Journal of Tropical Medicine The latest articles from Hindawi Publishing Corporation © 2015 , Hindawi Publishing Corporation . All rights reserved. Mycological Pattern of Dermatomycoses in a Tertiary Care Hospital Wed, 30 Sep 2015 13:14:54 +0000 Background. Dermatomycoses are not diseases requiring compulsory notifications; rather they cause cosmetic defacements. Indian subcontinent with a varied topography is favorable for various fungal infections. Objective. To look for the epidemiological and mycological profile of superficial mycoses in North India. Methods. Three hundred and fifty-one clinical samples of skin, hair, and nail were examined to find the fungal etiology of the dermatomycoses. Results. Dermatomycoses were seen in 215/351 (61.2%) of cases. Most common isolates obtained were nondermatophyte molds (NDMs) (36.1%), followed by dermatophytes (13.8%) and yeasts (8.6%). Aspergillus niger (9%) was the most common mold. Trichophyton rubrum (4.6%) was the most common dermatophyte isolated, while amongst the yeasts Non-albicans Candida (NAC) species were more common (6%). Many other NDMs like Syncephalastrum spp., Cunninghamella spp., Rhodotorula spp., A. terreus, Scytalidium spp. and Scopulariopsis spp. were also isolated. Conclusion. Our study reflects an increasing role of NDMs (thought to be normal laboratory or environmental contaminants) as a causative agent of dermatomycoses, replacing the dermatophytes. Clinician’s awareness of the demographic profile of the population involved along with more studies on dermatomycoses can help in understanding the etiological profile in area, leading to prevention of disease occurrence and cosmetic disfigurement. Ravinder Kaur, Pragyan Swagatika Panda, Kabir Sardana, and Sahanawaj Khan Copyright © 2015 Ravinder Kaur et al. All rights reserved. Clinical Presentation, Aetiology, and Outcomes of Meningitis in a Setting of High HIV and TB Prevalence Wed, 30 Sep 2015 09:26:18 +0000 Meningitis causes significant morbidity and mortality globally. The aim of this study was to study the clinical presentation, aetiology, and outcomes of meningitis among adult patients admitted to Queen Mamohato Memorial Hospital in Maseru, Lesotho, with a diagnosis of meningitis. A cross-sectional study was conducted between February and April 2014; data collected included presenting signs and symptoms, laboratory results, and clinical outcomes. Descriptive statistics were used to summarise data; association between variables was analysed using Fisher’s exact test. 56 patients were enrolled; the HIV coinfection rate was 79%. The most common presenting symptoms were altered mental status, neck stiffness, headache, and fever. TB meningitis was the most frequent diagnosis (39%), followed by bacterial (27%), viral (18%), and cryptococcal meningitis (16%). In-hospital mortality was 43% with case fatalities of 23%, 40%, 44%, and 90% for TB, bacterial, cryptococcal, and viral meningitis, respectively. Severe renal impairment was significantly associated with mortality. In conclusion, the causes of meningitis in this study reflect the high prevalence of HIV and TB in our setting. Strategies to reduce morbidity and mortality due to meningitis should include improving diagnostic services to facilitate early detection and treatment of meningitis and timely initiation of antiretroviral therapy in HIV-infected patients. Keneuoe Hycianth Thinyane, Keanole Mofona Motsemme, and Varsay Jim Lahai Cooper Copyright © 2015 Keneuoe Hycianth Thinyane et al. All rights reserved. Amodiaquine and Ciprofloxacin Combination in Plasmodiasis Therapy Tue, 29 Sep 2015 13:28:18 +0000 Objective. The study was designed to determine the efficacy of combined Amodiaquine and Ciprofloxacin in plasmodiasis therapy. Method. The in vivo antiplasmodial effect of different dosage levels of Amodiaquine, Ciprofloxacin, and their combinations against Plasmodium berghei berghei was evaluated using Swiss albino mice. Results. Amodiaquine (a known antiplasmodial agent) had a fairly significant antiplasmodial effect reducing the parasites for every 100 red blood cells (RBC) from 66 to 16 (75.75%) at the tolerable dosage level of 7.5 mg/kg body weight while Ciprofloxacin (an antibiotic known to have antimalarial effect) showed an insignificant antiplasmodial effect reducing the parasites for every 100 RBC from 65 to 64 (1.53%) at the tolerable dosage level of 10.7 mg/kg body weight. Conversely, the combination therapy of Amodiaquine and Ciprofloxacin had a significant antiplasmodial effect at all the doses administered. The combination of 7.5 mg/kg of Amodiaquine and 12.8 mg/kg of Ciprofloxacin, however, showed the most significant antiplasmodial effect of the doses used reducing the number of parasites per 100 RBC from 60 to 10 (83.33%). Conclusions. Appropriate Amodiaquine and Ciprofloxacin combination will be effective for the treatment of malaria and better than either Amodiaquine or Ciprofloxacin singly at their recommended dosage levels. Peace Mayen Edwin Ubulom, Chinweizu Ejikeme Udobi, and Mark Iheukwumere Madu Copyright © 2015 Peace Mayen Edwin Ubulom et al. All rights reserved. Prevalence of Intestinal Protozoa among Saudi Patients with Chronic Renal Failure: A Case-Control Study Mon, 28 Sep 2015 08:10:07 +0000 It has been hypothesized that chronic renal failure (CRF) predisposes patients to infection with intestinal protozoa. We tested this hypothesis with a matched case-control study to determine the prevalence of these protozoa and their diarrhea associated symptoms among 50 patients with CRF (cases) from Taif, western Saudi Arabia. Fifty diarrheal patients without CRF were recruited in the study as controls. Participants were interviewed by a structured questionnaire and stool samples were collected. Samples were thoroughly examined with microscopy and three coproantigens detection kits. Enteric protozoa were detected in 21 cases and 14 controls. Blastocystis spp. were the most predominant parasite (16% in cases versus 8% in controls), followed by Giardia duodenalis (10% in