Open Access Case Report

Unusual Findings in Morgellons Disease and Delusions of Parasitosis

Michael Fellner, Margarita Israilova, Adriana Lombardi, Jennifer Leininger

International Journal of TROPICAL DISEASE & Health, Page 1-6
DOI: 10.9734/IJTDH/2015/17045

We are presenting four new cases of delusions of parasitosis, two of which also had features of Morgellons disease. This illustrates the difficulties in therapy of these patients having almost universal refusal to accept the psychiatric component. Two of the patients responded to treatment while two did not. Of the two responders one was lost to follow up. The recommended treatments of pimozide, lexapro, and risperdone are examined. These rare diseases continue to be a challenge to the dermatologic community.

Open Access Case Study

A Case Report of Cutaneous Larvae Migrans with Associated Fungal Superinfection in Uyo, Nigeria

Christie Divine Akwaowo, Idongesit Odudu Umoh

International Journal of TROPICAL DISEASE & Health, Page 1-4
DOI: 10.9734/IJTDH/2015/17954

Aims: To describe a case of Cutaneous Larvae Migrans (CLM) with associated fungal and bacterial superinfection seen in the Tuberculosis and Infectious Disease Unit of University of Uyo Teaching Hospital.
Presentation of Case: A 31-year old male reported to the Tuberculosis and Infectious Disease Unit with a history of creeping eruptions, itching and right foot swelling following gardening. Investigations revealed associated bacterial and fungal super infection. Symptoms resolved after treatment with Albendazole, antibiotics and antifungals.
Discussion: Although CLM is self-limiting, non- recognition and home treatment using local herbal remedies may lead to associated superinfection, mask the presentation and lead to delayed diagnosis.
Conclusion: CLM is not frequently reported in the tropics and primary health care workers are likely unfamiliar with its presentation, which could delay the treatment. Associated use of local herbal remedies lead to superinfection as seen in the index case may lead to missed and delayed diagnosis. This calls for increased awareness of the condition and its treatment for primary care workers.

Open Access Original Research Article

Expanding Access to Maternal Health Services by the Use of Traditional Birth Attendants: Experiences of the Sunni Hospital Group, Maiduguri, Nigeria

Abdulkarim Garba Mairiga, Sadiq Garba Uthman, Bilkisu Isa

International Journal of TROPICAL DISEASE & Health, Page 1-8
DOI: 10.9734/IJTDH/2015/18474

Aim: We intend to ascertain the experience of Sunni Hospital Maiduguri on the use of TBAs in enhancing Maternal Health Care Services.
Study Design: It was a retrospective observational survey of a community health project.
Place and Duration of Study: Maiduguri, Borno State Northeastern Nigeria between January 2001 and December 2007.
Methodology: Post-intervention survey of a community health intervention that targeted Muslim underserved semi-urban women.
Results: One thousand seven hundred and seventy eight (1,778) women were referred for life-saving interventions. More than 80% of the referrals were due to maternal and fetal complications identified by the TBAs in their respective communities. Six hundred and ninety one (691) deliveries were conducted using clean delivery kits. Their counseling and services consistently enhanced contraceptive uptake seen by generation of over 2,000 CYPs.
Conclusion: TBAs play a significant role in expanding maternal and child health services in our communities. And TBAs are likely to continue to be key resource for improving maternal and child health. Therefore it is necessary to integrate these community workers in the health system.

Open Access Original Research Article

Usefulness of Various Biomarkers for the Differentiation of Bacterial from Viral Meningitis

Ghada A. Salem, Hanaa Abd Elmoety

International Journal of TROPICAL DISEASE & Health, Page 1-8
DOI: 10.9734/IJTDH/2015/18410

Background and Aim: Meningitis is an emergency condition, particularly bacterial meningitis for young and elderly patients. Differentiation between septic and aseptic meningitis may be difficult, the search for biochemical markers and laboratory tests to help in this task is crucial in order to optimize the treatment and avoid unnecessary use of antibiotics especially in aseptic meningitis. The aim of this study was to evaluate the diagnostic and prognostic utility of sTREM-1, CRP, IL-8 in septic meningitis and their usefulness in early differentiation between septic and aseptic meningitis in Egyptian patients.
Patients and Methods: This work included 70 patients (25 had septic meningitis group I, 30 had aseptic meningitis group II and 15 control individual group III). sTREM-1, IL-8 and CRP measurements were done on admission and after 48-72 h of treatment, in addition to Gram stain, culture of blood and CSF, latex agglutination test of CSF.
Results: Bacterial (septic) meningitis was found in 25 (35.7%) of the studied groups. Patients with septic meningitis had a significant increase in serum sTREM-1 and IL-8 and CRP at the time of admission (32.99±19.79, 2.46±1.8 and 126±90.5 respectively) while patients with aseptic meningitis had (6.8±5.67, 0.66±0.118 and 35±25.38 respectively), the control group had (6.6±4.6, 0.055±0.07 and 15{C}{C}±4 respectively) (P<0.05). sTREM-1 showed significant higher sensitivity (93.7%) and specificity (94.3%) in the early prediction of sepsis with an area under the receiver operator characteristic (ROC) curve (95% CI) of 88.2 (84-93) at a cut off value of 12.4 ng/ml. Moreover, sTREM-1 level was significantly low (P<0.001) at admission in 6 patients out of 25 patients who had septic meningitis who showed poor outcome.
Conclusion: sTREM-1 and IL-8 are valuable in early distinguishing of septic from aseptic meningitis but with higher diagnostic discriminatory power for sTREM-1 in determining septic meningitis prognosis and this marker would facilitate the clinical decision of interrupting antimicrobial therapy and avoiding unnecessary hospitalization.

Open Access Original Research Article

Health System Barriers and Facilitators Influencing TB/HIV Integration in Ghana

Gloria Akosua Ansa, John D. Walley, Kamran Siddiqi, Xiaolin Wei

International Journal of TROPICAL DISEASE & Health, Page 1-12
DOI: 10.9734/IJTDH/2015/17293

Introduction: A quarter of all TB cases in Ghana were HIV-positive at the end of 2012. The integration of TB and HIV services is anticipated to improve patient access to comprehensive care. Key health system components for successful integration are leadership and governance, health information systems, health financing, human resources for health, essential medical products and technologies, and service delivery This paper explores the health system barriers and facilitators influencing TB/HIV integration in Ghana.
Study design: An interpretivist qualitative approach was employed and semi-structured interviews were used to generate data.
Place and Duration: The study was conducted in the Eastern Region of Ghana between May and July 2009.
Methodology: Three urban district hospitals with three different service delivery models with increasing levels of integration were purposively selected as study sites. Semi-structured interviews were conducted with purposively sampled TB/HIV patients, providers and managers. The audio recorded interviews were transcribed and thematically analysed using a-priori and emergent codes.
Results: Twenty nine participants made up of 18 HIV-positive TB patients, eight providers and three managers participated in the study. Barriers included inadequate capacity, poorly motivated staff, different financial and health information systems, irregular and misapplied funds as well as differences in access to services. Facilitators included political will, direct supervision, regular supply of drugs, and privacy and confidentiality.
Conclusion: The impact of facilitators needs to be enhanced to address related barriers. Standardisation of norms and values, as well as new staff training methods should be used to achieve staff behavioural changes towards integration.