Open Access Case Study

A Paediatric Case Study Report of Cholera in an Endemic Area of Cebu Province of Philippines

Yogesh Kumar Sharma

International Journal of TROPICAL DISEASE & Health, Page 55-66
DOI: 10.9734/ijtdh/2021/v42i330445

ZD, 2 years old male child from Cebu city Philippines with chief complaint of loose watery stools was admitted by his mother to a tertiary hospital. Five days prior to the admission, onset of the disease with three episodes (approximately 100 ml each) of non-foul smelling loose watery (yellow) stools was observed with moderately severe dehydration. However, it was observed that the patient was playful and with a good appetite. He was given 1 pack per day Vivalyte rehydration solution hence, the episode reduced to one time. One night prior to admission, an increase in bowel movement frequency was noted. The stool colour changed to yellowish to greenish with mucus. The patient turned anorexic and weak with sunken eyeballs. In the morning of the admission, the patient had another 2 episodes of the stools with formed particles. Patient also had 3 episodes of non-projectile vomiting (approximately 30 ml/ episode) irrelevant to the food intake timings.

At the Emergency Room, the patient was treated with IV Fluids of Normal Saline Solution (60 cc/ kg/ day); CBC showed thrombocytosis with neutrophilic predominance, serum electrolytes revealed hyponatremia and hypokalaemia. Stool Culture was done. Medications started were Zinc Sulphate at 20 mg per day and Oral rehydration solution. The patient was referred to an infectious specialist care with a primary impression or consideration of Cholera thus Erythromycin was started at 50 mg/kg/day (3 doses/ day).

Since the patient was under developed or did not match with the normal developmental milestones like no teething, open anterior fontanel, and deviation in the weight height ratio had developed as significant deviation in head circumference, chest circumference and abdominal girth due to the infused fluid volume overload. There might be chances of making wrong clinical diagnosis like viral diarrhoea complicated to give rise meningitis by primary care givers in absence of a confirmed laboratory results, an immediate initiation of an empirical treatment with fluid resuscitation and antibiotics undertaken, hence, the patient was referred to the care of a specialist of the infectious diseases for further evaluation and treatment.

At ward, the patient was observed awakened, irritable, without respiratory distress and tachycardia, with moderate dehydration and a positive fluid balance of 210 ml. Stool exam results showed 55-65 WBC per high power field. Intra Venous (IV) Fluid to correct the imbalance of electrolytes and medications were continued. Following days, the patient had 4 episodes of loose watery stools amounting to 100 - 200 ml per episode with passage of Ascaris. Patient was slightly irritable, with still sunken eyeballs, otherwise with good turgor, mobility and strong pulses. IV Hydration was continued. Albendazole (400 mg/ tab) single dose was given. Electrolyte imbalance was already corrected. However, the stool culture was positive for Vibrio cholerae. On the fifth hospital day, the patient got normal for all the symptoms and signs. Erythromycin was prescribed for 3 days at the rate of 50 mg/ kg/ day (3 doses/ day). Further, Zinc Sulphate tablets (20 mg/ tab) twice a day was also prescribed and then the Patient was discharged.

In absence of teething, Doxycycline as the drug of choice for the Cholera treatment might have been prescribed for a fast recovery. However, doxycycline is contraindicated in children less than 8 years of age due to the risk of yellow tooth discolouration and dental enamel hypoplasia. Generally, V. cholerae often becomes drug-resistant against multiple antibiotics through its enzymatic functions (HGT) that modify antibiotics chemically. Hence changing the antibiotic regimen remains the best strategy to get the best prognosis if the previously administered antibiotic doesn’t work properly. Another, before discharging, the condition of the patient might also have confirmed as normal through the required laboratory exams even if the patient was tolerating orally well. Moreover, the patient might have been referred to a paediatrician or called for an early follow up to reassess him and prescribe probiotics and other growth regulatory supplements for complete well-being of the patient.

Open Access Original Research Article

Plasmodium falciparum Biomass and Haematological Changes during Treatment of HIV/AIDS Patients in Western Kenya

J. K. Kirinyet, C. S. Mulambalah

International Journal of TROPICAL DISEASE & Health, Page 1-11
DOI: 10.9734/ijtdh/2021/v42i330440

Background: Monitoring and evaluation (M & E) of anti-malarial treatment among people living with HIV/AIDS (PLWHA) is very important to assess the response and change in malaria parasite biomass in an endemic area. Published data have shown that HIV-related immunosuppression correlates with increased malaria biomass, treatment failure and complicated outcome despite an individual's immune status. We evaluated blood samples from PLWHA based on malaria parasite biomass and haematological changes during anti-malarial treatment

Aim: To evaluate Plasmodium falciparum biomass and haematological changes during antimalarial treatment of PLWHA.

