Disseminated cutaneous leishmaniasis resembling post-kala-azar dermal leishmaniasis caused by Leishmania donovani in three patients co-infected with visceral leishmaniasis and human immunodeficiency virus/acquired immunodeficiency syndrome in Ethiopia

We report paired strains of Leishmania parasites, one from the viscera and the other from skin lesions that were isolated from three patients with visceral leishmaniasis and disseminated cutaneous leishmaniasis that were co-infected with human immunodeficiency virus. The causative parasites were characterized by polymerase chain reaction-restriction length polymorphism of the ribosomal DNA internal transcribed spacer 1 and by a panel of multilocus microsatellite markers. We demonstrated that the causative agent was Leishmania donovani in all cases, irrespective of the phenotype of the disease. The paired strains from viscera and skin lesions of the same patients showed genetic identity across the 14 microsatellite markers investigated. These findings demonstrate that the skin lesions in these human immunodeficiency virus-positive patients with visceral leishmaniasis were caused by dissemination of viscerotropic L. donovani parasites as a consequence of severe immunosuppression. However, in all three patients, rapid clearance of the skin lesions was observed after antimonial therapy.     

Kawasaki syndrome and risk factors for coronary artery abnormalities: United States, 1994-2003

BACKGROUND: Kawasaki syndrome (KS) causes significant morbidity among children in the United States and other countries and can result in a range of cardiac and noncardiac complications. METHODS: To describe the occurrence of KS in the United States and risk factors for the development of coronary artery abnormalities (CAA), national KS surveillance data were analyzed for patients with KS onset during 1994-2003. The surveillance is a passive system, and information is collected on a standardized case report form. RESULTS: During 1994 through 2003, 3115 patients who met the KS case definition were reported to the national KS surveillance system. The median age of KS patients was 32 months; the male-female ratio was 1.5:1. Nearly one-third (31.8%) of the cumulative number of KS cases occurred during January through March. During the study period, 362 (12.9%) of 2798 KS patients had CAA. The proportion of patients with CAA increased from 10.0% in 1994 to 17.8% in 2003. Age younger than 1 year and 9-17 years, male sex, Asian and Pacific Islander race and Hispanic ethnicity (a previously unidentified risk factor) were significantly associated with the development of CAA. CONCLUSIONS: The increase in CAA was attributed to widespread use of the criteria of de Zorzi et al, resulting in increased recognition of coronary artery dilatations. The factors contributing to a higher risk of CAA, such as delayed treatment, particularly among Hispanics, need to be investigated.     

Levels and Trophic Transfer of Selected Pesticides in the Lake Ziway Ecosystem

The levels of 30 selected pesticides and trophic biomagnification of DDT were investigated in biota samples of the Lake Ziway in the Rift valley region, Ethiopia. Carbon source and trophic position were calculated by using ¹³C and ¹⁵N stable isotopes, individually, and trophic magnification factors (TMFs) were inferred. Only DDT and its metabolites were quantified in all samples analyzed. The most prominent metabolite was p,p?-DDE with mean concentration ranging from the 0.82–33.69 ng g^?1 lipid weight. Moreover, the ratio of DDT/DDD?+?DDE in all the biota samples was less than 1 signifying historical DDT application. Regression of log [ΣDDT] vs TL (trophic level) among all biota species showed a significant correlation, indicating that DDTs are biomagnifying along with the food web of Lake Ziway with an estimated TMF of 2.75. The concentrations of DDTs and other organochlorine pesticides found in biota from Lake Ziway were, in general, lower than studies found in previous studies carried out in the same lake.

     

Antipyretic and analgesic studies of the ethanalic extract of Teclea nobilis delile

The crude ethanol extract of the leaves of an African medicinal plant Teclea nobilis has been studied for its antipyretic, analgesic and anti-inflammatory activities. The extract exhibited marked antipyretic and analgesic activities while it was found to be weakly active against carrageenin oedema.     

HIV and intestinal parasites in adult TB patients in a teaching hospital in Northwest Ethiopia

The level of HIV infection and intestinal parasitoses among TB patients was assessed in a hospital-based cross-sectional study involving 257 patients in Gondar, Ethiopia. In TB patients, our study reported co-infection with HIV (52.1%) and intestinal parasites (40.9%) The high prevalence of HIV and intestinal parasites indicates an increased morbidity inTB patients and emphasized the importance of continued HIV sero-surveillance, stool analysis and treatment.     

Variant Creutzfeldt-Jakob disease death, United States

The only variant Creutzfeldt-Jakob disease (vCJD) patient identified in the United States died in 2004, and the diagnosis was confirmed by analysis of autopsy tissue. The patient likely acquired the disease while growing up in Great Britain before immigrating to the United States in 1992. Additional vCJD patients continue to be identified outside the United Kingdom, including 2 more patients in Ireland, and 1 patient each in Japan, Portugal, Saudi Arabia, Spain, and the Netherlands. The reports of bloodborne transmission of vCJD in 2 patients, 1 of whom was heterozygous for methionine and valine at polymorphic codon 129, add to the uncertainty about the future of the vCJD outbreak.     

Kawasaki syndrome hospitalizations and associated costs in the United States

OBJECTIVES: To describe the epidemiologic characteristics of patients hospitalized with Kawasaki syndrome (KS) and estimate associated costs in the United States, using a large national hospital discharge dataset. METHODS: Hospitalization discharge records with KS for 1997 through 1999 for U.S. residents <18 years of age were selected from Solucient's hospital discharge records. These records are collected from most of the self-governing children's hospitals and approximately one-third of short-term, non-federal general hospitals in the United States. RESULTS: A total of 7,431 hospital discharges with a KS diagnosis were identified; 2,270 of the discharges were in 1997, 2,700 in 1998, and 2,461 in 1999. Boys comprised 60.0% of the discharges, and 76.4% of discharges were among children ages <5 years. For the 44 states and the District of Columbia with at least one hospital reporting KS, the average annual KS hospitalization rate was 10.2 per 100,000 children ages <5 years. The KS hospitalization rate for boys (12.0 per 100,000) was higher than that for girls (8.3 per 100,000) (risk ratio 1.45; 95% confidence interval 1.37, 1.52). Extrapolation to the U.S. population showed an estimated average annual KS hospitalization rate of 21.6. The median KS hospitalization cost for children <5 years of age during the study period was $6,169 US dollars. CONCLUSIONS: The KS hospitalization rate was consistent with that of previous U.S. studies, although the extrapolated rate may be an overestimation. The median hospitalization cost for KS was higher than that for respiratory syncytial virus-associated bronchiolitis and diarrheal diseases. Large hospitalization datasets can be used to monitor the occurrence of KS in the United States.