The role of the infectious diseases unit at Groote Schuur Hospital in addressing South Africa's greatest burden of disease.
BACKGROUND
The greatest burden of disease in South Africa (SA) comes from infectious diseases (ID), with human immunodeficiency virus (HIV) and tuberculosis (TB) dominating the health landscape. However, other infections including community-acquired and imported infections and the rise in hospital-acquired infections pose a considerable threat to public health.


OBJECTIVE
We used a prospective cross-sectional study to examine the profile of patients referred to the Infectious Diseases Unit at Groote Schuur Hospital (GSH) between 2008 and 2011.


RESULTS
A total of 2 142 patient consultations were performed, the majority at the request of secondary hospital level medical teams; 80% of patients were HIV-infected (with a median CD4 count of 128/mm3). Approximately half of antiretroviral-naïve, HIV-infected patients started antiretroviral therapy in hospital. TB, predominantly extrapulmonary, was the most common diagnosis. Imported infections, notably severe falciparum malaria, accounted for a large number of the 81 different diagnoses in HIV-seronegative patients. Over half of all patients had co-morbidity complicating their clinical presentation. In-hospital mortality was 5.8%, with overwhelming sepsis the cause in 40% of deaths, largely due to hospital-acquired infection, particularly in the HIV-infected cohort.


CONCLUSIONS
The overwhelming burden of ID in SA is revealed in this experience at GSH, a tertiary level referral hospital serving the Cape metropolitan area. The needs of the population warrant a reappraisal of human resource capacity and training in ID in SA.
Division of Infectious Diseases and HIV Medicine, Department of Medicine, University of Cape Town.
Mishal
M
Pandie
Helen
H
Van der Plas
Gary
G
Maartens
Marc
M
Mendelson
D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis*; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D003428:Cross Infection / Q000382:microbiology; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D055552:Infectious Disease Medicine / Q000706:statistics & numerical data*; D016778:Malaria, Falciparum / Q000175:diagnosis; D008297:Male; D011446:Prospective Studies; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D013019:South Africa; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis*
D044966:Anti-Retroviral Agents