Primary cutaneous tuberculosis in a 27‐year‐old medical intern from needle‐stick injury: a case report

The authors report a case of cutaneous tuberculosis in a 27‐year‐old African male medical intern who contracted primary cutaneous from a needle‐stick injury. Cultures of pus aspirated from the finger initially grew Staphylococcus aureus that led to a delay in the diagnosis.     

肯尼亚内罗毕地区HIV携带者和艾滋病患者饮用中药Restore Plus颗粒冲剂提高免疫功能降低病毒载量的初步研究

目的:评价肯尼亚内罗毕地区HIV携带者和艾滋病(AIDS)患者饮用Restore Plus颗粒冲剂22个月后受试者免疫功能的改善情况。方法:将29～49岁的受试者71人随机分为2组:安慰剂组(n=30)和Restore Plus颗粒冲剂组(n=41)。其中61人(80%以上)为低收入、低教育背景的单身、已婚或离异女性。结果:与安慰剂组相比,服用Restore Plus的患者在服用期间和后续时间内,食欲、体重、身体机能、低体温方面均有所改善,特别是HIV和AIDS体征性状改善更佳,主要表现在:患者中有腹泻症状者的比例从10.5%降至0%;上呼吸道感染者从10.5%降至0%;头疼患者从15.8%降至4.0%;皮疹者从21.1%降至4.2%;感觉乏力者从15.8%降至0%。85.7%的患者在服用第12个月可见改善。而且,服用Restore Plus患者的CD 3+和CD 4+淋巴细胞计数增高,HIV病毒载量明显降低,甚至低于检测限。对服用者的肝功能检测表明其与对照组之间较为一致,未显示对肝脏的不良反应。结论:服用Restore Plus的患者没有出现毒性作用,用其对抗HIV感染和AIDS,患者免疫功能恢复,病毒载量...     

Aflatoxin B1 and M1 contamination of animal feeds and milk from urban centers in Kenya

Background

Aflatoxin M1 (AFM1) is the principal hydroxylated AFB1 metabolite present in milk of cows fed with a diet contaminated with AFB1and excreted within 12 hours of administration of contaminated feeds.

Objective

This study was initiated to assess the knowledge and practices of urban dairy farmers and feed millers about aflatoxin in feeds and milk, determine the prevalence and quantify the levels of AFB1 and AFM1 in animal feeds and milk respectively from urban environs in Kenya.

Methods

This work was carried out in the Department of Public Health Pharmacology and Toxicology, University of Nairobi, Kenya, between February 2006 and March 2007.

Results

A total of 830 animal feed and 613 milk samples from four urban centers were analyzed for aflatoxin B1 and M1 respectively using competitive enzyme immunoassay. Eighty six percent (353/412) of the feed samples from farmers were positive for aflatoxin B1 and 67% (235/353) of these exceeded the FAO/WHO level of 5µ gKg-1. Eighty one percent (197/243) of the feed samples from feed millers and 87% (153/175) from agrochemical shops were positive, while 58% (115/197) and 66% (92/153) of the positive samples exceeded the FAO/WHO limits respectively.Seventy two percent (315/439) of the milk from dairy farmers, 84% (71/85) from large and medium scale farmers and 99% (88/89) of the pasteurized marketed milk were positive for aflatoxin M1, and 20%, 35% an 31% of positive milk from dairy farmers, medium and large scale farmers and market outlets respectively, exceeded the WHO/FAO levels of 0.05µ g/Kg-1. Sixty seven percent of the urban smallholder dairy farmers had no knowledge that milk could be contaminated with aflatoxin M1 and neither knew how they could mitigate against this exposure. Feed millers knew about aflatoxin B1 in grains and excretion of aflatoxin M1 in milk, but were not alleviating exposure to animals.

Conclusion

There is need to create awareness and establish routine monitoring of animal feeds and milk to reduce animal and consequently human response.     

