ISRN Infectious Diseases The latest articles from Hindawi Publishing Corporation © 2014 , Hindawi Publishing Corporation . All rights reserved. Communication and the Decision Making Process among Couples with HIV/AIDS in Bulawayo, Zimbabwe Mon, 17 Mar 2014 13:37:44 +0000 The study explores how HIV-positive couples negotiate and make reproductive and sexually related decisions. The broader aim of the paper is to understand how men and women with HIV make decisions about contraception and reproduction and what those decisions indicate about the realities of HIV-positive relationships. In line with the study’s aim to explore meanings related to the decision making process, a qualitative research approach was adopted. In-depth interviews were conducted with 15 couples in which at least one of them was HIV-positive. A critical interpretive analysis of the data was adopted in order to gain insight into decision making among the HIV-positive couples. The results indicate that decisions made were usually a result of negotiation and compromise between partners. However, women’s fertility and sexual preferences were found to be a major factor in determining the outcome of the decision making process. Couples who intended to have a child were found to be active decision makers while those who only desired or did not desire to have a child were mainly passive decision makers. The study concludes that women exercise significant power over contraceptive and reproductive decisions among both active and passive decision makers. V. Ndlovu Copyright © 2014 V. Ndlovu. All rights reserved. Surgical, Ultrasound Guided Drainage, and Medical Management of Tuboovarian Abscesses Tue, 04 Mar 2014 12:53:50 +0000 Objective. To compare surgical, ultrasound guided drainage, and medical management of tuboovarian abscesses (TOA) and determine if different characteristics in patient presentation influence treatment and outcome. Methods. Retrospective cohort study of 158 patients admitted to Jackson Memorial Hospital between 2007 and 2012 with a TOA. Results. Patients treated with IV antibiotics (IV) alone were hospitalized for 5.59 days (SD 2.52), IV antibiotics and US guided drainage (IV/US) were hospitalized for 9.63 days (SD 7.58), and IV antibiotics and surgery (IV/surgery) were hospitalized for 8.14 days ((SD 3.9), ()). A total of 52 patients were readmitted with TOA; 41.8% were treated with IV; 26.9% were readmitted with IV/US; 7.1% were readmitted with IV/surgery (). Patients with a TOA measuring 0–8 cm were hospitalized for 5.97 days (SD 4.24), while those greater than 8 cm were hospitalized for 7.71 days ((SD 4.69), ()). Patients treated with a triple antibiotic regimen were hospitalized for 8.42 days (SD 5.70) versus 5.8 days (SD 3.24) when receiving an alternative regimen (). Conclusions. Longer hospitalization in patients treated uniformly with either triple antibiotics, ultrasound guided drainage, or surgery represents a delay in optimal treatment. Tailoring treatment plans based on patient presentation may allow for shorter hospital stays and improved morbidity. Frank A. Crespo, Dervi Ganesh, Kaming Lo, Kevin Chin, Paul Norris, and Nahida Chakhtoura Copyright © 2014 Frank A. Crespo et al. All rights reserved. Contexts of HIV-Related Risk Behaviors among Male Customers at Asian Massage Parlors in San Francisco Tue, 04 Mar 2014 12:32:57 +0000 Based on focus groups for male customers who frequented Asian massage parlors in San Francisco, the present study described their sexual and drug use behaviors and attitudes toward practicing safe sex with Asian masseuses. A pervasive view among patrons was that they could engage in sex with masseuses without using a condom if they offered extra money. Their sexual behaviors with Asian masseuses were influenced by perceptions about vulnerability toward HIV/STIs, substance use behaviors, and masseuses’ initiation of condom use, which was often governed by unspoken rules at parlors. Customers perceived massage parlors as being a safe place compared with street sex venues. Some customers sought emotional attachment with Asian masseuses and expressed stereotypical views toward them as being docile and submissive. Culturally appropriate HIV/STI prevention programs (e.g., communication about and practicing 100% condom use) are needed to target