November Issue 2010

Rastiundiagnosed HIV cases in accident and emergency unit of a Tertiary Health institution in south east Nigeria

Fri, 19 Nov 2010 11:10:37 GMT

Ogbuagu C.N, Emejulu J.K.C, Ofiaeli R.O, Ogbuagu E.N, Onyenekwe O.N, Oguoma VM

Abstract

Objective: This study aimed at investigating the cases of Undiagnosed Human Immunodeficiency Virus (HIV) amongst patients attending the Accident and Emergency (A&E) Unit of Nnamdi Azikiwe University Teaching Hospital (NAUTH) to determine the prevalence and individual awareness of their sero-status.
Method:Human Immunodeficiency Virus (HIV) 1 and 2 screening was conducted on randomly selected conscious patients (mostly trauma) presenting to the Accident & Emmergency (A&E) unit of Nnamdi Azikiwe University Teaching Hospital (NAUTH) using the STAT PAK™ (Chembio Diagnostic Systems Inc, USA) and Determine™ (Abbott Laboratories, IL, USA) kits for HIV 1 and 2, for a 6 month period, August 2008 - February 2009. Referrals were sent to the Virology Unit of the Health Institution for a further confirmation of the HIV 1 and 2 positive cases. Data accruing from the study was computed using SPSS Version 11.0. GraphPad StatMate™ 2.0 was used to calculate the Chi-square test using cross tabulations generated from SPSS.
Results: Out of a total number 1497patients that presented in Accident and Emergency during the 6 month study period, 102 patients were randomly recruited for the study. Those positive for HIV were 24 (23.5%) while 78 (76.5%) were confirmed negative. The result shows that 17 (16.7%) males were positive for HIV which is higher than females 7 (6.9%). The age group 30 – 39 years had the highest number of positive cases of HIV 8 (7.8%) followed by 40 – 49 years 7 (6.9%); 20 – 29 years 5 (4.9%); 50 – 59 years 4 (3.9%); and finally with 60> years having no identified HIV positive case.
Conclusion: Undiagnosed HIV infections constitute a significant proportion of Accident & Emergency Cases in our institution and thus a very important public health issue in Nigeria. The result of this finding has shown that a sizeable number of patients presenting in Accident & Emergency are HIV sero-positive and yet unaware of their status.

Secretory IgA as a marker of invasive amoebiasis

Fri, 19 Nov 2010 11:09:22 GMT

Abstract

Amoebiasis is a common intestinal protozoan infection due to Entamoeba histolytica with an annual mortality between 50,000- 110,000 due to the various complications associated with the invasive disease. In India, the prevalence of the disease varies from 2-67%. Recently, asymptomatic carriage has been shown to be due to a non-invasive species E.dispar which is morphologically indistinguishable from the invasive E.histolytica. The only serological test available to detect the two parasites is a monoclonal based enzyme linked immune sorbent assay (ELISA) to detect specific lectin. Serological tests are available to detect antibodies but these do not really help in the diagnosis in endemic areas. Detection of salivary antibodies has been tried in some parasitic infections and may be good test as it also avoids any invasive procedure or collection of blood. In the present study, levels of specific IgA antibodies to E.histolytica have been measured in the saliva as well as serum with a view to analyze the role in diagnosis of invasive disease. The highest levels of specific secretory anti-amoebic IgA levels were observed in patients with intestinal amoebiasis (Group B) and ALA cases (Group A). There was no significant difference between the two groups but, there was a significant difference between the specific secretory IgA levels seen in these two groups when compared to the patients with other parasitic infections (Group C), or healthy controls (Group D). Specific anti-amoebic serum IgA levels showed a similar trend, except that ALA patients showed the highest levels which were even significantly different from the intestinal amoebiasis group. This indicates that presence of high titers of specific IgA levels in saliva may have a role in the seroepidemiological surveys to detect the persons who have had past invasive infection. In addition, there is the possibility that the detection of this specific antibody may have a role in the diagnosis of clinically suspected invasive disease.

