Single low-dose ceftriaxone for the treatment of gonococcal ophthalmia - Implications for the national programme for the syndromic management of sexually transmitted diseases

No abstract

Re-screening for syphilis at the time of delivery in areas ofhigh prevalence

Two hundred women who were screened for syphilis at their initial antenatal visit were rescreened at the time of delivery. Umbilical cord blood specimens as well as maternal sera were tested. Twenty-two (11%) women were rapid plasma reagin (RPR)-positive at booking, while a total of 23 (12%) were RPR-positive at the time of delivery, including an additional 5 (3%) who seroconverted. Four women who were RPR-positive at initial testing had become negative by the time of delivery following treatment. Of all neonates born to seropositive women, only 1 demonstrated clinical evidence of congenital syphilis. In view of the high seroconversion rate, we recommend screening for syphilis at the initial antenatal visit and rescreening at the time ofdelivery in areas such as ours

Interventions to enhance the teaching status of parasitology.

Recent surveys have highlighted an erosion of the teaching of parasitology in medical and veterinary schools across Europe and other developed countries, despite reports of increasing instances of food and water borne parasitic infections in these regions. To facilitate the teaching of this subject, essential to develop future health care professionals, we are performing different interventions at De Montfort University (DMU, UK). Briefly, these include: a) curriculum modifications to increase the time dedicated to the study of parasitology; and b) implementation of web-based resources in the curricula for enhancing teaching (e.g. through introduction of blended learning) and to encourage self-learning and participation among the students. Thus, DMU is leading the development of an on-line package for teaching and learning parasitology named DMU e-Parasitology in collaboration with different European academics and clinicians. This package has four sections: a theoretical section with mini e-learning modules to study major human parasitic diseases; virtual laboratory describing major techniques used in parasitology; a microscopy section with resources to enhance the study of parasites; a section with virtual clinical case studies to encourage self-learning. To assess the effectiveness of DMU e-Parasitology as a learning resource, we have done preliminary testing with final year BSc Biomedical Science students at DMU (n=194; 2017/18). 94.5% of students highlighted they gained appropriate knowledge of the pathology, prevention and treatment of some parasitic diseases; and 93.1% indicated that they learnt basic skills to investigate parasitic disease. The interventions and resources described could be used to improve the teaching status of medical parasitology in human health degrees

Vaginal yeast infections in diabetic women

Two hundred and three diabetic women (89 with and 114 without genital symptoms) were examined for the presence of yeasts and Trichomonas vaginalis. Yeasts were isolated from the vaginas of 35,5% of patients and were more common in the symptomatic group (48,0%) than the asymptomatic group (25,4%; P < 0,(5). Candida albicans was isolated from 12,8% of all patients and showed a significant association with pruritus vulvae (P < 0,(5). A significant association was also shown between the presence of yeasts in the rectum and in the vagina. C. glabrata (Torulopsis glabrata) was the COmDlonest yeast species isolated (50,0%), with C. albicans the next most frequent (36,1%). T. vaginalis infection was present in 14,3% of all subjects

Human-related microsporidia in the English urban environment: what we know so far?

The potential zoonotic transmission route of Enterocytozoon bieneusi and Encephalitozoon spp. (E. intestinalis, E. hellem and E. cuniculi) is under discussion. “Urban animals” could represent a risk to the population that should be carefully studied. Following the detection of human-related microsporidia in 2 out of 18 dog faecal samples collected in the city centre of Leicester (UK) in January 2016, 228 animal faecal samples were randomly sampled from different parks and recreational areas across the city from June 2016 to February 2017. The presence of microsporidia species were sought by real time polymerase chain reaction (RT-PCR) with melting curve analysis after extracting DNA by dysrupting the spores using Fast-Prep for soil following previous methodologies. 28 stool samples were positive for human-pathogenic microsporidia, as follows: Enterocytozoon bieneusi was detected in 2 waterfowl stool samples. A higher prevalence of Encephalitozoon spp. was identified. Thus, 26 faecal samples (14 deer, 7 avian [3 waterfowl, 2 songbird, 1 pigeon, 1 uncertain], 2 dog, 1 fox and 2 unidentified due to diarhoea) were positive for Encephalitozoon spp. Specifically, E. intestinalis/ E. hellem were detected in two samples from avian species (waterfowl and diarrhoeic sample) and E. cuniculi in 7 (6 deer and 1 fox). Our results indicate that human-related microsporidia would be present in urban parks and recreational areas in Leicester, which could represent a risk for humans. Interventions to tackle this potential risk should be applicable to a variety of animals, although more studies are needed to fully understand the potential zoonotic role of these pathogens

