Emerging Leishmania/HIV co-infection in Africa

The HIV/AIDS pandemic is spreading at an alarmingly high rate in Africa. Leishmaniasis is also highly prevalent in the continent. Despite the emergence of Leishmania/HIV co-infection in Africa, the numbers reported are disproportionately low. Moreover, the number of cases of co-infection is expected to rise in Africa owing to the simultaneous spread of the two infectious diseases and their increasingly overlapping geographical distribution.     

Variations in helminth faecal egg counts in Kato-Katz thick smears and their implications in assessing infection status with Schistosoma mansoni

Examination of stool specimens by Kato-Katz (K-K) thick smears is the standard method recommended by the WHO for field diagnosis of intestinal schistosomiasis. However, there is increasing concern that this technique has low diagnostic sensitivity. In 326 study subjects, we compared the diagnostic yield of examining one, three or five Kato-Katz thick smears prepared from one stool specimen using 41.7 mg templates. In a subset of 169 subjects who had no demonstrable Schistosoma mansoni eggs in their first three Kato-Katz thick smears, we assessed the comparative advantage of examining an additional three Kato-Katz thick smears from another stool specimen, taken four weeks later, to that of cumulative yield obtained by examining all five Kato-Katz thick smears derived from the first stool specimen. For all helminth infections, single Kato-Katz thick smear-based prevalence estimates were significantly lower than those obtained from triplet or quintet Kato-Katz thick smears. Prevalence of S. mansoni infection based on single, triplet and quintet Kato-Katz thick smears from one stool specimen were 31.3%, 45.7% and 52.1%, respectively. Prevalence estimate of S. mansoni based on quintet Kato-Katz thick smears from the first day stool specimens was not different from cumulative estimate obtained with two triplet Kato-Katz thick smears from two stool specimens, 52.1% and 52.8%, respectively. In conclusion, either examination of quintet Kato-Katz thick smears from one stool specimen using 41.7 mg template or initial triplet Kato-Katz thick smears from one stool specimen, and if these are negative, followed by examination of additional triplet Kato-Katz thick smears from subsequent day stool specimen can adequately assess individuals for infection status with S. mansoni.     

Intestinal parasitic infections in relation to HIV/AIDS status, diarrhea and CD4 T-cell count

Background  

HIV infection has been modifying both the epidemiology and outcome of parasitic infections. Hence, this study was undertaken to determine the prevalence of intestinal parasitic infection among people with and without HIV infection and its association with diarrhea and CD4 T-cell count.     

An evaluation of the diagnostic value of clinical and radiological manifestations in patients attending the addis ababa tuberculosis centre.

Our investigation is based on 1,000 consecutive patients attending the routine outpatient services of the Addis Ababa Tuberculosis Demonstration and Training Centre (ATBDTC) in Addis Ababa during the period November 1996-March 1997. By using sputum microscopy for acid-fast bacilli (AFB), chest radiography (CXR) and clinical assessment these patients had been diagnosed as having either AFB-positive pulmonary tuberculosis (PTB) (n = 139), AFB-negative PTB (n = 61) or non-tuberculosis (non-TB) (n = 800). These three diagnostic groups were subsequently re-assessed by us with regard to selected demographic and clinical parameters, including CXR, in order to identify and weight markers significantly linked to proven PTB. The sum of the individual weights provided diagnostic scores (DS); the average DS for AFB-positive patients was 653.5 +/- 174 and that for non-TB patients was 219.1 +/- 138.7. The calculated cut-off value between these two groups was 444. Ten (7.2%) AFB-positive PTB patents had a DS below the calculated cut-off, while 46 (5.8%) of the 800 non-TB cases had diagnostic scores exceeding this value. Our DS system achieved 92.8% sensitivity and 94.3% specificity, with positive and negative predictive values of 73.7% and 98.7%, respectively. When plotting the individual DS values of the 61 AFB-negative TB patients, 24 (39.3%) fell below the cut-off. It is most likely that these patients did not have PTB. We conclude that there is a need for improved and standardized diagnostic approaches for TB-suspected patients who depend upon clinical and CXR criteria for correct diagnosis. Our score system may be helpful in this context.     

The Relationship between Disease Pattern and Disease Burden by Chest Radiography, <Emphasis Type="Italic">M. tuberculosis</Emphasis> Load,and HIV Status in Patients with Pulmonary Tuberculosis in Addis Ababa

Abstract Background: We evaluated the impact of HIV coinfection on the chest radiographic pattern and extent of disease and its relation to the load of Mycobacterium tuberculosis in Ethiopian out-patients with pulmonary tuberculosis. Patients and Methods: A total of 168 patients with cultureverified pulmonary tuberculosis had their chest X-rays (CXR) reviewed for the site, pattern, and extent of disease and the findings were correlated to (a) the mycobacterial culture count and bacillus load after sputum concentration and (b) the HIV status of the patients. Results: HIV-positive patients were less likely to have cavitary disease (p < 0.001) and more likely to have pleural effusion (p = 0.08), miliary (p < 0.05), and interstitial (p < 0.01) patterns. A total of 15 (9.2%) patients had normal chest X-rays. HIV-infected patients had a CXR classified as normal or with minimal involvement (p = 0.059) and a reduced mycobacterial colony count (p = 0.002) compared to HIV-negative patients. Middle and lower lung involvement were more common in HIV-positive patients. Conclusion: CXR findings in the setting of an underlying HIV infection tend to be more atypical and could present as either normal or with minimal involvement. In general, HIV-positive patients had lower colony count of M. tuberculosis than HIV-negative patients. Of particular interest is the finding of a large number of normal chest X-rays in HIV-infected patients. With the rising incidence of both tuberculosis and HIV infection in Ethiopia, the finding of a normal chest X-ray and a negative smear poses a challenge for the diagnosis of pulmonary tuberculosis.     

Cerebral malaria. Factors affecting outcome of treatment in a suboptimal clinical setting

Over a period of 6 months, 109 patients were admitted to the medical wards of the Gondar College Hospital with malaria. Out of these, 26 patients (24.8%) had cerebral malaria as defined by the WHO Malaria Action Programme 1986. Fifteen of the 26 patients (57.7%) died. Longer duration of unconsciousness before coming to the hospital, hyperparasitaemia, oliguria, recurrent hypoglycaemia and convulsions were found to be significantly associated with mortality.     

Evaluation of colonic anastomoses performed in the last twenty-five years

AIMS: The authors scrutinize the results of elective large-bowel operations, comparing the healing of handsewn and stapled anastomoses. A brief history of large-bowel surgery is also presented. METHODS: Altogether 710 elective colonic anastomoses were made between 01. January 1979. and 31. December 2004. are evaluated. The complications and mortality rate after these operations are also mentioned. The 710 large-bowel anastomoses were performed under standard personal and material conditions 2/3 of them handsewn, while 1/3 by the stapled method. RESULTS: According to the operation results no significant differences in morbidity and mortality were found between the two technics. CONCLUSION: Stapled anastomoses are more expensive, but in case of recto-sigmoid tumours, particularly in low rectum resections, the instruments are indispensable.