both customers and Asian masseuses at multiple levels (individual, owner/manager, work environment, and community levels). Also, customers’ and masseuses’ perceptions toward relationships at massage parlors and power dynamics need further investigation to promote safe work environments and 100% condom use at massage parlors. Tooru Nemoto, Mariko Iwamoto, Elnaz Eilkhani, Maria Sakata, Mai Nhung Le, and Anne Morris Copyright © 2014 Tooru Nemoto et al. All rights reserved. An Email Survey of Physician and Licensed Midwife Vaccination Practices in Washington State in 2011 Tue, 11 Feb 2014 11:01:22 +0000 Despite proven benefit to mothers and infants, influenza and Tdap vaccination for pregnant women remain suboptimal. We conducted an email survey for physicians (MDs) and licensed midwives (LMs) in Washington to assess vaccination practices. The Washington State Department of Health and University of Washington, Department of Obstetrics and Gynecology, created an electronic survey and sent it to 644 providers. We used chi-square statistic for comparisons, with Fisher’s exact test for cell size smaller than 5. We received responses from 121 (19%), 106 of whom provided prenatal or obstetric care: 81 MDs and 25 LMs. MDs were more likely than LMs to ask whether pregnant patients are current on vaccinations for influenza and pertussis (96% versus 56% and 84% versus 40%, resp., ) and to recommend influenza and pertussis vaccine during pregnancy (100% versus 20% and 86% versus 24%, resp., ). Significantly more MDs received influenza vaccine in the most recent season than did LMs (99% versus 20%, ). In this study, LMs were less likely to inquire about immunization status, recommend influenza and pertussis vaccines, or be vaccinated against influenza than MDs. Enhancing educational communication with LMs deserves further study and may provide an opportunity to improve immunization rates in pregnant women. Marisa Anne D’Angeli and Linda O’Neal Eckert Copyright © 2014 Marisa Anne D’Angeli and Linda O’Neal Eckert. All rights reserved. Targeted Screening for Latent TB Infection prior to Biologic Therapy to Improve Patient Safety and Reduce Costs: A Prospective Observational Study Mon, 10 Feb 2014 09:25:42 +0000 Objective. Our current practice of screening for latent TB infection (LTBI) using universal T-SPOT assays is not in line with British Thoracic Society (BTS) recommendations. We set out to determine the clinical benefit and cost effectiveness of blanket TSPOT.TB (T-SPOT) testing as a screening tool for patients awaiting anti-TNF-α therapy. Methods. 130 consecutive rheumatology patients were investigated for LTBI before commencing anti-TNFα therapy at Gartnavel General Hospital, Glasgow, an area of low TB prevalence and high BCG vaccination. Chest radiograph and clinical interview were used to identify risk factors for LTBI. The annual risk of TB was calculated using tables from BTS recommendations and then compared to the risk of drug-induced hepatitis. All patients were given a T-SPOT according to current local policy. Indeterminate T-SPOTs were recorded and repeated. Results. For 130 patients, a total of 160 tests were required resulting in a cost of £24,000. 99 (76%) patients had no TB risk factors and a total of 22 repeat tests were required before returning negative results. This equates 121 T-SPOTs and potential cost savings of £18,150. Conclusion. In the absence of risk factors for TB and an abnormal chest radiograph, the use of T-SPOT as a first line test for LTBI may result in unnecessary risk of TB chemoprophylaxis-induced hepatitis, increased costs, and a delay in early anti-TNFα therapy. R. Hassanzadeh, J. France, and S. Bawa Copyright © 2014 R. Hassanzadeh et al. All rights reserved. Necrotizing Fasciitis: Diagnostic Challenges and Current Practices Wed, 22 Jan 2014 09:33:49 +0000 Necrotizing fasciitis or necrotizing soft-tissue infections (NSTIs) are infrequent but highly lethal infections. They can be defined as infections of any of the layers within the soft tissue compartment (dermis, subcutaneous tissue, superficial fascia, deep fascia, or muscle) that are associated with necrotizing changes. At onset, necrotizing fasciitis can be difficult to differentiate from cellulitis and other superficial infections of the skin. In fact, only 15% to 34% of patients