A descriptive study of the spectrum of dermatological surgery services provided by the University of KwaZulu-Natal Department of Dermatology at Inkosi Albert Luthuli Central Hospital

A descriptive study of the spectrum of dermatological surgery services provided by the University of KwaZulu-Natal Department of Dermatology at Inkosi Albert Luthuli Central Hospita

Microbicide trials for preventing HIV/AIDS in South Africa: Phase II trial participants' experiences and psychological needs

The Microbicide Division of the Department of Medical Microbiology at MEDUNSA, South Africa, recently completed a phase II expanded safety trial of the candidate microbicide Carraguard. A microbicide is a vaginal product that women might use, if proven safe and effective, to protect themselves from HIV and possibly other sexually transmitted infections (STIs). The study participants were from Ga-Rankuwa and its neighbouring areas, an historically disadvantaged residential township near Pretoria. We conducted six focus group discussions with phase II trial participants to evaluate their experiences with trial participation and their psychological needs. Participants spontaneously talked about their experiences with the study gel and speculum examinations. They felt that they had received high quality medical care. They indicated that their personal hygiene and knowledge of the female reproductive system, HIV and other STIs had improved, which helped their families and empowered them as women. Participants valued being able to discuss their anxiety about HIV/AIDS with study staff. They felt that the study provided them with a supportive environment in which their personal problems (not necessarily restricted to HIV/AIDS) could be addressed. Some recommended that the study staff improve their professionalism and punctuality. They suggested the formation of participant support groups, and expressed a preference to remain involved in the trial. Some participants appeared to have become dependent on services provided during the trial. We have taken the results of these focus group discussions into account during planning for a phase III efficacy trial of Carraguard to be conducted in the same and other similar communities. SAHARA-J (2004) 1(2): 78-86 Keywords: HIV prevention, South Africa, microbicide, ethical challenges in microbicide trials. RÉSUMÉ La Division de Microbicide du Département de Microbiologie Médicale de l'Université Médicale d'Afrique Australe, MEDUNSA, Afrique du Sud, a récemment accompli la phase II de l' épreuve de sûreté renforcée du candidat microbicide Carraguard. Un microbicide est un produit vaginal que les femmes pourraient employer, s'il est prouvé sûr et efficace, pour se protéger elles-mêmes contre le VIH et probablement d'autres infections sexuellement transmises (STIs). Les participantes à l'étude étaient de Ga-Rankuwa et de ses environs, une banlieue noire résidentielle historiquement désavantagée près de Pretoria.Nous avons conduit des discussions en six groupes d'étude avec les participants à la phase II de l'épreuve pour évaluer leurs expériences concernant la participation à l'épreuve et leurs besoins psychologiques. Les participantes ont spontanément parlé de leurs expériences relatives aux études du gel et aux examens du speculum. Elles ont estimé qu'elles avaient reçu le soin médical de haute qualité. Elles ont indiqué que leur hygiène et connaissance personnelles du système reproducteur femelle, de VIH et de tout autre STIs s'étaient améliorées, qui ont aidé leurs familles et les ont émancipées comme femmes. Les participantes ont estimé qu'elles étaient en mesure de discuter leur inquiétude au sujet de VIH/SIDA avec le personnel de l'étude. Ils ont estimé que l'étude leur a fourni un environnement de soutien dans lequel leurs problèmes personnels (pas nécessairement limités au VIH/SIDA) pourraient être adressés. Certaines ont recommandé que le personnel d'étude améliore son professionnalisme et ponctualité. Elles ont suggéré la formation des groupes de soutien de participantes, et ont exprimé leur préférence de rester impliquées dans l'épreuve. Quelques participantes ont semblé être devenues dépendantes des services fournis pendant l'épreuve. Nous avons tenu compte des résultats de ces discussions de groupe d'étude pour la planification de la phase III de l'épreuve d'efficacité du Carraguard qui devra être conduite dans la même communauté et d'autres communautés semblables. SAHARA-J (2004) 1(2): 78-86 Mots clés: Prévention de VIH, Afrique du Sud, microbicide, défis éthiques dans des épreuves de microbicid

