ISRN Infectious Diseases

Trichomonas vaginalis Infection among Pregnant Women in Jimma University Specialized Hospital, Southwest Ethiopia

Abdurehman Eshete, Zeleke Mekonnen, and Ahmed Zeynudin — Thu, 14 Mar 2013 15:16:39 +0000

Background. Trichomonas vaginalis is a sexually transmitted parasitic protozoan known to be responsible for an estimated 180 million new infections per year, making it the most prevalent nonviral sexually transmitted pathogen worldwide. Method. A cross-sectional study design was conducted on vaginal swabs by wet mount and Modified Columbia Agar culture technique in Jimma University Specialized Hospital (JUSH), ANC clinic, Jimma, Ethiopia. The study was done to assess the magnitude and associated risk factors of T. vaginalis infection from December to May, 2011/2012. Result. A total of 361 pregnant women were involved in this study. From these, 18 (4.98%) of the pregnant women were positive for T. vaginalis infection by Modified Columbian Agar culture technique. Education status (AOR = 0.186, 95% CI: 0.059–0.585, ), patients with dysuria (AOR = 0.180; 95% CI: 0.046–0.704, ) and dyspareunia (AOR = 0.152; 95% CI: 0.035–0.667, ) were significantly associated with T. vaginalis infection. Conclusion. The prevalence of T. vaginalis infection at 4.89% is relatively high among young reproductive aged women. Because this infection increases the risk of HIV transmission and is associated with adverse pregnancy outcomes, there is a need for increased provision of health information concerning T. vaginalis to the community, educating women, screening, and treatment of T. vaginalis infection in Ethiopia.

The Effect of HIV/AIDS Education on Adolescents in Trinidad and Tobago

Vanessa Jones, Naomi Modeste, Helen Hopp Marshak, and Curtis Fox — Thu, 31 Jan 2013 08:39:56 +0000

Objective. This study was conducted to determine the effectiveness of an HIV/AIDS educational intervention on adolescents’ knowledge about and perceptions of susceptibility and severity of HIV/AIDS. We also examined whether providing information about assertiveness skills led to an intention to delay initiation of sexual activity. Methods. A quasi-experimental design was used to conduct this study among secondary school students in Trinidad and Tobago. The five constructs of the Health Belief Model were used to design and test the impact of the educational lessons for the intervention group while the comparison group watched one educational video about HIV over four sessions. A total of 196 secondary school students (from nine schools) between the ages of 11 and 18 years participated in the study, 92 in the intervention group and 104 in the comparison group. Results. Those in the comparison group had higher knowledge scores at posttest than the intervention group, controlling for pretest knowledge (), but those in the intervention group were more likely to plan to delay sexual initiation (). Conclusions. While knowledge scores increased for both groups, intention to delay sexual intercourse was only seen among the intervention group and within the younger age groups.

Genital Infections of HIV-Infected Women Assisted by a Specialized Service

Caroline Acquaro, Marli Teresinha C. Duarte, and Lenice do Rosário de Souza — Sat, 29 Dec 2012 10:25:50 +0000

The present study aimed at analyzing the persistence/recurrence of genital infections and its associated factors in HIV-infected women. Fifty-eight women treated for chlamydial infection, trichomoniasis, vulvovaginal candidiasis, and/or bacterial vaginosis (BV) and who had specimens collected for cure control up to one year after treatment were studied. Diagnoses were performed by the Gram staining method for cases of BV and candidiasis and by T. vaginalis culture and qualitative PCR for C. trachomatis. Antiretroviral therapy was used by 79.3% of patients, and 62.1% showed an undetectable HIV plasma load. The most frequent infection was BV with persistence/recurrence of 52.4%, which was associated with a longer time period between treatment and cure control (), postmenopausal period (), and having a steady partner (). Persistence/recurrence of vulvovaginal candidiasis was observed in 25%, trichomoniasis in 23.1%, and chlamydial infection in 10.5%. The latter was associated with inadequate treatment of the partner (). There was a tendency to higher persistence/recurrence of BV () and trichomoniasis () among patients with low T CD4+ lymphocyte counts. The majority of women in the present study showed good HIV-infection control and a vulnerable sexual behavior, which stress the importance of maintaining gynecological followup.

