Genital tuberculosis presenting as pyrexia of undetermined origin

A case of Genital tuberculosis in a female patient is presented. The key presenting features in this lady were chronic weight loss, colicky lower abdominal pains, fever, and amenorrhea.     

Efficacy of Praziquantel Treatment and Schistosoma Mansoni Infection among Primary School Children in Kemisse Town,Northeast Ethiopia

BackgroundSchistosoma mansoni infection is endemic in Ethiopia. The epidemiology of S. mansoni and the efficacy of praziquantel among schoolchildren have not been well documented in different parts of the country including our study area. Therefore, this study aimed to determine the status of S. mansoni infection and evaluate the therapeutic efficacy of praziquantel among school children in northeast Ethiopia.MethodsA comparative cross-sectional study was conducted among 499 children of two preschool children. Stool specimens were collected and microscopically examined using Kato-Katz (41.7 gram) methods. Positive children were treated with a single oral dose of praziquantel at 40 mg/kg body weight. Egg reduction and cure rates were assessed 4 weeks post-treatment to evaluate the therapeutic efficacy of praziquantel against S. mansoni infection.ResultsThe overall prevalence of S. mansoni infection among the schoolchildren was 52.1% with a mean intensity of 546 eggs per gram of stool. Majorities of the S. mansoni infections were moderate to heavy intensity, with only 5.0% light infections. Praziquantel administered at a single oral dose of 40 mg/kg achieved a cure rate of 91.7% and reduced the egg rate by 86.8%. Twenty-one schoolchildren remained infected at 4 weeks post-treatment, among which 6 and 15 children had moderate and light infections, respectively.ConclusionsS. mansoni prevalence among primary school children in Northeast Ethiopia was high, highlighting the need to implement school-based chemotherapy with annual frequency. The efficacy of praziquantel at 40 mg/kg is sufficient to permit continued use in treating S. mansoni-infected schoolchildren.     

Relationship between left ventricular diastolic function and geometric patterns in Nigerians with newly diagnosed systemic hypertension

Background

It is not known whether abnormalities of left ventricular diastolic function are influenced by the various cardiac geometric patterns in Nigerians with newly diagnosed systemic hypertension.

Objective

To evaluate the relationship between the parameters of left ventricular diastolic function and the geometric patterns in this group of patients.

Methods

Two-dimensional, guided M-mode echocardiography including Doppler was performed in 150 consecutive, newly diagnosed hypertensive individuals and normotensive controls aged between 35 and 74 years. Left ventricular mass index and relative wall thickness were used to classify the hypertensive individuals into four geometric patterns, and the pulsed-wave Doppler parameters obtained were used to categorise the abnormalities of diastolic function.

Results

Four left ventricular geometric patterns were identified: 23 (15.3%) had normal left ventricle geometry, 33 (22%) had concentric remodelling, 37 (24.7%) were found to have eccentric hypertrophy, and concentric hypertrophy occurred in 57 (38%) of the hypertensive individuals. Left ventricular diastolic dysfunction occurred more in hypertensives with concentric left ventricular geometric pattern. Increased left ventricular mass index and relative wall thickness were found to be associated with the mitral E-wave, E/A ratio and pulmonary venous flow S-wave in the hypertensives (p < 0.001).

Conclusion

In newly diagnosed Nigerian hypertensives, the abnormalities in left ventricular diastolic function varied between the different left ventricular geometric patterns, being worst in those with concentric geometry.     

Characterization of field and vaccine infectious bursal disease viruses from Nigeria revealing possible virulence and regional markers in the VP2 minor hydrophilic peaks

Outbreaks of infectious bursal disease in vaccinated chicken flocks are frequent in Nigeria. For the control of infectious bursal disease, live vaccines based on foreign infectious bursal disease virus (IBDV) strains are used. The present study investigated the phylogenetic relationship between field and vaccine IBDV strains from northwestern Nigeria. Thirty field IBDV strains and three commercial vaccines strains were characterized through sequencing the VP2 hypervariable region. In addition, the complete genome segment A coding region for two vaccines and two field strains was sequenced. The deduced amino acid sequences (position 212 to 331) of IBDV strains from Nigeria and other regions of the world were aligned and possible regional and virulence markers were identified associated with VP2 minor hydrophilic peaks. Reversion to virulence of a vaccine strain with a Q to L mutation at position 253 was observed. Phylogenetic analyses revealed a unique cluster of northwest Nigerian field IBDV strains alone or related to imported characterized classical and very virulent IBDV vaccines. The results suggest that when IBDV strains spread from their region of origin to a different region they mutate alongside indigenous field strains but may retain their identity on the VP2 region.     

