Chronic lungs disease such as relapsed tuberculosis of the lungs could lead to complications that could alter the gross anatomy of a region of the body. Many complications have been reported due to chronic and relapsed lungs infections such as Mycobacterium tuberculosis, when they are not properly managed, although, our indexed case improved within a short time after admission. The reported case was a rare presentation of complicated relapsed right lungs tuberculosis with pathologic dextrocardia. He was a 45 year old businessman who presented with history of chronic cough of 25 years duration with associated hemoptysis, treated in the past for lung tuberculosis. He had clinical and radiological features of destroyed right lung syndrome with dextrocardia following relapsed tuberculosis with possible superimposed infection. He was managed with category two regimen although did not complete his treatment in this facility. He had his medication for almost 4 months on out-patient basis in this facility. Though, the first 8 days was as in-patient basis. Radiographic complications in the index case were mediastinal shift, gross distortion of the right lung with associated fibrosis, contra-lateral, pathologic dextrocardia, lung emphysema which was noticed to compensate for the destroyed right lung. These findings are strongly consistent with some other reports that artificial/pathologic dextrocardia can be as a result of relapsed tuberculosis with gross distorted chest region. Therefore, physicians can demonstrate clinical destroyed lung syndrome with pathologic dextrocardia through radiographic findings and should guide against relapsed tuberculosis by revamping Direct observe treatment (DOT) through counseling, as well as prevent transmission of multi-drug resistance tuberculosis through proper investigation.
Non-human primates (NHPs) are distributed worldwide and have several unique features that may account for opportunistic and pathogenic zoonotic bacteria. Aim: To evaluate the incidence of enteric organisms with zoonotic and biohazard potential in captive NHPs in a zoo setting. Study Design: Descriptive study. Place and Duration of Study: This study was conducted in Jos, Plateau State, Nigeria between June-September, 2012. Methodology: We examined 33 clinically healthy young adult monkeys and apes over a three months interval. The animals were sampled at six weeks intervals by faecal culture. Samples were inoculated on appropriate media using specific selective culture methods. Suspect isolates potentially transmissible to humans were purified and identified based on their cultural and biochemical characteristics. Results: The survey revealed six (6) bacterial pathogens using API 20E, Escherichia coli (100.0%), Salmonella paratyphi A 31(93.9%), Proteus mirabilis 14(42.4%), Campylobacter species 6(18.2%), Citrobacter ferundii 7(21.2%), and Yersinia enterocolitica 3(9.1%). Conclusion: The incidence of infections during the period of study (first week and the twelfth week) indicated increased patterns of transmission between species of primates. Research among primate populations has the potential to predict which pathogens might enter human populations as human contact with these animals both in captivity and in the wild is on the increase.
Background: Knowledge of the Sociodemoraphic factors associated with HSV-2 seroprevalence and identification of the associated patient-recognizable clinical features will enable informed preventive public health interventions. There’s yet no documented data on the clinical and sociodemographic factors associated with HSV 2 Seroprevalence among pregnant women in Nigeria. Objectives: To identify sociodemographic and clinical correlates of HSV-2 seroprevalence among pregnant women attending ante-natal clinics in Benin, Nigeria. Study Location, Design and Duration: All the participants were prospectively recruited from the two major hospitals in Benin: University of Benin Teaching Hospital and Central Hospital, Benin. The cross-sectional study took place between November 2011 and June 2012. Methodology: Participants were recruited on booking. Data on their sociodemographic profiles, clinical history and obstetric characteristics were obtained by the use of structured questionnaires and hospital case records. Their blood samples were also promptly collected on recruition. Each participant’s serum was analyzed for HSV-2 IgG antibodies by gG-based type-specific ELISA. Counselling and testing for HIV were also carried out. Data analysis was done using SPSS version 16. Results: The average age of the 674 enrolled participants was 30.6±5.2 years and most of them were married and had complete secondary education. Seroprevalence of HSV-2 was 46.3%. Factors that was significantly associated with HSV-2 seropositivity included age, level of education, parity, HIV seropositivity and positive history of sexually transmitted infections. The HSV-2-infected were also significantly more likely to recall episodes of genital rashes (occurrence of rashes of any type in the external genitalia), vaginal discharge and urethral discharge. Conclusion: Risk factors for HSV-2 infection among pregnant women could include increasing age, higher parity, education below secondary level, HIV-positive status, and positive history of sexually transmitted infections. History of genital rashes, vaginal discharge and urethral discharge syndromes were associated with HSV-2 infection.