Sexual Practices and HIV Prevalence amongst Men Who Have Sex with Men at a Community-Based Voluntary Counseling and Testing Centre in Malaysia

K. C. Koh, K. Kanagalingam, F. T. Tai, and A. Kamarulzaman — Mon, 24 Dec 2012 14:21:45 +0000

We describe the sexual practices and condom usage of men who have sex with men (MSM) at a community-based anonymous voluntary counseling and testing centre in Kuala Lumpur, Malaysia. This study is a first for Malaysia in this context. 433 MSM clients disclosed their sexual practices and condom use in the preceding 6 months using a self-reported questionnaire during pre-HIV test counseling at the centre. The mean age was 29.7 years, and 356 were homosexuals while 77 were bisexuals. Forty tested HIV positive (9.2%). 387 (94.9%) of 408 clients had anal sex, 395 (97.8%) of 404 clients had oral sex, while 43 (18.4%) of 233 clients had vaginal sex which revealed that even men who identified themselves as homosexuals do practice vaginal sex. Having multiple sexual partners is common (mean 11.6 partners per client). 259 (59.8%) had unprotected sex within the last 6 months. Consistent condom use rates during vaginal, anal, and oral sex were 20%, 23.5%, and 1.3%, respectively. The odds ratio of testing HIV positive with inconsistent condom use during anal sex was 3.7 (). Clients who used condoms inconsistently during anal sex are more likely to be HIV positive.

Prevalence of Treatment Failure among Pulmonary Tuberculosis Patients in Federal Medical Centre, Gombe, Northeastern Nigeria

Y. B. Jibrin, A. B. Ali, S. T. Saad, and P. M. Kolo — Sun, 23 Dec 2012 13:12:15 +0000

Treatment failure in patients with pulmonary tuberculosis poses a great danger to the global effort in control of tuberculosis. This study evaluated prevalence of treatment failure among pulmonary tuberculosis patients at Federal Medical Centre (FMC) Gombe, Nigeria. Consecutive patients managed between August 2008 and August 2009 at the Directly Observed Therapy (Tuberculosis) Unit of our hospital were enrolled for the study. Sputum specimens were collected from each patient at entry for Acid Fast Bacilli and repeated at the end of 2nd, 5th and 7th month of treatment. Of the 247 patients recruited, 200 patients consisting of 118 (59%) males and 82 (41%) females aged 15–78 years with a mean of 36.8 ± 12.4 years completed the study. One hundred and fifteen (57.5%) of the patients were sputum smear positive at entry while 85 (42%) were negative. Among 115 smear positive patients at baseline, 80 patients (69.6%), 26 (22.6%) and 24 (20.9%) remained positive after 2nd, 5th and 7th month of treatment respectively. In conclusion, there is a high treatment failure rate (22.6%) among our TB patients; and this poses a great danger to healthcare personnel and close contacts in the community.

Impact of Long-Lasting Insecticidal Nets and Indoor Residual Sprayings on Susceptibility of Anopheles gambiae (Diptera: Culicidae) in Western Côte d'Ivoire

Mahama Touré, Pierre Carnevale, and Fabrice Chandre — Mon, 17 Dec 2012 11:55:23 +0000

Pyrethroid insecticides resistance in several Anopheles species represents a threat for the success of malaria vector control based on using treated nets and indoor sprayings. Impact of the long-lasting insecticidal net (LLIN) of Permanet type and indoor residual spraying (IRS) with deltamethrin on the levels of susceptibility to pyrethroids and DDT were investigated in field populations of Anopheles gambiae in 12 villages located in the Danané area in Western Côte d'Ivoire. From May 2001 to July 2002, adult An. gambiae reared from larvae collected from these villages were tested with 0.05% deltamethrin, 1% permethrin, and 4% DDT impregnated papers using WHO standard test kits. Knockdown times for 50% of adult mosquitoes (kdT50) of field specimens from LLINs, untreated nets, IRS, and control villages significantly differed from those of the Kisumu susceptible strain. However, the resistance ratios of the kdT50 were very low. KdT50 did not significantly differ with all treatments, chemicals (LLINs and IRS), physical (untreated nets), and control. The mortalities were above 80% indicating susceptible populations of An. gambiae in the Danané area. There was no significant difference between mortality rates from the different treatments.

Efficacy of a Mosaic Long-Lasting Insecticide Net, PermaNet 3.0, against Wild Populations of Culex quinquefasciatus in Experimental Huts in Togo

