁcity (84.6% (95%

CI65.1-95.6) v. 73.1% (95% CI52.2-88.4)), and positive predictive value

(90.2% (95% CI78.6-95.9) v. 83.7% (95% CI72.7- 0.9)).

Conclusion. A high proportion (two-thirds) of individuals with

microbiologically conﬁrmed TB had evidence of metabolically active

cavitary disease, suggesting that they were probably infectious. CAD may

be a useful POC rule-in test to detect cavitary disease, and could inform

contact tracing and treatment strategies in endemic settings.

Clinical evaluation of computer-aided

digital X-ray detection of pulmonary

tuberculosis during community-based

screening/active case-ﬁnding

A J Scott, T Perumal, A Pooran, S Oelofse, T Mthiyane,

MvanderWalt, Z Z Qin, J Fehr, A D Grant, E B Wong, A Esmail,

K Dheda

Centre for Lung Infection and Immunity, Division of Pulmonology, Department

of Medicine and University of Cape Town Lung Institute, Cape Town,

SouthAfrica; Centre for the Study of Antimicrobial Resistance, SouthAfrican

Medical Research Council, Cape Town, SouthAfrica

Corresponding author: K Dheda (keertan.dheda@uct.ac.za)

Background. Computer-aided detection (CAD) has been recommended

as a tuberculosis (TB) screening tool. However, few studies have

evaluated CAD in a community-based setting.

Objectives. To determine the clinical utility of CAD during community-

based active case-ﬁnding (ACF).

Methods. Individual patient data were pooled from ﬁve community-

based ACF studies in SouthAfrica. CAD-interpreted chest radiography

(CAD4TB v7) was assessed against a microbiological reference standard

(sputum Xpert Ultra and/or culture positivity). e clinical utility of

CAD was evaluated, and a preliminary cost analysis was performed.

Results. Of 20 770 individuals enrolled across all studies, 530 (2.6%)

had microbiologically proven TB. Evaluable controls (non-TB) and

cases (TB) were randomly selected from this parent population in a 2:1

ratio (n=501 TB positive and n=938 TB negative; total N=1 439). CAD

achieved an areaunder the receiver operating curve (AUC) of 0.83 (95%

condence interval (CI) 0.80-0.85). At ﬁxed sensitivities of 90% and

85% (thresholds of5 and 10), speciﬁcity was 44.9% (95% CI42.5-47.3)

and 54.1% (95% CI51.7-56.5), respectively. CAD (AUC) performed

worse in individuals living with HIV (v. HIV negative) (0.76 v. 0.85;

p=0.004) and in asymptomatic (v. symptomatic) individuals (0.79 v.

0.85; p=0.008). Nevertheless, CAD-directed Xpert (v.universal Xpert

testing) reduced cost by ~20% per individual with TB diagnosed, at the

detriment of a ~10% reduction in the true TB positives detected.

Conclusion. In the setting of community-based ACF, CAD did not meet

the World Health Organization screening test target product proﬁle

(>90% sensitivity, >70% speciﬁcity) and performed more poorly in

certain subgroups. However, a context-speciﬁc CAD-directed strategy

could still be cost-saving. ese data inform community-based ACF

strategies aiming to disrupt the TB transmission cycle.

Can AI-driven computer-aided

detection optimise Xpert-orientated

community-based active case-ﬁnding

for TB (XACT-19)? An interim trial

progress report

A J Scott, A Chizema, G Chongo, T Perumal, S Jaumdally,

DMilimo, S Oelofse, A Esmail, J Mutsvangwa, H Ayles, K Dheda

Centre for Lung Infection and Immunity, Division of Pulmonology, Department

of Medicine and University of Cape Town Lung Institute, Cape Town,

SouthAfrica; Centre for the Study of Antimicrobial Resistance, SouthAfrican

Medical Research Council, Cape Town, SouthAfrica

Corresponding author: K Dheda (keertan.dheda@uct.ac.za)

Background. Approximately one-third of individuals newly ill with

tuberculosis (TB) are undiagnosed/unreported. Detecting such

individuals in endemic communities has been restricted by the lack of

sensitive, point-of-care (POC) diagnostic tools.

Objectives. To determine the impact of computer-aided detection

(CAD) during community-based active case-ﬁnding (ACF).

Methods. In an ongoing multicentre open-labelled randomised

controlled trial, individuals at risk for TB were recruited from TB/HIV-

endemic communities in SouthAfrica (SA), Zambia and Zimbabwe.

Using a low-cost mobile van staffed by three healthcare workers

and equipped with an ultra-portable X-ray and GeneXpert system,

participants were randomised into either POC ‘CAD+Xpert’ (CAD

followed by Xpert in CAD-positive participants) or POC ‘Xpert only’

(Xpert in all). e reference standard was microbiologically proven TB

(Xpert-MTB/RIF-Ultra and/or sputum culture positivity).

Results. As of March 2024, 1 667 participants had been randomised

(SA n=544 (32.6%), Zambia n=756 (45.4%), Zimbabwe n=367 (22.0%)).

ere were 714/1 667 people living with HIV (42.8%), of whom 108/714

(15.1%) were newly diagnosed. A total of 56/1 667 participants (3.4%)

tested positive for TB (SA n=37/544 (6.8%), Zambia n=18/756 (2.4%),

Zimbabwe n=1/367 (0.3%)), of whom 27/56 (48.2%) were subclinical

(i.e. asymptomatic) and 17/56 (30.4%) were smear positive. Among

the 826 participants randomised into the CAD+Xpert arm, CAD

detected 17/21 individuals with TB (81.0%). ere were 337/826 CAD

false positives (40.8%). However, CAD was truly negative in 468/826

participants (56.7%) who did not undergo Xpert testing.

AJTCCM VOL. 30 NO. 3 2024 139

ABSTRACTS

Conclusion. Community-based ACF detected a high burden of TB,

TB-HIV and undiagnosed HIV. Approximately 50% of participants had

asymptomatic TB. CAD missed ~20% of TB, and false-positivity rates

in those without TB were high. Nevertheless, Xpert testing was halved.