Aim: To investigate outbreak of IBD in Zaria, Nigeria. Study Design: Prospective study. Place and Duration of Study: Sample: Poultry Unit of the Ahmadu Bello University Veterinary Teaching Hospital, Faculty of Veterinary Medicine, Ahmadu Bello University, Zaria between March 2009 to July 2009. Methodology: Poultry cases reported to the clinics were investigated. Date, age, address, flock size, morbidity rate, mortality rate, breed, species, type of birds, vaccination history were noted; post mortem and agar gel precipitation test were done on 10 flocks, the incidence rate, morbidity rate, mortality rate and organ (bursa, spleen and thymus) to body weight ratio of the 10 flocks were calculated. Results: Chicks in all the flocks revealed the clinicopathologic manisfestation of IBD which include depressions, somnolence, anorexia, ruffled feathers, trembling, postration followed by death. In all the flocks, the BF were either turgid, swollen and or haemorrhagic, severe haemorrhages on the thigh and pectoral muscles, haemorrhages at the junction of proventriculus and gizzard or oesophagus, congested or pale carcasses, swollen kidneys with prominent tubules and enlarged pale or congested liver were also observed during postmortem examination. All the bursal homogenates from the 10 flocks gave precipitation line in the AGPT. An incidence of 12.1% was recorded. Average morbidity (40.5%) and mortality (40.7%) rates were recorded in ten outbreaks of IBD. Improved breeds of chickens were more likely to suffer from IBD with broilers 3.87 times at risk. Birds, 3-6 weeks-old were at a risk of being infected with IBDV. Chickens vaccinated once against IBD were 4.8 times more likely to suffer from IBD. Conclusion: IBD is a disease of improved breeds of poultry with clinical disease seen only in chickens. The disease mostly affects chickens of 3 to 6 weeks of age. Birds vaccinated twice are less susceptible to the disease.
Aim: To determine the predictors of low body mass index (BMI) among tuberculosis (TB) cases in three high TB/HIV burden provinces in Kenya. Study Design: Cross-sectional survey, July 2010 to May 2011. Study Setting: Three high TB/HIV burden provinces in Kenya. Study Population: Notified new smear positive TB cases on anti-TB treatment. Sample Size: 1,298 Data Collection: Structured questionnaire. Data Analysis: The association of nutritional status (normal versus low BMI) is tested using a chi square for categorical variables while student t-test was used for continuous variables. Explanatory factors that were significantly associated with nutritional status (p value <0.05) were subjected to a logistic regression. HIV status was considered a priori risk factor in the multivariate model. Results: Of the participants, 57% (734/1298) and 43% (564/1298) had normal and low BMI respectively. There was no significant difference (p-value 0.71) by HIV status between normal BMI and low BMI. Employment, water source and HIV status were identified as significant predictors of low BMI in smear positive TB cases. Adjusting for all other factors in the multivariate model, lack of employment with the base being having an employment, was significantly found to have increased odds of low BMI of 1.8 times (95% CI 1.39 -2.26; p value <0.001). HIV status was not found to be a significant predictor of low BMI in TB cases. Conclusion: Lack of employment is a predictor of low BMI in TB cases in Kenya. Nutritional status does not differ by HIV status.
