Open Access Original Research Article

Risk Factors of Human African Trypanosomiasis in Mbuji Mayi, Eastern Kasai Province, Democratic Republic of the Congo

Alphonsine Bilonda Mpiana, Emmanuel Kabengele Mpinga, Jean Christophe Bukasa Tshilonda, Philippe Chastonay, Médard Ilunga wa Kyhi, Ngoyi K. Zacharie Bukonda, Tshimungu Kandolo

International Journal of TROPICAL DISEASE & Health, Page 190-208
DOI: 10.9734/IJTDH/2015/14182

Aims: Our study is aimed at determining the risk factors of Human African Trypanosomiasis (HAT) in Mbuji Mayi, Eastern Kasai Province, Democratic Republic of the Congo.
Study Design: We used a case-control design with a ratio of 2 controls for every HAT case.
Place and Duration of Study: Our multidisciplinary research team collected primary data on cases of HAT patients treated at the Referral and Treatment Center of Dipumba in Mbuji Mayi in 2012 and on their controls of similar gender and age, living in Mbuji Mayi, but free of HAT infection.
Methodology: We analyzed data, using both descriptive and analytical statistical procedures such univariate and multivariate methods of logistic regression. The association between the different factors studied and HAT infection has been determined by estimating the odds-ratio (OR) with a confidence interval (CI) of 95% and a P-value of less than 0.05. We interviewed 180 subjects (60 cases and 120 controls).
Results: The 60 cases were predominantly male (male-female ratio of 2.2:1) with the majority (53%) in the age group of 20-40 years. Subjects in the age group of over 40 represented 28.3% of the patients. The same patterns were seen in the control group. The age of interviewees varies from 11 to 65 years. HAT cases reported drawing water from wells (16.7% vs 6.7%; P > .05), walking along the river bed and in the peat lands (11.7% vs 9.2%; P > .05) at a higher rate than controls. The HAT cases reported involvement in various activities that put them in much closer proximity with water sources: bathing (8.3% vs 6.6%; P >.05), dishwashing and laundry (20% vs 37.5%), fetching household water (50% vs 24.2%; P<.0001), cassava retting roots (1,7% vs 7.5%), diamond digging in the mines (51.7% vs 21.6%; P < .0001), trafficking or buying diamond from diggers (13,3% vs 8.3% ; P > .05).
Conclusion: Involvement in activities that connect with water sources increases the risk of acquiring HAT infection in Mbuji Mayi.

Open Access Original Research Article

Utilization of HIV Testing and Counseling Services by Men in the Bolgatanga Municipality

Ezekiel Apasera, Amos Laar

International Journal of TROPICAL DISEASE & Health, Page 209-220
DOI: 10.9734/IJTDH/2015/14198

Background: In the absence of an effective vaccine and cure for Human Immunodeficiency Virus (HIV), testing and counseling for HIV remains an important intervention in the control of the infection. However, utilization of this service in Ghana is very low especially among men. This study assessed the utilization of HIV testing and counseling (HTC) and the associated reasons for use or non-use of the service among men in the Bolgatanga Municipality.
Methods: The study was a population-based cross-sectional survey. A total of 610 men, aged 18–59 years residing in Bolgatanga Municipality were randomly selected using a modified WHO cluster sampling technique. Data was collected using a structured questionnaire through home visits over a period of three weeks. Associations between the outcomes and each of the explanatory variables were assessed using bivariate Chi squares test. A p-value less than 0.05 was taken to be statistically significant.
Results: Majority of the respondents (99.3%) knew of a test that could identify HIV in an individual; however, 63.6% felt they were at no risk/low risk of being infected with HIV. About 89.8% of those who had heard of HIV test could locate at least one testing centre. Radio/television was the most frequent (68.4%) source of information. Only 27.7% of the respondents had ever tested for HIV of which 99.4% of them had received their test results. The annual HIV testing rates among the sampled men was 7.7%. Reasons given by respondents for use or non-use of testing and counseling services span socio-cultural and health service-related reasons, and personal beliefs. Educational and employment statuses of respondents were found to be associated with the utilization of HIV testing and counseling services (P < 0.001).
Conclusion: Utilization of HIV testing and counseling services by men in Bolgatanga Municipality is low. Low perception of HIV risk, fear of stigma, and false positive results were the key reasons for not being tested.

Open Access Original Research Article

In vitro Antiplasmodial, Antitrypanosomal, Antileishmanial and Cytotoxic Activities of Various Fractions of Abrus precatorius Leaf

Saganuwan Alhaji Saganuwan, Patrick Azubuike Onyeyili, Igoche George Ameh, Ngozi Justina Nwodo, Reto Brun

International Journal of TROPICAL DISEASE & Health, Page 221-229
DOI: 10.9734/IJTDH/2015/13683

