BackgroundTuberculosis (TB) is a major cause of severe anaemia in patients with human immunodeficiency virus (HIV) infection in South Africa. However, TB can be difficult to diagnose as it may be extra pulmonary and paucibacillary.AimThe aim of this study was to investigate undiagnosed TB in patients with HIV infection and severe anaemia and to identify the optimal investigations for diagnosing TB.SettingMthatha General Hospital, a district hospital.MethodsThe study was a case series.ResultsHaemoglobin levels ranged from 3.6 g/dL to 7.9 g/dL, the mean CD4 count was 176 cells/μL and 80% of patients had a positive TB symptom screen. Forty-three (86%) patients had either clinical or bacteriologically proven TB of whom 33 had pulmonary TB, 34 had extra pulmonary TB and 24 had both types. The diagnostic yield for TB was: chest X-ray (CXR) 91%; ultrasound (US) abdomen pericardium and lower chest 62%; sputum Xpert MTB/RIF 35%; TB blood culture 21% and TB urine culture 15%. Blood and urine cultures did not identify any additional cases over those identified by CXR and US. The laboratory turnaround times were as follows: sputum Xpert, 1.6 days; blood culture, 20 days and urine culture, 28 days. CXR and US were done within one day of initial patient assessment.ConclusionsThe majority of HIV patients with severe anaemia had TB disease, and extra pulmonary TB was as prevalent as pulmonary TB. CXR, US and sputum Xpert were the optimum tests for rapid diagnosis of TB. South African national TB/HIV guidelines should incorporate these specific tests to diagnose TB in patients with HIV and severe anaemia.

Background: Anaemia affects one in four adults in South Africa, with a higher prevalence in persons with HIV and tuberculosis. The aim of this study is to characterise the causes of anaemia in primary care and a district hospital setting. Methods: A cross-sectional study design investigated a purposive sample of adult males and non-pregnant females at two community health centres and a hospital casualty and outpatients. Fingerpick blood haemoglobin was measured with HemoCueHb201+. Those with moderate and severe anaemia underwent clinical examination and laboratory tests. Results: Of 1327 patients screened, median age was 48 years, and 63.5% were female. Of 471 (35.5%) with moderate and severe anaemia on HemoCue, 55.2% had HIV, 16.6% tuberculosis, 5.9% chronic kidney disease, 2.6% cancer, and 1.3% heart failure. Laboratory testing confirmed 227 (48.2%) with moderate and 111 (23.6%) with severe anaemia, of whom 72.3% had anaemia of inflammation, 26.5% iron-deficiency anaemia, 6.1% folate deficiency, and 2.5% vitamin B12 deficiency. Overall, 57.5% had two or more causes of anaemia. Multivariate modelling showed that patients with severe anaemia were three times more likely to have tuberculosis (OR = 3.1, 95% CI = 1.5–6.5; p-value = 0.002). Microcytosis was present in 40.5% with iron deficiency, macrocytosis in 22.2% with folate deficiency, and 33.3% with vitamin B12 deficiency. The sensitivities of the reticulocyte haemoglobin content and % hypochromic red blood cells in diagnosing iron deficiency were 34.7% and 29.7%, respectively. Conclusions: HIV, iron deficiency, and tuberculosis were the most prevalent causes of moderate and severe anaemia. The majority had multiple causes. Iron, folate, and vitamin B12 deficiencies should be identified by biochemical testing rather than by red cell volume.

Appendicitis is a common childhood condition requiring surgical intervention and delayed diagnosis can have serious consequences. This report describes the case of a child who presented with an acute abdomen and intestinal obstruction. Multidetector (MD) CT demonstrated a left-sided caecum and an inflamed appendix with a faecolith. Maximum intensity projection (MIP) post-processing was key in identifying the appendicular artery and determine the diagnosis. At surgery, however, a mobile caecum and the appendix were positioned on the right side.

Background: Invasive micropapillary carcinoma (IMPC) of the breast is a rare variant of invasive ductal breast carcinoma (IDC), with most cases characterized by lymph node metastasis and lymphatic vascular invasion. It is a ductal breast cancer subtype with a very high risk of recurrence and therefore requires special attention from breast cancer physicians and radiologists. Case: We present a case of an IMPC that has been followed up for two years since diagnosis and management. Based on clinical breast examination, ultrasound, and mammography, the initial diagnosis was a suspicious mass that required further investigation. Radiological and histological findings informed the diagnosis of a highly suspicious lesion, which turned out to be IMPC. The patient underwent surgery, left mastectomy with nodal dissection. During the 24-month follow-up, ultrasound and mammography revealed no evidence of local recurrence or involvement of the contralateral breast. Conclusions: This case reveals that invasive micropapillary carcinoma is a distinct but poorly recognized variant and subtype of invasive ductal carcinoma.