with necrotizing fasciitis have an accurate admitting diagnosis. Early diagnosis and management with surgical debridement, antimicrobials, and supportive measures reduce mortality. Even with modern ICU care mortality ranges between 16 and 36%; this is related to delays in diagnosis and comorbidities. Various scoring systems have been developed which help in diagnosis and stratifying patients into risk groups. The present review deals with varied presentation, early diagnosis, and management of necrotizing fasciitis. Abhishek Vijayakumar, Rajeev Pullagura, and Durganna Thimmappa Copyright © 2014 Abhishek Vijayakumar et al. All rights reserved. Supplemental Perioperative Oxygen (80% FIO2) for the Prevention of Surgical Site Infection after Emergency Cesarean Section Sun, 29 Dec 2013 17:10:25 +0000 Objective. Cesarean section can be a lifesaving procedure. However, as with many surgeries, it is not exempt of complications. Surgical site infections generate higher costs, serious morbidity, and mortality. This study evaluates the benefits of perioperative oxygen to prevent surgical site infections. Methods. We conducted a randomized controlled trial to assess the effects of perioperative oxygen to prevent surgical site infection after emergency cesarean section. Patients were randomized to receive either oxygen (80% FIO2) during cesarean section plus two hours postsurgery or no supplemental oxygen. A sample of 326 patients was calculated for the primary outcome (163 in each group) and they were evaluated daily before leaving the hospital, at days 15 and 30. Results. Initially, 360 patients were enrolled, from which 17 were excluded (sample size: 343 (179 patients in the air group and 164 in the oxygen group)). We found no significant difference in the incidence of surgical site infection between these two groups at any of the evaluation times. Conclusion. In this study of patients with emergency cesarean section, we showed that the use of supplemental oxygen does not reduce the incidence of surgical site infection. This trial is registeres with NCT01340534. Bleixen Admadé and Osvaldo Reyes Copyright © 2013 Bleixen Admadé and Osvaldo Reyes. All rights reserved. Lesson Learned from the Emergence of Influenza Pandemic H1N1 in 2009 in Indonesia: The Importance of Influenza-Like Illness (ILI) Surveillance Sun, 29 Dec 2013 13:07:58 +0000 Background. In 2009 there were outbreaks of influenza pandemic H1N1 in Indonesia that were caused by different virus from the previous circulated H1N1. Further, the influenza-like illness (ILI) surveillance plays an important role in the early detection of influenza outbreaks in outpatients. To understand the disease burden of ILI in the community at the time of H1N1 pandemic 2009, a sentinel-based survey was performed. Methods. The nasal and throat swabs were obtained from 20 primary health centers of ILI sentinel in Indonesia in 2009. Identification of virus influenza pandemic H1N1 was carried out by real-time RT-PCR using primers that are specific for influenza A. Results. Out of 3254 ILI cases from community-based ILI surveillance in 2009, 11.03% cases were Influenza A positive and 42.59% cases were influenza pandemic H1N1. The first influenza pandemic HINI case was detected at week 15 in April, a case from the province of Banda Aceh, reaching a peak in August and ending at week 44 in November of 2009. Conclusion. The influenza pandemic H1N1 outbreak was detected in ILI surveillance network in Indonesia. This outbreak lasted for eight months which was the final wave of the influenza pandemic H1N1 in the world. Roselinda, Eka Pratiwi, Agustiningsih, and Vivi Setiawaty Copyright © 2013 Roselinda et al. All rights reserved. Bacterial Vaginosis, Educational Level of Pregnant Women, and Preterm Birth: A Case-Control Study Wed, 25 Sep 2013 09:49:10 +0000 Objective. In a prospective study, we have recruited two groups of pregnant women (the first one with preterm labor activity; the second one with labor in term), trying to find a correlation between bacterial vaginosis (BV) and preterm birth activity. Other parameters influencing the presence of BV have been studied as well, such as educational level and history of previous preterm deliveries. Materials and Methods. Each group was composed of 75 women; recruitment stopped when the number