Open Access Case Study

Strongyloides Hyperinfection in Renal Transplant - diagnosis by Endoscopic Intestinal Biopsy

Desai Madhav, K. Praveen Kumar, N. Mohan Rao, Y. Pavan Kumar

International Journal of TROPICAL DISEASE & Health, Page 244-249
DOI: 10.9734/IJTDH/2014/6568

Introduction: Intestinal parasites continue to be a significant health problem in renal transplantation patients. Strongyloides infection is unique that it excretes larvae and can continue life cycle by auto infective cycle also.
Presentation of the case: We present a 26 years old man presented with acute cellular rejection after three months of kidney transplantation. Before transplantation stool of both recipient and donor was negative for parasites. He received three doses of intravenous methylprednisolone. After one month he presented with severe epigastric pain and vomiting. On examination he was malnourished, dehydrated and lost two kilograms of weight over one month. His serum albumin was 2.9 mg/dL. Pain did not subside with proton pump inhibitors. Stool examination was negative for parasites. As index of suspicion for parasites was high, upper GI endoscopy was done; it showed multiple ulcers in duodenum. Biopsy of the ulcer showed strongyloides infection He was treated with ivermectin. Abdomen Pain was subsided soon. He gained weight of 1.5 kilograms over next month.
Conclusion: When transplant patients from developing country with recent increase of immunosupression presents with severe abdomen pain, the intestinal parasitic infection should be entertained. If stool examination is negative and serology is unavailable, early evaluation by endoscopic biopsy is helpful to diagnose strongyloides. Prolonged treatment with ivermectin and follow-up stool examinations are important for complete cure of strongyloides infection.

Open Access Original Research Article

Pattern of Neonatal Mortality in a Teritiary Health Facility in Umuahia, South East, Nigeria

Eke Christopher B, Ezomike Uchechukwu O, Chukwu Bartholomew F, Chinawa Josephat M, Korie Francis C, Chukwudi Ndubuisi, Ukpabi Ihuoma K

International Journal of TROPICAL DISEASE & Health, Page 136-146
DOI: 10.9734/IJTDH/2014/4985

Background: Neonatal mortality rates are highest in Sub-Saharan Africa, with Nigeria inclusive. And so the aim of the current study was to audit the pattern of neonatal deaths.
Study Design: A cross sectional retrospective descriptive study was undertaken.
Place and Duration of Study: The study was carried out at the Newborn Special Care Unit (NBSCU) of Federal Medical Centre (FMC), Umuahia with a review of the admissions and mortality register between 2000 and 2010.
Methods: A review of the admissions and mortality register of the NBSCU between 2000 and 2010 was undertaken. Data extracted from the register included socio-demographic variables, birth weight, diagnosis/cause of death, duration of hospitalization, place of delivery (inborn/out-born), source of referral.
Results: Total admission over the period was 2,756 comprising 1541 (55.9%) males and 1215 (44.1%) females. Total deaths was 440, comprising 235 (53.4%) males and 205 (46.6%) females.An overall case fatality rate of 16.0% was reported in the current study with mean age at death being 4.7± 6.0 days (0.01- 28 days).
Majority of the dead cases were out-born, 263/440 (59.8%) compared to in-born, 177/440 (40.2%).
Forty two percent (185 cases) of the deaths occurred with 24 hours of hospitalization while 25.9% (114 cases) passed on after 72 hours of admission.
The leading probable direct causes of neonatal deaths were birth asphyxia (141), preterm delivery (133), neonatal sepsis (58), severe neonatal Jaundice (41), and neonatal tetanus (14).
Most deaths (42.0%) occurred in the first 24hours irrespective of the cause of death.
Conclusion: High rate of neonatal mortality, most of which are largely preventable as observed in the index study still abound in our locale.
High cost effective maternal and newborn interventions could be applied even at community levels where most of the deliveries occur to save lives of the newborns.