Wed, 05 Dec 2012 16:09:51 +0000

PermaNet 3.0 was evaluated against Culex quinquefasciatus in experimental huts in Lomé. Endpoints were deterrence, exophily, blood feeding inhibition, and mortality. Insecticide susceptibility of Culex quinquefasciatus was assessed with permethrin (1%), DDT (4%), bendiocarb (0.1%), deltamethrin (0.5%, 0.05%), carbosulfan (0.4%), and chlorpyrifos methyl (0.4%). Total of 1,223 Cx. quinquefasciatus females were collected. PermaNet 3.0 unwashed deterred 16.84% Culex mosquitoes. After 20 washes, it deterred 5.79% mosquitoes compared to 6.84% deterrence by unwashed PermaNet 2.0. PermaNet 3.0 induced mosquitoes to exit huts 50.48% and inhibited blood feeding 70.97% in unwashed state. After 20 washes, the net induced 42.91% mosquitoes to exit and inhibited 67.06% mosquitoes from blood feeding. PermaNet 3.0 gave 76% personal protection at zero wash and 69% protection after 20 washes. The net retained 7.1% insecticidal effect in the unwashed state and after 20 washes 6.5%. Cx. quinquefasciatus was resistant to tested insecticides (6%–50% mortality). PermaNet 3.0 is a good control tool against mosquitoes. However, Cx. quinquefasciatus is less affected by PermaNet 3.0. The evaluation depicts the success of vector control innovations using pyrethroids and nonpyrethroids in combination on nets. Additional studies with Culex species are recommended to know whether the difference in blood feeding is interspecific (difference in vector behaviour) and not due to intertrial variability.

Prevalence of Metallo-β-Lactamases Producing Acinetobacter baumannii in a Moroccan Hospital

Mon, 03 Dec 2012 10:30:34 +0000

Objective. To determine the prevalence of metallo beta-lactamases (MBL) among carbapenem resistant strains of Acinetobacter baumannii in our hospital. Methodology. During a period of 12 months (January–December 2010), 47 isolates of Acinetobacter baumannii were collected from different clinical specimens of in-patients. Antimicrobial susceptibility was determined and interpreted using the disk diffusion method according to the Antibiogram Committee of the French Society for Microbiology guidelines. Imipenem nonsusceptible isolates were further screened for production of MBL. Results. All Acinetobacter baumannii’ isolates were resistant to ticarcillin, ticarcilline/clavulanate, piperacillin, piperacillin/tazobactam, gentamicin, tobramycin, and ciprofloxacin, except an isolate that was sensitive to ceftazidime and cefepime. In addition to that, amikacin and trimethoprim/sulfamethoxazole were, respectively, sensitive by 59.5% and 53%. Among 57,4% (27/47) imipenem non-susceptible isolates of Acinetobacter baumannii, 74% (20/27) were found to be MBL producers. Conclusion. Although the rate of imipenem non-susceptible isolates of Acinetobacter baumanni seems to remain stable in 2005 (57%) and 2010 (57,5%), the prevalence of MBL producer strain is increasing (38% in 2005 versus 75% in 2010). The findings strongly suggest that there is a need to track the detection of MBL producers; moreover, a judicious use of carbapenems is necessary to prevent further spread of these organisms.

Oral Lesions: Poor Markers of Virologic Failure in HIV-Infected Patients on Antiretroviral Therapy

Mon, 03 Dec 2012 10:19:16 +0000

The objective of this study was to assess the use of HIV-oral lesions (OLs) as markers of virologic failure (VF) in response to antiretroviral therapy (ART). Concurrent virologic status was compared between 744 individuals with and without OL (). Time to VF between OL groups was compared (Kaplan-Meier), and baseline factors associated with VF were determined (Cox Hazard models). Sensitivity, specificity, positive predictive value, and negative predictive value were also computed. At baseline and 12 months, individuals with OL were more likely to have viral load copies/ml compared to patients without OL (). Time to VF between patients with baseline OL (mean: 17 months, 95% CI 16–18) and patients without baseline OL (mean: 19 months, 95% CI: 18–20) was statistically different. Patients who were African-American (HR 1.356; 95% CI: 1.045–0.759), ART-experienced (HR 2.298; 95% CI: 1.743–3.030), had mental disorders (HR 1.410; 95% CI: 1.078–1.843), and had high baseline viral load (HR 2.82; 95% CI: 1.661–3.137), were more likely to have VF after the first six months of ART. OL had a moderate positive predictive value for concurrent VF at 6 months (45.5%) and 18 months (33.3%), but a strong positive predictive value at 12 months (80.0%) and 24 months (100.0%). Findings of this study suggest that OLs could be poor predictors of VF in HIV-infected patients on ART therapy.

Paragonimiasis Reemergence in Nigeria: Predisposing Factors and Recommendations for Early Intervention and Everlasting Eradication

Reginald A. Eke, Udochi M. Nwosu, Ezinne E. Enwereji, and Chima V. Emerole — Sun, 02 Dec 2012 15:49:54 +0000

Effective paragonimiasis eradication programme in Nigeria eradicated the once endemic disease and no case was reported from 1980 to 2007. The first reported reemergence case was in 2007 and five more cases till January 2011 when this study was undertaken. This study is to determine the pre-disposing factors for the reemergence. The factors will help plan a sustainable long lasting and hopefully everlasting eradication programme. 2760 households from the identified twelve villages with the endemic disease were systematically selected. Pretested questionnaires were interviewer administered to the head of each of the selected household. The data collected were analyzed quantitatively and qualitatively. The pre-disposing factors that precipitated the reemergence of the disease included low level of awareness of the disease by the entire populace including the health workers. This included the causative agent, the mode of transmission, and control; conservative cultural habits of preparing crab meal; eating improperly cooked crab and also insanitary disposal of faeces and sputum. A holistic eradication programme should be planned to have sustained activities that will usher in everlasting disease-free area. The programme should involve all people, policy makers, health workers, and the entire populace, taking care of peculiarities of the peoples habits.