was reached. Bacteriological data were retrospectively collected from the follow-up visits that pregnant women had performed at the regional hospital facility, where the study was performed. The diagnosis of BV was made according to Amsel criteria. Results. Our study showed a significant correlation between BV and preterm labor. BV seems to be an independent risk factor for preterm labor. In the study group, the prevalence of BV was 32%, whereas in the control group, the figure was 14.6% (). Conclusion. Highly risked groups for a preterm birth activity, such as pregnant women presenting BV and with a low educational level, have to be followed up and eventually treated cautiously in order to avoid early and late complications of preterm delivery. Lindita Yzeiraj-Kalemaj, Vjollca Shpata, Gentian Vyshka, and Afërdita Manaj Copyright © 2013 Lindita Yzeiraj-Kalemaj et al. All rights reserved. Contextualizing Child Malaria Diagnosis and Treatment Practices at an Outpatient Clinic in Southwest Nigeria: A Qualitative Study Tue, 24 Sep 2013 09:31:24 +0000 Background. This study sought to explore contextual features of an outpatient clinic located in southwest Nigeria that enable and/or discourage effective diagnosis and treatment of child malaria. Methods. We conducted in-depth interviews with mothers of 135 febrile children attending a pediatric outpatient clinic in southwest Nigeria. Also, participant observations and informal discussions with physicians were conducted to examine the potential impact of context on effective child malaria diagnosis and treatment. Results. The findings indicate that availability of drugs and laboratory testing for malaria, affordability of antimalarial drugs, access to the clinic (particularly access to pediatricians), adequacy of the outpatient clinic, and acceptability of services provided at the clinic are key contextual factors that influence effective case management of malaria in children. Conclusion. If the Millennium Development Goal 6 of reversing malaria incidence by 2015 particularly among children is to be achieved, it is necessary to identify the contextual factors that may act as potential barriers to effective diagnosis and treatment practices at clinical settings. Understanding the context in which case management of child malaria occurs can provide insights into the factors that influence mis- and over-diagnosis of malaria in clinical settings. Juliet Iwelunmor, Collins O. Airhihenbuwa, Gary King, and Ayoade Adedokun Copyright © 2013 Juliet Iwelunmor et al. All rights reserved. Surveillance System and Prevalence of Healthcare-Associated Infections in a Maternity Hospital Tue, 10 Sep 2013 16:34:16 +0000 Obstetrician-gynaecologist (Ob-Gyn) medical and nursing personnel usually have minimal in action training on infection control (IC). Limited information exists also about the epidemiology of healthcare-associated infections (HAIs) in maternity hospitals. The aim of this study was to determine in a 30-day survey prevalence of HAIs among hospitalised patients and neonates in a maternity hospital in Athens, Greece, and to offer to the IC office a practical IC manual. Patients hospitalized for more than 24 h in the clinics and the neonatal intensive care unit (NICU) were enrolled. An IC guide was created and distributed to the medical and nursing staff through educational seminars. Through the survey, among Ob-Gyn patients 16 HAIs were recognized during hospitalization and 14 HAIs after patients’ discharge; the overall prevalence of infected patients was 2.9% and the prevalence of HAIs was 3.2%. Among NICU patients, the prevalence of HAIs was 3.9%. The IC manual was found easily implemented in daily use improving staff’s compliance to IC practices. The results of the survey can be used as a baseline for future comparisons between maternity hospitals (benchmarking). The implementation of steady IC guideline protocols for a maternity hospital may update staff education and promote staff compliance on IC practices. Pagona Flevari, Irene Zorou, Athanassios Tsakris, and George Saroglou Copyright © 2013 Pagona Flevari et al. All rights reserved. Nosocomial Pneumonia Associated to PVL-Producing Staphylococcus aureus in Children in Benin Mon, 05 Aug 2013 10:33:18 +0000 We determined the type of toxins produced by Staphylococcus