Extra-uterine myoid tumours in patients with acquired immunodeficiency syndrome: a clinicopathological reappraisal

Ramdial P K, Sing Y, Deonarain J, Vaubell J I, Naicker S, Sydney C, Hadley L G P, Singh B, Kiratu E, Gundry B & Sewram V
(2011) Histopathology  59 , 1122–1134
Extra‐uterine myoid tumours in patients with acquired immunodeficiency syndrome: a clinicopathological reappraisal Aims: AIDS‐associated myoid tumours (AIDS‐MTs), often Epstein–Barr virus (EBV)‐associated (EBV‐positive MTs), include smooth muscle tumors (SMTs) and the relatively recently recognized myopericytomas (MPCTs). The myoid immunophenotype of AIDS‐MTs has been documented inconsistently. The aim of this study was to reappraise the phenotypic and immunophenotypic features of extra‐uterine AIDS‐MTs and the clinical profile of afflicted patients. Methods and results: EBV early RNA in‐situ hybridization testing on 27 AIDS‐MTs from 25 patients identified 19 of 27 (70.4%) EBV‐positive MTs and eight of 27 (29.6%) EBV‐negative MTs. EBV‐positive MTs comprised 12 of 19 EBV‐positive SMTs [six leiomyomas, one smooth muscle tumour of uncertain malignant potential (STUMP), five leiomyosarcomas] and seven of 19 EBV‐positive MPCTs [benign (five), malignant (two)]. The EBV‐negative MTs, made up exclusively of EBV‐negative SMTs, included angioleiomyoma (one), leiomyoma (one), STUMP (one) and leiomyosarcomas (five). Malignant AIDS‐MTs demonstrated hypercellularity, pleomorphism, increased mitoses and necrosis. EBV‐positive leiomyosarcomas retained a conspicuous fascicular architecture. Four of five EBV‐negative leiomyosarcomas demonstrated marked pleomorphism. All EBV‐positive MPCTs and two EBV‐positive leiomyosarcomas contained aggregates of desmin‐negative round and oval cells. Seventeen of 25 patients died, mainly from comorbid diseases. Conclusion: While the reappraised spectrum of AIDS‐MTs does not demonstrate divergent subtype‐determined clinical behaviour, heightened awareness/recognition of this expanded spectrum will not only promote improved diagnosis of pleomorphic and myopericytic variants, which may be the sentinel clue to AIDS and its comorbidity, but will also facilitate distinction from histopathological mimics in specific anatomic locations.     

Prevalence and diversity of cystic echinococcosis in livestock in Maasailand, Kenya

Cystic echinococcosis (CE) is a zoonotic disease caused by several members of the Echinococcus granulosus species complex. In East Africa, several species/strains are known to occur in livestock and humans, but host preferences, relative frequencies and spatial distribution of these taxa are poorly known. Here, we contribute livestock data for Maasailand of southern Kenya. Total CE prevalence was 25.8?% in cattle (151/587), 16.5?% in sheep (71/430) and 10.8?% in goats (21/194), which is a significant increase compared to surveys done about three decades ago. The majority of cysts occurred in the liver (56?% in cattle, 70?% in sheep and 65?% in goats). Molecular characterization by PCR?CRFLP and sequencing of parts of the mitochondrial nad-1 gene was done for a subsample of 285 cysts. E. granulosus G1 was dominant in all host species (200 of 201 cysts from cattle, 68 of 69 from sheep and 11 of 15 from goats); the remaining taxa were Echinococcus canadensis G6 (one cyst from sheep, four from goats) and Echinococcus ortleppi (one cyst from cattle). Considering cyst fertility, sheep appear to be the most important hosts for E. granulosus G1, while goats were found to be suitable hosts for E. canadensis G6 (three of four cysts were fertile). For the first time, E. ortleppi was found in cattle from southern Kenya. Our data show an intense and possibly increasing level of CE transmission in southern Kenya, and the predominance of E. granulosus G1, which appears to be particularly pathogenic to humans, calls for urgent control measures.     

The influence and benefits of controlling for inflammation on plasma ferritin and hemoglobin responses following a multi-micronutrient supplement in apparently healthy, HIV+ Kenyan adults

Hemoglobin and ferritin are important biomarkers of iron status but are both altered by inflammation. We used the inflammation biomarkers C-reactive protein (CRP) and alpha1-acid glycoprotein (AGP) to adjust hemoglobin and ferritin concentrations to clarify interpretation of iron status. Apparently healthy adults who tested positive twice for HIV but who had not reached stage IV or clinical AIDS were randomly allocated to receive a food supplement (n = 17 and 21) or the food plus a micronutrient capsule (MN; 10 men and 34 women, respectively) containing 30 mg iron/d. Hemoglobin, ferritin, CRP, and AGP concentrations were measured at baseline and 3 mo and subjects were divided into 4 groups (reference, no inflammation; incubating, raised CRP; early convalescence, raised AGP and CRP; and late convalescence, raised AGP). Correction factors (the ratios of the median for the reference group over each inflammatory group) improved the consistency of the ferritin but not the hemoglobin results. After correction, ferritin (but not hemoglobin) increased in both men (48 microg/L; P = 0.02) and women (12 microg/L; P = 0.04) who received MN but not in the food-only group. However, hemoglobin did improve in subjects who showed no inflammation both at baseline and mo 3 (P = 0.019), but ferritin did not increase in this group. In conclusion, ferritin concentrations were more closely linked to current inflammation than hemoglobin; hence, correction by inflammation biomarkers improved data consistency. However, low hemoglobin concentrations were the consequence of long-term chronic inflammation and improvements in response to MN supplements were only detected in subjects with no inflammation.     