The Burden of Visceral Leishmaniasis in India: Challenges in Using Remote Sensing and GIS to Understand and Control

Sun, 04 Nov 2012 09:28:55 +0000

Visceral leishmaniasis (VL) continues to constitute immense public health problems and be an obstacle to socioeconomic development in India. The scrutiny of this disease remains a necessary step in its control, eradication, and prevention. Space technologies proffer new opportunities for rapid appraisal of endemic areas, stipulation of trustworthy estimation of populations at risk, prediction of disease distributions in areas that lack baseline data and are difficult to access, and guiding intervention strategies. Here, we focus on the epidemiology and control of VL in India and review remote sensing (RS) and GIS applications to date. For the original evidenced report, a search was done on electronic databases of PubMed, ERMSS, EQUEST and from online Internet searching to come across the recent research problems. We discuss the previous work conducted in this field, outlined potential new applications of GIS and RS techniques, and utilization of emerging satellite information, as they hold a promising area to further enhance VL risk mapping and prediction. Finally, we concluded with a discussion of strategies to overcome some of the perspective challenges of GIS and RS applications for VL control, so that supplementary and continued progress can be made to control this disease in India and elsewhere.

Current Status of Schistosoma mansoni Infections and Associated Risk Factors among Students in Gorgora Town, Northwest Ethiopia

Tarko Essa, Yemane Birhane, Mengistu Endris, Asmeret Moges, and Feleke Moges — Thu, 01 Nov 2012 19:17:07 +0000

Background and Objective. Schistosomiasis is highly prevalent in tropics and causes morbidity and mortality in developing countries including Ethiopia. This study is aimed to assess the current status of S. mansoni infections and associated risk factors among students in Gorgora town, Northwest Ethiopia. Method. A cross-sectional study was conducted from October 2010 to November 2010 at Gorgora, Northwest Ethiopia. All students (579) present during the study period were enrolled. Pretested questionnaires were used to collect sociodemographic data and predisposing factors. Stool examination was performed using wet mount and Kato-Katz techniques. Data were entered and analysed using SPSS version 20.0 statistical software. Result. Among 579 students enrolled, 291 (50.3%) were positive for one or more intestinal parasites. Prevalence of S. mansoni was found to be 20.6% with mean intensity of infection (125 eggs per gram of feces). Lack of awareness and water contact habits such as frequent swimming in the open water source, agricultural activities on bare foot, and washing clothes were also associated with high risk of S. mansoni infection. Conclusion. Even though there seems to be a decline in the prevalence of S. mansoni infections in the study area, the problem still persists and affects students significantly. Therefore, therapeutic intervention and health education are needed.

A Comparative Analysis of GeneXpert Real-Time PCR with Culture for the Detection of Methicillin-Resistant Staphylococcus aureus Colonization in Selected Hospital Admissions

Sun, 21 Oct 2012 15:22:02 +0000

Contact isolation of patients with methicillin-resistant Staphylococcus aureus (MRSA) reduces transmission to other patients and to health care workers. PCR technology can provide rapid detection of these patients. We tested the utility of using PCR for MRSA detection in patients with a history of MRSA infection or colonization or in a high risk group admitted to a general referral hospital. Nasal swabs from 342 patients were tested for MRSA on days one and three using the GeneXpert MRSA system. Swabs with a positive PCR result were cultured to identify staphylococcal species present in the nares. Fifty-six patients (38% of 147) with a history of MRSA colonization or infection were positive; forty-seven patients (24% of 195) in a high risk group were positive. Eighty-one percent of the patients with positive PCR swabs grew out MRSA on culture. Some cultures grew out only methicillin-sensitive Staphylococcus aureus, methicillin-sensitive, coagulase negative Staphylococcus, or methicillin-resistant, coagulase negative Staphylococcus. This study demonstrates that most patients at risk for MRSA colonization are not colonized and that microbiological surveillance using PCR technology can facilitate contact isolation decisions. Not all PCR positive results represent the presence of MRSA, and hospitals need to consider policies for additional evaluation of positive PCR tests.