A cross-sectional study of adult patients

presenting with airways disease

exacerbations in Cape Town, SouthAfrica

M Stolbrink, L Liebenberg, T Ndelana, K Petersen,

SGrith-Richards, K Mortimer, B Allwood

Division of Pulmonology, Department of Medicine, Faculty of Medicine and

Health Sciences, Stellenbosch University, Cape Town, SouthAfrica; Clinical

Sciences, Liverpool School of Tropical Medicine, UK

Corresponding author: M Stolbrink (mstolbrink@doctors.org.uk)

Background. ere is a high burden of airways diseases in SouthAfrica.

Individuals experiencing exacerbations have increased healthcare

utilisation and risk of death. Diagnoses are often made without

investigations, yet some diseases, such as asthma, require specific

treatments.

Objectives. To characterise the diagnoses of adults attending hospitals

with exacerbations.

Methods. We conducted a cross-sectional study of adults with chronic

airways disease exacerbations attending two hospitals in CapeTown.

Participants were recruited on presentation and attended for

investigations at least 8 weeks later. Burden of disease questionnaires,

full lung function studies with bronchodilator reversibility, serum

eosinophil count, total and specic immunoglobulin E, exhaled nitric

oxide measurements, sputum analysis and high-resolution computed

tomography were completed.

Results. Between November 2021 and March 2023, 224 participants

were recruited, of whom 101 attended for investigations; 40 (17.9%)

died before investigations could be completed. Most were current

(49.5%) or ex-smokers (40.4%), and 46 (45.5%) had previously had

pulmonary tuberculosis (TB). Serum (or any indicator of) eosinophilia

was present in 19/100 (19.0%) (and n=51/101; 50.5%) participants.

Spirometric obstruction (n=62/82; 75.6%), hyperination (n=45/61;

73.8%) and reduced diusion capacity (n=29/44; 5.9%) were common.

Post-TB lung disease (PTLD) with chronic obstructive pulmonary

disease (COPD) (n=28/101; 27.7%) or COPD alone (n=27/101; 26.7%)

were the most common diagnoses. Ten participants had asthma.

Conclusion. COPD and PTLD were common among patients attending

hospital with an exacerbation; modiable risk factors (TB, smoking) were

also common. Approximately 1 in 5 patients died shortly aer recruitment.

Strategies to serve this patient group better are urgently needed.

Transbronchial lung cryobiopsy and

mediastinal lymph node cryobiopsy:

Experience from a resource-limited

African setting

A Esmail, K Tsoka, R Hofmeyer, J C Maluleke, H Donson,

RRoberts, T Pennell, N Vorajee, M Emhemed, S Eknewir,

BMbena, K Dheda

Centre for Lung Infection and Immunity, Division of Pulmonology, Department of

Medicine and University of Cape Town Lung Institute, Cape Town, SouthAfrica

Corresponding author: K Dheda (keertan.dheda@uct.ac.za)

Background. Transbronchial lung cryobiopsy (TBLC) is a relatively

new technique recommended for sampling of lung parenchyma in

patients with suspected diuse parenchymal lung disease (DPLD), and

as an alternative to surgical lung biopsy. A more recently introduced

technique is endobronchial ultrasound-guided mediastinal cryobiopsy

(EBUS-TMC) to enable tissue biopsy of mediastinal lymph nodes.

However, there are no data on the feasibility of implementing these

techniques in a resource-poor African setting where there is a chronic

bed shortage and same-day discharges are preferable.

Methods. We performed an audit of lung and lymph node cryobiopsy

procedures performed at the E16 Respiratory Clinic, Groote

Schuur Hospital, Cape Town, SouthAfrica. Indications, diagnostic

performance outcomes and lessons learned were documented and

analysed.

Results. Sixteen patients underwent 19 cryobiopsy procedures,

performed under general anaesthesia (n=11 TBLC, n=8 EBUS-TMC,

including 3 patients in whom TBLC and EBUS-TMC were performed

concurrently). e main indications were evaluation of DPLD and

suspected lymph node malignancy. e diagnostic yield was 63.6%

for TBLC (n=7/11; n=2 NSIP, n=2 sarcoidosis, n=1 respiratory

bronchiolitis-interstitial lung disease; n=1 organising pneumonia, n=1

nonspecic chronic inammation) and 50% for EBUS-TMC (n=4/8;

n=1 plasmacytoma, n=1 lymphoma, n=2 cryptococcus infection, n=1

tuberculosis). Two patients had moderate bleeding while 3 patients

had mild bleeding, and all patients were discharged on the same day.

Conclusion. TBLC and EBUS-TMC, with avoidance of surgical lung

biopsy in most patients and with same-day discharge, are feasible in

an African setting. ese data inform clinical practice and programme

implementation in resource-poor settings.

The prevalence of pulmonary

hypertension in post-tuberculosis

and active tuberculosis populations:

Asystematic review and meta-analysis

J K van Heerden, E H Louw, F ienemann, M E Engel,

BWAllwood

Medical Sciences Division, Nueld Department of Surgical Sciences,

University of Oxford, UK

Corresponding author: J K van Heerden (jenniferkatevanheerden@gmail.com)

Background. The prevalence of tuberculosis (TB)-associated

pulmonary hypertension (PH) has not previously been quantied,

resulting in an under-appreciated burden of disease.

Objectives. To estimate the prevalence of PH in post-TB and active

TB populations.

Methods. In this systematic review and meta-analysis, we searched

PubMed/Medline, the Cochrane Library, EBSCOhost, Scopus, African

Journals Online and Google Scholar, with no language restriction, for

available literature published aer 1950. Eligible studies described adult

participants (≥16 years), with documented evidence of active or prior

TB, diagnosed with PH. Study quality was assessed using a risk-of-bias

tool specically developed for prevalence studies. Aggregate prevalence

estimates with 95% condence intervals (CIs) were synthesised using

a random-eects meta-analysis model, incorporating the Freeman-

Tukey transformation. Subgroup analysis was conducted to ascertain

prevalence estimates in specic patient populations.