Settings and Designs: Cross-sectional and descriptive study design

Subjects and Methods: A randomized antimalarial treatment involving 126 subjects was carried out in a hospital setup in Western Kenya. Blood samples were collected and analysed to determine malaria parasitaemia, changes in parasite biomass and haemoglobin levels in 28 days among PLWHA following treatment with Quinine and Coartem® antimalarial drugs.  Descriptive and chi-square tests were used to determine the association of parasitaemia with gender and relevant haematological changes during treatment.

Results: A significant difference between females and males of those with parasitaemia on day-3 was noticed (p - 0.031). Quinine and Coartem® arms recorded a 100% parasite deletion/clearance by day-14 but showed recurrence on day-21 of 6.3% and 3.1% of day-14 respectively. On day-28 the Quinine arm had higher parasitaemia (306.3%).   Mean Hb improved from 11.0 gm/dL to 11.6 gm/dL by day-28.

Conclusion: Recurrence of malaria parasite biomass was noticeable from day-21 to day-28 with Quinine arm of recipients and by day-28 haematological parameters had improved indicating recovery.   Routine M &E of malaria cases and haematinic agent dosages to correct anaemia among PLWHA are recommended.

Open Access Original Research Article

Indigenous Knowledge Affords Antimicrobial Plants for the Management of Infections

John Alake, Samuel A. Akwetey, Wisdom Ahlidja, Francis A. Armah, Isaac Kingsley Amponsah

International Journal of TROPICAL DISEASE & Health, Page 12-21
DOI: 10.9734/ijtdh/2021/v42i330441

Aim: The research was carried out to ascertain the antimicrobial effect of the plants Omphalocarpum ahia, Homalium letestui, and Coelocaryon oxycarpum, which are used locally to treat some infectious diseases.

Place and Duration of Study: Department of Biomedical Sciences, School of Allied Health Sciences, University of Cape Coast, Cape Coast, Ghana and Department of Herbal Medicine, KNUST, Ghana from June to August 2014.

Method: The stem barks of the plants were extracted with 70 % methanol and successively partitioned with petroleum ether, ethyl acetate, methanol to obtain three different fractions. The antimicrobial activities of the extracts and fraction against MRSA, S. typhi, E. coli, S. pneumoniae, P. aeruginosa, E. faecalis, and S. aureus were determined using the disk diffusion method and the minimum inhibition concentration by the serial microplate dilution method with 0.2 mg/ml p-iodonitrotetrazolium as growth indicator whereas gentamycin was used as the positive control. Phytochemical tests on the plant materials were done according to standard methods.

Result:  All the fractions of each plant had activity against some of the bacteria. Ethyl acetate (EA) and hydro-methanolic (CE) extracts of Coelocaryon oxycarpum exhibited activity against all selected bacteria with MIC ranging from 0.625-5 mg/ml for CE and 0.3125-5 mg/ml for EA. Hydro-methanolic (CE) extracts of Omphalocarpum ahia also exhibited antibacterial activity against all the selected bacteria.

Conclusion: The current research showed that Omphalocarpum ahia and Coelocaryon oxycarpum have considerable antimicrobial activity against all the strains used in the study. Local knowledge may afford lead materials for the development of novel antimicrobial agents.

Open Access Original Research Article

The Epidemiology of Rubella in Lesotho before the Introduction of a Rubella Containing Vaccine: A Review of Measles Case-based Surveillance, 2012-2016

Azubuike Benjamin Nwako, Thabelo Makhupane

International Journal of TROPICAL DISEASE & Health, Page 22-31
DOI: 10.9734/ijtdh/2021/v42i330442

Aim: The aim of the study was to determine the burden and epidemiology of rubella infection in Lesotho before the introduction of a rubella-containing vaccine. It was also to assess the performance of the measles case-based surveillance system in Lesotho.

Study Design: Retrospective cross-sectional descriptive study.

Place and Duration of Study: The study was done in Lesotho from February to March 2019 based on the 2012 to 2016 data.

Methods: There was a review of the measles case-based surveillance data with a total of 1587 suspected cases reported during the study period. Samples were collected from suspected measles cases and tested for measles. Those samples that tested negative for measles were subsequently tested for rubella IgM at the National Reference Laboratory. The serum samples were analysed for rubella IgM using commercial enzyme-linked immunosorbent assay (ELISA) kits SERION and EUROIMMUN.