cases versus 12% in controls) and Cryptosporidium spp. (10% in cases versus 6% in controls). Cyclospora cayetanensis was identified in two cases, while Entamoeba histolytica was described in one case and one control. Intestinal parasitism was positively associated with the male gender, urban residence, and travel history. Clinical symptoms of nausea/vomiting and abdominal pain were significantly varied between the parasitized cases and controls (P value 0.05). Given the results, we recommend screening all diarrheal feces for intestinal protozoa in the study’s population, particularly those with CRF. Yousry A. Hawash, Laila Sh. Dorgham, El-Amir M. Amir, and Osama F. Sharaf Copyright © 2015 Yousry A. Hawash et al. All rights reserved. Newer Classification System for Fissured Tongue: An Epidemiological Approach Sun, 20 Sep 2015 12:37:09 +0000 Introduction. Fissured tongue is a commonly encountered tongue disorder in dental practice. But there is a lack of data on different pattern, severity, and association of fissuring with various systemic disorders and other tongue anomalies. This study attempts to establish a classification system for fissured tongue and to know the correlation with the systemic health and other disorders of the tongue. Materials and Methods. A total of 1000 subjects between the age groups of 10 and 80 years were included in the study. Pattern of fissuring, allied systemic diseases, and related tongue anomalies were tabulated. Results. Out of 1000 subjects, 387 subjects presented with fissured tongue. Out of 387 subjects, hypertension was present in 57 cases, 18 subjects had diabetes, and 3 subjects had both hypertension and diabetes. Central longitudinal type was found to be the most common type of tongue fissuring. Conclusion. Fissured tongue has been found to be associated with certain systemic disease and further researches are required to know positive correlation. If a correlation exists, such disorders could be diagnosed earlier by identifying fissured tongue at an earlier age. Ramachandran Sudarshan, G. Sree Vijayabala, Y. Samata, and A. Ravikiran Copyright © 2015 Ramachandran Sudarshan et al. All rights reserved. Cytokine Profiles and Cell Proliferation Responses to Truncated ORF2 Protein in Iranian Patients Recovered from Hepatitis E Infection Tue, 15 Sep 2015 14:09:58 +0000 Background. The aim of this study was to evaluate hepatitis E virus (HEV) specific cellular immune responses to truncated ORF2 protein in Iranian patients recovered from HEV infection. Information about HEV-specific immune responses could be useful in finding an effective way for development of HEV vaccine. Methods. A truncated form of HEV ORF2 protein containing amino acids 112-608 was used to stimulate peripheral blood mononuclear cells (PBMCs) separated from HEV-recovered and control groups. Finally, the levels of four cytokines, IFN-γ ELISPOT, and cell proliferative responses following stimulation with the truncated ORF2 protein were assessed in the both groups. Results. The truncated ORF2 protein was able to induce IFN-γ ELISPOT and cell proliferation responses and to produce significant amounts of IFN-γ and IL-12 cytokines, but low amounts of IL-10 and IL-4 cytokines in vitro. These responses were significantly higher in the recovered group compared to the control group. These results indicate the antigenic nature of the truncated ORF2 protein and production of T helper type 1 cytokines. Conclusion. The truncated ORF2 protein can effectively induce significant cellular immune responsesand can be introduced as a potential vaccine candidate. However, further studies are required to evaluate this protein in vivo. Reza Taherkhani, Fatemeh Farshadpour, Manoochehr Makvandi, Hamid Rajabi Memari, Ali Reza Samarbafzadeh, Nasrin Sharifi, Behrouz Naeimi, Saeed Tajbakhsh, and Samad Akbarzadeh Copyright © 2015 Reza Taherkhani et al. All rights reserved. Short-Course Induction Treatment with Intrathecal Amphotericin B Lipid Emulsion for HIV Infected Patients with Cryptococcal Meningitis Thu, 10 Sep 2015 08:57:08 +0000 Cryptococcal meningitis (CM) is a common cause of death among HIV infected patients in developing countries, especially in sub-Saharan Africa. In this observational HIV cohort study in a resource-limited setting in India, we compared the standard two-week intravenous amphotericin B deoxycholate (AmBd) (Regimen I) with one week of intravenous AmBd along with daily therapeutic lumbar punctures and intrathecal AmB lipid emulsion (Regimen II) during the intensive phase of CM treatment. 78 patients received Regimen I and 45 patients received Regimen II. After adjustment for baseline characteristics (gender, age, altered mental status or seizures at presentation, CD4 cell count, white blood cells, cerebrospinal fluid white cells, and haemoglobin), the use of Regimen II was associated with a significant relative risk reduction in mortality (adjusted hazard ratio 0.4, 95% confidence interval, 0.22–0.76) and 26.7% absolute risk reduction (95% confidence interval, 9.9–43.5) at 12 weeks. The use of Regimen II resulted in lower costs of drugs and hospital admission days. Since the study is observational in nature, we should be cautious about our results. However, the good tolerability of intrathecal administration of AmB lipid emulsion and the clinically important mortality reduction observed with the short-course induction treatment warrant further research, ideally through a randomized clinical trial. Gerardo Alvarez-Uria, Manoranjan Midde, Raghavakalyan Pakam, Pradeep Sukumar Yalla, Praveen Kumar Naik, and Raghuprakash Reddy Copyright © 2015 Gerardo Alvarez-Uria et al. All rights reserved. Prevalence and Pattern of Soil-Transmitted Helminthic Infection among Primary School Children in a Rural Community in Imo State, Nigeria Mon, 07 Sep 2015 12:17:31 +0000 Background. Soil-transmitted helminthic infection is a common public health challenge of primary school children in resource challenged and developing countries. Our aim was to determine the prevalence and pattern