140 AJTCCM VOL. 30 NO. 3 2024

ABSTRACTS

Results. We identied 1 452 unique records, of which 34 met our

inclusion criteria. Twenty-three studies, with an acceptable risk of

bias and where PH was diagnosed at right heart catheterisation

or echocardiography, were included in the meta-analysis. In post-

TB studies (n=14/23), the prevalence of PH was 67.0% (95%

CI50.8-81.4) in patients with chronic respiratory failure, 42.4%

(95% CI31.3-54.0) in hospitalised or symptomatic patients, and

6.3% (95% CI2.3-11.8) in non-healthcare-seeking outpatients

(I2=96%). ere was a lower estimated prevalence of PH in studies

of populations with active TB (9.4% (95% CI6.3-13.0); I2=84%).

Conclusion. Our results highlight the signicant burden of PH

in post-TB and active TB populations. We emphasise the need for

increased recognition of TB-associated PH and additional high-

quality prevalence data.

PAEDIATRIC PULMONOLOGY

Pleuropulmonary blastoma: Acase report

N Adjetey, J Bangirana, D Smith, P Mwanyika, A Brookes,

TPillay, H de Quintal, D M Gray, A Vanker, M Zampoli

Division of Pulmonology, Department of Paediatrics and Child Health, Red

Cross War Memorial Children’s Hospital and Faculty of Health Sciences,

University of Cape Town, SouthAfrica

Corresponding author: N Adjetey (naadjeley@ymail.com)

Background. Pleuropulmonary blastoma (PPB) is a rare and

aggressive malignant pulmonary tumour that occurs in children. e

clinical presentation can be nonspecic, and the tumour can easily be

misdiagnosed as other respiratory tract conditions. We report a case

of a 2.5-year-old girl with PPB who presented with acute respiratory

distress and wheezing.

Case presentation. A previously well 2.5-year-old girl was brought

to hospital with a 3-day duration of cough, diculty in breathing and

intermittent noisy breathing. ere had been no preceding fever or

coryzal symptoms and no witnessed or reported incidence of choking.

Initial management involved inhaled bronchodilators, antibiotics and

cough syrup, with little improvement. Chest examination revealed

reduced entry on the le with unilateral biphasic wheezing. A chest

radiograph showed le lung hyperination with attenuation of the le

main bronchus. e ndings were suspicious for an inhaled foreign

body, so exible bronchoscopy was performed. It revealed a stalked

polypoid lesion arising from the left main bronchus, straddling

across the carina into the right main bronchus. The tumour was

removed by rigid bronchoscopy, and histopathological examination

showed rhabdoid elements. Further imaging with a chest computed

tomography scan and magnetic resonance imaging of the abdomen

showed a single nodular lesion in the le lower lobe and a cystic

nephroma in the le kidney, respectively. e patient was diagnosed

with type 3 PPB, and adjuvant chemotherapy was initiated with further

plans for complete resection of any residual disease aer completion of

chemotherapy. DICER1 gene mutation analysis is yet to be carried out.

Conclusion. PBB accounts for <1% of primary malignant lung

tumours in children. It is classied into three types, with type 3

being predominantly solid tumours. PPB with cystic nephroma is

associated with DICER1 syndrome, and surveillance is required.

Treatment of PBB involves aggressive surgery and chemotherapy;

prognosis is poor for type 3. Unexplained and unusual wheezing

should always trigger further exploration to uncover the cause.

Antenatal ambient pollution and

impulse oscillometry in children

from the Mother and Child in the

Environment (MACE) birth cohort,

Durban, SouthAfrica

K Asharam, P Jeena, R N Naidoo

Discipline of Occupational and Environmental Health, School of Nursing

and Public Health, College of Health Sciences, University of KwaZulu-Natal,

Durban, SouthAfrica

Corresponding author: K Asharam (ramchar4@ukzn.ac.za)

Background. Ambient pollutant-related large-airways disorders may

arise preclinically through impacts on the distal airways.

Objectives. To determine whether antenatal exposure to ambient

pollutants is associated with impulse oscillometry (IOS) measurements

in schoolchildren.

Methods. Pregnant women from low-socioeconomic communities

in Durban, SouthAfrica, were recruited at public antenatal clinics in

their rst trimester and followed up until delivery. Newborns were

followed up in infancy and annually. To date, 312 children have had

IOS, clinical assessments and interviews. Hybrid land-use regression

and dispersion modelling provided household-level exposure. Exposure

metrics included averages for the pregnancy year, rst trimester and

birth month for particulate matter 10 and 2.5 microns in diameter

(PM10 and PM2.5), nitrogen dioxide (NO2) and sulphur dioxide (SO2).

Results. e median (range) levels of the pollutants (μg/m3) were as

follows: NO2: 15.9 (7.54-25.9); PM10: 30.5 (3.8-57.9); PM2.5: 13.3

(9.02-14.1); and SO2: 3.3 (2.1-5.8). e mean (standard deviation)

age of the children was 7.4 (1.4) years, and 50.3% were female.

Features compatible with asthma were present in 13.8%. e median

(interquartile range) IOS measurements (cm H2O/L) were: Rx5-20: 2.5

(–2.8-7.4); Ax: 41.6 (0.9-114.6); X5 z-score: 0.65 (–3.9-4.3); and R5

z-score: 0.27 (–2.3-2.9). Although showing an increase in resistance

and a decline in reactance, pollutant metrics did not generally reach

statistical signicance, except for annual SO2 (with X5 z-score) and

annual PM10 and PM2.5 (with frequency response).

Conclusion. Preliminary ndings suggest that associations between air

pollution and responses of the distal airways in children may be present.