Background: Infectious diseases are the worst problem in tropical and subtropical regions of the world. The Nupe ethnic group from Nigeria has been using the leaves of Abrus precatorius for treatment of malaria and various forms of cancers. However studies have shown that the plant has antimicrobial and anti-cancer activities. In this study the crude methanolic extract, methanolic, ethyl acetate, chloroform and n-hexane fractions of Abrus precatorius leaf were tested In vitro against chloroquine and pyrimethamine resistant Plasmodium falciparum K1, Trypanosoma brucei rhodesiense, Trypanosoma cruzi, Leishmania donovoni and rat skeletal myoblasts (L-6 cells).
Methods: The leaf ingredients were extracted and separated via methanol, ethyl acetate, chloroform and n-hexane solvents using column chromatography. In vitro activity against erythrocytic stages of P. falciparum was determined by a modified [3H]-hypoxanthine incorporation assay. In vitro activities against T. brucei rhodesiense, T. cruzi and L. donovoni and cytotoxicity against L6 cells line were assayed. Regression analysis was adopted for computation of the 50% inhibitory concentrations. The antiprotozoan activity of the extracts was qualified as active when IC50 value was less than 50 μg/ml. The extract that showed selectivity index higher than 3.29 was considered to have potential for safer therapy.
Results: n-hexane fraction showed the best antiplasmodial activity with inhibitory concentration (IC50) value of 12.1 μg/ml followed by chloroform fraction (23.0 μg/ml), crude methanolic extract (30.4 μg/ml) and ethyl acetate fraction (45.9 μg/ml) with selectivity index of 3.66, 1.90, 2.18 and 3.29 respectively. Chloroform fraction showed the best activity against T. brucei rhodesiense with IC50 value of 17.9 μg/ml and selectivity index of 2.44 and followed by n-hexane fraction with IC50 (34.5 μg/ml) and selectivity index of 1.28.
Conclusion: Since leaf extract has significant antiplasmodial, antitrypanosomal and antileshmanial activities in vitro, bioassay guided isolation of the active principles can be done with a view to discovering novel drugs for the treatment of malaria, trypanosomiasis and leishmaniasis.

Open Access Original Research Article

Clinical Description, Bacterial Causes and the Association of HIV with Pyodermas Presenting at a Skin Clinic of a Tertiary Hospital in Rural South Western Uganda

Ogwang Edward, Joel Bazira, Mulyowa Grace

International Journal of TROPICAL DISEASE & Health, Page 230-238
DOI: 10.9734/IJTDH/2015/12294

Background: Diagnosis of pyoderma is clinical and antibiotic therapy in low resource setting is largely empirical. At MRRH Skin clinic repetitive visits by some patients with pyoderma led to speculation of antibiotic resistance. This indicated a need to survey the bacterial aetiology of pyoderma, their antibiotic susceptibility, clinical presentation, and look for association with HIV if any.
Methods: We consecutively enrolled 216 study participants with clinical diagnosis of pyodermas in a descriptive cross sectional study. Consenting participants had photographic documentation of pyoderma lesions, HIV counselling and testing. Skin swabs were cultured and sensitivity performed on the isolates. Pearson’s chi-square and Fischer’s exact test were performed to determine association between HIV status and bacterial causes of pyoderma.
Results: Non-bullous impetigo was the commonest clinical presentation, followed by folliculitis/perifolliculitis and lastly ecthyma. The major aetiological agents for the pyodermas were Staphylococcus aureus 77.78% and Streptococcus pyogenes 7.41% respectively. Other bacteria isolated were Klebsiella species 2.31% (5/216), Proteus species 1.85% (4/216) and Pseudomonas species 0.93% (2/216). Resistance of Staphylococcus aureus isolates to the anti-staphylococcal penicillin oxacillin was at 19.53% (33/169). The bacteria isolated from HIV positive participants were no different from that of HIV negative participants; for Staphylococcus aureus (82.35% versus 77.47% or p-value =0.527), Streptococcus pyogenes (5.88% versus 9.34% or p-value = 0.513) and for Klebsiella species (2.94% versus 2.75% or p-value = 0.647). Antibiotic susceptibility to most antibiotics was not significantly different between HIV positive and HIV negative participants except susceptibility to the cephalosporin cefalexin (p-value 0.039) which was much lower in the HIV positive pyoderma patients (83.87% versus 95.12%).
Conclusion: Non-bullous impetigo is the most common pyoderma in this population with Staphylococcus aureus and Streptococcus pyogenes being the major causes of pyoderma and pyoderma aetiology was not affected by HIV status.

Open Access Review Article

Schistosomiasis: The Disease, Anti-Schistosoma Vaccine Candidates and Baboons as Ideal Models in Schistosomiasis Studies

C. A. Omedo Robin

International Journal of TROPICAL DISEASE & Health, Page 170-189
DOI: 10.9734/IJTDH/2015/13094

Schistosomiasis is still a major health hazard in developing countries. Acute form, Katayama's syndrome occurs weeks after the initial infection and manifestations include fever, cough, abdominal pain, diarrhea and hepatosplenomegaly. Chronic infection may cause granulomatous reactions and fibrosis in the affected organs. These reactions may result in: colonic polyposis with bloody diarrhea; portal hypertension with haematemesis and splenomegaly; cystitis and ureteritis with hematuria, which can progress to bladder cancer; pulmonary hypertension; glomerulonephritis; and CNS lesions. Cerebral granulomatous disease may be caused by ectopic S. japonicum eggs in the brain, and granulomatous lesions around ectopic eggs in the spinal cord from S. mansoni and S. haematobium infections may result in a transverse myelitis with flaccid paraplegia. At present the effective control method is chemotherapy with use of praziquantel as the drug of choice. But with the possibility of drug resistance and re-infection, the focus is on development of vaccine[s] that can reduce the incidence of the disease. Different Schistosoma antigens capable of inducing some protection in experimental animals have been identified. The potential of these vaccine candidates need to be validated fully in humans. As a starting point, these antigens need to be tested in an animal model that is biologically and immunologically closely related to humans. Baboons may be the ideal models for this purpose as prelude for human clinical trials. This article reviews the disease schistosomiasis; anti-Schistosoma vaccine candidates; and also looks at baboons as ideal models in schistosomiasis studies.