Pathogenesis of Dengue Haemorrhagic Fever and Its Impact on Case Management

Kolitha H. Sellahewa — Sun, 21 Oct 2012 11:43:39 +0000

Plasma leakage and intrinsic coagulopathy are the pathological hall marks in dengue haemorrhagic fever (DHF). Viral virulence, infection enhancing antibodies, cytokines and chemical mediators in the setting of intense immune activation are the key players implicated in the pathogenesis of DHF; the exact nature of which is yet to be fully understood. The pathophysiological changes the attended clinical features of plasma leakage necessitate recognition of changing physiological parameters for the early recognition of plasma leakage and appropriate fluid therapy. On the other hand, the changes in the haematological indices resulting from coagulopathy can tempt the clinician to initiate other modalities of therapy. A clearer understanding of the pathogenesis of DHF and the appreciation that both of these fundamental pathological changes share common pathogenic mechanisms would facilitate the appropriateness of management decisions and the early recognition of severe disease. Thus, thrombocytopaenia, reduced fibrinogen, and prolonged partial thromboplastin time early in the disease course connoted severe disease and attended plasma leakage rather than clinical bleeding. The detection of plasma cytokine profile by a multiple bead immunoassay could also complement clinical parameters in predicting severe disease early in the disease course. Thus, MIP-β indicates good prognosis while IFN-γ portends severe disease.

Paragonimiasis and Renewed Crab-Eating Behavior in Six Communities from Two Ethnocultural Clusters in Southeastern Nigeria

Emmanuel Chukwunenye Uttah — Thu, 18 Oct 2012 19:27:47 +0000

This work was aimed at assessing the prevalence of paragonimiasis and crab-eating behavior in Southeastern Nigeria. Sputum examinations and questionnaire administration were carried out. Prevalence was 13.2% and was significantly higher among females (14.6%) than males (11.2%) (). Overall, 77.2% of respondents across the communities eat crabs, and this was comparable between males (76.4%) and females (77.6%) (). The prevalence was comparable between the two ethnocultural groups and between communities within each ethnocultural group ( for both tests). The mean age of crab eaters was 43 years, while that of noncrab eaters was 26 years. Many (46.3%) infected individuals presented low intensity infections (1–50 eggs/ova per 5 mL−1 sputum), while 28.8% and 23.8% presented moderate (51–100 eggs/ova per 5 mL−1 sputum) and high (above 100 eggs/ova per 5 mL−1 sputum) intensity infections, respectively. Infection risk among weekly eaters of crabs was 3 times higher than that of monthly eaters (OR 3.68), 19 times higher than that of quarterly eaters (OR 19.0), and 9 times higher than that of irregular eaters (OR 9.38). Concerted awareness campaign is needed to curb the renewed increase of the scourge in endemic Southeastern Nigeria.

Vertical Transmission of HIV in Sub-Saharan Africa: Applying Theoretical Frameworks to Understand Social Barriers to PMTCT

Karen Hampanda — Mon, 24 Sep 2012 09:50:23 +0000

In sub-Saharan Africa, over 1,000 newborns are infected with HIV every day, despite available medical interventions. Pediatric HIV is a large contributor to the high rates, the largest in the world, of infant and child mortality in this region. Prevention of mother-to-child transmission of HIV (PMTCT) can dramatically reduce the risk of infection for the infant during pregnancy, childbirth, and breastfeeding. Throughout most urban areas of Africa, free medications are readily available. However, approximately 50% of HIV-positive pregnant women in sub-Saharan Africa are not accessing or adhering to the necessary medications to prevent mother-to-child transmission. In order for this region to eliminate the vertical transmission of HIV and meet the Millennium Development Goals, interventions need to move beyond the individual-level and address the structural and social barriers preventing women from utilizing PMTCT services. This paper reviews current literature on PMTCT interventions in sub-Saharan Africa from 2006–2012, specifically examining theoretical underpinnings. Overwhelmingly, the approach has been education and counseling. This paper calls to action a paradigm shift to a social ecological approach that addresses barriers at all societal levels, especially gender inequality, enabling a much greater impact on mother-to-child transmission of HIV.

Tuberculosis Characterization in a Special Population of Kidney Transplant Recipients

Barbara Reis-Santos and Ethel Leonor Noia Maciel — Mon, 17 Sep 2012 09:32:50 +0000

Setting. Tuberculosis clinical presentation is not typical in kidney transplant recipients and the diagnosis of active disease is usually delayed. Objective. To characterize tuberculosis presentation in Brazilian's kidney transplant recipients. Study Design. We analyzed the clinical records of tuberculosis cases regarding sociodemographic data and health history. Results. Thirteen TB cases were identified among 843 transplant recipients. The average time for TB development after transplantation was 4 years. Eight subjects presented pulmonary disease, seven patients required hospitalization Alertness to the possibility of TB and the careful evaluation for possible TB of all kidney transplant recipients with unexplained is vital, as is the related work of transplant and TB control teams and four died as a consequence of TB. Conclusion. The severe consequences of TB in posttransplantation can become critical.