Epithelioid malignant peripheral nerve

sheath tumour of the trachea in an

adolescent male: A case report

J Bangirana, K Grebe, N Adjetey, P Mwanyika, D Smith, ABrooks,

S Singh, T Pillay, H J Zar, M Zampoli, A Vanker, DMGray

Division of Pulmonology, Department of Paediatrics and Child Health,

RedCross War Memorial Children’s Hospital, Cape Town, SouthAfrica

Corresponding author: J Bangirana (bangiranaj@yahoo.com)

Background. Epithelioid peripheral nerve sheath tumours are aggressive

malignant tumours that uncommonly occur in the trachea. Patients

usually present with wheezing and cough, and so can easily be mistaken

as having asthma. ere are no reported cases in children.

AJTCCM VOL. 30 NO. 3 2024 141

ABSTRACTS

Case presentation. An 11-year-old boy presented with a 4-week

history of intermittent wheezing, without prior foreign body aspiration

or asthma. He had severe respiratory distress, and initially seemed to

respond to inhaled bronchodilators and corticosteroids, including

intravenous pulse methylprednisolone, although with only short-term

relief. Lung function testing showed a mixed picture of obstructive-

restrictive disease. A computed tomography (CT) scan of the chest

revealed a mass in the distal trachea. Bronchoscopy revealed a eshy

lobulated mass in the distal trachea, occluding >80% of the trachea,

and histological examination of a biopsy specimen showed features

of an epithelioid peripheral nerve sheath tumour. He underwent

complete surgical resection of the tumour mass, including the

surrounding margins, with minimal postoperative complications.

Repeat bronchoscopy 6 weeks after surgical resection showed no

recurrence of the mass, and the results of spirometry were normal.

He has completed radiotherapy with no adverse eects and will have

surveillance bronchoscopy 6-monthly.

Conclusion. Primary tracheal tumours should be considered in the

dierential diagnosis when a child presents with persistent wheezing,

especially if unresponsive to the typical treatment for asthma. A chest

CT scan and bronchoscopy are important diagnostic modalities in

these patients. Complete surgical resection of tracheal tumours may

lead to complete resolution of symptoms.

A classication model to identify

severe paediatric lymphobronchial

tuberculosis with a focus on airway

obstruction

M Basson, J Grobler, P Goussard

Department of Industrial Engineering, Faculty of Engineering, Stellenbosch

University, SouthAfrica

Corresponding author: M Basson (basson.marthinus@gmail.com)

Background. Lymphadenopathy is an indicator of severe tuberculosis

(TB) in children. Use of chest X-rays (CXRs) to detect lymphadenopathy

by trained physicians yielded a moderate sensitivity of 67-74% and a

specicity of 39-59%. e diagnosis of pulmonary TB in children aged

<5 years is dicult, as the symptoms mimic those of several childhood

illnesses, while studies show that advanced diagnostic methods have

failed to distinguish between TB and other conditions in this age group.

Objectives. To improve the sensitivity and specicity of the currently

available methods used to identify TB in children.

Methods. A method to automatically identify pulmonary TB with

severe lymphadenopathy in children aged <5 years using computer

vision advancements was developed. Four deep-learning classication

modules were created for evaluation. e airway was segmented on

the CXR images to focus on the eects of TB lymphadenopathy on

the airway.

Results. Three models were created that outperformed the base

model sensitivity and specicity by 25-30 percentage points. e

best-performing model, the custom ResNet50 model, achieved a

statistically signicant sensitivity of 94.43% (95% condence interval

(CI) 92.11-97.47) and specicity of 94.79% (95% CI91.645-97.22).

The results show that using the segmented airway to detect TB

lymphadenopathy is possible based on airway deformation and

compression.

Conclusion. A machine-learning model that can predict severe

pulmonary TB in children aged <5 years with only a few CXR images

was produced, which shows signicant improvements compared with

manual diagnostic methods.

The prevalence of bronchiectasis

in SouthAfrican children with

postinfectious bronchiolitis: A

retrospective observational study

C Jacobs, A Gie, C le Roux, M M van der Zalm, N Parker, E Eber,

PGoussard

Department of Paediatrics and Child Health, Faculty of Medicine and Health

Sciences, Stellenbosch University, Cape Town, SouthAfrica

Corresponding author: P Goussard (pgouss@sun.ac.za)

Background. Postinfectious bronchiolitis obliterans (PIBO) occurs

following severe respiratory infection. PIBO results in small-airway

injury and bronchiectasis, leading to prolonged respiratory sequelae.

It is unclear which children are at risk of PIBO and PIBO-associated

bronchiectasis.

Methods. is retrospective study performed at a SouthAfrican tertiary

hospital identied all cases of PIBO between 1 January 2016 and 31

December 2022. Electronic medical and radiological records were

examined, and data on clinical characteristics, prior hospital admissions

for respiratory infections and chest computed tomography (CT)

ndings were collected. e clinical and radiological characteristics of

cases with and without bronchiectasis were compared.

Results. Fiy-nine children with PIBO were included. e median

(interquartile range) age at diagnosis was 16 (11-28) months, the

median age at primary lung insult 10 (6-17) months, and the median

interval between insult and diagnosis 4 (2-9) months. At initial lung

insult, mechanical ventilation was required in 19 children (32.2%), with 9

requiring high-frequency oscillation ventilation. Twenty-three children

(39.0%) had comorbidities, of which the most common were premature

birth (n=18; 30.5%) and HIV infection (n=4; 6.8%). Adenovirus was

the leading pathogen, identied in 41cases (69.5%). Chest CT scans

demonstrated mosaic attenuation in all cases, with 33 children (55.9%)

having bronchiectasis (unilateral n=17 (51.5%), bilateral n=16 (48.5%)).

ere was no dierence in clinical characteristics, ventilation, causative

pathogens or comorbidities between children with and without

bronchiectasis.

Conclusion. A significant proportion of children with PIBO have

bronchiectasis present within 4 months of the initial respiratory insult.

Premature birth is a common comorbidity and may contribute to the

development of PIBO.