Open Access Original Research Article

Knowledge, Attitude, and Practices Related to Dengue among Caretakers of Elementary School Children in Chanthaburi Province, Thailand

Risa Takahashi, Calistus Wilunda, Karani Magutah, Tun-Linn Thein, Naoko Shibuya, Sangchom Siripanich

International Journal of TROPICAL DISEASE & Health,
DOI: 10.9734/IJTDH/2014/6390

Aim: To assess dengue related knowledge, attitudes, and practices among caretakers of elementary school children in Thailand.
Study Design: Cross sectional study
Place and duration of the Study: Chanthaburi Province, Thailand, in April 2012
Methods: Data on socio-demographic characteristics, sources of information; knowledge; attitudes and practices related to dengue were sought from a random sample of 640 caretakers. Logistic regression was performed to explore factors associated with dengue-related knowledge, attitude and practices.
Results: Of the 640 respondents invited to participate in the study, 628 (98.1%) returned completed questionnaires. Mass media (76.7%) and healthcare facilities (67.4%) were the most common sources of information on dengue. Only 37.8% of caretakers had high levels of knowledge of dengue; caretakers with post-secondary education were more likely to have higher knowledge than those with primary education (adjusted odds ratio [aOR] 2.0, 95% confidence interval [CI] 1.28–3.31). Caretakers with a family annual income greater than 6,400 US $ were more likely to have higher knowledge compared to those with an income less than 1,600 US $ (aOR 1.94, 95% CI 1.16–3.23). Dengue knowledge was not significantly associated with caretaker age, sex, marital status, or occupation. Attitudes towards dengue prevention were moderate but not significantly associated with any particular factor. Civil servants were less likely to use mosquito repellent compared to factory workers (aOR 0.44, 95% CI 0.20–0.10). Most caretakers (80.7%) had discussed dengue with their children in the past 6 months.
Conclusion: Knowledge of dengue among school children’s caretakers was low. This needs improvement, especially in caretakers with low income and/or education. Attitude towards dengue was moderate and most caretakers were practising dengue prevention. Dengue prevention interventions among children, that involve caretakers, may require improving knowledge and attitude towards dengue among the caretakers.

Open Access Original Research Article

Bloodstream Infections and Malaria as Causes of Fever among Adult Medical Patients at a Referral Hospital in Malawi

Antje Theurer, Edwin Chitandale, Charles Munthali, Heidi Schütt-Gerowitt, Jan Rybniker, Gerd Fätkenheuer, Florian Neuhann

International Journal of TROPICAL DISEASE & Health, Page 182-193
DOI: 10.9734/IJTDH/2014/6809

Background and Aims: In Sub-Saharan Africa management of adult patients with febrile illness consists very often of empirical antibacterial and ant malarial treatment. This study examines the frequency, species identification and antibiotic susceptibility of bacterial isolates from blood and determines the frequency of malaria and the proportion of verified malaria cases among presumptively treated patients at a Malawian hospital.
Study Design: This is a cross-sectional survey.
Place and Duration of Study: Patients were enrolled at the Medical Department of Kamuzu Central Hospital, a referral hospital in Lilongwe, Malawi, between October 2010 and March 2011.
Methodology: Patients ≥18 years with an axillary temperature ≥37.5°C were included. Blood cultures, malaria rapid diagnostic tests (RDTs), thick blood smears and HIV testing were performed.
Results: 180 patients (58.3% female, median age: 31 years) were enrolled. Out of 157 patients, 89 (56.7%) tested HIV positive. Bacteremia was found in 19 (10.6%) patients including 6 (31.6%) Streptococcus pneumoniae, 6 (31.6%) Escherichia coli and 5 (26.3%) Salmonella enterica (4 Salmonella enterica serotype Typhimurium and 1 Salmonella enterica serotype Typhi). S. typhimurium and E. coli isolates showed frequent resistance to chloramphenicol, ampicillin and cotrimoxazole. Ceftriaxone was given to 110 (61.1%) patients. Malaria was confirmed by positive smear and/or positive RDT(s) in 57 (31.7%) cases. Presumptive antimalarial treatment was administered to 120 (66.7%) patients, however only 54 (45%) of these tested malaria positive.
Conclusion: Empirical treatment of bloodstream infections should be based on antibiotic susceptibility of common local pathogens. Clinically suspected malaria should be confirmed by using malaria diagnostic testing before treatment. The use of malaria RDTs has to be carefully supervised and adherence to test results is advisable.

Open Access Original Research Article

Black Women's Predisposition to Preterm Birth; Could We Be Near The Answer?

