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Clinical Services

Paediatric Infectious Diseases Unit (PIDU)

Clinical Activities | Teaching and Training | Research | Resources | Useful links

Staff


A multidisciplinary team that includes paediatric ID specialists, ID clinical fellows / senior registrars, a medical officer, nursing sisters, a social worker and lay counsellors, and a clerk.

TO CONSULT WITH THE DUTY SENIOR REGISTRAR / CONSULTANT PLEASE CONTACT THE TELEPHONE EXCHANGE:  +27-21-658-5111


Clinical Activities


The PIDU is responsible for the management of HIV infection, complicated drug-susceptible TB, drug-resistant including MDR and XDR-TB, complicated or atypical infections particularly in immunosuppressed children, vaccine adverse events, and the diagnosis and treatment of primary immune deficiencies, and antibiotic stewardship including advice on the treatment of drug-resistant bacterial infections. The PIDU plays a role in hospital antimicrobial and infection control policy and practice, and the production of standardised treatment guidelines for paediatric infectious diseases.

  1. Inpatient consultation / telephonic consultation: A senior registrar-consultant team is available for ad hoc consultation throughout the working week. Please direct consultation requests to the duty senior registrar. A monthly roster is available at the telephone exchange. Patients on antiretroviral therapy in the S11 area are reviewed daily by a nursing sister or medical officer.

  2. Antibiotic stewardship ward round: Consultant-led ward rounds are conducted every Monday at 14h00. Consult the current roster for the starting location of these rounds.

  3. ID ward round:  Hospital-wide consultant-led ward rounds are conducted every Thursday at 09h00 starting in Ward B1.

  4. Outpatient clinics are conducted in A11 on Monday morning (general ID and immunology), Tuesday morning (HIV infection), Wednesday morning (HIV, school-going children & adolescents) and Friday morning (HIV, mainly younger children). During clinics, individual counselling and group counselling sessions are conducted by the clinic lay counsellors or clinic social worker. Outside clinic hours, a nursing sister or medical officer is available to see patients on an ad hoc basis in A11. Bookings for the Monday clinic may be made through the A11 clerk, Ms Simone Twaku on extension: 5812.  Clinic appointments for the HIV clinics may be made through Sister Patti Apolles on extension: 5613 or Sr Charday Mortlock-Scheepers on 5812.

  5. Immunology consultation / investigation: The duty senior registrar (contact through telephone exchange) and Prof Eley (extension 5321 or cell: 0839477637) share clinical responsibilities for immunology.

  6. Monthly intravenous immunoglobulin infusions: Intravenous immunoglobulin infusions are administered in the 'Day Room', ward E2, usually on Friday mornings. Bookings for IVIG appointments are co-ordinated by Ms Simone Twaku on extension 5812. All children managed through the immunology service should be discussed with a senior registrar or immunology consultant to ensure continuity of care.

  7. After-hours consultation: Most ID problems should be managed by the registrar and consultant on-call for general paediatrics. Specialised problems may benefit from ID consultation. An ID call roster has been incorporated into the monthly roster of the Department of Paediatrics and Child health. The on-call consultant may be contacted through the RCWMCH telephone exchange.

  8. Paediatric outreach: The PIDU provides telephonic support to level 1 & 2 institutions in the Western Cape. The duty registrar may be contacted through the telephone exchange at Red Cross War Memorial Children's Hospital (RCWMCH). Furthermore, the following outreach visits are conducted by the ID Consultants: (1) monthly clinical meeting for doctors and nurses treating HIV-infected children usually at level 1 clinics in the Klipfontein sub-district. (2) monthly ward rounds/clinical meetings at New Somerset Hospital alternating with Victoria Hospital, and (3) monthly antibiotic stewardship rounds at both Mitchell's Plain and Groote Schuur Hospital.


Teaching and Training


Undergraduate teaching: 

Infectious diseases staff members contribute to weekly bedside teaching of 5th year medical students. Prof Eley and Dr J Nuttall conducts regular lectures to 4th and 5th year medical students on ID topics including paeditric HIV infection, childhood TB and vaccine-preventable infections. Infectious Diseases ward rounds are used to educate 5th and 6th year students.

Postgraduate teaching:

Dr Nuttall convenes a regular educational course for doctors preparing for the Diploma in Child Health (DCH) examinations. The ID unit conducts periodic ID seminars for paediatric registrars and contributes to the Wednesday morning academic programme of the Department of Paediatrics and Child Health. ID ward rounds are used to educate senior house officers and paediatric registrars. Dr Nuttall and Prof Eley support various continuous medical education courses and symposia.