Surgical pathology of schistosomiasis

Schistosomiasis remains an important health problem in many tropical countries and is being seen with increasing frequency in immigrant populations and tourists in developed countries. The pattern of organ involvement and clinical presentation of schistosomiasis in 80 patients (male: female, 9:1) during a five-year period (2001-2005) was examined from archival histopathology records. The urinary bladder was the most common organ affected [50 (62.5%)]. Gastrointestinal, male and female genital schistosomiasis were detected in 12 (15%), eight (10%) and five (6.1%) cases, respectively. Hematuria was the most common presenting symptom [34 (42.5%)], and bladder cancer was the only malignancy found to be associated with the infection. A high clinical index of suspicion usually allows for a preoperative diagnosis where indicated and avoidance of radical surgery. While research for the development of an effective vaccine continues, a plea is made for the expansion of multinational control programs in sub-Saharan Africa.     

Stopping circulatory vaccine-derived poliovirus in Kaduna state by scaling up special interventions in local government areas along rivers of interest- kamacha basin experience, 2013–2015

Background

The Kamacha river is one of the five polio environmental surveillance sites in Kaduna State where 13 circulating vaccine-derived polioviruses (cVDPDs) were isolated between 2014 and 2015. Kamacha river accounted for 5 of all reported cVDPVs in Kaduna State between 2014 and 2015. Poor quality Supplemental Immunization Activities (SIAs) and low population immunity have been reported in the 10 LGAs with tributaries that flow into the river. We described the processes of implementing the various health interventions in these targeted LGAs along the Kamacha River and assessed the effectiveness of the interventions in stopping cVDPV in Kaduna, state, Nigeria.

Methods

Special interventions that had been proven to be functional and effective in reaching unreached children with potent vaccines in the state were scaled up in these targeted 10 LGAs along the Kamacha River. These interventions included revision of house based microplans, scaling up of transit vaccination, scaling up of youth engagement, intensified supportive supervision, scaling up of Directly Observed Polio Vaccination (DOPV) and in-between rounds vaccination activities. We analyzed immunization plus days (IPDs) administrative tally sheet and monitoring data from 10 rounds before and 10 rounds after the special interventions.

Results

The number of children immunized increased from 1,862,958 in December 2014 before the intervention to 1,922,940 in March 2016 after the intervention.Lot Quality Assurance Sampling (LQAS) results showed an increase in the proportion of LGAs accepted at coverage >?90% after the interventions, from 67% before intervention to 84% after intervention. The proportion of non-polio AFP children with >?4 doses of oral polio vaccine increased from 2 to 8% before to 93–98% after the interventions.. No new environmental cVDPV has been isolated since the introduction of the interventions in April 2015 until July 2016.

Conclusion

Scaling up known working interventions in the 10 LGAs with tributaries that drain to Kamacha River environmental sample site may have contributed to improved immunity and interruption of cVDPV in Kaduna state. These interventions should be replicated in LGAs and states with persistent poliovirus isolation.

     

Targeting the last polio sanctuaries with Directly Observed Oral Polio Vaccination (DOPV) in northern Nigeria, (2014–2016)

Background

The declaration of poliomyelitis eradication as a programmatic emergency for global public health by the 65th World Health Assembly in 2012 necessitated innovations and strategies to achieve results. Review of the confirmed polio cases in 2013 showed that most of the cases were from non-compliant households, where parents connived with vaccinators to finger mark the children without actually vaccinating the children with oral polio vaccine or children were absent from home at the time of the visit of vaccinators.

Methods

We used pre-post design to quantify the outcomes of directly observed vaccination in 90 local government areas from 12 northern Nigeria states at very high risk of polio transmission.The strategy is an intervention, vaccinating children under the direct supervision of an independent supervisor to ensure compliance. Attractive incentives (pluses) were used to make parents willingly submit their children for vaccination or directly attract children to the vaccination teams or post as part of this strategy.

Results

There was a steady increase in population immunity in all the 90 DOPV implementing LGAs since the introduction of DOPV in 2013. The number of states in which >?90% of children received >?4 OPV doses increased from 7 in 2013 to 11 states by July 2016.Yobe state reported the highest proportional increase from 75 to 99% by July 2016 (22% increase), while Kano state reported 17% increase, from 82 to 99% by July 2016.

Conclusion

Directly observed polio vaccination strategy improved uptake of polio vaccines and population immunity in high-risk areas for polio transmission.