Open Access Original Research Article

Changing Epidemiology of Dengue Fever: Newer Insights and Current Concepts

Arun Agarwal, Mudit Agarwal, Vishnu Gupta

International Journal of TROPICAL DISEASE & Health, Page 1-12
DOI: 10.9734/IJTDH/2017/36416

Background: Dengue fever (DF) is the most common of the arboviral infections in humans and more than two-fifths of the world's population lives in areas potentially at risk for dengue. Effective vector control, prompt case detection and appropriate clinical management can reduce the mortality from severe dengue. The objective of this paper is to present current epidemiology of dengue in this part of the country and, additionally, reflect on some important clinical issues involved in the management of these cases. The global incidence of DF and dengue hemorrhagic fever (DHF) has increased dramatically in recent decades. Endothelium is the target of the immune-pathological mechanism in DF and DHF, its hallmark being vascular permeability and coagulation disorders. Plasma leakage or capillary leak syndrome (CLS) is the most specific and life-threatening feature of DHF and is considered to be the primary lesion that underlies DHF.

Materials and Methods: The present study is a four year (January 2013- December 2016), retrospective observational study. The study population consists of 264 male or female indoor patients with confirmed diagnosis of dengue fever. Inclusion criteria were discharge diagnosis with International Classification of Disease (ICD) code A90 - A91 and availability of minimal dataset (name, registration number, age, sex, diagnosis, symptoms, laboratory investigations, transfusions if any, co-infection, other co-morbidities, date of admission, date of discharge, and discharge status). Indoor files of all these 264 cases were collected from medical records department and data tabulated. The study focuses on incidence and outcomes of CLS in dengue infection along with other various issues among these patients.

Results: In all 264 patients were included in the study with a male female ratio of 1.6:1. The youngest and the eldest patient were of 13 year and 95 year age respectively. Primary dengue fever (pDF) was seen in 219 (83%) and secondary dengue fever (sDF) in 45 (17%) cases respectively. Besides fever, chills, vomiting, abdominal pain, body-ache, bleeding manifestations, and hepato-splenomegaly, features of CLS were present in 164 (62.1%) cases. None of the cases had only left side pleural or pericardial effusion. In all 258 (97.7%) cases had thrombocytopenia, 39 (14.8%) cases had bleeding manidestations, 11 (4%) cases had severe organ involvement, 19 (7.2%) cases had co-infections, 43 (16.3%) cases required medical intensive care unit (MICU) admissions, and there were only 4 (1.5%) mortalities. The pathophysiology and management challenges of CLS along with other parameters are discussed.

Conclusion: Currently, no specific antiviral therapy exists for dengue virus. With prompt case detection and appropriate clinical management, the case fatality rate (CFR) is declining and the overall CFR in the southeast Asia region is now less than 1%. In our case series it was 1.5%. We conclude that patients of DF with thrombocytopenia and transaminitis should be evaluated early by ultrasonography for CLS. Hemoconcentration and hypoproteinemia are not sensitive tools to pick up capillary leakage in clinical practice. Isolated left side pleural effusion and pericardial effusion are not seen in DF and if present one should look for another cause. The case series raises question on the accepted theory of relation between capillary leakage and severe dengue infection. Further, since capillary leakage was seen in 78.8% of primary dengue infection cases, it also questions the validity of the immune enhancement theory of DHF/severe dengue. Viral burden may be a key factor in determination of disease severity rather than sequential infections or secondary infection. Early detection and appropriate case management practices are critical factors for survival.

Open Access Original Research Article

Evaluation of the Efficacy of Microscopy and PCR in the Diagnosis of Urinary Schistosomiasis among Primary School Children in Wamakko Local Government Area of Sokoto State – Nigeria

E. J. Effiong, T. H. I. Spencer, K. Mohammed, M. F. Useh, N. D. Ndodo, F. P. N. Umahi

International Journal of TROPICAL DISEASE & Health, Page 1-8
DOI: 10.9734/IJTDH/2017/35462

Aims: The aim of this study was to evaluate the efficacy of microscopy and PCR in the diagnosis of urinary schistosomiasis among primary school children in Wamakko Local Government Area. Sokoto, North-western, Nigeria.