Fractional exhaled nitric oxide

expression from infancy to childhood in

SouthAfrican children

C Jacobs, S Chaya, N Marozva, M Botha, A Vanker, A Custovic,

HJZar, D M Gray

Department of Paediatrics and Child Health, Red Cross War Memorial

Children’s Hospital and MRC Unit on Child and Adolescent Health, University

of Cape Town, SouthAfrica

Corresponding author: C Jacobs (carvern.jacobs@uct.ac.za)

142 AJTCCM VOL. 30 NO. 3 2024

ABSTRACTS

Background. Fractional exhaled nitric oxide (FeNO) is a marker of

respiratory eosinophilic airway inammation. ere are limited data

on FeNO expression in early life, particularly in low- to middle-income

settings.

Objectives. To assess FeNO expression from infancy through to childhood

in the Drakenstein Child Health Study, an African birth cohort.

Methods. FeNO testing was performed during sleep at 6 weeks and

1 and 2 years, and with the child awake at 8 years. Exposures were

longitudinally collected. Statistical analysis included Mann-Whitney

rank-sum and Kruskal-Wallis tests and logistic regression.

Results. Of the 1 143 enrolled children, 910 (79.6%) had successful FeNO

testing at 6 weeks and 486 (42.5%) at 8 years. Lower household income

(median (interquartile range) 8 (3.95-13.6) parts per billion (ppb) v.

11 (6.4,15.1) ppb; p=0.008) and preterm birth (5.40 (2.44-9.31) ppb

v. 6.99 (4.31-12.36) ppb; p=0.012) were associated with lower FeNO

at 6 weeks. Postnatal maternal smoke exposure (5.98 (3.81-10.38)

ppb v. 7.73 (4.38-13.4) ppb; p=0.022) and household smoking (6.42

(3.96-11.14) ppb v. 9.23 (5.13-16.40) ppb; p=0.01) were associated

with reduced FeNO at 8 years. Maternal atopy was not associated with

child FeNO. Children born preterm and in winter were more likely to be

in the lowest FeNO quartile at 8 years (preterm: odds ratio (OR) 1.89;

95% condence interval (CI) 1.05-3.4; p=0.03; winter: OR 1.73; 95%

CI1.01-3.18; p=0.05) compared with children born at term and during

summer. Smoke-exposed children were less likely to have high FeNO

compared with unexposed children (antenatal smoke exposure: OR 0.59;

95% CI0.36-0.95; p=0.03; postnatal household smoking: OR 0.58; 95%

CI0.36-0.9; p=0.02).

Conclusion. FeNO at birth tracks through to school age and is inuenced

by season of birth, environmental tobacco smoke and socioeconomic

status.

Funding. e study received funding from the Bill and Melinda Gates

Foundation (grant nos OPP1017641 and OPP1017579); the National

Institutes of Health, USA (H3 Africa grants U54HG009824 and

U01AI110466); the Wellcome Trust (098479/Z/12/Z, 204755/Z/162);

the Medical Research Council, SouthAfrica (SA); the National Research

Foundation, SA; and Harry Crossley Clinical Research.

Bronchiectasis in children in a high HIV

and TB prevalence setting

P Juggernath, K Mopeli, R Masekela, Z Dangor, A Goga,

DMGray, C Verwey

Department of Paediatrics and Child Health, Faculty of Health Sciences,

University of the Witwatersrand, Johannesburg, South Africa

Corresponding author: P Juggernath (pearlinejuggy@gmail.com)

Background. Bronchiectasis is a largely neglected disease, especially in

low- to middle-income countries (LMICs). Post-infectious causes are

more common in LMICs, while in high-income countries, inborn errors

of immunity, recurrent aspiration, primary ciliary dyskinesia (PCD) and

cystic brosis are more common. Children living with HIV (CLWH),

especially those who are untreated, are at increased risk of bronchiectasis.

Objectives. To describe the demographics, medical history, aetiology and

clinical characteristics of children with bronchiectasis, and the results of

special investigations, and compare these according to HIV status.

Methods. is was a retrospective descriptive study of children aged

<16 years of age with chest computed tomography (CT) scan-conrmed

bronchiectasis in Johannesburg over a 10-year period. Data were collected

from the paediatric pulmonology database at Chris Hani Baragwanath

Academic Hospital.

Results. Ninety-one participants (51% male, 98% black African, median

(interquartile range) age 7 (3-12) years) were included. Compared with

HIV-negative children, CLWH were older at presentation (median 10

(6-13) years v. 4 (3-9) years; p<0.01), and more likely to be stunted

(p<0.01), to have clubbing (p<0.01) and hepatosplenomegaly (p=0.03),

and to have evidence of multilobar involvement on the chest CT scan

(p<0.01). All the children had a cause identied; the majority (86%) of

these were presumed to be post-infectious, based on a previous history

of a severe lower respiratory tract infection. is group included all 38

CLWH. Only a small proportion of the children had inborn errors of

immunity, secondary immune deciencies or PCD.

Conclusion. A post-infectious cause for bronchiectasis was the most

common aetiology described in children from an LMIC in Africa,

especially in CLWH. With improved access to diagnostic techniques, the

aetiology of bronchiectasis in LMICs is likely to change.

Comparative analysis of oscillometry

and spirometry trajectories in lung

function assessment

N Marozva, S Chaya, C Jacobs, K Brittain, M Botha, Z Hantos,

ACustovic, H J Zar, D M Gray

Department of Paediatrics and Child Health, Red Cross War Memorial

Children’s Hospital and MRC Unit on Child and Adolescent Health, University

of Cape Town, SouthAfrica

Corresponding author: N Marozva (nicola.marozva@uct.ac.za)

Background. Tracking the trajectories of lung function over time is

important for understanding lung function maturation, enabling us

to monitor respiratory health, implement timely interventions and

identify strategies to optimise respiratory health in early life. Spirometry

trajectories have been described from childhood to adulthood. Given

the importance of lung health in early life, more recently early-life

trajectories have been described using oscillometry. It is not yet

understood how these early-life trajectories relate to established

spirometry trajectories.

