A clinical and epidemiologic update on the interaction between tuberculosis and human immunodeficiency virus infection in adults

Background : Tuberculosis (TB) is an important cause of mortality and morbidity in human immunodeficiency virus (HIV) infection in Africa. The interaction between TB and HIV infections is reviewed. Methods : Literature on TB, HIV and their co-infection, especially in sub-Saharan Africa, including Nigeria, is reviewed. Results : Burden of TB is fueled by the HIV epidemic, and clinical presentation of TB may be atypical with co-infection. Recommendations on drugs and timing of antiretroviral therapy (ART) initiation are discussed. Use of cotrimoxazole prophylaxis (CPT) in co-infected patients reduces morbidity and mortality, while the principles of TB prevention in HIV infection can be summarized with the three I\u2032s: intensive TB case finding and surveillance, isoniazid preventive therapy (IPT) and infection-control measures; to these can be added a fourth \u2032I,\u2032 viz., instituting ART. Clinical complications like drug resistance, toxicity and drug interactions; and immune reconstitution inflammatory syndrome (IRIS) with CPT, IPT and ART are highlighted. Emergence of drug-resistant- and nosocomial- TB in HIV infection poses serious challenges and potential consequences in Africa, and appropriate measures are recommended. Conclusions : Many barriers exist for optimizing the care of the two diseases, but the aim should be strengthening capacities, collaborations, linkages and eventually integrating the services. Interventions for TB prevention in HIV infection should be widely implemented.arri\ue8re-plan: La tuberculose (TB) est une cause importante de mortalit\ue9 et morbidit\ue9 en homme Infection de virus (VIH) de l\u2019immunod\ue9fi cience humaine en Afrique. L\u2019interaction entre TB et l\u2019infection \ue0 VIH est examin\ue9e. m\ue9thodes: documentation sur la tuberculose, VIH et de leurs Co-infection en particulier en Afrique subsaharienne, notamment du Nig\ue9ria est examin\ue9e. r\ue9sultats: Charge de TB est aliment\ue9 par l\u2019\ue9pid\ue9mie de VIH et la pr\ue9sentation clinique de la tuberculose peut \ueatre atypique avec co-infection. Recommandations sur les drogues et calendrier des initiation de traitement (ART) antir\ue9troviraux sont abord\ue9s. Utilisation de cotrimoxazole prophylaxie (CPT) chez les patients Co-infect\ue9s r\ue9duit \ue0 la morbidit\ue9 et mortalit\ue9 tout en les principes de pr\ue9vention de la TB en infection au VIH peuvent \ueatre r\ue9sum\ue9es avec le \u2018 trois est \u2019: intensive TB affaire conclusion et la surveillance, isoniazid pr\ue9ventive th\ue9rapie (IPT) et l\u2019infection mesures de contr\uf4le; ces peuvent \ueatre ajout\ue9s un \u2018 quatri\ue8me Je \u2019, instituant l\u2019ART. Complications cliniques comme r\ue9sistance aux m\ue9dicaments, toxicit\ue9, et interactions m\ue9dicamenteuses et la reconstitution immunitaire syndrome infl ammatoire (IRIS) avec CPT, IPT et art. sont mises en \ue9vidence. \uc9mergence de r\ue9sistant aux m\ue9dicaments - et nosocomiales- TB dans l\u2019infection \ue0 VIH pose graves d\ue9fi s et les cons\ue9quences possibles en Afrique et les mesures appropri\ue9es sont recommand\ue9es. conclusions: many obstacles existent pour optimiser les soins de deux maladies mais l\u2019objectif devrait \ueatre renforcement des capacit\ue9s, collaborations, liens et fi nit par int\ue9grer les services. Interventions de pr\ue9vention TB dans l\u2019infection \ue0 VIH devraient \ueatre largement mise en oeuvre