aureus strains and the possible source of contamination during an outbreak of nosocomial pneumonia in a Paediatric service in Benin. Data of 37 patients admitted in the malnourished unit who were diagnosed with pneumonia according to WHO definition and with radiological evidence of a pulmonary infiltrate were collected within six weeks. Pneumonia was further confirmed by the identification of corresponding pneumonia-related S. aureus. Samples were also collected from hospital personnel, the environment, and the food fed to the patients. Pulsed field gel electrophoresis (PFGE) was used to compare the bacterial profile from different sources. Among the 37 patients admitted during this period, 17 developed pneumonia and 10 were associated with S. aureus strains. Nine patients infected with S. aureus PVL-producing strains had underlying diseases and developed an acute multilobar pneumonia, which was fulminating and rapidly became fatal in all except the oldest child. Most of the isolates found on sick children were similar to those from special nutrients consumed by children and on the personnel at the hospital. The highly probable relationships between children contamination and isolate presence in the special nutrient underline the rapid and disastrous dissemination of some PVL-producing isolates in this paediatric unit. Lamine Baba-Moussa, Théodora Angèle Ahoyo, Cécile Le Brun, Michel Makoutodé, Karim Dramane, Simeon Oloni Kotchoni, and Gilles Prévost Copyright © 2013 Lamine Baba-Moussa et al. All rights reserved. Chemical Composition and Trypanocidal Activity of the Essential Oils from Hedychium coronarium J. Koenig (Zingiberaceae) Tue, 09 Jul 2013 15:07:29 +0000 The composition of the essential oils (EO) from leaves and rhizomes of Hedychium coronarium was analyzed both by gas chromatography and gas chromatography-mass spectroscopy. Thirty and thirty-nine compounds were identified, respectively, in the oils from leaves and rhizomes, representing 88% and 86.1% of the whole compositions. Caryophyllene oxide is the major component in rhizomes while 1,8-cineole predominates in leaves oil. Essential oils and major components were tested for trypanocidal activity using procyclic forms of Trypanosoma brucei (427 and 29-13 strains). The cytotoxicity index (CI50), using the MTT colorimetric method, showed that essential oils and 1,8-cineole were inactive (>100 μg·mL−1. Nevertheless, caryophyllene oxide revealed a remarkable activity against both T. brucei strains (CI50 = 65.77 μg·mL−1 and 24.53 μg·mL−1, resp.), and the synergism between caryophyllene oxide plus pentamidine (1 : 1, v/v) highly increased the trypanocidal activity (<1.0 μg·mL−1). Danilo Fernando Rodrigues, Angela María Arenas Velásquez, Carlos Cavaleiro, Lígia Salgueiro, Gilmárcio Zimmermann Martins, Nathália Oliveira Magalhães, Maria Bernadete Gonçalves Martins, Regina Maria Barretto Cicarelli, and Raquel Regina Duarte Moreira Copyright © 2013 Danilo Fernando Rodrigues et al. All rights reserved. Prevalence of HPV in Adolescents Virgins and Sexually Active at a University Hospital in the City of Rio de Janeiro, Brazil Wed, 26 Jun 2013 15:00:35 +0000 Sexually transmitted diseases (STDs) are common worldwide, with especially alarming numbers in Brazil. Among the most common infections is human papillomavirus (HPV). The possibility of the nonsexual transmission of HPV is not well defined and is the subject of debate. This study aimed to identify the prevalence of HPV in adolescents with no history of sexual intercourse compared with a group of similar age with sexual activity. 100 adolescents were evaluated with at least two years after menarche, who attended from January 2007 to January 2009 at the University Hospital Pedro Ernesto, Rio de Janeiro, Brazil. Among the adolescents, 50 had intact hymen and 50 reported regular sexual activity. For patients without sexual intercourse (group 1) we collected material from vestibule and for patients with sexual activity (group 2) we collected material from vagina and endocervix. The search for HPV-DNA 2nd generation hybrid capture (hC2) was performed. In group 1 the test was positive in 3 cases (6%). In the second group, 33 cases (66%) were positive for at least one site. The positivity in girls with sexual activity is high. On the other hand, the HPV infection, although