S. O. Nwhator, K. A. Umeizudike, P. O. Ayanbadejo, G. A. Agbelusi, M. Arowojolu, T. Sorsa, O. I. Opeodu, J. A. Olamijulo, G. O. Akaba, B. A. Ekele

International Journal of TROPICAL DISEASE & Health, Page 194-203
DOI: 10.9734/IJTDH/2014/6669

Background: Pre-term Premature Rupture of Membranes (PPROM) is attributable to several causes including asymptomatic bacterial vaginosis among Caucasians and is commoner among black pregnant women. While malaria and high Body Mass Index (BMI) have been reported among Nigerians, the influence of metalloproteinases on PPROM has never been studied in Nigeria.
Methods: A qualitative estimation of active matrixmetalloproteinase-8 (a-MMP-8) to assess the effect of chronic periodontitis on time to conception led to an accidental discovery of widespread elevation of a-MMP-8 among pregnant participants. Values of a-MMP-8 were compared across demographics of participants as well as educational status, BMI and other parameters.
Results : One hundred and seventeen of 134 participants (117, 87.3%) had elevated a-MMP-8 based on a novel qualitative assessment using salivary diagnostics. Levels were increased across independent of age, Estimated Gestational Age(EGA), BMI, educational level and trimester.
Conclusion: This population of black pregnant women exhibited higher a-MMP-8 levels than reported among pregnant Caucasians independent of demographics, educational level and trimester of pregnancy. Reasons for the association need to be further investigated.

Open Access Original Research Article

Effect of Alcohol Consumption on Platelet, Prothrombin Time and Activated Partial Thromboplastin Time of Alcoholics in Birnin Kebbi, Kebbi State, Nigeria

O. Erhabor, A. Yakubu, I. Z. Isaac, A. L. Sule, A. Wase, A. C. Ezimah, A. Mainasara, B. A. Isah, E. K. Uko, F. Udomah, T. C. Adias, I. P. Iwueke, D. Ikhuenbor, F. Aghedo, O. O. Igbineweka

International Journal of TROPICAL DISEASE & Health, Page 224-232
DOI: 10.9734/IJTDH/2014/6187

Aims: Alcoholism is a global public health problem with significant socioeconomic implications. The aim was to investigate the effect of alcoholism on the haematological and haemostatic parameters of consecutively recruited alcoholics in Birnin Kebbi, Kebbi State and North Western Nigeria.
Study Design and Methodology: This prospective case-control study included one hundred adults alcoholics [≥18 years), aged range (18-60), mean age (38.46 ± 13.26) and made up of 68 males (68%) and 32 females (32%)]. Fifty gender and age matched non-alcoholics were monitored as controls. Ethical approval was obtained from the research and ethics committee in the Faculty of Medical Laboratory Science of the Usmanu Danfodiyo University Sokoto, North Western Nigeria. Written informed consent was obtained from all study subjects after counselling.
Place and Duration of Study: This study was carried out at the service laboratory in the Department of Haematology, Faculty of Medical Laboratory Science in Usmanu Danfodiyo University in Sokoto North Western Nigeria between May 2011 to February, 2012.
Result: Participants for this study included 50 heavy alcoholics and 50 moderate alcoholics (subjects) and 50 age and gender –matched non-alcoholics (controls). Platelet count of non-alcoholics, moderate and heavy alcoholics was; 260.7 ± 48.17, 253.3 ± 43.16 and 130.6 ± 6.79 respectively. Platelet count was significantly lower among heavy alcoholics compared to non-alcoholics (p=0.0001). Although marginally higher, there was no statistically significant difference in the platelet count of moderate alcoholics and non-alcoholics (p=0.10). We observed a negative correlation between platelet count and duration of alcoholism (r=-0.62). The mean prothrombin time (PT) and activated partial thromboplastin time (APTT) values of non-alcoholics, moderate alcoholics and heavy alcoholics was; (14.46 ± 0.97 and 34.82 ± 13.71), (15.74 ± 1.26 and 35.78 ± 3.50) and (19.46 ± 0.93 and 43.42 ± 5.13) respectively. Prothrombin time and activated partial thromboplastin time values were significantly lower among heavy alcoholics compared to non-alcoholics (p=0.0001). PT and APTT were marginally higher among moderate alcoholics compared to non-alcoholics but the difference however was not statistically significant (p= 0.08 and 0.62 respectively). We observed a positive correlation between duration of alcoholism and prolonged prothrombin time and activated partial thromboplastin time (r = 0.46 and 0.55 respectively).
Conclusion: Our study has shown that alcoholism produces a significant adverse effect on some haematological and haemostatic parameters. Evidenced data generated from this study can facilitate the development of a policy on the effective management of haematological and haemostatic complications associated with alcoholism. There is need to enact laws that regulate the production, sales and consumption of various alcoholic beverages to prevent abuse and protect the health of citizens.