Comparison of the VersaTREK blood culture system against the Bactec9240 system in patients with suspected bloodstream infections

BACKGROUND: To evaluate the VersaTREK (TREK Diagnostic Systems, Cleveland, Ohio) blood culture system against the Bactec9240 (BD Microbiology, Cockeysville, MD), for the recovery of bloodstream pathogens. METHODS: Venous blood from patients with suspected bacterial sepsis was evenly distributed into bottles of each system. Positive signals were recorded and bottles processed onto standard media for organism recovery. False positive signals were regarded if no organisms were seen on Gram stain and no growth was observed. RESULTS: 177 bottles were available for analysis; the Bactec9240 system yielded 43 positive, 134 negative results and no false positive signals. The VersaTREK system had 58 positive signals with 14 being false positives. CONCLUSIONS: In our setting with high background burden of immuno-compromised patients, the VersaTREK system compared favourably with the Bactec9240 in recovering blood stream aerobic and facultative anaerobic pathogens from patients with suspected bacterial sepsis. A concern is the high false positivity rate. Due to its versatility to accommodate small and large workloads as well as using smaller volumes of blood, this system may establish itself as a useful alternative for the recovery of bloodstream pathogens

First detection of microsporidia in deer faecal samples in England.

Background: Animals infected with human-pathogenic microsporidia (Encephalitozoon spp., Enterocytozoon bieneusi) can release spores into the environment through their faeces representing a public health concern. However, information on their presence in wild animals in the United Kingdom (UK) is very limited despite wildlife living close to densely populated urban areas. Two species of deer can be found in Bradgate Park, a public park in the northwest of Leicester (UK): the red deer and fallow deer. The aim of this study was to determine the presence of human-pathogenic microsporidia in deer as information on their presence in deer is limited in the literature. Materials/methods: A total of 68 deer faecal samples were collected during winter 2016/17; a qualified veterinarian confirmed the source. Fresh faecal smears were immediately prepared and stained using Weber’s modified trichrome stain following previous methodologies. Two microscopists screened the slides for these species. Results: Nine of the 68 faecal samples collected (13.2%) were found to be positive for spores of Encephalitozoon spp. via coprological analysis. These positive results are being confirmed using PCR. These results are in agreement with a pilot study performed by our group in the same park in summer 2016 in which we detected Encephalitozoon spp. in 25%deer faecal samples collected. Conclusions: To our knowledge, this is the first study showing the presence of Encephalitozoon spp. in deer and in an English region. Previous studies have reported spores of microsporidia in deer but for Enterocytozoon bieneusi, in a similar study performed in faeces from sika and red deer in China (Zhao et al., 2014). Our results, although preliminary, could highlight the role of deer as a reservoir and source of environmental contamination for potential zoonotic Encephalitozoon spp. infections. We have also detected Encephalitozoon spp. and Enterocytozoon bieneusi in faecal samples from fox, waterfowl and pigeon collected in the same period but in different parks across Leicester, which could indicate a certain distribution of microsporidia in the Leicester urban environment with different animal species involved in their life cycle. Due to their potential as human pathogens, these reservoirs represent a potential health risk for the Leicester population