Open Access Case Report

Pulmonary Cryptococcosis Co-existing with Pulmonary Tuberculosis in a Nigerian HIV-infected Patient: A Case Report

O. F. Nwako, E. O. Ofondu, G. C. Mbata, C. O. U. Eke, A. B. Nwako, P. Obi, C. A. Nwako, M. O. Iroezindu

International Journal of TROPICAL DISEASE & Health, Page 1-5
DOI: 10.9734/IJTDH/2016/25157

Tuberculosis (TB) and cryptococcosis cause severe morbidity and mortality in HIV-infected individuals in sub-Saharan Africa. However, cryptococcosis and TB co-infection is rare. We present a case of pulmonary cryptococcosis co-existing with pulmonary TB in a 42 year old Nigerian woman who had received Highly Active Antiretroviral Therapy (HAART) for about 6 months with CD4 count of 98 cells/mm3. In the second month of HAART, she developed smear positive TB and was commenced on anti-TB therapy. Following initial improvement, she developed new onset cough, low grade fever, weight loss, breathlessness and chest pain. Repeat sputum Acid Fast Bacilli (AFB) was negative but GeneXpert/MTB/Rif detected Mycobacterium tuberculosis (MTB) with no resistance to Rifampicin. Sputum fungal culture and Indian ink staining confirmed cryptococcosis. The patient was commenced on oral fluconazole therapy; anti-TB and HAART were continued. She subsequently improved but was unfortunately lost to follow-up. Pulmonary cryptococcosis should be considered in the differential diagnosis of severely immunosuppressed HIV-infected patients with chronic respiratory symptoms.

Open Access Systematic Review Article

The Synergy of Diet, Exercises and Lifestyle Modification for the Prevention of Osteoporosis

G. O. Ayenigbara

International Journal of TROPICAL DISEASE & Health, Page 1-8
DOI: 10.9734/IJTDH/2016/23403

This paper did a review of literature on osteoporosis, the risk factors, the consequences, and the prevention through the synergy of diet, exercises and appropriate lifestyle modification. Osteoporosis is a condition in which bones become dangerously thin and fragile over time. Fractures are the most serious consequence of osteoporosis, and up to 20% of all people who suffer a hip fracture die within a year. Other problems associated with osteoporosis are loss of height and a stooped posture due to vertebral fractures, severe back and hip pain, and breathing problems caused by changes in the shapes of the skeleton. Women are at greater risk than men for osteoporosis because they have 10 – 25% less bone in their skeletons. Women’s bones become dangerously thin sooner than men’s bones after Menopause when oestrogen production is diminished. Oestrogen improves calcium absorption and reduces the amount of calcium the body excretes. Preventing osteoporosis requires building as much bone as possible during ones young years and then maintaining it as one age. Diet and exercises also play key roles. Other life style modifications, such as abstaining from cigarette smoking, and alcohol consumption are imperative in preventing osteoporosis.

Open Access Original Research Article

Hepatic Hydrothorax in Patients with Decompensated Cirrhosis in Zagazig University Hospitals: A Cross-sectional and Single Center Study

Sameh M. Abdel Monem

International Journal of TROPICAL DISEASE & Health, Page 1-8
DOI: 10.9734/IJTDH/2016/25475

Background and Study Aim: Hepatic hydrothorax is the presence of more than 500 ml of pleural effusion in a patient with liver disorder. The work aimed to study the frequency of Hepatic hydrothorax in patients with decompensated cirrhosis admitted to the Tropical Medicine department, Faculty of Medicine, Zagazig University (inpatients, outpatient and intensive care unit) trying to determine the frequency of this disorder.

Patients and Methods: This study was performed on 208 decompensated cirrhotic patients (112 males and 96 females), their ages ranged from 27 to73 years old (53.8±7.09) between April 2013 to April 2014. Which were randomly divided into Group I included 182 decompensated cirrhotic patients without pleural effusion and Group II included 26 cirrhotic patients with pleural effusion. Clinical assessment, laboratory evaluation, plain chest x-ray and diagnostic paracentesis and pleurocentesis for cytological, biochemical analysis and bacteriological, biochemical and bacteriological analysis were carried out. 

Results: In this study; the frequency of pleural effusion in decompensated cirrhotic patients was 26/208 cases with a percentage of (12.5%) Also, this work showed (76.9%) of pleural effusion patients had effusion on right side, (15.4%) on left side, and (7.7%) have bilateral pleural effusion. This study showed; (23.1%) of cases with pleural effusion had mild effusion, (46.1%) had moderate effusion and (30.8%) had massive effusion.

Conclusion: Hepatic hydrothorax is an uncommon complication of advanced liver disease. In this study; the frequency of pleural effusion in decompensated cirrhotic patients was (12.5%), the majority of patients with hepatic hydrothorax were in child (C) 61.5%.