Open Access Original Research Article

288 Pioneer Computed Tomographic Examinations in University of Uyo Teaching Hospital, Uyo, Nigeria

U. Uduma Felix, U. Eduwem Dianabast, V. Obong Jane

International Journal of TROPICAL DISEASE & Health, Page 233-243
DOI: 10.9734/IJTDH/2014/6677

Background: Computed tomography (CT) is a cross sectional imaging tool that has dramatically improved diagnosis. Its increasing availability was recently extended to University of Uyo teaching hospital (UUTH), Uyo, Nigeria.
Aim: Evaluating pioneer CT examinations in UUTH, Uyo.
Materials and Methods: A retrospective study of all CT examinations conducted after the installation of the 16 slice Activion Toshiba, 2009 CT scanner. Period studied was from 4th November, 2012 to 9th August, 2013. Some CT scans were done with intravenous contrast with/without oral contrast. Demographic data, clinical presentations, type of examination and positive radiological features were extracted from records of all computed tomograms.
Results were analysed with SSPS 13 computer package.
Results: 288 Patients were studied but 281 with adequate demographic data were analyzed. Of this number, 56.6% (n=159) were males and 43.4% (n=122) were females giving M: F ratio of 1.3:1. The largest male and female studied populations were 10.3% (n=29) in 50-59 age range and 8.2% (n=9) in 40-49 respectively.
The commonest examination was cranio-cerebral 62.5% (n=180), followed by abdomino-pelvic CT 3.5% (n=10). The commonest indication for cranio-cerebral CT was trauma (20%) followed by cerebro-vascular accident (CVA) 16.1%. Normal brain CT were 33 (18.3%) , whereas unrelated CT brain findings were 29 (16.1%).
11.4% (n=33) of 288 patients who underwent CT were candidates for test-running the machine (male to female ratio 1.12: 1) at no cost to the patient.
Conclusions: The commonest CT examinations in Uyo, Nigeria are cranio-cerbral with the commonest indications being trauma and CVA.

Open Access Original Research Article

Trends in the Epidemiology of Brucellosis in a Highly Afflicted Region in Egypt: A 16 Year Experience (1997-2012)

Engy M. El-Ghitany, Sherif R. Omar, Amany M. Abaza, Ezzat M. Hassan, Ekram W. Abd El- Wahab

International Journal of TROPICAL DISEASE & Health, Page 250-271
DOI: 10.9734/IJTDH/2014/7025

Background: Brucellosis is a serious re-emerging zoonosis which vastly afflicts human health and animal productivity. The reported incidence may under-represent the real burden of the disease that has drastically evolved during the past decade. Incomplete epidemiological data particularly from developing countries and remote areas reflects partly the lack of accurate disease diagnosis and under reporting. This necessitates the comprehensive review of past experiences and disease trends over time to tailor proper intervention and control strategies.
Aim: This hospital based study is an attempt to explain reasons beyond the evolution and alteration of brucellosis epidemiology in a highly burdened rural region in Egypt over 16 years (1997-2012).
Methods: All cases of human brucellosis admitted to Damanhour fever hospital from 1997 to 2012 were analyzed. During 2007, the study was complemented by a detailed patient evaluation and disease description. Data about animal brucellosis were reviewed from records in the veterinary sector.
Results: A total of 4371 [2609 (59.7%) males and 1762 (40.3%) females, median of age=31 years] brucellosis cases were reviewed during the study period. The annual occurrence among human has increased early in the decade and showed two peaks of incidence in 2002 and 2005-2006. On the other hand, animal brucellosis showed significant decline across decades thanks to enforcement of control measures. The disease was frequently presented by nonspecific constitutional symptoms and reticuloendothelial system involvement, yet sever complications were less encountered. All patients were treated according to the standard therapeutic guidelines and showed clinical improvement before discharge.
Conclusion: These results indicate that human and livestock brucellosis persisted in Northern Egypt across the study period albeit with a fluctuating incidence. The current situation necessitates more appropriate disease surveillance and improving the control and containment strategies in order to alleviate disease burden on both human and animal populations.