Ebola virus disease and pregnancy outcome: A review of the literature

Introduction: Ebola virus disease (EVD) is a disease of humans and other primates caused by Ebola viruses. The most widespread epidemic of EVD in history occurred recently in several West African countries. The burden and outcome of EVD in pregnant women remains uncertain. There are few reports to date on maternal and fetal outcomes among pregnant women with EVD, hence the justification for this comprehensive review of these published studies.Materials and Methods: Published literature in Englishthat reported on maternal and or fetal outcome among pregnant women with EVD up to May 2016 were searched in electronic databases (Google Scholar, Medline, Embase, PubMed, AJOL, and Scopus). Studies that did not meet the inclusion criteria were excluded. We extracted the following variables from each study: Geographical location, year of the study, settings of the study, participants, maternal and fetal outcome.Results: A total of 12 studies reported on 108 pregnant women and 110 fetal outcomes. Six of the studies were case reports, three retrospective studies, two cross‑sectional studies, and one was a technical report. There were 91 (84.3%) deaths out of the 108 pregnant women, while only one (0.9%) fetal survival was reported out of 110. The survival rate among the 15 patients that had spontaneous abortion/stillbirth or induced delivery was 100%.Conclusion: There was a poor maternal and fetal outcome among pregnant women with EVD, and fetal evacuation significantly improves maternal survival.Key words: Africa; Ebola; fetal; maternal; outcome

Epidemiology of peripartum cardiomyopathy in Africa

Peripartum cardiomyopathy (PPCM) is a disease that predominantly affects Black African women. The history of peripartum cardiac failure in Africa dates to the 1960s, before the availability of echocardiography. With the availability of echocardiography in the late 1970s, studies on well-characterised PPCM began to be reported. To date, there is no population-based PPCM study in Africa. However, hospital-based studies have reported incidence rates as high as 1:100 deliveries in Nigeria and representing up to 52% of all cardiomyopathies. For reasons that are not yet very clear, there are obvious wide disparities in incidence and prevalence within and between African Countries. Likewise, prevalence of suggested risk factors for the disease vary widely between studies. However, the disease seems to be more common among the poor rural population. Clinical outcomes are much worse in Africa than in Western Europe and North America. Mortality rates as high as 24.2% at 6 months and 47.4% at 1 year of follow-up had been recorded in Kano, Nigeria, 48.3% over 4 years in Burkina Faso, 11.6% over 6 months in Zimbabwe and 13.0% over 6 months in South Africa. It is hoped that the ongoing peripartum cardiomyopathy in Nigeria (PEACE) Registry and the worldwide EURObservational Research Programme (EORP) on PPCM will soon shed more light on the epidemiology of PPCM in Africa. The present article aimed to review the epidemiology of the disease in Africa, where the disease is relatively more common

COMMUNITY ACQUIRED PNEUMOCOCCAL PNEUMONIA IN NORTHWESTERN NIGERIA: EPIDEMIOLOGY, ANTIMICROBIAL RESISTANCE AND OUTCOME

Background: Pneumococcus is the leading cause of community acquired pneumonia (CAP) worldwide, and the leading cause of mortality. Pneumococcal pneumonia is poorly studied in Nigeria. We describe the epidemiology including associated co-morbidities and outcome of pneumococcal pneumonia in North-western Nigeria. Material and methods: We conducted a prospective, hospital based study on patients with community acquired pneumococcal pneumonia. Detailed clinical evaluation and relevant laboratory investigations were carried out. Susceptibility test to commonly used antibiotics was carried out on all confirmed pneumococcal isolates. In hospital mortality was recorded. Analysis was carried out using descriptive statistics with differences and relationships were determined using Chi square and Fisher’s exact tests as appropriate, with p < 0.05 regarded as significant. Results: Of the one hundred and twenty-five (125) patients with pneumococcal pneumonia were studied. The mean age of the patients was 41.3years (± 16.84), and 69/125(55.2%) were males. Co-morbidities were observed in 63/125 (53.8%) of the patients. Resistance to commonly used antibiotics was observed. Overall in-hospital mortality was 9/117(7.8%). HIV (OR=2.081; 95%CI 1.651-3.237), age ≥65years (OR=5.947; 95%CI3.581-17.643), and CURB-65 score of ≥ 3 (OR=2.317; 95%CI1.734-4.719) were independent predictors of mortality. Conclusion: Pneumococcal pneumonia is the commonest cause of CAP in North-western Nigeria with relatively high mortality. There is need to strengthened the vaccination policy targeting at risk adult population in Nigeria

Snakebite envenoming.