Results: There were 2 measles IgM and 748 rubella IgM positive cases confirmed. The rubella IgM positive cases accounted for 48% of the samples tested for rubella infection. There were also several rubella outbreaks during the study period. The Lesotho surveillance system met the two principal surveillance performance indicators for each year during the period of the study.

Conclusion: This study showed that there was high level of rubella sero-positivity with several outbreaks of rubella infections during the study period. Rubella infection was predominantly seen in those aged between 5 and <13 years of age. This justified the introduction of a rubella containing vaccine in Lesotho in 2017. Although the two principal surveillance performance indicators (non-measles febrile rash illness rates and the percentage of districts that reported at least one case of measles with blood specimen per year) were met during the period under review, there were districts that performed poorly. This study revealed the need for strengthening of rubella-containing vaccine component of routine immunization to lower the impact of rubella infection in Lesotho. A detailed district level review to identify and address the causes of poor performance in some districts is recommended. There is also a need to identify the current challenges and evaluate the impact of the recently introduced rubella-containing vaccine on rubella infection in Lesotho.

Open Access Original Research Article

Predictors of Spontaneous Conception Following Myomectomy among Women with Infertility at Federal Medical Centre Yenagoa, Nigeria

Ikobho Ebenezer Howells, Omietimi E. James, Isaac Joel Abasi

International Journal of TROPICAL DISEASE & Health, Page 32-45
DOI: 10.9734/ijtdh/2021/v42i330443

  • Background: Uterine fibroid or leiomyoma (myoma) is the commonest uterine neoplasm in women, and it has been associated with infertility. Though it’s not regarded as a direct cause, surgical removal (myomectomy) has been reported to increase the spontaneous conception rate in women with infertility.
  • Objective: The objective of this study was to determine the factors associated with conception after myomectomy in women with infertility. It would determine the pregnancy rate, demographic, and surgical factors (pre and postoperative factors).
  • Materials and Methods: This was a retrospective observational study of 107 women who had myomectomy during the study period, out of these, 68 were done for infertility. The case notes of these women were retrieved, and information related to demographic factors obtained was: maternal age, parity, address, tribe, educational level, and occupation. The preoperative surgical factors obtained were previous history of myomectomy, indication for myomectomy, the size, number and location of myomas, and the caliber of the surgeon. Postoperative surgical data collected include conception, interval between myomectomy and conception, pregnancy outcome, mode of delivery, and fetal sex and birth weight. Categorical variables were compared with chi square and odds ratio, and the degree of association for quantitative variables was determined using Pearson’s correlation coefficient. Predictor variables were determined using simple logistic regression, and multivariate analysis.
  • Results: The infertility rate among the women who had myomectomy was 63.6%, the conception rate was 14.7%, and the mean myomectomy to pregnancy interval was 9.20 ± 1.24 months. The factors that favor conception were: younger women P = 0.003, uterine size ≤ 16 weeks odds ratio = 3.50(0.14, 84.20), high parity (p = 0.002), solitary fibroid odd ratio = 2.65(0.44, 16.04), tertiary education P = 0.0001 and surgery by consultants P = 0.004. Others were absence of submucous myomas, and pelvic pathology at laparotomy. Using multivariate analysis, the most significant predictors for conception were age and parity, accounting for 10.7%, and all the factors put together could only explain 36.5%.
  • Conclusion: The conception rate following myomectomy in Yenagoa was relatively low, and the most important predictors were maternal age and parity. The bulk of the factors (65.5%) that determine conception are outside the scope of our study; these could be male factor infertility, factors within the tubal lumen, unidentified uterine synechia, and ovarian failure.

Open Access Original Research Article

Modeling the Effect of Public Awareness in Local Dialects in the Spread of Corona Virus in Nigeria

S. C. Nwasuka, O. A. Ignatius, K. T. Nwala, J. C. Ogbonna, G. U. Nwamuruamu

International Journal of TROPICAL DISEASE & Health, Page 46-54
DOI: 10.9734/ijtdh/2021/v42i330444

To study Corona virus, a non-linear deterministic mathematical model is formulated and analyzed to study a measure which will be efficient and sufficient to control corona virus combining the already existing control measures. In this model, all individuals are susceptible having the tendency of being infected if control measures are not implemented. The disease-free equilibrium point, feasible region of the model’s solutions was carried out and proves the systems uniqueness and existence.  Numerical solutions of this model indicate that the combination of already existing control measures of corona virus and public awareness in local dialects) is an efficient method to control the spread of corona virus.