Open Access Review Article

Current and Future Trends in the Clinical Diagnosis of Rickettsioses Sensu lato

S. Missailidis, D. T. Godoy, M. A. M. M. Mares-Guia, A. R. M. Favacho, E. R. S. Lemos

International Journal of TROPICAL DISEASE & Health, Page 147-181
DOI: 10.9734/IJTDH/2014/6019

Aims: The aim of this review is to present Rickettsioses sensu lato, with emphasis on their current and future clinical diagnosis. The review presents the conditions, the agents that cause them, and the current gold standards on their diagnosis in national and international reference centres. Additionally, this review covers the various emerging technologies available in the diagnosis of Rickettsioses and discusses their potential for future use as gold standards in the diagnosis of these diseases.
Introduction: The introduction presents Rickettsioses sensu lato and gives a broad overview of the conditions they cause, the issues associated with their current diagnosis and the need for their improved, earlier and more accurate diagnosis, in order to prevent current issues with false negatives, misdiagnosis or delay in the diagnosis associated with these conditions, which often renders them grave or lethal.
Main Body: The main body of the review presents in independent sections Rickettsias, Ehrlichia, Anaplasma, Bartonella and Coxiella and the conditions associated with each of these bacteria. Spotted fever, endemic typhus, human granulocytic anaplasmosis, human monocytic ehrlichioses, bartonellosis and Q-fever are some of the conditions associated with this group of proteobacteria. The emphasis is on the clinical diagnosis of these conditions and an overview of the current practice, gold standards in reference laboratories and improvements in these methodologies is presented. The last part of the review focuses on novel technologies in bacterial detection and their application specifically on Rickettsioses sensu lato, demonstrating how these technologies are being applied in this field and how they could improve current standards and resolve issues associated with the clinical diagnosis of rickettsioses.
Conclusion: Rickettsioses sensu lato are conditions associated with proteobacteria historically included in the Rickettsiaceae family, able to cause a number of conditions, often grave or lethal. One of the major issues associated with poor clinical outcome is the lack of early and accurate differential diagnostic methodologies. Current methods, including serological and molecular biology techniques have various advantages and disadvantages, which new technologies available or currently in development may be in a position to resolve and the issues associated with the institution of such technologies.

Open Access Review Article

The Epidemiology and Health Burden of Neurocysticercosis in Nepal

Bishnu Joshi, Basant Pant, Pravesh Rajbhandari, Ram Prasad Aganja, Rajani Malla, Krishna Das Manandhar, Lakshmaiah Sreerama

International Journal of TROPICAL DISEASE & Health, Page 204-223
DOI: 10.9734/IJTDH/2014/5029

Neurocysticercosis (NCC) is a public health burden in Nepal. In patients burdened by this disease epileptic seizures are common. Computerized tomography scan (CT-scan) and Magnetic resonance imaging (MRI) techniques are most commonly used investigative tools for the diagnosis of NCC. Radio imaging techniques combined with serological techniques such as Enzyme linked immunosorbent assay (ELISA) and/or Enzyme linked immunoelectrotransfer blot (EITB) are commonly used as confirmatory diagnostic tools for this disease. Poor sanitation and hygiene accompanied with free range system of keeping pigs, deliberate use of human feces as pig feeds and social economic status of the society were reviewed the main causes for the persistence of Neurocysticercosis in Nepal. It was found that NCC exists in various development stages in the human brain as vesicular, colloidal, granular nodular and calcified forms. Based on the developmental stage and location of the cyst, a patient may present a focal seizure (FS), focalised seizure secondary generalised (FSSG), generalised toniclonic seizure (GTCS) , intractable seizures, headache, vomiting, impaired vision and or cognitive dysfunctions. Radio-imaging (CT scan and MRI) techniques and immunodiagnostic kits (ELISA, EITB, Dot Blots, and Western Blots) were found to be the main tools for diagnosis of NCC/Cysticercosis in Nepal. The chemotherapeutic treatment for NCC associated epilepsy was found to be analgesics, corticosteroids, and/or a combination of both. Albendazole was found the most used and effective anthelminthic drug for the treatment of multiple lesion. NCC is an easily preventable disease of poor and the neglected people. In a resource limited setting like Nepal, effective diagnostic techniques and treatment routines in place is very difficult. It is recommended that provision of education to the public on the epidemiology of the disease, promotion of safe pork production practices, supply of tap water, improvement of personal hygiene and sanitation would play a bigger role in eradicating the disease.