Study Design: This was a cross-sectional, descriptive study designed to evaluate the efficacy of microscopy and Polymerase Chain Reaction in the diagnosis of urinary schistosomiasis among primary school children in Wamakko Local Government Area. Sokoto, North-western, Nigeria.

Place and Duration of Study: This research was conducted at the centre for advance research and training Usmanu Danfodiyo University, Sokoto, Sokoto State, from May to July, 2016.

Methodology: Study was carried out on randomly selected 50 urine samples of Primary school children in Wamakko. The DNA extraction was carried out using the phenol-chloroform method and the extracted DNA was amplified by PCR using a set of primers to detect Dra 1 repeat gene fragment at 121bp. The PCR products were detected using Agarose gel electrophoresis.

Results: Among the study population, S. haematobium eggs were detected in 5 subjects while S. haematobium DNA was detected in 3 subjects. One of the subject was positive with PCR but negative with microscopy. The sensitivity and specificity for PCR were 60.0% and 95.92%, respectively.

Conclusion: From the result presented, even-though there are only five samples (5) positive for Schistosoma haematobium but conclusion cannot be made that microscopy is the gold standard but that, it is suitable for diagnosis of acute urinary schistosomiasis in children Due to high cost, PCR should be reserved for clinically susceptible cases, areas of low endemicity and light infection.

Open Access Original Research Article

Knowledge and Practices Related to Food Hygiene among Food Handlers in Sokoto, Nigeria

Ahunna Zainab Ezenwoko, Kehinde Joseph Awosan, Mansur Oche Oche, Muhammad Aliyu Makusidi, Bilkisu Gulma Abubakar, Ismail Abdullateef Raji

International Journal of TROPICAL DISEASE & Health, Page 1-16
DOI: 10.9734/IJTDH/2017/35728

Introduction: Unsafe food poses global health threats, endangering everyone Vended foods are considered to be a public health hazard because the food handlers are often poor, have poor schooling and lack appreciation for food hygiene practices (particularly in developing countries). However, the restaurants have a large clientele base ranging from the rich to the poor who are exposed to these hazards and thus any outbreak of food borne illnesses could be disastrous. This study aimed to determine the knowledge and practice related to food hygiene among food handlers in Sokoto, Nigeria.

Methods: A cross-sectional study was conducted among 263 food handlers selected by a multistage sampling technique. Data were collected with a set of pre-tested interviewer- administered, semi-structured questionnaire, and observer’s checklist. Data were analyzed using IBM SPSS version 20 statistical package.

Results: The mean age of the respondents was 27.14 ± 8.84.years. Most of the respondents were females (82.9%), and a majority of respondents were single (52.5%), and had at least primary education (51.3%). Most, 198 (75.3%) of the 263 respondents had good knowledge of food hygiene, and close to two-thirds 152 (57.8%) had good knowledge of food borne illness. Although a majority of respondents consistently observe food hygiene practices such as covering their nose and mouth while sneezing (86.3%) and cooking food thoroughly (66.5%), compliance with the other food hygiene practices was poor (ranged from 1.1 to 35.4%). The sanitary condition in a substantial proportion of the restaurants was also poor.

Conclusion: Despite good knowledge of food hygiene and food borne illnesses among the respondents in this study, they showed poor compliance with food hygiene practices; and the sanitary condition of a substantial proportion of the restaurants was poor. Promotion of good sanitary practices among food handlers and regulation of their practices by the government agencies concerned to ensure compliance with basic sanitary standards were suggested.

Open Access Original Research Article

Some Haematological Parameters and Immunoglobulin Levels in Mycobacterium tuberculosis Infected Patients in Benin City, Southern Nigeria

Ifeanyichukwu, Martin Ositadimma, C. Meludu Samuel, Odozi, Efeota Bright, Okeke, Chizoba Okechukwu

International Journal of TROPICAL DISEASE & Health, Page 1-9
DOI: 10.9734/IJTDH/2017/25693