A Behavior-Based Intervention That Prevents Sexual Assault: the Results of a Matched-Pairs,Cluster-Randomized Study in Nairobi,Kenya

Design

The study’s design was a cluster-randomized, matched-pairs, parallel trial of a behavior-based sexual assault prevention intervention in the informal settlements.

Methods

The participants were primary school girls aged 10–16. Classroom-based interventions for girls and boys were delivered by instructors from the same settlements, at the same time, over six 2-h sessions. The girls’ program had components of empowerment, gender relations, and self-defense. The boys’ program promotes healthy gender norms. The control arm of the study received a health and hygiene curriculum. The primary outcome was the rate of sexual assault in the prior 12 months at the cluster level (school level). Secondary outcomes included the generalized self-efficacy scale, the distribution of number of times victims were sexually assaulted in the prior period, skills used, disclosure rates, and distribution of perpetrators. Difference-in-differences estimates are reported with bootstrapped confidence intervals.

Results

Fourteen schools with 3147 girls from the intervention group and 14 schools with 2539 girls from the control group were included in the analysis. We estimate a 3.7 % decrease, p?=?0.03 and 95 % CI?=?(0.4, 8.0), in risk of sexual assault in the intervention group due to the intervention (initially 7.3 % at baseline). We estimate an increase in mean generalized self-efficacy score of 0.19 (baseline average 3.1, on a 1–4 scale), p?=?0.0004 and 95 % CI?=?(0.08, 0.39).

Interpretation

This innovative intervention that combined parallel training for young adolescent girls and boys in school settings showed significant reduction in the rate of sexual assault among girls in this population.

     

Cryptosporidiosis: prevalence, genotype analysis, and symptoms associated with infections in children in Kenya

Cryptosporidium parasites are leading causes of enteric disease, especially in children. A prospective survey on the prevalence of cryptosporidiosis in children less than five years of age was undertaken at six microbiology laboratories in Kenya on fecal samples submitted for routine parasite and ova investigations. Analysis of 4,899 samples over a two-year study period showed an overall prevalence of cryptosporidiosis of 4% that was highest between November to February. Investigations on the nature of enteric diseases prompting ova and cyst examination requests showed 66.4% had acute diarrhea, 9% had persistent diarrhea, and 21% had recurrent diarrhea. The main symptoms were abdominal pain (51.1%), vomiting (51.6%), and abdominal swelling (11%). The prevalence of cryptosporidiosis was highest among children 13-24 months of age (5.2%) and least among those 48-60 months of age (2%). No significant differences were observed by sex but vomiting was slightly higher in males than in females (65% males and 52% females; P = 0.07). Cryptosporidiosis was significantly associated with persistent diarrhea (P = 0.0001, odds ratio [OR] = 2.193, 95% confidence interval [CI] = 1.463-3.29), vomiting (P = 0.0273, OR = 1.401, 95% CI = 1.04-1.893), and abdominal swelling (P = 0.0311, OR = 1.56, 95% CI = 1.04-2.34). Genotype analysis based on polymerase chain reaction-restriction fragment length polymorphism of the 18S rRNA gene fragment showed that 87% (153 of 175) of the Cryptosporidium isolates were C. hominis, 9% (15 of 175) were C. parvum, and remaining 4% were C. canis, C. felis, C. meleagridis, and C. muris. The most common protozoa in coinfected patients were Entamoeba histolytica/E. dispar, E. coli, and Giardia intestinalis (6%, 5%, and 2%, respectively). Our results show that Cryptosporidium is among the most common protozoan parasites in children with enteric diseases and that anthroponotic species are the leading cause of human cryptosporidiosis in Kenya, which suggests that human-to-human transmission is the main mode of spread.