of soil-transmitted helminthic infection among primary school children in a rural community in Imo State, Nigeria. Method. The study involved a cross-sectional survey of 284 primary school children in a rural community. Results. The overall prevalence of soil-transmitted helminthic infection (STHI) was 30.3%. Of all STHIs, hookworm was the commonest geohelminth observed, 81 (94.2%). The prevalence of soil-transmitted helminthic infection was more in males, 58 (38.4%), than in females, 28 (21.1%). This difference was statistically significant (). Conclusion. The high prevalence rate of soil-transmitted helminthic infection amongst the study population is worrisome. There is need for organized and routine deworming among school children in the community. Kelechi Kenneth Odinaka, Emeka Charles Nwolisa, Francis Mbanefo, Alfreda Chinekwu Iheakaram, and Seline Okolo Copyright © 2015 Kelechi Kenneth Odinaka et al. All rights reserved. Clinicoradiological Profile of Lower Lung Field Tuberculosis Cases among Young Adult and Elderly People in a Teaching Hospital of Madhya Pradesh, India Tue, 25 Aug 2015 14:16:50 +0000 Aim. To study the clinical and radiological features of lower lung field tuberculosis (LLFTB) in relation to the patients of nonlower lung field tuberculosis (non-LLFTB). Material and Methods. All the patients of lower lung field tuberculosis defined by the lesions below an arbitrary line across the hila in their chest X-rays were included in the study. Their sputum for acid fast bacilli, HIV, blood sugar, and other relevant investigations were performed. Results. The total of 2136 cases of pulmonary tuberculosis was studied. Among them 215 (10%) cases of patients were diagnosed as the case of lower lung field tuberculosis. Females (62%) were more commonly affected. Most common clinical feature in non-LLFTB was cough (69%) followed by fever (65%), chest pain (54.7%), and weight loss (54.4%). Chest X-ray showed predominance of right side (60.9%) in cases of LLFTB. The relative risk of having the LLFTB in diabetes patients, HIV seropositive patients, end stage renal disease patients, and patients on corticosteroid therapy was high. Conclusion. Lower lung field tuberculosis is not an uncommon entity. It is more common in diabetes, HIV positive, end stage renal disease, and corticosteroid treated patients. Clinical and radiological features are different from upper lobe tuberculosis patients. Saurabh Kumar Singh and Kamlesh Kumar Tiwari Copyright © 2015 Saurabh Kumar Singh and Kamlesh Kumar Tiwari. All rights reserved. Protective Effect of Aqueous Crude Extract of Neem (Azadirachta indica) Leaves on Plasmodium berghei-Induced Renal Damage in Mice Tue, 25 Aug 2015 10:14:04 +0000 Malaria is a major public health problem in the world because it can cause of death in patients. Malaria-associated renal injury is associated with 45% of mortality in adult patients hospitalized with severe form of the disease. Therefore, new plant extracts to protect against renal injury induced by malaria infection are urgently needed. In this study, we investigated the protective effect of aqueous crude extract of Azadirachta indica (neem) leaves on renal injury induced by Plasmodium berghei ANKA infection in mice. ICR mice were injected intraperitoneally with 1 × 107 parasitized erythrocytes of PbANKA, and neem extracts (500, 1,000, and 2,000 mg/kg) were given orally for 4 consecutive days. Plasma blood urea nitrogen (BUN) and creatinine levels were subsequently measured. Malaria-induced renal injury was evidenced as marked increases of BUN and creatinine levels. However, the oral administration of neem leaf extract to PbANKA infected mice for 4 days brought back BUN and creatinine levels to near normalcy, and the highest activity was observed at doses of 1,000 and 2,000 mg/kg. Additionally, no toxic effects were found in normal mice treated with this extract. Hence, neem leaf extract can be considered a potential candidate for protection against renal injury induced by malaria. Voravuth Somsak, Sukanya Chachiyo, Ubonwan Jaihan, and Somrudee Nakinchat Copyright © 2015 Voravuth Somsak et al. All rights reserved. Determinants of Adherence with Malaria Chemoprophylactic Drugs Used in a Traveler’s Health Clinic Mon, 24 Aug 2015 12:24:32 +0000 Background. The WHO recommends mefloquine, atovaquone/proguanil, and doxycycline for malaria chemoprophylaxis. Adherence to a drug is determined by many factors. Objective. To detect the determinants of travelers’ adherence to malaria chemoprophylaxis. Methods. A prospective comparative study was conducted from January 2012 to July 2013 that included travelers (928 travelers) to malaria endemic countries who visited the THC. They were classified into 3 groups: the 1st is the mefloquine group (396 travelers), the 2nd is the doxycycline group (370 travelers), and finally those who did not receive any drugs (162 travelers). The participants from the 1st and 2nd groups enrolled in the study. Results. Univariate and multivariate analyses were performed. The predictors for adherence in the mefloquine group were travel to an African destination [OR = 51 (6.8–2385)], higher than a secondary school education [OR = 21 (4.1–144.2)], organized travel [OR = 4 (2.1–6.5)], traveling for leisure [OR = 2.1 (1.1–0.4)], and nationality [OR = 2 (1.11–4.00)]. In the doxycycline group, the predictors included higher than a secondary education [OR = 20.1 (4.5–125.1)], organized travel [OR = 11.4 (5.5–20.9)], travel for leisure [OR = 7 (2.3–22.9)], travel to an African destination [OR = 6.1 (0.41–417)], and nationality [OR = 4.5 (2.3–9.5)]. Conclusion. Adherence with malaria chemoprophylaxis could be affected by many factors such as nationality, education, and organized travel. Ibrahim Shady Copyright © 2015 Ibrahim Shady. All rights reserved. Voluntary Counseling and Testing for HIV in Rural Area of Democratic Republic of the Congo: Knowledge, Attitude, and Practice Survey among Service Users Sun, 09 Aug 2015 09:44:42 +0000 Aims. To determine the prevalence of HIV, the