Mycobacterium tuberculosis (MTB) infection is a major public health challenge in Nigeria. This research aims at determining the effect of MTB infections on some haematological and immunological parameters in MTB patients in Benin, Nigeria. One hundred and fifty subjects were recruited for the studies. These subjects comprised of 50 MTB positives, 50 MTB positives on direct observation and treatment (DOTS), and 50 controls. Ethical approval was obtained from the Ethics Committee of Faculty of Health Sciences and Technology, Nnamdi Azikiwe University, Nnewi campus. Informed consent was obtained from all subjects recruited for the studies. Five milliliters of blood was collected from each subject for HIV test by ELISA method, CD4 count by Flow Cytometeric technique, immunoglobulin test by immune-turbidimetric method, estimation of leucocyte profile by automated haematological analyser and ESR by routine method. In addition, sputum was collected from each subject for Ziehl Neelsen technique of Mycobacterium tuberculosis examination. Statistical Package for Social Science (version 20) was used for the data analysis. Results obtained from the study showed that the comparison of the WBC of the control subjects and MTB positive subjects was significantly higher in the MTB positive subjects (p < 0.05). Also, WBC of Mycobacterium tuberculosis (MTB) positive subjects was significantly higher than MTB positives on DOTS. The CD4 count of DOTS administered MTB positives was significantly higher than non-DOTS MTB positive subjects (p < 0.05). The mean values of immunoglobulin A, G, M (IgA, IgG and IgM) in MTB positive subjects were significantly higher compared with the values in the controls (p < 0.05). Also, IgG value in the DOTS administered MTB positive subjects was significantly higher than the mean value in the control subjects. In same manner, the IgA and IgM value for non-DOTS in each case was higher than MTB on DOTS subjects (p < 0.05). The value of Haematocrit (HCT)  and Lymphocyte (LYM) count were significantly higher in control subjects when compared with DOTS administered MTB positives and MTB positives in each case (p < 0.05). The value of neutrophil for MTB positives was significantly higher than the value in the control subjects (p < 0.05). Thus Immunoglobulin G, A, and M could be used as a predictive marker for monitoring MTB infections, alongside haematological parameters and CD4 count.

Open Access Original Research Article

Effect of Helicobacter pylori Infection on Selected Biochemical Parameters of Hypertensive Patients at Dschang District Hospital in Cameroon

Jean-de-Dieu Tamokou, Yvette Alvine Tonleu Guimtsop, Martin Ernest Ndebi, Vanessa Linda Nzesseu, Arsène Kamamo Djokge, Jules-Roger Kuiate

International Journal of TROPICAL DISEASE & Health, Page 1-8
DOI: 10.9734/IJTDH/2017/36252

Aims: Helicobacter pylori infection is an important cause of peptic ulcer disease and other gastrointestinal disorders. The gastritis caused by H. pylori leads to lipid metabolism disorders that may act as risk factors for hypertensive patients. The aim of the study was to seek for possible correlation between H. pylori IgG seropositivity and the variations of some biochemical parameters amongst hypertensive patients in the District Hospital of Dschang.

Place and Duration of Study: Department of Biochemistry and District Hospital of Dschang, between November 2015 to March 2016.

Methods: We conducted a cross-sectional study from November 2015 to March 2016 consecutively enrolling 125 consenting patients of average age 54.36 ± 8 years attending the hospital for medical check-up. Two blood pressure measurements and the determination of IgG anti H. pylori by the indirect enzyme-linked immunosorbent assay (ELISA) technique, enabled us to distinguish four groups of patients: hypertensive (HT+), H. pylori IgG seropositive (HP+), H. pylori IgG seropositive and hypertensive (HT+HP+), and a group of patients free from the two pathologies (HT-HP -). Measurements of biochemical parameters such as total cholesterol, HDL cholesterol, LDL cholesterol, triglycerides, creatinine, CRP, glucose and albumin were done in serum/plasma by methods resulting from commercial kits. 

Results: Analysis of biochemical data showed significant elevated levels (p < 0.05) of total cholesterol, creatinine, albumin and LDL cholesterol levels in the groups HT+ and HT+HP+ compared to the group of HT-HP -. Moreover, average rate of HDL cholesterol was significantly lower in the groups HT+, HT+HP+ and HP+ compared to the control group (HT-HP-). Abnormal high elevated levels of LDL cholesterol, HDL cholesterol, total cholesterol, trigylcerides, CRP and creatinine were observed in the groups HT+HP+, HP+ and HT+ as compared to the group HT-HP-. 

Conclusions: Our findings suggest a significant association between H. pylori IgG seropositivity and hypertension and the joint effects of these two diseases on certain biochemical parameters studied. These results constitute an original contribution in the monitoring and handling the studied pathologies.