Effect of a Mycoplasma hyopneumoniae-commercial vaccine on concurrent lung infections in pigs in the field

Fri, 19 Nov 2010 11:07:33 GMT

Tzivara A, Burriel A.R, Kritas S.K, Filioussis G, Kyriakis S.K

Abstract

The efficacy of an inactivated aqueous vaccine against Mycoplasma hyopneumoniae was evaluated in two M. hyopneumoniae-infected farrow-to-finish commercial farms in Greece. In a prospective, randomized double-blind study, two groups on each farm received either two intramuscular doses of vaccine or two doses of adjuvant alone injected at 1 and 4 weeks of age. From each farm, 50 pigs, 25 originating from unvaccinated (placebo) group and 25 from vaccinated group, showing enzootic pneumonia lesions were sampled. Lung samples for microbiology and blood for serology were collected. The average score of lung lesions associated with enzootic pneumonia was significantly lower in vaccinated piglets compared to unvaccinated ones (p<0.05). Streptococcus spp and Pasteurella multocida have been isolated from the lungs of significantly fewer vaccinated compared to non-vaccinated piglets (p<0.05), while such was not observed for M. hyopneumoniae, Haemophilus spp, Bordetella spp and Staphylococcus spp. Significantly fewer vaccinated piglets were serologically positive for type Η3Ν2 influenza virus compared to non-vaccinated pigs (p<0.05). In conclusion, our results suggest that vaccination against M. hyopneumoniae may reduce concurrent bacterial and viral spread among pigs.

Enterobacteria in drinking water: a public health hazard

Fri, 19 Nov 2010 11:06:05 GMT

Mukhtar M. Dauda

Abstract

Drinking water is being incriminated as one of the major vehicles for disseminating infectious and antibiotic-resistant members of the family – Enterobacteriaceae. This was variously reported by results of epidemiological study in many parts of developing countries. Typhoid, paratyphoid fevers, diarrhea, dysentery, cholera, meningitis and gasteroenteristis particularly between 1985 and 1995 were prevalent. Few similars were seen in2001, 2003 and even 2009. Increasing morbidity and mortality cases due to these diseases generated high suspicions upon public water systems and irrigated vegetable items as vehicles for transmission of the organisms. This is an addition to the problem of antimicrobial resistance being increasingly displayed by the bacterial groups. However the contribution of β-lactamase inhibiting antimicobials as well as developing of new drugs from plant sources may help to alleviate the menace.

Evaluation of the efficacy of directly observed treatment short course (DOTS) in patients with tuberculosis and HIV Co-infection in Kano, Nigeria

Fri, 19 Nov 2010 11:04:32 GMT

Mukhtar M. Dauda (Ph.D)

Abstract

Background: A prospective study to assess the outcome of the directly observed treatment short course (DOTS) in tuberculosis patients with HIV co – infection was conducted in Kano, Nigeria between 2005 and 2006.
Methods:The study group included one thousand six hundred and ninety two Tuberculosis patients (1066 men and 626 women) aged 15years and above. The recruitment protocol involved patients clinically diagnosed by X – ray and Mantoux test but with no previous tuberculosis treatment whose initial sputum demonstrated acid fast bacilli (AFB) on at least two occasions as confirmed by Ziehl Neelsen techniques and microscopical procedures. HIV serostatus was confirmed using HIV-1/HIV-2 ELISA Capillus, Geni-II HIV1/HIV2 kit and Determine HIV1/2 protocols. Standardized treatment regimen containing isoniazid, rifampicin, pyrazinamide and ethambutol were administered to the in patients for two months as intensive phase under the researchers direct clinical observation and monitoring. Treatment and follow up continued to the eighth month while the outcome of cure, were assessed using standard protocols.
Results:A total of six hundred and fifty (38.4%) sputum smear acid fast bacilli (AFB) positive patients(391 male and 259 female) were found to be sero positive for HIV. Treatment success rates after completion of dose regimen was 40% (261), of which 91% were sputum negative for AFB after the first treatment phase of two months. This increased to 94% and 97% by the 5th and 8th month respectively.
Conclusion: An incidence of 38.4% of HIV/TB co-infection was reported at the Kano State Government officially designated Infectious Disease Hospital (IDH) Kano (2005 – 2006). However, chemotherapy by DOTS was able to cure only 40% of patients, indicating efficacy much lower than the 85% targeted by the World Health Organization(WHO). Thus, new regimens and administration protocols are needed.