level of sexual risk for HIV, and determinants of VCT attendance among adult population living in a rural area. Methods. A cross-sectional study was conducted in Mbanza-Ngungu, Democratic Republic of the Congo. An anonymous questionnaire was designed to extract relevant data. Results. In our cohort, 69% were respondents of more than 24 years of age and the single marital status was most represented (64.1%). A high proportion of respondents (90.6%) visited VCT service for requiring information (good acceptability). Positive test for HIV was reported in 9.4% of respondents. In this cohort, 49.6% of respondents had declared themselves to never use condom. In binary analysis, there was association between positive HIV test and age () and religions (). In this cohort, it was observed that positive HIV test was significantly associated with confidentiality (). However, there was no association between positive HIV test and condom use (), knowledge of VCT (), service requested (), and previous HIV test (). Conclusions. Preventive information for AIDS should be recommended in the population living in rural zone. Mida Kautako-Kiambi, Mathilde B. Ekila, Smith Kama-Lemba, Roger Wumba, and Michel N. Aloni Copyright © 2015 Mida Kautako-Kiambi et al. All rights reserved. End Stage Renal Disease: Seroprevalence of Hepatitises B and C along with Associated Aetiology and Risk Factors in Children Wed, 05 Aug 2015 13:00:00 +0000 Background. End Stage Renal Disease (ESRD) normally requires dialysis or transplantation for survival. Since ESRD patients are on long term dialysis, infections such as Hepatitis B (HBV) and Hepatitis C (HCV) are commonly reported. Methods. This was a retrospective study carried out at a government hospital during a 12-month period from January 2013 to December 2013. The data was collected using a predesigned pro forma to note the etiology, gender, age, and HBsAg and anti-HCV test result of each patient. Results. 444 children suffering from ESRD were included in our analysis. The mean age of sample was 12.7 ± 4.1 years. Sixty percent () of the children were boys. The most common etiology of ESRD was kidney stones (, 29.3%). HBV was positive in 11 children (2.5%) while HCV was positive in 13 (2.9%). Conclusion. This study asserts the need for carrying out further work to confirm these findings and expand our recommendations. It is imperative to reliably determine the burden of HBV and HCV disease and to determine the aetiology of their spread especially in children with ESRD. Syed Raza Shah, Muhammad Shahzeb Khan, Muhammad Tanveer Alam, Adnan Salim, Mehwish Hussain, and Areeba Altaf Copyright © 2015 Syed Raza Shah et al. All rights reserved. Physiological Age Structure and Leishmania spp. Detection in Phlebotomus (Larroussius) orientalis (Parrot, 1936) (Diptera: Psychodidae) at an Endemic Focus of Visceral Leishmaniasis in Northern Ethiopia Wed, 29 Jul 2015 09:51:48 +0000 Visceral leishmaniasis (VL) caused by Leishmania donovani is endemic in northern Ethiopia, where P. orientalis is the most important presumed vector. This study was designed to determine the physiological age structure and the occurrence of Leishmania infection in the vector of VL in Tahtay Adiyabo district, northern Ethiopia. Sand flies were collected using CDC light traps from peridomestic and agricultural fields between May 2011 and April 2012 and P. orientalis females were dissected for age determination and detection of Leishmania promastigotes. Sand flies were also analyzed for L. donovani detection using molecular methods. Of 1,282 P. orientalis examined for abdominal stages and age characterization, 66.2%, 28.2%, 4.1%, and 1.6% were unfed, freshly fed, half-gravid, and gravid. Parous rate in unfed females was 34.1% and 35.4% in peridomestic and agricultural fields, respectively. Out of 921 P. orientalis females dissected, one specimen (0.1%) was found naturally infected with promastigotes. Five pools (25 females) of unfed P. orientalis were also found with DNA of Leishmania spp. In particular, a single P. orientalis was positive for L. donovani (0.5%). Based on this and other evidences (abundance, human blood feeding, and xenodiagnostic studies), P. orientalis is the principal vector of VL in this endemic focus. Araya Gebresilassie, Ibrahim Abbasi, Oscar David Kirstein, Essayas Aklilu, Solomon Yared, Habte Tekie, Meshesha Balkew, Alon Warburg, Asrat Hailu, and Teshome Gebre-Michael Copyright © 2015 Araya Gebresilassie et al. All rights reserved. Perceptions about Eclampsia, Birth Preparedness, and Complications Readiness among Antenatal Clients Attending a Specialist Hospital in Kano, Nigeria Tue, 14 Jul 2015 11:10:10 +0000 Background. Eclampsia is a reliable indicator of poor birth preparedness and complications readiness. We determined perceptions about eclampsia, birth preparedness, and complications readiness among antenatal clients in Kano, Nigeria. Materials and Method. A cross-sectional design was used to study 250 randomly selected antenatal clients. Data was analyzed using SPSS 16.0. Result. The mean age of the respondents was 26.1 ± 6.4 years. The majority perceived that eclampsia is preventable through good ANC (76.4%) and hospital delivery (70.8%). Overall, 66.8% had good perception about eclampsia. Having at least secondary school education and multigravidity were associated with good perception about eclampsia on multivariate analysis. About a third (39.6%) of the mothers was less prepared. On binary logistic regression, good perception about eclampsia and multigravidity were associated with being very prepared for birth. Up to 37.6% were not ready for complications. Half (50.4%) knew at least three danger signs of pregnancy, and 30.0% donated blood or identified suitable blood donor. On multivariate analysis, having at least secondary school education, being very prepared for birth, and multigravidity emerged as the only predictors of the respondents’ readiness for complications. Conclusion and Recommendations. Health workers should emphasize the practicability of