Sub-specialist ID training: 

The paediatric ID unit at RCWMCH is registered with the Health Professions Council of South Africa as a training unit for paediatric ID sub-specialists. Trainees register with the University of Cape Town for this two-year course. Training includes clinical ID, microbiology, virology and immunology. Trainees must complete the exit examination (Cert ID (SA) Paed examination) set by the Colleges of Medicine of South Africa, a requirement for registering as an ID sub-specialist in South Africa. Prof Eley is the convenor of the training programme at RCWMCH.  Refer Appendix A for a comprehensive description of the training programme.

To facilitate research training, an M Phil degree in paediatric ID was created through the Faculty of Health Sciences, University of Cape Town.  Thus, in addition to the Cert ID (SA) Paed qualification, ID sub-specialist trainees can successfully complete a minor dissertation and obtain the M Phil (Paediatric Infectious Diseases) degree.


Meetings


ID journal club meetings alternating with HIV clinic meetings are held every week on a Wednesday between 14h30 and 16h00 in the conference room in A11, RCWMCH.

Immunology clinical meeting is held on an ad hoc basis on Tuesday at ±13h00 in the conference room in A11, RCWMCH.

Blood culture meetings are conducted by the Division of Microbiology every Monday and Thursday at 12h00 in C18, Groote Schuur Hospital. At these meetings the clinical presentation and antibiotic treatment of children and adults with positive blood culture results are discussed. The on-duty ID team usually attends the blood culture meetings on a Thursday.


Research


The research activity of the PIDU focuses on HIV infection, tuberculosis and other common childhood infections. Current projects include the effectiveness and outcome of antiretroviral therapy, clinical aspects of bloodstream infection, hospital associated infection and primary immunodeficiency diseases.

Research meetings are conducted on an ad hoc basis between the principal investigator and relevant ID staff members.


Resources


1. Appendix A version 3: ID Training Programme

2. Protocols & Guidelines
2.1  TB drug dosing chart
2.2  ART guidelines at Red Cross Children’s Hospital
2.3  HIV testing at Red Cross Children's Hospital
2.4  ARV dosing chart for children 2013
2.5  Post-exposure prophylaxis 2012
2.6  Guidelines for SF HIV & TB referrals 2012
2.7  Antimicrobial recommendations 2012
2.8  Infection control ward practice 2012
2.9  FNAB procedure for clinicians at RCWMC
2.10  PIDs-diagnostic treatment considerations
2.10a   PIDs-Appendix 4 SABMR preliminary search request form August 2014
2.10b   PIDs-Appendix 5 Tissue typing request form
2.11  Blood Culture Guideline RCWMCH
2.11a   Poster of BC procedure
2.12  Western Cape Consolidated HIV guidelines, October 2016
2.13  TB-drug-induced hepatotoxicity, 2016
2.14  Western Cape guideline on the use of Xpert MTB-RIF, 2014
2.15  Antibiotic Recommendations for HAI April 2017

3. Paediatric HIV Course 2016
3.1  Part I - Programme
3.1.1  Stephanie Fourie_Metro West HIV response
3.1.2  Max Kroon_PMTCT
3.1.3  Verona Witbooi_Nutrition an integrated approach  
3.1.4  James Nuttall_HIV testing 
3.1.5  Stephen Korsman Laboratory HIV testing
3.1.6  David Le Roux_Paediatric ART_eligibility & regimens

3.2  Part II - Programme
3.2.1  Rudzani Muloiwa_Cotrimoxazole INH immunisation practice
3.2.2  Vashini Pillay_1st line treatment failure
3.2.3  Cathy Kalombo_Illustrative case 1
3.2.4  Cathy Kalombo_Illustrative case 2
3.2.5  Cathy Kalombo_Illustrative case 3
3.2.6  James Nuttall_3rd line ART
3.2.7  Cathy Kalombo_Adolescent care level 1
3.2.8  Rebecca Sher_Adolescent Care level 2
3.2.9  Brian Eley_Management of HIV-TB coinfection


Useful links


  1. WHO: Guidelines on ARV drugs for treating & preventing HIV infection, 2016 2nd edition
  2. American ART guidelines
  3. Southern African HIV Clinician’s Society
  4. Federation of Infectious Diseases Societies of Southern Africa
  5. National Institute of Communicable Diseases
  6. SA malaria guidelines, 2016