Objectives. To describe tracking of oscillometry measures from 6weeks

to 10 years of age and how they relate to longitudinal (5-10years)

spirometry results in an African population-based cohort.

Methods. Lung function was measured from 6 weeks and annually to

10 years of age. Summary statistics and trajectory plots were generated

to describe trajectories of oscillometry (compliance (C) and resistance

(R) of the respiratory system) and forced spirometry (forced expiratory

volume in the 1st second (FEV1) and forced vital capacity (FVC)). Lung

function quartiles determined at 6 weeks and 3 years for C and R were

tracked over the rst 10 years of life. e relationship between C and R

and subsequent spirometry measures (FEV1 and FVC) was analysed.

Results. C trajectories remained consistent across quartiles, with

children in the highest quartile maintaining highest values of C through

to 10 years. R quartiles were more variable over time, with only the

lowest quartile tracking consistently to 10 years. However, when tracked

from 3 years of age, they remained consistent across quartiles. Children

in the highest C trajectory had higher spirometry values and lower R,

AJTCCM VOL. 30 NO. 3 2024 143

ABSTRACTS

and children in the highest R trajectories, determined at 3years, had

consistently low spirometry values from 5 to 10 years of life.

Conclusion. These results suggest a correlation between early-life

oscillometry measures and subsequent spirometry values. e consistency

observed in the C and R trajectories highlights the importance of early

detection and monitoring to identify children at risk for respiratory issues

and to implement early interventions. e study demonstrates that it

is possible to track lung function along the life course from early life,

thereby enhancing our understanding of respiratory health trajectories

and the implications for early intervention strategies.

Funding. e study received funding from the Bill and Melinda Gates

Foundation (grant nos OPP1017641 and OPP1017579); the National

Institutes of Health, USA (H3 Africa grants U54HG009824 and

U01AI110466); the Wellcome Trust (098479/Z/12/Z, 204755/Z/162);

the Medical Research Council, SouthAfrica (SA); the National Research

Foundation, SA; a Hungarian Scientic Research Fund grant (K 128701);

the European Respiratory Society (INCIRCLE CRC-2013-02); and Harry

Crossley Clinical Research.

Aetiology and outcome of pleural

empyema in children admitted to

Pietersburg Hospital Limpopo, South

Africa

M Tshamiswe, G Tiva

Paediatric Pulmonology Unit, School of Medicine, Faculty of Health Sciences,

University of Limpopo, Polokwane, South Africa

Corresponding author: M Tshamiswe (mbilaelot@gmail.com)

Background. Pleural empyema in children is associated with high

morbidity and high mortality. Incidence of pleural empyema in

children appears to have improved in developed countries such as

the US and UK, with an annual incidence of ~3 per 100 000 children.

Staphylococcus aureus (S. aureus) has been shown to be the most

common in developing countries. In South Africa, S. aureus has also

been identied as the leading causative organism in a study performed

at the Chris Hani Baragwanath Hospital, Johannesburg.

Objectives. To determine the causative organisms of pleural

empyema, the treatment outcomes, and the relationship between

pleural empyema, TB and HIV infection.

Methods. is was a retrospective quantitative descriptive study of

children admitted to Pietersburg Hospital, Polokwane, with pleural

empyema during January 2016 - December 2020. A self-generated

data collection tool was used to obtain secondary data of all patients

that met the operational denition of pleural empyema. Data that

addressed the objectives of the study were extracted.

Results. Descriptive statistic methods were used to analyse the data.

Of the 11 patients included in the study, 4 (36%) had their pleural

uid cultured. S. Aureus was the leading cause of pleural empyema

followed by Streptococcus Pneumonia (n=1, 9%). ree (27%)of the

patients died, two (18%) were lost to follow-up and six (55%) were

discharged to other facilities.

Conclusion. e results show S. Aureus as the leading cause of pleural

empyema in Limpopo, in line with the results of studies in the Western

Cape (Red Cross War Memorial Children’s Hospital) and Gauteng

(Chris Hani Baragwanath Hospital ). Intercostal drainage and VATS

were performed in 91% of the patients. Due to the small sample

size however, there was no statistical signicance in the correlation

between pleural empyema, HIV and TB. Immunisation status was not

documented in clinical records which made it dicult to correlate

with pleural empyema.

Chronic cough not improving with

antituberculosis treatment: A case report

S F Mokati, S A ula, R Masekela

Department of Paediatrics and Child Health, Nelson R Mandela School of

Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban,

SouthAfrica

Corresponding author: S F Mokati (msizakele@yahoo.com)

Background. Aspergillus fumigatus is an opportunistic mould found

in the environment. It can cause a spectrum of clinical manifestations

depending on host’s immune status. In an immunocompromised host,

it can cause invasive pulmonary aspergillosis (IPA).

Case presentation. A 7-year-old girl presented with a 1-year history

of productive cough associated with fever and weight loss. She was

started on antituberculosis treatment with isoniazid/rifampicin,

pyrazinamide and ethambutol by the base hospital on the basis of

chest radiographic findings (Fig. 1). All sputa were negative for

tuberculosis (TB), and she was HIV negative. e ndings on clinical

examination were nonspeciﬁc. She had signiﬁcant weight loss,

digital clubbing and mild respiratory distress with continued oxygen

dependence. e erythrocyte sedimentation rate was 127mm/h. She

was treated for pulmonary TB with minimal clinical response. Achest

computed tomography scan (Fig. 2) revealed multiple nodules with

hilar lymphadenopathy. Bronchoscopy showed a narrow right main

Fig. 1. Chest radiograph (anteroposterior view) showing splayed carina,

inltrates in the right middle lobe, and a conuent opacication in the

lingular region.

144 AJTCCM VOL. 30 NO. 3 2024

ABSTRACTS

bronchus, and bronchoalveolar lavage cultured A. fumigatus. Treatment

with voriconazole was initiated with good response.