birth preparedness and complications readiness during ANC and in the communities, routinely review plans, and support clients meet-up challenging areas. The importance of girl-child education to at least secondary school should be buttressed. Umar Muhammad Lawan, Idris Usman Takai, and Hamza Ishaq Copyright © 2015 Umar Muhammad Lawan et al. All rights reserved. Adherence to Artemisinin-Based Combination Therapy for the Treatment of Uncomplicated Malaria: A Systematic Review and Meta-Analysis Thu, 28 May 2015 13:47:37 +0000 Adherence to artemisinin-based combination therapy (ACT) is not clearly defined. This meta-analysis determines the prevalence and predictors of adherence to ACT. Twenty-five studies and six substudies met the inclusion criteria. The prevalence of ACT adherence in the public sector was significantly higher compared to retail sector (76% and 45%, resp., ). However, ACT adherence was similar across different ACT dosing regimens and formulations. In metaregression analysis prevalence estimates of adherence significantly decrease with increasing year of study publication . Factors found to be significant predictors of ACT adherence were years of education ≥ 7 odds ratio (OR) (95% CI) = 1.63 (1.05–2.53), higher income 2.0 (1.35–2.98), fatty food 4.6 (2.49–8.50), exact number of pills dispensed 4.09 (1.60–10.7), and belief in traditional medication for malaria 0.09 (0.01–0.78). The accuracy of pooled estimates could be limited by publication bias, and differing methods and thresholds of assessing adherence. To improve ACT adherence, educational programs to increase awareness and understanding of ACT dosing regimen are interventions urgently needed. Patients and caregivers should be provided with an adequate explanation at the time of prescribing and/or dispensing ACT. Ahmad M. Yakasai, Muhammad Hamza, Mahmood M. Dalhat, Musa Bello, Muktar A. Gadanya, Zuwaira M. Yaqub, Daiyabu A. Ibrahim, and Fatimah Hassan-Hanga Copyright © 2015 Ahmad M. Yakasai et al. All rights reserved. A Prospective Study of Tuberculosis Drug Susceptibility in Sabah, Malaysia, and an Algorithm for Management of Isoniazid Resistance Mon, 09 Mar 2015 09:27:27 +0000 Introduction. The burden of tuberculosis is high in eastern Malaysia, and rates of Mycobacterium tuberculosis drug resistance are poorly defined. Our objectives were to determine M. tuberculosis susceptibility and document management after receipt of susceptibility results. Methods. Prospective study of adult outpatients with smear-positive pulmonary tuberculosis (PTB) in Sabah, Malaysia. Additionally, hospital clinicians accessed the reference laboratory for clinical purposes during the study. Results. 176 outpatients were enrolled; 173 provided sputum samples. Mycobacterial culture yielded M. tuberculosis in 159 (91.9%) and nontuberculous Mycobacterium (NTM) in three (1.7%). Among outpatients there were no instances of multidrug resistant M. tuberculosis (MDR-TB). Seven people (4.5%) had isoniazid resistance (INH-R); all were switched to an appropriate second-line regimen for varying durations (4.5–9 months). Median delay to commencement of the second-line regimen was 13 weeks. Among 15 inpatients with suspected TB, 2 had multidrug resistant TB (one extensively drug resistant), 2 had INH-R, and 4 had NTM. Conclusions. Current community rates of MDR-TB in Sabah are low. However, INH-resistance poses challenges, and NTM is an important differential diagnosis in this setting, where smear microscopy is the usual diagnostic modality. To address INH-R management issues in our setting, we propose an algorithm for the treatment of isoniazid-resistant PTB. Muhammad Redzwan S. Rashid Ali, Uma Parameswaran, Timothy William, Elspeth Bird, Christopher S. Wilkes, Wai Khew Lee, Tsin Wen Yeo, Nicholas M. Anstey, and Anna P. Ralph Copyright © 2015 Muhammad Redzwan S. Rashid Ali et al. All rights reserved. Health-Seeking Behaviors and Self-Care Practices of People with Filarial Lymphoedema in Nepal: A Qualitative Study Wed, 28 Jan 2015 17:33:46 +0000 Background. Lymphatic filariasis is endemic in Nepal. This study aimed to investigate health-seeking behaviors and self-care practices of people with filarial Lymphoedema in Nepal. Methods. A cross-sectional study was conducted using qualitative methods in three endemic districts. Twenty-three patients with current Lymphoedema were recruited in the study. Results. Hydrocele was found to be a well-known condition and a major health problem in the studied communities. People with Lymphoedema primarily sought health care from traditional healers, whereas sometimes home-based care was their first treatment. Later Ayurvedic and allopathic hospital-based care were sought. Respondents reported various psychological problems such as difficulty in engaging in sexual intercourse, anxiety, worry and stress, depression, low self-esteem, feeling weak, fear of being abandoned, and fear of transmitting disease to the children. Standard foot care practices except washing were largely absent. Conclusions. Lymphoedema in the limbs and hydrocele were found to be major health problems. The traditional health care providers were the first contact of care for the majority of respondents. Only a few patients had been practicing standard foot care practices. Ram Kumar Adhikari, Jeevan Bahadur Sherchand, Shiva Raj Mishra, Kamal Ranabhat, Amrit Pokharel, Pramila Devkota, Durga Mishra, Yadu Chandra Ghimire, Khageshwor Gelal, Rajan Paudel, and Rajendra Raj Wagle Copyright © 2015 Ram Kumar Adhikari et al. All rights reserved. Patterns of Brucellosis Infection Symptoms in Azerbaijan: A Latent Class Cluster Analysis Sun, 14 Dec 2014 09:11:49 +0000 Brucellosis infection is a multisystem disease, with a broad spectrum of symptoms. We investigated the existence of clusters of infected patients according to their clinical presentation. Using national surveillance data from the Electronic-Integrated Disease Surveillance System, we applied a latent class cluster (LCC) analysis on symptoms to determine clusters of brucellosis