rare, may occur in girls without sexual intercourse. Renata Mírian Nunes Eleutério, Marco Aurélio Pinho de Oliveira, Cláudia Márcia de Azevedo Jacyntho, Josele de Freitas Rodrigues, Diane Isabelle Magno Cavalcante, and José Eleutério Junior Copyright © 2013 Renata Mírian Nunes Eleutério et al. All rights reserved. The Development of Unconventional Extrathymic Activated CD4+CD8+ T Cells in Chagas Disease Wed, 19 Jun 2013 12:16:40 +0000 The numbers of extrathymic CD4+CD8+ double-positive (DP) T cells are augmented in various pathophysiological conditions, such as infectious diseases caused by intracellular pathogens, organs subjected to autoimmune attack and malignant tumors. The roles performed by extrathymic DP T cells are not clear, and it is not known how they are distributed in the body. In animals they have been considered memory cells involved in adaptive immune responses against virus infections or participating in pathological responses. In experimental Trypanosoma cruzi infections, there is a severe thymic atrophy and this results in the release of activated DP T cells to peripheral organs. In severe cardiac forms of human chronic Chagas disease activated HLA-DR+ DP T cells are present in the blood. In investigating the basis of premature thymocyte release during chagasic thymic atrophy we found that the parasite trans-sialidase (TS) altered intrathymic thymocyte maturation and was associated with increased numbers of recent T cells in peripheral lymphoid organs. In what follows we propose to describe what is known about the origin of the extrathymic DP T cells in human Chagas disease and animal models of the disease. Alexandre Morrot Copyright © 2013 Alexandre Morrot. All rights reserved. Residual Risk of Hepatitis-B-Infected Blood Donations: Estimation Methods and Perspectives Mon, 10 Jun 2013 18:04:33 +0000 Despite a considerable reduction of the risk of HBV-infected blood donation entering blood supply (residual risk) due to improved screening by HBV NAT in the developed countries, the bulk of the people with HBV living in the developing countries still needs to be screened by serologic tests such as HBsAg and anti-HBc. Many of these countries lack resources for implementing NAT and are likely to remain so in the next decade or longer, thus depending on the HBV residual risk monitoring based on serologic testing and corresponding estimation methods. This paper reviews main HBV residual risk findings worldwide and the methods based on serology used for their calculation with repeat donors, as well as their extension to the first-time donors. Two artificial datasets with high (4.36%) and low (0.48%) HBV prevalence were generated to test the performance of five methods: the original incidence/window-period model based solely on HBsAg, its modification by Soldan in 2003, the Müller-Breitkreutz model, the HBsAg yield model, and its extension to include anti-HBc seroconversions within a year. The last model was closest to the true values of residual risk and had smallest variation of the estimates in both high and low prevalence data. It may be used for residual risk evaluation in relatively small samples, such as regional blood banks data. Emil Kupek Copyright © 2013 Emil Kupek. All rights reserved. Combating STI Epidemic: Community Perspectives Learned from Mixed-Gender Focus Group Study Thu, 30 May 2013 09:20:09 +0000 Background. Since 2004, Douglas County in Nebraska has been experiencing higher rates of sexually transmitted infections (STIs) than the rest of the state. Northern Omaha has been considered to be one of the “hot spots” for STIs in the county. In 2011-2012, a focus group study was conducted to investigate the community’s perception of STIs and to identify strategies to increase the testing and treatment of STIs. Methods. Fourteen young adults were recruited to participate in two mixed-gender focus group sessions, each lasting 1.5 hours. Sessions covered various topics on STIs. Audio-recorded sessions were transcribed and analyzed by the study team. Results. Participants were aware of the STI problem in their community. They identified risk factors for STIs included careless sexual behavior, unprotected sex, and lack of communication with parents. Participants believed that the club environment and drug and alcohol use contribute