Positive Predictive Value of Blood Cultures Utilized by Community Emergency Physicians

Edward C. Lin and Kevin M. Boehm — Sun, 16 Sep 2012 10:59:56 +0000

Objective. To determine the positive predictive value of blood cultures obtained from patients from a suburban ED and how the ED physicians use empirical antibiotics. Method. This retrospective chart review study was conducted at the ED of a suburban teaching hospital. The study consisted of adult patients who presented to the ED with evidence of clinical conditions suggesting bacteremia. Result. Over a 12-month period, 408 patients with positive blood cultures were drawn in the ED. The mean age of the patients was 65.85 years. The positive predictive value was 58.3%, and community ED physicians used appropriate empirical antibiotics in 72.3% of patients with true bacteremia. Conclusion. The positive predictive value indicated that many of the positive blood culture results were false positives from skin contamination. Blood cultures are necessary to follow up any positive results with more reliable tests to obtain a more accurate assessment as to whether bacteremia is present in the emergency department. True positive blood cultures can assist other doctors in adjusting the antibiotics. Emergency physicians overall used appropriate antibiotics in 72.3% of patients with true bacteremia. This study demonstrated that emergency physicians have the potential to improve the empirical treatment in treating patients.

Prevalence and Utility of Positive Pneumococcal Urinary Antigen Tests in Australian Patients with Community-Acquired Pneumonia

Lauren K. Troy, Keith K. H. Wong, and David J. Barnes — Sun, 09 Sep 2012 13:29:20 +0000

Background and Objectives. The pneumococcal urinary antigen test (UAT) has superior sensitivity to other investigations in determining the aetiology of community-acquired pneumonia (CAP), but data specific to Australian populations is limited. This study aimed to establish the prevalence and clinical utility of positive UAT in patients admitted to hospital with CAP, as well as associations with positive testing. Methods. A prospective, cross-sectional, single-centre study was performed. Urine antigen tests were performed on all adult patients admitted to hospital with the diagnosis of CAP. Sputum and blood culture results, CURB-65 score of severity, current and prior antibiotics, comorbidities, mortality, and length of hospital stay were recorded. Results. There was a positive test prevalence of 13/170 [7.6% (95% confidence intervals 4.3–13%)]. The overall prevalence of pneumococcal pneumonia was 19/170 (11%), including 8 patients confirmed on positive UAT alone. Patients with a positive UAT result had a higher mean CURB-65 score compared with those with a negative result (𝑃=0.01), and a greater likelihood of requiring intensive care support (𝑃=0.006). Conclusions. The prevalence of positive UAT was low. Positive results were more often recorded in those with greater severity pneumonia. The clinical utility of the test in this cohort of patients was low.

Frequent Misconceptions and Low-to-Moderate Knowledge of HIV and AIDS amongst High-School Students in Malaysia

Tue, 04 Sep 2012 13:21:28 +0000

We describe the findings from a survey of 572 high-school students aged between 15 and 19 years in the city of Seremban, Negeri Sembilan state, Malaysia. Knowledge regarding HIV and AIDS is assessed using a self-administered validated 48-item questionnaire modified from the validated HIV Knowledge Questionnaire (HIV-K-Q). Our questionnaire was divided into 4 parts assessing different areas in HIV/AIDS, namely, general knowledge of risk factors; knowledge of modes of transmission of HIV; knowledge of HIV prevention; knowledge of HIV testing. The answers were divided into “correct”, “wrong”, and “I don't know”. One mark was awarded for every “correct” answer; one mark was deducted for every “wrong” answer, while no mark was awarded for “I don't know”. The total marks for each student were converted to percentage and used for analysis. The average total score percentage was 64.7%. The highest scores were in the area of knowledge of mode of HIV transmission, while the lowest scores were in the area of knowledge of HIV testing. The level of HIV knowledge was correlated with age of the students (𝑃<0.05) but not with gender and ethnicity. Our paper revealed frequent misconceptions and a general low-to-moderate level of knowledge amongst the high school students surveyed.

Neonatal Herpes Simplex Infection

Shahid K. Sukhbir — Wed, 29 Aug 2012 13:57:37 +0000

Maternal genital herpes is a sexually transmitted infection; asymptomatic in 70% of cases. Newborn babies usually catch the infection from maternal birth tract during delivery. Neonatal herpes simplex infection is a highly morbid and fatal dreadful infection. Though there have been great advances in diagnosis and management of this neonatal infection in last 3 decades, its morbidity continues to be high due to greater lag-time between symptoms and diagnosis. This delay is due to its non-specific presentation and lack of adequate awareness about the disease amongst the practising physicians. A high level of clinical suspicion is vital for early treatment initiation and better outcomes. Maternal education on safe sex practices, selective and elective caesarean surgery and prophylactic acyclovir for recurrent maternal herpes would diminish transmission and disease in newborn.