Background: Pediatric mortality rates are high throughout sub-Saharan Africa with most deaths occurring within 48 hours of admission to hospital. Early identification and treatment of at risk children is essential to improve outcomes, however, few studies have identified disease specific risk factors for early mortality. Study Aims: To identify risk factors for early pediatric mortality and to explore areas for improvement in diagnostic and treatment practices. Study Design: Case-control study of patients admitted to the pediatrics ward of Zomba Central Hospital, Malawi. Methodology: Cases included all pediatric deaths over a four-month period in 2010 occurring within 48 hours of admission with a diagnosis among the four most common causes of death (malaria, pneumonia, diarrhea/dehydration, meningitis or measles given a large outbreak during the study period). Controls included children admitted during the same period, with a discharge diagnosis among the same 5 diagnoses, who survived to at least 72 hours. Analysis: Associations between mortality and clinical characteristics were assessed using STATA 11.0. Results: Overall, 142 cases and 162 controls were included. 62.7% of deaths occurred within 12 hours with malaria the most common diagnosis in both groups. Clinical characteristics on presentation associated with death included: symptoms/signs of respiratory distress (OR1.9, 95% CI 1.0-3.4, p=0.04), low Blantyre Coma Score (OR 3.4, 95% CI 2.1-5.6, p<0.01), age under 5 (OR 3.2, 95% CI 1.1-9.3, p=0.03) and pallor among malaria cases (OR2.2, 95% CI 1.8-6.6), p<0.01). Areas identified for quality improvement included delay in initial investigations and initiation of treatment both prior to transfer to and after admission to the district hospital. Conclusion: Improvements in the identification of children at risk for early mortality are critical to reducing mortality through early intervention.
Aim: To evaluate the association between serum lipids and diabetic retinopathy (DR) in type 2 diabetic subjects. Study Design: Cross-sectional observational study. Place and Duration of Study: Diabetes and Ophthalmology units of the Komfo Anokye Teaching Hospital, Kumasi in the Ashanti Region of Ghana, between September 2011 and June 2012. Methodology: Serum levels of total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) were assessed in 251 type 2 diabetic mellitus patients. Diagnosis and classification of diabetic retinopathy was based on dilated ophthalmoscopy. Classification of lipid abnormalities was done according to the National Cholesterol Education Programme-Adult Treatment Panel 111 (NCEP-ATP111) Guidelines. Results: Among 251 type 2 diabetic mellitus patients, 41.0% had retinopathy of which 31% were of the non-proliferative type and 10% were proliferative. The mean ± SD age of the diabetics with retinopathy was 52.64±11.80 years; their mean duration of diabetes was 17.69±4.06 years. Subjects with DR were older (P<0.001), had longer duration of diabetes (P<0.001) and higher fasting blood glucose (P<0.001) than those without DR. HDL-C level (P=0.016) was lower, and TC (P<0.001), TG (P<0.001) and LDL-C levels (P<0.001) were higher in subjects with diabetic retinopathy (DR) compared with those without diabetic retinopathy. Multiple logistic regression analysis revealed that unadjusted TC (odds ratio [OR] 3.57 [95% CI 4.471-12.26] P<0.001), TG (odds ratio [OR] 2.25 [95% CI 1.54-3.2] P<0.0001), HDL-C (odds ratio [OR] 0.664 [95% CI 0 .471- 0.938] P=0.020), and LDL-C (odds ratio [OR] 2.97 [95% CI 2.22-3.96] P<0.001) were associated with DR. After adjusting for age and duration of diabetes, only TC (odds ratio [OR] 4.00 [95% CI 1.12-14.25], P=0.032) maintained a significant association with DR. However, after adjusting for fasting blood glucose (FBG), the association of TC (odds ratio [OR] 30.73 [95% CI 0.018-53.68] P=0.36) with DR lost its significance. Conclusion: Our analyses suggest that there is no significant association between serum lipids with DR in Ghanaians patients with Type 2 diabetes mellitus. However, further studies are needed to confirm this finding.