cases. A total of 454 cases reported between July 2011 and July 2013 were analyzed. LCC identified a two-cluster model and the Vuong-Lo-Mendell-Rubin likelihood ratio supported the cluster model. Brucellosis cases in the second cluster (19%) reported higher percentages of poly-lymphadenopathy, hepatomegaly, arthritis, myositis, and neuritis and changes in liver function tests compared to cases of the first cluster. Patients in the second cluster had a severe brucellosis disease course and were associated with longer delay in seeking medical attention. Moreover, most of them were from Beylagan, a region focused on sheep and goat livestock production in south-central Azerbaijan. Patients in cluster 2 accounted for one-quarter of brucellosis cases and had a more severe clinical presentation. Delay in seeking medical care may explain severe illness. Future work needs to determine the factors that influence brucellosis case seeking and identify brucellosis species, particularly among cases from Beylagan. Rita Ismayilova, Emilya Nasirova, Colleen Hanou, Robert G. Rivard, and Christian T. Bautista Copyright © 2014 Rita Ismayilova et al. All rights reserved. Elevated Dengue Virus Nonstructural Protein 1 Serum Levels and Altered Toll-Like Receptor 4 Expression, Nitric Oxide, and Tumor Necrosis Factor Alpha Production in Dengue Hemorrhagic Fever Patients Thu, 11 Dec 2014 09:02:03 +0000 Background. During dengue virus (DV) infection, monocytes produce tumor necrosis factor alpha (TNF-α) and nitric oxide (NO) which might be critical to immunopathogenesis. Since intensity of DV replication may determine clinical outcomes, it is important to know the effects of viral nonstructural protein 1 (NS1) on innate immune parameters of infected patients. The present study investigates the relationships between dengue virus nonstructural protein 1 (NS1) serum levels and innate immune response (TLR4 expression and TNF-α/NO production) of DV infected patients presenting different clinical outcomes. Methodology/Principal Findings. We evaluated NO, NS1 serum levels (ELISA), TNF-α production by peripheral blood mononuclear cells (PBMCs), and TLR4 expression on CD14+ cells from 37 dengue patients and 20 healthy controls. Early in infection, increased expression of TLR4 in monocytes of patients with dengue fever (DF) was detected compared to patients with dengue hemorrhagic fever (DHF). Moreover, PBMCs of DHF patients showed higher NS1 and lower NO serum levels during the acute febrile phase and a reduced response to TLR4 stimulation by LPS (with a reduced TNF-α production) when compared to DF patients. Conclusions/Significance. During DV infection in humans, some innate immune parameters change, depending on the NS1 serum levels, and phase and severity of the disease which may contribute to development of different clinical outcomes. Denise Maciel Carvalho, Fernanda Gonçalves Garcia, Ana Paula Sarreta Terra, Ana Cristina Lopes Tosta, Luciana de Almeida Silva, Lúcio Roberto Castellano, and David Nascimento Silva Teixeira Copyright © 2014 Denise Maciel Carvalho et al. All rights reserved. Seroepidemiology of Toxoplasma gondii amongst Pregnant Women in Jazan Province, Saudi Arabia Thu, 13 Nov 2014 11:49:18 +0000 Background. Toxoplasma gondii (T. gondii) is an obligate intracellular protozoan parasite of worldwide distribution. There is limited information about the seroprevalence of toxoplasmosis in the southern area of Saudi Arabia. The current study was carried out to determine the prevalence of T. gondii in pregnant women in Jazan province. Materials and Methods. The study was conducted between January and June 2013 and included 195 pregnant women, data on sociodemographic and predisposing factors were collected from each participant. Venous blood samples were collected following standard operating procedures. Serological analysis for latent toxoplasmosis (levels of IgG) and active toxoplasmosis (IgM) was done using Enzyme Linked Immunosorbent Assay (ELISA). Results. The overall seroprevalence of T. gondii in the study area was 24.1%. The seroprevalence of anti-Toxoplasma IgG was 20% (39 out of 195), whereas IgM seropositivity was 6.2% (12 out of 195). Only 4 pregnant women tested positive for both IgG and IgM. The highest IgG and IgM seroprevalence was among the study participants aged 35 to 39 years (13.5% and 35.1%, resp.). The seropositivity rate of T. gondii-specific antibodies was higher among pregnant women from the urban areas than those from rural communities (7.4% versus 0% and 21% versus 15.4% for IgM and IgG, resp.). Conclusions. The seroprevalence of T. gondii was high in pregnant woman in Jazan. The prevalence of toxoplasmosis increases with increase of age. Awareness health education program in Jazan needs to be maintained and developed to targeted pregnant women. Hussein Aqeely, Eman K. El-Gayar, Darakhshan Perveen Khan, Abdullah Najmi, Ayesha Alvi, Ibrahim Bani, Mohamed Salih Mahfouz, Saif Elden Abdalla, and Ibrahim M. Elhassan Copyright © 2014 Hussein Aqeely et al. All rights reserved. Absolute Lymphocyte Count Is Not a Suitable Alternative to CD4 Count for Determining Initiation of Antiretroviral Therapy in Fiji Mon, 27 Oct 2014 00:00:00 +0000 Introduction. An absolute lymphocyte count is commonly used as an alternative to a CD4 count to determine initiation of antiretroviral therapy for HIV-infected individuals in Fiji when a CD4 count is unavailable. Methods. We conducted a retrospective analysis of laboratory results of HIV-infected individuals registered at all HIV clinics in Fiji. Results. Paired absolute lymphocyte and CD4 counts were available for 101 HIV-infected individuals, and 96% had a CD4 count of ≤500 cells/mm3. Correlation between the counts in individuals was poor (Spearman rank correlation ). No absolute lymphocyte count could be determined in this population as a suitable surrogate for a CD4 count of either 350 cells/mm3 or 500 cells/mm3. The currently used absolute lymphocyte count of ≤2300 cells/μL had a positive predictive value of 87% but a negative