Eosinopenia as a Prognostic Marker in Patients with Peritonitis

T. S. Jagdeesh, Arpan Mishra, Arjun Saxena, and Dhananjaya Sharma — Tue, 28 Aug 2012 15:22:15 +0000

Introduction. Eosinopenia has been, recently, found to have strong association with inflammatory-syndrome-associated bacterial infectious diseases. This prompted us to investigate its use as a prognostic marker in perforation peritonitis patients. Methods. A prospective study of perforation peritonitis patients admitted to the surgical wards at a teaching hospital in Central India was conducted. jabalpur prognostic score (JPS, a simplified prognostic score for developing countries), C-reactive protein (mg/dL) levels, and absolute eosinophil counts (cells/cmm) were measured on admission. Their correlation with inpatient mortality was evaluated. Results. 94 consecutive patients were studied, peptic (𝑛=55) followed by ileal, colonic, and appendicular perforations were the commonest cause of peritonitis. 13/94 died; ileal perforations had the highest (𝑛=6/34, 17.6%) mortality. When correlated with mortality, univariate analysis showed JPS, CRP, and AEC to be accurate prognostic markers (𝑃<0.00001), while multivariate analysis showed only AEC to be accurate (𝑃=0.03). At a cut-off value of 8, JPS showed sensitivity of 77%, a specificity of 85.1%, positive predicted value (PPV) of 55%, negative predicted value (NPV) of 95%, and area under receiver operating curve (AUROC) was 0.86. CRP level, at a cut-off value of 7.4, yielded sensitivity of 92.3%, specificity of 79%, PPV of 41%, NPV of 98%, and AUROC was 0.93. At a cut-off value of 45, the sensitivity of the AEC was 92.3%, specificity of 92.5%, PPV 85%, NPV of 99%, and AUROC was 0.96. Discussion. Eosinopenia on admission is a prognostic marker of mortality in patients with peritonitis.

2009 H1N1 Influenza Infection-Related Hospital Admissions: A Single Center Experience with Adult Patients in West Texas

Thu, 16 Aug 2012 10:51:46 +0000

Background. Clinical information collected during the first wave of influenza pandemics may provide important projections about disease activity during subsequent waves. Methods. We performed a retrospective study of hospitalized patients with 2009 H1N1 influenza infection during the second wave and compared our findings with literature reports from the first wave. Results. There were 31 admissions, including 15 to the intensive care unit (ICU). Twenty-five patients (81%) had at least one chronic medical condition; 12 patients (39%) were obese. Thirty-three percent of the ICU patients and 75% of the non-ICU patients were admitted within 48 hours of symptom onset (𝑃=0.03). Infiltrates on CXR were seen in 60% of the ICU group and 19% of the non-ICU group within 48 hours of admission (𝑃=0.03). Forty-three percent of the ICU patients and 71% of the non-ICU patients received oseltamivir within 48 hours of illness. All non-ICU patients survived; 73% of the ICU patients survived (𝑃=0.043). Conclusions. Our patients in the second wave resembled patients reported from the first wave of the 2009 pandemic and had similar mortality rates. Delayed medical attention possibly explains the high number of ICU admissions in our study.

Transmissible Spongiform Encephalopathies Affecting Humans

Tue, 14 Aug 2012 08:30:42 +0000

Transmissible spongiform encephalopathies (TSEs) or prion diseases are group of rare and rapidly progressive fatal neurologic diseases. The agents responsible for human prion diseases are abnormal proteins or prion that can trigger chain reactions causing normal proteins in the brain to change to the abnormal protein. These abnormal proteins are resistant to enzymatic breakdown, and they accumulate in the brain, leading to damage. TSEs have long incubation periods followed by chronic neurological disease and fatal outcomes, have similar pathology limited to the CNS including convulsions, dementia, ataxia, and behavioral or personality changes, and are experimentally transmissible to some other species.

Fertility Desires and Intentions and the Relationship to Consistent Condom Use and Provider Communication regarding Childbearing among HIV Clients in Uganda

Glenn J. Wagner and Rhoda Wanyenze — Tue, 07 Aug 2012 10:05:12 +0000

Family planning services emphasize prevention of unplanned pregnancies, but rarely account for the childbearing desires of HIV clients. We examined the correlates of fertility desires and intentions among 767 HIV clients (34% male) starting antiretrovirals in Uganda. Half of participants had a primary sex partner. Among those with a desire (31%) or intention (24%) for having a child in the near future, 60% had not discussed this with providers. Over one quarter (27%) were told by their provider that they should not bear a child because of their HIV status. In regression analysis, male gender, younger age, higher CD4, having fewer children, and having a primary partner were associated with fertility desires and intentions; having been told by provider not to have a child was associated with intentions but not desires. Among participants with a primary partner, consistent condom use was greater among those with no fertility intentions, as was receipt of advise about family planning, while HIV disclosure to partner was greater among those with intentions. Partner HIV status was not associated with fertility desires or intentions. These findings highlight the need for reproductive health programs for HIV clients to incorporate safer conception counseling and improve communication regarding childbearing.

