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Improving access to safe delivery for poor pregnant women: a case study of vouchers plus health equity funds in three health districts in Cambodia
No full textWorsening and unmasking of tuberculosis in HIV-1 infected patients after initiating highly anti-retroviral therapy in Uganda
No full textObjectives
To determine the proportion of patients developing active tuberculosis (TB) versus that of patients who experience worsening of TB, after initiating highly active anti retroviral therapy (HAART).
Methods
Charts of HAART naïve patients with or without clinically activeTB who consecutively commenced HAART at Mulago Hospital Infectious Diseases Institute were reviewed. Patients were assessed for worsening of TB on treatment or development of new active TB (unmasking of TB) after initiating HAART.
Results
Of 271 patients without activeTB at baseline who initiated HAART, 16 (5.9%) developed activeTB within 6 months (early unmasking) and 10 (2.7%) after 6 months (late unmasking). Seven of 10 late unmasking patients had a past history of treatment for aTB disease episode. Of 45 patients who commenced HAART with coexisting active TB, 13 (29%) experienced worsening of TB symptoms, signs and/or radiological features. Nine of these 45 commenced HAART during the intensive phase of TB treatment, of whom 2 (22%) experienced worsening of TB. Thirty six of 45 started HAART during the continuation phase of TB treatment of whom 11 (31%), experienced worsening of TB. The median time from initiation of HAART to worsening of TB in patients on concurrent active TB treatment was 5 weeks, and 18 weeks to unmasking of new active tuberculosis.
Conclusion
Unmasking of TB was commonest in the first 6 months of HAART and declined in the subsequent months with most in the late unmasking group being TB recurrences. Worsening of TB occurred even after HAART was delayed to the continuation phase of TB treatment
Trends of norfloxacin and erythromycin resistance of Campylobacter jejuni/Campylobacter coli isolates recovered from international travelers, 1994 to 2006
No full textThe definitive version is available at www3.interscience.wiley.comBACKGROUND: Campylobacter sp. is a major cause of bacterial enterocolitis and travelers' diarrhea. Empiric treatment regimens include fluoroquinolones and macrolides. METHODS: Over the period 1994 to 2006, 724 Campylobacter jejuni/Campylobacter coli isolates recovered from international travelers at the outpatient clinic of the Institute of Tropical Medicine, Antwerp, Belgium, were reviewed for their susceptibility to norfloxacin and erythromycin. RESULTS: Norfloxacin resistance increased significantly over time in isolates from travelers returning from Asia, Africa, and Latin America. For the years 2001 to 2006, norfloxacin resistance rates were 67 (70.5%) of 95 for Asia, 20 (60.6%) of 33 for Latin America, and 36 (30.6%) of 114 for Africa. The sharpest increase was noted for India, with no resistance in 1994, but 41 (78.8%) of 52 resistant isolates found during 2001 to 2006. Erythromycin resistance was demonstrated in 20 (2.7%) isolates, with a mean annual resistance of 3.1% +/- 2.8%; resistance increased over time, with up to 3(7.5%) of 40 and 3 (8.6%) of 35 resistant isolates in 2004 and 2006, respectively (p < 0.05); there was no apparent geographic association. Combined resistance to norfloxacin and erythromycin was observed in five isolates. CONCLUSIONS: The high resistance rates to fluoroquinolones warrant reconsideration of their use as drugs of choice in patients with severe gastroenteritis when Campylobacter is the presumed cause. Continued monitoring of the incidence and the spread of resistant Campylobacter isolates is warranted
Presence of Trypanosoma theileri in Spanish cattle
No full textTrypanosoma theileri (Laveran, 1902) has been diagnosed in many countries and is commonly considered as a nonpathogenic hemoparasite, although some authors have described clinical signs in cattle infected with T. theileri. In April and May, 2005, 12 blood samples were received at the Exopol Diagnostic Laboratory (Zaragoza, Spain) from a Spanish bull-fighting farm located at Seville province. Clinical exploration of the animals revealed fever, progressive weight loss, anemia, and frequent recumbent position. Microscopic examination showed Theileria spp. in all cases (12), and in four of them, T. theileri was also observed. The clinical picture observed in the animals could be compatible with T. theileria infection. However, the contribution of T. theileri to the clinical signs seen at least in four cases is unknown. Further studies are necessary to determine the pathogenicity of T. theileri in the different animal species. To our knowledge, this is the first isolation of T. theileri in Spain
Waar en hoe ontstond de hiv-pandemie?
No full textAIDS has first been described in homosexual men in the United States in 1981. Still, the oldest known case of hiv infection was a resident of Kinshasa (Democratic Republic of Congo) whose blood was taken in 1959 and kept frozen for several decades.
The variability of hiv strains which circulate in the human population, has been used to estimate the likely date hiv was introduced in the human population. Thus it is thought that hiv entered the human population between 1890 and 1945.
Two types of HIV do exist, HIV-1 and HIV-2. The former is found mainly in West Africa and its ancestor appears to be a lentivirus that infects the sooty mangabey. This primate has its habitat in West Africa. HIV-1 is by far the most common HIV type and appears to have originated from Simian Immunodeficiency Viruses of the chimpanzee, Pan troglodytes troglodytes, whose habitat is situated in Central Africa.