Conclusion. IPA remains dicult to diagnose and treat. It is commonly

seen in immunocompromised individuals. Early investigations and

treatment are crucial to prevent complications. Voriconazole is the new

gold standard for the treatment of IPA, with a minimum duration of 12

weeks. Our case underscores the critical signiﬁcance of early recognition

and intervention. e complex diagnostic challenge highlights the need

for a multidisciplinary approach.

Eect of respiratory syncytial virus and

SARS-CoV-2 co-infection on clinical

severity and outcomes among children

hospitalised with lower respiratory

tract infections in Soweto, SouthAfrica

K-L Mrubata, V Bailie, F Solomon, A Izu, M Ncube, M C Nunes,

Z Dangor, S A Madhi, D P Moore, C Verwey

Department of Paediatrics and Child Health, School of Clinical Medicine, Faculty

of Health Sciences, University of the Witwatersrand, Johannesburg, SouthAfrica

Corresponding author: K-L Mrubata (kitsomrubata@gmail.com)

Background. ere are few data available on the interplay between

and clinical manifestations of respiratory syncytial virus (RSV) and

SARS-CoV-2 infection in African children. We compared clinical

characteristics and outcomes between RSV-only, SARS-CoV-2-only,

and RSV/SARS-CoV-2 co-infection lower respiratory tract infections

(LRTIs) in hospitalised African children.

Methods. is was a retrospective review of children (0-59 months)

hospitalised with severe LRTI in Johannesburg, SouthAfrica, between

1 January 2020 and 31 March 2023. Clinical data and nasopharyngeal

swabs for respiratory viruses were collected, and clinical characteristics

and outcomes were described and compared. Respiratory Index of

Severity in Children (RISC) scores were calculated for HIV-uninfected

children, and covariates associated with high RISC scores (≥5) were

evaluated using Poisson regression models.

Results. Of 7 456 children enrolled (median (interquartile range) age

6.1 (14.4-18.6) months, 57.7% male), 1 372 (18.4%) tested RSV+/

SARS-CoV-2– (RSV only), 223 (3.0%) RSV–/SARS-CoV-2+ (SARS-

CoV-2 only), and 28 (0.4%) RSV+/SARS-CoV-2+ (RSV/SARS-CoV-2

co-infection). Children with RSV only and RSV/SARS-CoV-2 co-

infection were more likely to present with bronchiolitis than those

with SARS-CoV-2 only (673/1 372 and 15/28 v. 46/223; p<0.001).

Children with RSV/SARS-CoV-2 co-infection had more severe

disease than those with RSV or SARS-CoV-2 only, as well as a higher

RISC score than those with SARS-CoV-2 only. In multivariable Poisson

regression models, weight-for-age z-scores (adjusted risk ratio (aRR)

0.92), room air saturations (aRR 0.988) and RSV-positive status (aRR

1.40) were independently associated with severe disease.

Conclusion. Although both RSV and SARS-CoV-2 LRTI occurred

commonly, co-infection with RSV/SARS-CoV-2 did not. Children

with RSV/SARS-CoV-2 co-infection had a higher prevalence of severe

disease than those with RSV or SARS-CoV-2 only. ese ndings

reinforce the urgent need for safe and eective RSV vaccines.

Right lung agenesis: A case report

P Mwanyika, J Bangirana, N Adjetey, D Smith, T Pillay, H J Zar,

DMGray, A Vanker, M Zampoli

Division of Pulmonology, Department of Paediatrics and Child Health,

RedCross War Memorial Children’s Hospital, Cape Town, SouthAfrica

Corresponding author: P Mwanyika (pmwanyika@yahoo.co.uk)

Background. Unilateral lung agenesis is a rare congenital abnormality.

Right lung agenesis is the less common form, and may have a poorer

prognosis owing to severity of coexisting anomalies. We present a case

of an infant with right lung agenesis.

Case presentation. A 3-month-old girl, previously well, was brought

to hospital with a cough, a runny nose and fast breathing for the past 2

days. She had been born by normal delivery at term with no perinatal

complications. Physical examination revealed tachypnoea with nasal

aring, head bobbing, and subcostal and intercostal retractions. e

right hemithorax was dull to percussion with reduced breath sounds

on auscultation on the right so wheezes. e point of maximal

impulse was felt on the third intercostal space right midclavicular

line. First and second heart sounds were heard normally with no

murmur. ere were no other relevant ndings. e results of relevant

investigations were as follows: nasopharyngeal aspirates negative,

full blood count within normal ranges, and C-reactive protein 2

mg/L. A chest radiograph showed asymmetrical lung volume with

homogeneous opacity on the right hemithorax. Chest computed

tomography angiography revealed absence of the right lung and

pulmonary artery with attenuation of the trachea and left main

bronchus. Supportive management was provided, and the infant was

discharged in an improved condition.

Conclusion. Lung agenesis can be incidentally diagnosed later in

life when complicated by pulmonary infection, which we suspect

was the case in our patient. e dierential diagnosis includes lung

atelectasis or congenital overinﬂation of the ipsilateral lung or one

of its lobes. Management is mainly supportive, with close follow-up

and prevention and early treatment of pulmonary infections. e

prognosis depends on other associated congenital anomalies.

The cost-eectiveness of anti-

inammatory reliever therapy “AIR”

or maintenance and reliever therapy

“MART” for mild to moderate asthma:

A systematic review

N Ndimande, K Mortimer, M Stolbrink, J Mbonigaba, R Masekela

Department of Paediatrics and Child Health, School of Clinical Medicine,

College of Health Sciences, University of KwaZulu-Natal, Durban, SouthAfrica

Fig. 2. Chest computed tomography scan showing bilateral lymphadenopathy.

AJTCCM VOL. 30 NO. 3 2024 145

ABSTRACTS

Corresponding author: N Ndimande (ondimanden2@ukzn.ac.za)

Background. Asthma is a common respiratory disease estimated

to aect ~262 million people globally. Anti-inammatory reliever

therapy (AIR) and maintenance and reliever therapy (MART) are

now standard of care in many countries for treating mild to moderate

asthma in adolescents and adults, but little is known about the cost-

eectiveness of these approaches.