Role of Fat-Soluble Vitamins A and D in the Pathogenesis of Influenza: A New Perspective

Anthony R. Mawson — Thu, 19 Jul 2012 14:53:19 +0000

Reduced exposure to solar radiation, leading to a deficiency of vitamin D and hence impaired innate immunity, has been suggested as a trigger for influenza viral replication and as an explanation of seasonal influenza. Although this hypothesis accounts for many unexplained facts about the epidemiology of influenza, gaps remain in understanding the pathogenesis and manifestations of the disease. Several observations suggest a role for vitamin A compounds (retinoids) in the disease. This paper presents a new model of the etiopathogenesis of influenza, suggesting that host resistance and susceptibility depend importantly on the ratio of vitamin D to vitamin A activity. Retinoid concentrations within normal physiological limits appear to inhibit influenza pathogenesis whereas higher background concentrations (i.e., very low vitamin D : A ratios) increase the risk of severe complications of the disease. There is also evidence that influenza-induced or preexisting liver disease, diabetes, and obesity worsen the severity of infection, possibly via liver dysfunction and alterations in retinoid metabolism. The model could be tested by determining the presence of retinoids in the secretions of patients with influenza and by studies of retinoid profiles in patients and controls. Potential strategies for prevention and treatment are discussed.

Overdiagnosis and Overtreatment of Malaria in Children That Presented with Fever in Lagos, Nigeria

Oladipo O. Oladosu and Wellington A. Oyibo — Thu, 19 Jul 2012 09:29:57 +0000

Background. Malaria diagnosis has been largely done clinically. The implication is the likely overdiagnosis of malaria when diagnosis is done soley on the basis of symptoms. Methods. Parasitological diagnosis was done among 1211, 0–12 years old febrile children that attended a Primary Health Centre in Lagos, Nigeria, who were diagnosed clinically and treated based on symptoms. Results. A total of 251 of 1,211 (20.7%) children less than 12 years old and 174 of the 1,027 of children 0–≤5 yrs (16.9%) were slide positive while 853 (83.1%) of 0–≤5 yrs that were slide negative were treated with Artemisinin based combination therapies (ACTs) in line with the Integrated Management of Childhood Infectioins (IMCI) guidelines and standard practice of the Clinic. Chills, diarrhoea, convulsions, headache, cough, respiratory distress, inactivity, loss of apetite, and vomiting occured significantly in the 0–≤5 and >5–12 years old malaria negative children. Conclusions. Overdiagnosis and overtreatment of malaria in this study was high. Therefore, malaria medicines should be prescribed on the basis of parasitological confirmation of all suspected malaria cases. The availability of quality-assured malaria rapid diagnostic tests (RDTs) is a useful tool to confirm malaria cases while the cause of the non-malaria fevers can be followed up and managed appropriately.

Resistance of Gram-Negative Bacilli in Lebanon

S. E. Salem, E. Dahdouh, and Z. Daoud — Tue, 17 Jul 2012 08:23:26 +0000

Several studies have reported the isolation of resistant Gram-Negative Bacilli in Lebanon. However, those studies are new and scarce as compared to worldwide data and mostly restricted to single center studies. In this review, we attempt to provide a reliable and comprehensive report describing the current situation and providing prospects for bacterial resistance in Lebanon. Several studies have shown that Extended Spectrum β-Lactamase-producing E. coli and K. pneumoniae strains are being increasingly reported. Moreover, 2.15% of E. coli and 7.84% of K. pneumoniae isolates have shown carbapenem resistance and up to 30% of isolated E. coli strains were found to be Multi-Drug Resistant. Molecular studies showed that the most widespread β-Lactamases in Lebanon are of the CTX-M-15 and SHV types. In addition, K. pneumoniae strains producing metallo-β-Lactamase and Klebsiella pneumoniae Carbapenemase have been reported. Resistant Pseudomonas aeruginosa and Acinetobacter baumannii caused several nosocomial infections and some Acinetobacter baumannii strains were found to produce OXA-58 type ESBL. The few data addressing the rate of antibiotic consumption in Lebanon show a high rate of antibiotic misuse and abuse. In conclusion, there is a need for antibiotic stewardship programs and additional studies that go beyond the scope of single-center studies in Lebanon.