Transmission of viruses from primates to humans occurred most likely through the consumption of bush meat and contact of humans with blood of infected animals
Diagnostic tests for kala-azar: a multi-centre study of the freeze-dried DAT, rK39 strip test and KAtex in East Africa and the Indian subcontinent
No full textThree diagnostic tests for visceral leishmaniasis (VL), the freeze-dried direct agglutination test (FD-DAT), the rK39 dipstick and a urine latex antigen test (KAtex), were evaluated for use in primary care in East Africa and the Indian subcontinent. Clinical suspects were prospectively recruited and tissue, blood and urine samples were taken. Direct microscopic examination of tissue smear, and FD-DAT, rK39 and KAtex were performed. Sensitivity and specificity with 95% credible intervals were estimated using Bayesian latent class analysis. On the Indian subcontinent both the FD-DAT and the rK39 strip test exceeded the 95% sensitivity and 90% specificity target, but not so in East Africa. Sensitivity of the FD-DAT was high in Ethiopia and Kenya but lower in Sudan, while its specificity was below 90% in Kenya. Sensitivity of the rK39 was below 80% in the three countries, and its specificity was only 70% in Ethiopia. KAtex showed moderate to very low sensitivity in all countries. FD-DAT and rK39 can be recommended for clinical practice on the Indian subcontinent. In East Africa, their clinical use should be carefully monitored. More work is needed to improve existing formats, and to develop better VL diagnostics
Influence of diet and photoperiod on development and reproduction of European populations of Harmonia axyridis (Pallas) (Coleoptera: Coccinellidae)
No full textEosinophilic meningitis due to Angiostrongylus cantonensis in a Belgian traveller
No full textEosinophilic meningitis is a rare clinical entity. The most frequent cause in travellers to the tropics is infection with the rat lungworm Angiostrongylus cantonensis. In this report, we describe a case of eosinophilic meningitis due to infection with this nematode in a traveller who presented with slight headache, diarrhoea, general malaise and thoracic radicular pain after a trip through Latin America and the Fiji Islands. She responded less than optimally to repeated steroid and albendazole treatments, but finally recovered completely
Seasonal distribution and abundance of tsetse flies Glossina spp. in the Faro and Deo division of the Adamaoua plateau in Cameroon
No full textTen years after the large-scale tsetse control campaigns in the important cattle rearing areas of the Faro and Deo Division of the Adamaoua Plateau in Cameroon, the seasonal distribution and abundance of tsetse flies (Glossina spp.) were determined. During a period of 12 consecutive months (January-December 2005), the tsetse population was monitored along four trap transects consisting of a total of 32 traps and two flyround transects traversing the study area, which comprised the tsetse-infested valley, a buffer zone and the supposedly tsetse-free plateau. Throughout the study period, a total of 2195 Glossina morsitans submorsitans and 23 Glossina tachinoides were captured in the traps and 1007 G. m. submorsitans (78.8% male flies) were captured along the flyround transects. All G. tachinoides and almost all G. m. submorsitans were captured in the valley. Five G. m. submorsitans were captured in traps located in the buffer zone, whereas no flies were captured in traps located on the plateau. The index of apparent abundance (IAA) of G. m. submorsitans was substantially higher in the areas close to game reserves. In the remaining part of the valley, where wildlife is scarce and cattle are present during transhumance (dry season), the IAA of tsetse was substantially lower. In this part of the valley, the abundance of tsetse seemed to be associated with the presence of cattle, with the highest IAA during transhumance when cattle are present and the lowest apparent abundance during the rainy season when cattle have moved to the plateau. It is concluded that the distribution of tsetse in a large part of the valley undergoes substantial seasonal changes depending on the presence or absence of cattle. The repercussions of those findings for the control of tsetse in the valley and the probability of reinvasion of the plateau are discussed
Scaling-up antiretroviral treatment in Southern African countries with human resource shortage: how will health systems adapt?
No full textScaling-up antiretroviral treatment (ART) to socially meaningful levels in low-income countries with a high AIDS burden is constrained by (1) the continuously growing caseload of people to be maintained on long-term ART; (2) evident problems of shortage and skewed distribution in the health workforce; and (3) the heavy workload inherent to presently used ART delivery models. If we want to imagine how health systems can react to such challenges, we need to understand better what needs to be done regarding the different types of functions ART requires, and how these can be distributed through the care supply system, knowing that different functions rely on different rationales (professional, bureaucratic, social) for which the human input need not necessarily be found in formal healthcare supply systems. Given the present realities of an increasingly pluralistic healthcare supply and highly eclectic demand, we advance three main generic requirements for ART interventions to be successful: trustworthiness, affordability and exclusiveness--and their constituting elements. We then apply this analytic model to the baseline situation (no fundamental changes) and different scenarios. In Scenario A there are no fundamental changes, but ART gets priority status and increased resources. In Scenario B the ART scale-up strengthens the overall health system: we detail a B1 technocratic variant scenario, with profoundly re-engineered ART service production, including significant task shifting, away from classical delivery models and aimed at maximum standardisation and control of all operations; while in the B2 community-based variant scenario the typology of ART functions is maximally exploited to distribute the tasks over a human potential pool that is as wide as possible, including patients and possible communities. The latter two scenarios would entail a high degree of de-medicalisation of ART