predictive value of only 17% for a CD4 of ≤350 cells/mm3 and if used as a surrogate for a CD4 of ≤500 cells/mm3 it would result in all HIV-infected individuals receiving ART including those not yet eligible. Weight, CD4 count, and absolute lymphocyte count increased significantly at 3 months following ART initiation. Conclusions. Our findings do not support the use of absolute lymphocyte count to determine antiretroviral therapy initiation in Fiji. Dashika A. Balak, Karen Bissell, Christine Roseveare, Sharan Ram, Rachel R. Devi, and Stephen M. Graham Copyright © 2014 Dashika A. Balak et al. All rights reserved. A Descriptive Study of Nosocomial Infections in an Adult Intensive Care Unit in Fiji: 2011-12 Wed, 17 Sep 2014 08:42:01 +0000 Nosocomial infections in an intensive care unit (ICU) are common and associated with a high mortality but there are no published data from the Oceania region. A retrospective study in Fiji’s largest ICU (2011-12) reported that 114 of a total 663 adult ICU admissions had bacteriological culture-confirmed nosocomial infection. The commonest sites of infection were respiratory and bloodstream. Gram negative bacteria were the commonest pathogens isolated, especially Klebsiella pneumoniae (extended-spectrum β-Lactamase-producing), Acinetobacter, and Pseudomonas species. Mortality for those with a known outcome was 33%. Improved surveillance and implementation of effective preventive interventions are needed. Keshni Naidu, Ilisapeci Nabose, Sharan Ram, Kerri Viney, Stephen M. Graham, and Karen Bissell Copyright © 2014 Keshni Naidu et al. All rights reserved. Clinical, Molecular, and Epidemiological Analysis of Dengue Cases during a Major Outbreak in the Midwest Region of Minas Gerais, Brazil Thu, 10 Jul 2014 07:02:45 +0000 This study aims to perform the first molecular and clinical-epidemiological analysis of dengue cases in Divinopolis, MG, Brazil. Data from 4,110 cases of dengue were accessed and 190 clinical samples were collected for molecular analyses. In this study, 2.7% of the men and 3.0% of the women were admitted to hospital. There was no association between gender and hospital admission. The symptoms observed in this study are according to the Health Ministry, but fever was present in 82.2% and not in 100% of cases. The chance of hospital admission was 1.55 higher in patients with any kind of bleeding (334) and 2.4% of individuals without bleeding were also hospitalized due to other warning signs. In the molecular analyses, 23% of the samples were positive for DENV. DENV-2 and DENV-3 were identified in 2010, DENV-3 in 2011, DENV-1 in 2012, and DENV-1 and DENV-4 in 2013. DENV detection was possible in samples with only one day of symptoms. This first report of dengue data in Divinópolis provided more insight into the viral types and effects of disease in the city, confirming the need for caution in assessing cases of suspected dengue and for revision of the criteria proposed by the Health Ministry to classify cases of the disease. Juliana Cristina Duarte Braga, Leandro César da Silva, Jacqueline Domingues Tibúrcio, Mirna de Abreu e Silva, Lailah Horácio Sales Pereira, Karina Rocha Dutra, Jaqueline Maria Siqueira Ferreira, Débora de Oliveira Lopes, and Luciana Lara dos Santos Copyright © 2014 Juliana Cristina Duarte Braga et al. All rights reserved. Prevalence of Brucellosis among Women Presenting with Abortion/Stillbirth in Huye, Rwanda Sun, 29 Jun 2014 09:41:29 +0000 The incidence of human brucellosis is not documented in Rwanda despite several reports on the disease in cattle. Because brucellosis has been associated with abortion, the aim of this study was to investigate the prevalence of positive serology in women presenting with abortion and/or stillbirth. The study was done in Huye District, in the Southern Province of Rwanda, and the patients were recruited from both the University Teaching Hospital of Butare (CHUB) and Kabutare District Hospital. Serum samples were collected and the Rose Bengal plate test (RBPT) was performed on each sample. A questionnaire was also used to investigate potential contacts with animals and/or consumption of raw milk. A total of 60 women were recruited and 15 (i.e., 25%) were Brucella seropositive. The questionnaire showed that those with seropositivity either were in contact with domestic animals (cattle, goat, or sheep) or were consuming raw cow’s milk. Human brucellosis appears to be of public health importance in Rwanda and more attention should be drawn on the disease. The current study provides a basis for larger studies to establish the incidence of human brucellosis in Rwanda. More mechanistic studies will also demonstrate the pathogenicity of Brucella in human placentas. Nadine Rujeni and Léonidas Mbanzamihigo Copyright © 2014 Nadine Rujeni and Léonidas Mbanzamihigo. All rights reserved. Thrombocytopenia in Plasmodium vivax Malaria: How Significant? Tue, 17 Jun 2014 10:46:00 +0000 Introduction. Thrombocytopenia is frequently noticed with P. falciparum malaria but is less reported and studied with P. vivax. Materials and Methods. The study was conducted in the Department of Medicine, SBKS MI & RC, Pipariya. We included patients who were diagnosed with vivax malaria. The data regarding their clinical and hematological profile was collected and analysed. Result. A total of 66 patients were included. 