Open Access Original Research Article

Malaria Parasite and Anaemia Prevalence in Adult HIV-patients Attending Care and Treatment Centre in Baptist Hospital Mutengene, Cameroon

Emmaculate Lum, Helen K. Kimbi, Elias F. Onyoh, Bate Ayukenchengaba, Godlove B. Wempnje, Conica M. Njabi, Leopold G. Lehman

International Journal of TROPICAL DISEASE & Health, Page 1-11
DOI: 10.9734/IJTDH/2016/25022

Aim: This study was aimed at investigating malaria parasite and anaemia prevalence, the impact of co-infection on immune-haematological parameters, clinical/treatment profiles and how malaria preventive measure associate with malaria and anaemia in adult HIV-patients attending care and treatment centre in Baptist Hospital Mutengene.

Study Design: Cross-sectional study.

Place and Duration of Study: This study was carried out in Mutengene from June to August, 2012.

Methodology: A semi-structured questionnaire was used to record information on demographic factors and use of preventive measures from adult HIV-patients. Venous blood was collected; blood films were prepared and Giemsa-stained for malaria parasite detection. Haemoglobin concentration was determined. A total of 470 adults HIV-patients aged 20 - 68 years were studied.

Results: There was an overall malaria parasite prevalence of 36.38% but there was no significant difference in malaria parasite prevalence between the various categories examined. The overall anaemia prevalence in the study was 24.89% with a significant difference (p=0.02) between males and females. There was a highly significant difference (p<0.001) in anaemia prevalence between different CD4+ levels, WHO clinical stages, fever status, clinical symptoms status, HAART consumption status, NRTIs and NNRTIs classes of HAART. There was however no significant difference in anaemia prevalence between the various malaria preventive measures applied in the study.

Conclusion: This study demonstrates that malaria infection in HIV patients can lead to a reduction in CD4+ count and increase anaemia and fever. This can facilitate the HIV-patient’s change from clinical stage 1 to 4 where the patients will find it difficult to manage the disease and stay healthy. HIV-patients need to implement malaria control measures such as use of ITN and keep the environment clean in order to avoid malaria-related morbidity and mortality and improve generally on their health.

Open Access Original Research Article

Assessment of Ischemia Modified Albumen in Chronic Liver Diseases

Neven Farouk Abbas, Ehsan Rizk, Azza Baiomy, Mona Arafa

International Journal of TROPICAL DISEASE & Health, Page 1-9
DOI: 10.9734/IJTDH/2016/25293

Aims: Ischemia modified albumin (IMA) level is increased in ischemic conditions and in diseases such as myocardial infarction, systemic sclerosis, advanced cancer, end-stage renal disease and intrauterine disorders. The role of IMA in chronic liver diseases and its correlation with disease severity needs further investigations. So we aimed to assess IMA and its ratio to albumin as a marker of advanced liver cirrhosis and their correlation with the disease severity.

Study Design: A cross sectional study including125 patients with chronic liver disease (80 males and 45 females) with mean age 54.63 years; and 35 healthy controls.

Place and Duration of Study: Hepatology Unit Specialized Medical Hospital and Tropical Department, Mansoura University between June 2014 and March 2015.

Methodology: The patients with chronic liver disease (80 males, 45 females) with age range from 46 to 62 years, 70 cases were chronic HCV, 15 chronic HBV, 20 combined HCV, HBV 10 autoimmune liver diseases, 5 NASH, and 5 of unknown cause. They were further subdivided according to Child-Pugh scoring into 50 patients with Child A, 45 patients with Child B and 30 patients with Child C. 35 healthy subjects of matched age and sex were included as control group. Laboratory analysis including complete blood count, liver profile, prothrombin time, IMA and IMAR were done to all patients and control.

Results: There was significant increase in IMA and IMAR in studied patient groups versus controls, in Child B versus Child A and in Child C versus both Child A & B. A significant positive correlation was found between both IMA & IMAR with total bilirubin and INR while a significant negative correlation was reported between both IMA & IMAR with albumin, ALT, AST, Hb, WBCs and PLT in liver cirrhosis. At cut off > 0.767 IMA had a sensitivity of 86.99% and a specificity of 77.1% (AUC; 0.85) and at cut off > 0.213 IMAR had a sensitivity of 92.5% and a specificity of 88.5% (AUC; 0.95) for detecting liver cirrhosis. For detecting severity of liver cirrhosis, by comparing Child B and Child C, at cut off > 0.968 IMA had a sensitivity of 93.3% and a specificity of 94.2% (AUC; 0.96) and at cut off > 0.453 IMAR had a sensitivity of 92.8% and a specificity of 72.7% (AUC; 0.86) for detecting severity of liver cirrhosis.

Conclusion: IMA and IMAR are sensitive markers in chronic liver disease and better correlated with the degree of decompensation. A further study to assess their role in follow up of treatment response is recommended.