Aims: Female genital mutilation is a harmful traditional practice which is an infringement on the sexual and reproductive rights of women and girls and has profound psychosocial as well as reproductive health morbidities. This study aimed at measuring the change in the incidence of the female genital mutilation in Port Harcourt, South-South Nigeria. Study Design: A cross-sectional study. Place and Duration of Study: Department of ObstetricGynaecology of the University Port Harcourt Teaching Hospital (UPTH) between 1st January and 31st January 2009. Methodology: Five hundred clients were selected randomly and agreed to participate in the study. They were interviewed using a structured questionnaire and examined clinically. Data management was with SPSS 15.0 for Windows statistical software. Results: The prevalence of female genital mutilation (FGM) was 34%. Four hundred and eighty one (96.2%) were aware of female circumcision generally. Ninety five (55.8%) of those circumcised, had it done in infancy. Thirty seven percent of the practitioners of female circumcision were traditional birth attendants while 14.7% were trained health professionals. The commonest reason for female circumcision included reduction of sexual passion/promiscuity and conformity with tradition. Type 1 female genital mutilation was the commonest (58.2%). Among those clients aged 50 years and above, 78.8% had FGM while 9.1% of those aged 10 – 19 years had FGM. This showed a downward trend. Conclusion: Female circumcision is a harmful traditional practice which has remained a serious health problem. Its prevalence is still high in our environment. This study suggests that it is on a downward trend.
Aims: To assess the performance of sputum AFB smear for monitoring treatment response and outcome of anti-tuberculous drugs among newly diagnosed smear positive pulmonary TB patients. Study Design: This study was conducted prospectively among newly diagnosed smear positive pulmonary TB patients. Place and Duration of Study: Queen Savang Vadhana Memorial Hospital and Chonburi Regional Hospital, Chonburi province, Thailand during April 2010 and July 2012. Methodology: Sputum AFB smear, culture and drug susceptibility test were performed at the time of diagnosis, the second and the fifth month of treatment. Baseline characteristic, clinical and laboratory parameters, treatment regimens and adverse events were recorded. Descriptive statistics and multiple logistic regression analysis were applied as appropriate. The performance of sputum AFB smear for monitoring treatment response and outcome of anti-tuberculous drugs was done using culture as the gold standard. Results: Of 297 eligible pulmonary TB cases, majorities were male (72.4%) with median age of 39 years, illiterate to low educated (52.6%) and earning low income (77.5%). Cough was the most common symptom (91.2%) and cavity was present in 31.1%. At the second month, 17.0% of patients had discordance between sputum AFB smear and culture. High bacilli load (adjusted OR=2.38, CI=1.09-5.18), and hearing alteration (adjusted OR=10.98, CI=1.79-67.28) were significant predictors. Hypoalbuminemia was significantly more severe in patients with false positive AFB smear (P=.04). Sensitivity and specificity for AFB smear were 44.7% and 89.6% at the second month and 57.1% and 97.5% at the fifth month, respectively. MDR-TB was diagnosed in 1.0% and success rate was 77.1%. Conclusions: Baseline AFB smear ≥ 2+ and hypoalbuminemia as well as adverse events during intensive phase are strongly recommended as the criteria to prioritize culture and DST for new smear positive pulmonary TB patients with positive AFB smear at the second and the third month of treatment in developing countries.
The immune system consists in part of a functionally competent T-cell repertoire that is reactive to foreign antigens but tolerant to self-antigens. The repertoire of T cells is primarily formed in the thymus through positive and negative selection of developing thymocytes that are critical for establishing central tolerance. One of the features of the thymus is to sense stress hormones produced in pathophysiological conditions. Increased levels of these hormones are associated with infections and are able to induce thymic atrophy. We have shown that in acute Trypanosoma cruzi infections, the atrophic thymus is a consequence of increased thymocyte apoptosis and premature export of immature thymocytes to secondary lymph nodes. This atrophy does not necessarily result in dysfunction of the thymus since the organ micro architecture is preserved and maintains negative selection, thus avoiding the development of tolerance to the pathogen during the establishment of protective immunity. However, in chronic infections, the dissemination of invading pathogens able to target the thymus interferes with T cell differentiation, generating T cells that are tolerant to pathogen-specific antigens. In what follows we propose to describe what is known about thymic atrophy induced by infectious pathogens in the context of host-pathogen interactions.