42 (63%) had platelet count <100000/mm3. Mean platelet count was 1,18,650, range being 8000/mm3–6,10,000/mm3. Amongst those with thrombocytopenia, 16 (38.09%) had anemia, 14 (33.33%) had serum creatinine >1.2 gm/dL, 15 (35.71%) had jaundice (s. bilirubin > 1.2), 2 (4.76%) had altered sensorium, 6 (14.28%) had ARDS, 2 needed ventilator support, and 1 expired. Amongst those with normal platelet count, 5 (20.83%) had anemia and 1 had jaundice whereas none had elevated s. creatinine, altered sensorium, or lung involvement. Conclusion. Thrombocytopenia is now being seen more commonly with vivax malaria. Patients with platelet count <1 lac/cumm have more severe disease. Arti Muley, Jitendra Lakhani, Saurabh Bhirud, and Abhinam Patel Copyright © 2014 Arti Muley et al. All rights reserved. Clinical, Laboratory, and Management Profile in Patients of Liver Abscess from Northern India Wed, 04 Jun 2014 12:14:44 +0000 Objective. To describe the clinical profile, microbiological aetiologies, and management outcomes in patients with liver abscess. Methods. A cross-sectional study was conducted from May, 2011, to April, 2013, on 200 consecutive liver abscess patients at PGIMER and Dr. RML Hospital, New Delhi. History, examination, and laboratory investigations were recorded. Ultrasound guided aspiration was done and samples were investigated. Chi-square test and multivariate regression analysis were performed to test association. Results. The mean age of patients was 41.13 years. Majority of them were from lower socioeconomic class (67.5%) and alcoholic (72%). The abscesses were predominantly in right lobe (71%) and solitary (65%). Etiology of abscess was 69% amoebic, 18% pyogenic, 7.5% tubercular, 4% mixed, and 1.5% fungal. Percutaneous needle aspiration was done in 79%, pigtail drainage in 17%, and surgical intervention for rupture in 4% patients. Mortality was 2.5%, all reported in surgical group. Solitary abscesses were amoebic and tubercular whereas multiple abscesses were pyogenic (). Right lobe was predominantly involved in amoebic and pyogenic abscesses while in tubercular abscesses left lobe involvement was predominant (). Conclusions. The commonest presentation was young male, alcoholic of low socioeconomic class having right lobe solitary amoebic liver abscess. Appropriate use of minimally invasive drainage techniques reduces mortality. Soumik Ghosh, Sourabh Sharma, A. K. Gadpayle, H. K. Gupta, R. K. Mahajan, R. Sahoo, and Naveen Kumar Copyright © 2014 Soumik Ghosh et al. All rights reserved. Frequency and Clinical Manifestations of Dengue in Urban Medellin, Colombia Thu, 29 May 2014 09:28:32 +0000 A dengue fever surveillance study was conducted at three medical facilities located in the low-income district of San Javier in Medellin, Colombia. During March 2008 to 2009, 781 patients with fever regardless of chief complaint were recruited for acute dengue virus infection testing. Of the 781 tested, 73 (9.3%) were positive for dengue infection. Serotypes DENV-2 (77%) and -3 (23%) were detected by PCR. One patient met the diagnostic criteria for dengue hemorrhagic fever. Only 3 out of 73 (4.1%) febrile subjects testing positive for dengue infection were diagnosed with dengue fever by the treating physician. This study confirms dengue virus as an important cause of acute febrile illness in Medellin, Colombia, but it is difficult to diagnose without dengue diagnostic testing. Berta Nelly Restrepo, Mark E. Beatty, Yenny Goez, Ruth E. Ramirez, G. William Letson, Francisco J. Diaz, Leidy Diana Piedrahita, and Jorge E. Osorio Copyright © 2014 Berta Nelly Restrepo et al. All rights reserved. Evaluation of the In Vitro and In Vivo Antioxidant Potentials of Aframomum melegueta Methanolic Seed Extract Thu, 15 May 2014 07:27:04 +0000 Aframomum melegueta Schum (Zingiberaceae) is a perennial herb widely cultivated for its valuable seeds in the tropical region of Africa. The present study evaluated the antioxidant effects of methanolic seed extract of A. melegueta. The antioxidant effects were evaluated using in vitro, 2, 2-diphenylpicrylhydrazine photometric assay and in vivo serum catalase, superoxide dismutase and thiobarbituric acid reactive substance assay method. The extract (25–400 μg/mL concentration) produced concentration dependent increase in antioxidant activity in 2, 2-diphenylpicrylhydrazine photometric assay. The extract (400 mg/kg) showed a significant () increase in serum catalase and superoxide dismutase activity when compared with the control group. The extract (400 mg/kg) showed a significant () decrease in the serum level of thiobarbituric acid reactive substance when compared with the control group. These findings suggest that the seed of A. melegueta has potent antioxidant activity which may be responsible for some of its reported pharmacological activities and can be used as antioxidant supplement. Samuel Okwudili Onoja, Yusuf Ndukaku Omeh, Maxwell Ikechukwu Ezeja, and Martins Ndubuisi Chukwu Copyright © 2014 Samuel Okwudili Onoja et al. All rights reserved. Early Treatment with Intranasal Neostigmine Reduces Mortality in a Mouse Model of Naja naja (Indian Cobra) Envenomation Wed, 14 May 2014 10:05:26 +0000 Objective. Most snakebite deaths occur prior to hospital arrival; yet inexpensive, effective, and easy to administer out-of-hospital treatments do not exist. Acetylcholinesterase inhibitors can be therapeutic in neurotoxic envenomations when administered intravenously, but nasally delivered drugs could facilitate prehospital therapy for these patients. We tested the feasibility of this idea in experimentally envenomed mice. Methods. Mice received intraperitoneal injections of Naja naja venom 2.5 to 10 times the estimated LD50 and then received 5 μL neostigmine (0.5 mg/mL) or 5 μL normal saline by nasal administration. Animals were observed up to 12 hours and survivors were euthanized. Results. 100% of control mice died. Untreated mice injected with 2.5× LD50 Naja naja died at average 193 minutes after injection, while 10 of 15 (67%) of treated mice survived and were behaviorally normal by 6 hours (). In the 5× LD50 group, survival was prolonged from 45 minutes to 196 minutes () and for 10× LD50 mice, survival increased from 30 to 175 minutes (). Conclusion. This pilot suggests that intranasal drugs can improve survival and is the first direct demonstration that such an approach is plausible, suggesting means by which treatment could be initiated before reaching the hospital. Further investigation of this approach to neurotoxic and other types of envenomation is warranted. Matthew R. Lewin, Stephen P. Samuel, David S. Wexler, Philip Bickler, Sakthivel Vaiyapuri, and Brett D. Mensh Copyright © 2014 Matthew R. Lewin et al. All rights reserved.