Snakebite envenoming is a neglected tropical disease that kills >100,000 people and maims >400,000 people every year. Impoverished populations living in the rural tropics are particularly vulnerable; snakebite envenoming perpetuates the cycle of poverty. Snake venoms are complex mixtures of proteins that exert a wide range of toxic actions. The high variability in snake venom composition is responsible for the various clinical manifestations in envenomings, ranging from local tissue damage to potentially life-threatening systemic effects. Intravenous administration of antivenom is the only specific treatment to counteract envenoming. Analgesics, ventilator support, fluid therapy, haemodialysis and antibiotic therapy are also used. Novel therapeutic alternatives based on recombinant antibody technologies and new toxin inhibitors are being explored. Confronting snakebite envenoming at a global level demands the implementation of an integrated intervention strategy involving the WHO, the research community, antivenom manufacturers, regulatory agencies, national and regional health authorities, professional health organizations, international funding agencies, advocacy groups and civil society institutions

Transmission dynamics of monkeypox virus in Nigeria during the current COVID-19 pandemic and estimation of effective reproduction number

Monkeypox virus (MPXV) continues to pose severe threats to global public health, especially in non-endemic areas. Like all other regions, Africa faces potential public health crises due to the ongoing COVID-19 pandemic and other infectious disease outbreaks (such as Lassa fever and malaria) that have devastated the region and overwhelmed the healthcare systems. Owing to the recent surge in the MPXV and other infections, the COVID-19-control efforts could deteriorate and further worsen. This study discusses the potential emergencies of MPXV transmission during the current COVID-19 pandemic. We hypothesize some of the underlying drivers that possibly resulted in an increase in rodent-to-human interaction, such as the COVID-19 pandemic’s impact and other human behavioral or environmental factors. Furthermore, we estimate the MPXV time-varying effective reproduction number ([Formula: see text]) based on case notification in Nigeria. We find that [Formula: see text] reached a peak in 2022 with a mean of 1.924 (95% CrI: 1.455, 2.485) and a median of 1.921 (95% CrI: 1.450, 2.482). We argue that the real-time monitoring of [Formula: see text] is practical and can give public health authorities crucial data for circumstantial awareness and strategy recalibration. We also emphasize the need to improve awareness programs and the provision of adequate health care resources to suppress the outbreaks. These could also help to increase the reporting rate and, in turn, prevent large community transmission of the MPXV in Nigeria and beyond

Uniting behind a common goal: Collaboration between traditional healers and allopathic health care workers to improve rural snakebite care

Snakebite envenoming is an acute medical emergency which affects hundreds of thousands of people worldwide, primarily in remote rural areas of low-and middle income countries in the Global South. A considerable proportion of snakebite patients turn to traditional healers (THs) for help, driven by a number of push and pull factors. These include socio-cultural factors, geographical proximity, and the absence or inaccessibility of overstretched and often costly allopathic healthcare services. Although traditional healers and allopathic healthcare staff share a common focus-the recovery and well-being of their patients-both systems operate largely in parallel to each other with collaborations being an exception rather than the rule. This is to the detriment of snakebite patients, who frequently find themselves being caught-up in the dualism between the two separate systems. Given the right circumstances, snakebite patients could benefit from elements of care from both modalities. Here, we have reviewed the role of THs in snakebite care and explored how their integration into the formal healthcare system could improve the implementation and outcome of care. The effective recruitment of THs to aid in disease control and treatment efforts in diseases other than snakebite underscores the potential benefits of this strategy. Carefully devised proof-of concept studies are needed to test our hypothesis that collaborations between the formal healthcare sector and THs are feasible and improve outcomes in snakebite care

Paediatric snakebite envenoming: the world's most neglected 'Neglected Tropical Disease'?