to risky sexual behavior. Participants perceived lack of confidentiality as the most important barrier to getting tested. The most important reason for not seeking treatment was lack of awareness about the signs of infection. Participants called for measures to increase trustworthy relationships with the health care system and suggested opening more testing and treatment sites. Discussion. The uniqueness of our study is that it is the first conducted epidemiological study in this population to better understand risk factors of STIs specific to this population. The study identified several important factors that may assist in future interventions to reduce STIs in this population. K. M. Islam, Laura Vinson, Sherri Nared, Ira Combs, Melissa Tibbits, Shinobu Watanabe-Galloway, and Ruth Margalit Copyright © 2013 K. M. Islam et al. All rights reserved. Trichomonas vaginalis Infection among Pregnant Women in Jimma University Specialized Hospital, Southwest Ethiopia 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. Abdurehman Eshete, Zeleke Mekonnen, and Ahmed Zeynudin Copyright © 2013 Abdurehman Eshete et al. All rights reserved. The Effect of HIV/AIDS Education on Adolescents in Trinidad and Tobago 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. Vanessa Jones, Naomi Modeste, Helen Hopp Marshak, and Curtis Fox Copyright © 2013 Vanessa Jones et al. All rights reserved. Genital Infections of HIV-Infected Women Assisted by a Specialized Service 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. Caroline Acquaro, Marli Teresinha C. Duarte, and Lenice do Rosário de Souza Copyright © 2013 Caroline Acquaro et al. All rights reserved. Sexual Practices and HIV Prevalence amongst Men Who Have Sex with Men at a Community-Based Voluntary Counseling and Testing Centre in Malaysia 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. K. C. Koh, K. Kanagalingam, F. T. Tai, and A. Kamarulzaman Copyright © 2013 K. C. Koh et al. All rights reserved. Prevalence of Treatment Failure among Pulmonary Tuberculosis Patients in Federal Medical Centre, Gombe, Northeastern Nigeria 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. Y. B. Jibrin, A. B. Ali, S. T. Saad, and P. M. Kolo Copyright © 2013 Y. B. Jibrin et al. All rights reserved. Impact of Long-Lasting Insecticidal Nets and Indoor Residual Sprayings on Susceptibility of Anopheles gambiae (Diptera: Culicidae) in Western Côte d'Ivoire 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. Mahama Touré, Pierre Carnevale, and Fabrice Chandre Copyright © 2013 Mahama Touré et al. All rights reserved. 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. Dominic B. Dery, Guillaume K. Ketoh, Joseph Chabi, George Apetogbo, Isabelle A. Glitho, Thierry Baldet, and Jean-Marc Hougard Copyright © 2013 Dominic B. Dery et al. All rights reserved. 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. Hakima Kabbaj, Myriam Seffar, Bouchra Belefquih, Dalal Akka, Najat Handor, Morad Amor, and Ahmed Essaid Alaoui Copyright © 2013 Hakima Kabbaj et al. All rights reserved. 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. Irene Tami-Maury, James Willig, Pauline Jolly, Sten H. Vermund, Inmaculada Aban, Jeff Hill, and Craig M. Wilson Copyright © 2013 Irene Tami-Maury et al. All rights reserved. Paragonimiasis Reemergence in Nigeria: Predisposing Factors and Recommendations for Early Intervention and Everlasting Eradication 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. Reginald A. Eke, Udochi M. Nwosu, Ezinne E. Enwereji, and Chima V. Emerole Copyright © 2013 Reginald A. Eke et al. All rights reserved. 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. Gouri Sankar Bhunia, Shreekant Kesari, Nandini Chatterjee, Vijay Kumar, and Pradeep Das Copyright © 2013 Gouri Sankar Bhunia et al. All rights reserved. Current Status of Schistosoma mansoni Infections and Associated Risk Factors among Students in Gorgora Town, Northwest Ethiopia 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. Tarko Essa, Yemane Birhane, Mengistu Endris, Asmeret Moges, and Feleke Moges Copyright © 2013 Tarko Essa et al. All rights reserved. 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. Fuzhan Parhizgar, Jane Colmer-Hamood, Jodene Satterwhite, Richard Winn, and Kenneth Nugent Copyright © 2013 Fuzhan Parhizgar et al. All rights reserved.