Objectives. To assess the cost-eectiveness of AIR and MART.

Methods. A systematic literature review of results from randomised

controlled trials, non-randomised controlled trials, modelling, and

comparative-observational studies was conducted. Four databases

were searched to identify articles from any country from 2013 to

2023. Recording and reporting of results was done using the Preferred

Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

Results. A total of 8 articles were included, involving 10 179 people.

Most were model based, with 6 studies using Markov modelling

and1 decision analytical modelling, and only 1 being a retrospective

matched observational study. Half the studies were conducted in

high-income countries v. low- to middle-income countries (none in

Africa). AIR was assessed as cost-eective v. inhaled corticosteroids

(ICS), short-actingbeta-agonists (SABA) and ICS-SABA for both

payer and society, as it improved exacerbation rates and quality-

adjusted life-years (QALY) while saving costs or increasing costs

within acceptable thresholds. MART was cost-eective v. ICS-SABA

and ICS-LABA, as it was cheaper while improving exacerbation rates

and QALY.

Conclusion. AIR and MART are cost-eective approaches for the

treatment of mild to moderate asthma. We found no cost-eectiveness

data for AIR or MART for treating asthma in the unique and diverse

conditions seen in Africa, highlighting an important evidence gap

that must be lled to inform African policy and decision-makers.

Disseminated cryptococcosis in an

immunocompetent child: A case report

S L Ngaka, A S ula, R Masekela

Department of Paediatrics and Child Health, Nelson R Mandela School of

Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban,

SouthAfrica

Corresponding author: S L Ngaka (sanelisiwengaka@gmail.com)

Background. Cryptococcus species predominantly causes signicant

infections in immunocompromised individuals, particularly those

with HIV infection. Over the past few decades, infections with these

rare pathogens have become more common in immunocompetent

individuals, especially children.

Case presentation. We report a case of disseminated cryptococcosis

with so-tissue, pulmonary and cerebral involvement in an otherwise

healthy immunocompetent patient. Radiological imaging revealed an

intrathoracic mass with posterior thoracic wall extension and features

in keeping with leptomeningitis. The diagnosis was confirmed on

cerebrospinal uid analysis and histopathological examination of the

posterior thoracic wall mass.

Conclusion. e morbidity and mortality associated with cryptococcosis

would be signicantly reduced with early recognition, diagnosis and

appropriate treatment.

Pulmonary function testing in healthy

infants in rural Bangladesh: Feasibility

study

C Verwey, G K Sojib, S Islam, A D Roy, A Islam, D Czovek,

GMakan, S Ahmed, A H Baqui, Z Hantos, E D McCollum

School of Clinical Medicine, Faculty of Health Sciences, University of

the Witwatersrand, Johannesburg, SouthAfrica; SouthAfrican Medical

Research Council Vaccines and Infectious Diseases Analytics Research Unit,

Johannesburg, SouthAfrica

Corresponding author: C Verwey (charl.verwey@wits.ac.za)

Background. Despite a high respiratory disease burden, infant

pulmonary function testing (iPFT) in low- and middle-income countries

is limited.

Objectives. To establish an iPFT laboratory in a rural area of Bangladesh.

Methods. A cohort in rural Sylhet, Bangladesh, included pregnant

women and their offspring followed through 6 months. Experts

established an iPFT laboratory and trained study sta. Infants were

eligible for respiratory oscillometry (Osc), tidal breath ow-volume

loops (TBFVL) and sulphur hexauoride (SF6) multiple breath washout

(MBW) at 2 and 6 months of age, from November 2021 until October

2022, during natural sleep. Measurement average and dispersion were

summarised, and the mean measurement dierence between study sta

and expert analyses was calculated.

Results. Oscillometry and TBFVL/MBW were implemented in

sequential phases. e rst 25 measurements for Osc (mean (standard

deviation) 116.6 (56.5) days; 52% (n=13/25) male) and TBFVL/MBW

(mean 84.2 (8.8) days; 48% (n=12/25) male) were analysed. Acceptable

tests were achieved in 88% (n=22/25) for Osc, 100% (n=25/25) for

TBFVL, and 88% (n=21/24) for MBW. Resistance at 7 Hz was 66.3

(25.2) and 64.0 (22.4) hPa.s/L-1 at 2 and 6 months. At 2 months the mean

respiratory rate was 41.1 (7.1) breaths/minute, tidal volume/kg 7.5 (1.3)

mL, functional residual capacity 83.6 (19.0) mL, and lung clearance

index 7.2 (1.0). e dierences between study sta and expert analyses

were minimal across all measurements.

Conclusion. Establishing an iPFT laboratory, performing quality

measurements, and conducting expert-level analysis in rural Bangladesh

is feasible.

Outcomes of children admitted to a

paediatric intensive care unit with

adenovirus pneumonia: A single-centre

study

S Maleni, R Masekela

Department of Paediatrics and Child Health, School of Clinical Medicine,

College of Health Sciences, University of KwaZulu-Natal, Durban, SouthAfrica

Corresponding author: S Maleni (malenistella@yahoo.com)

Background. Pneumonia is the leading cause of death in children aged

<5 years. Pneumonia in early life can impair long-term lung health by

decreasing lung function. Adenovirus pneumonia causes signicant

morbidity and mortality, with up to 30% of children developing

complications such as bronchiolitis obliterans and bronchiectasis.

Objectives. To determine the short-term outcomes of children with

adenovirus pneumonia admitted to the paediatric intensive care unit at

Inkosi Albert Luthuli Central Hospital, Durban.

146 AJTCCM VOL. 30 NO. 3 2024

ABSTRACTS

Methods. A retrospective review of medical records of children aged

<5 years admitted to the paediatric intensive care unit with polymerase

chain reaction-conrmed viral pneumonia between July2017 and July

2022. Data will be analysed using SPSS Version 25. Factors signicant

will be subjected to binary logistical regression and the results expressed

as odds ratios.