Snakebite disproportionally affects children living in impoverished rural communities. The WHO has recently reinstated snakebites on its list of Neglected Tropical Diseases and launched a comprehensive Strategy for the Prevention and Control of Snakebite Envenoming. In the first of a two paper series, we describe the epidemiology, socioeconomic impact and key prevention strategies. We also explore current challenges and priorities including the production and distribution of safe and effective antivenom.Revisión por pare

Laboratory-confirmed hospital-acquired infections:An analysis of a hospital's surveillance data in Nigeria

Objective: Hospital-acquired infections (HAI) are a global problem and a major public health concern in hospitals throughout the world. Quantification of HAI is needed in developing countries; hence we describe the results of a 2-year surveillance data in a tertiary hospital in Nigeria. Methodology: This study is a 2-year review using secondary data collected at a tertiary referral center in northwestern Nigeria. The data was collected using surveillance forms modeled based on the Centre for Disease Control (CDC) protocol. Descriptive statistics were used to present results as frequencies and percentages. Result: 518 patients developed HAI out of 8216 patients giving an overall prevalence of 6.3%. The mean age of the patients was 35.98 years (±15.92). Males constituted 281 (54.2%). UTI 223 (43.1%) was the most prevalent HAI. Overall, E. coli 207 (40.0%) was the most frequent isolates followed by P. aerugenosa 80 (15.4%). There was a high prevalence of cloxacillin resistant S. aureus (67.9%) and gram-negative rods resistant to third-generation cephalosporins. Trimethoprim-sulfamethoxazole resistance across the board was more than 90%. Conclusion: There is a high burden of HAI especially UTI in our hospital with resistance to commonly used antibiotics documented. Keywords: Public health, Infectious diseas

Investigating Snake-Venom-Induced Dermonecrosis and Inflammation Using an Ex Vivo Human Skin Model

Snakebite envenoming is a neglected tropical disease that causes >100,000 deaths and >400,000 cases of morbidity annually. Despite the use of mouse models, severe local envenoming, defined by morbidity-causing local tissue necrosis, remains poorly understood, and human-tissue responses are ill-defined. Here, for the first time, an ex vivo, non-perfused human skin model was used to investigate temporal histopathological and immunological changes following subcutaneous injections of venoms from medically important African vipers (Echis ocellatus and Bitis arietans) and cobras (Naja nigricollis and N. haje). Histological analysis of venom-injected ex vivo human skin biopsies revealed morphological changes in the epidermis (ballooning degeneration, erosion, and ulceration) comparable to clinical signs of local envenoming. Immunostaining of these biopsies confirmed cell apoptosis consistent with the onset of necrosis. RNA sequencing, multiplex bead arrays, and ELISAs demonstrated that venom-injected human skin biopsies exhibited higher rates of transcription and expression of chemokines (CXCL5, MIP1-ALPHA, RANTES, MCP-1, and MIG), cytokines (IL-1β, IL-1RA, G-CSF/CSF-3, and GM-CSF), and growth factors (VEGF-A, FGF, and HGF) in comparison to non-injected biopsies. To investigate the efficacy of antivenom, SAIMR Echis monovalent or SAIMR polyvalent antivenom was injected one hour following E. ocellatus or N. nigricollis venom treatment, respectively, and although antivenom did not prevent venom-induced dermal tissue damage, it did reduce all pro-inflammatory chemokines, cytokines, and growth factors to normal levels after 48 h. This ex vivo skin model could be useful for studies evaluating the progression of local envenoming and the efficacy of snakebite treatments