Spectrum of aspergillosis: Pathogenesis, risk factors and management

This article reviews comprehensively the spectrum of diseases (aspergillosis) caused by Aspergillus spp, the commonest pathogenic form being the A.fumigatus. Aspergilus spp are ubiguitous in the environment and the respiratory tract is the portal of entry in most cases. Aspergillosis is associated with significant mortality and morbidity, the prevalence appears to be on the increase. About 10million people are at risk of aspergillosis, and 50% would die even with treatment. Immunodeficiency, especially neutropenia is central to the pathogenesis of aspergillosis. Diseases caused by A. fumigatus include;1) Invasive aspergillosis seen mostly in stem cell and organ transplant recipients, patients with haematological malignancies, cancer patients on chemotherapy and patients with AIDS. Invasive aspergillosis is life threatening, it affects the lungs and sinuses but could disseminate to affect the CNS, eye, skin and kidney. 2) Chronic pulmonary Aspergillosis occurs in the setting of previous cavitatry lung disease, most commonly tuberculous infections. 3) Allergic bronchopulmonary aspergillosis (ABPA) affects people with asthma and cystic fibrosis. A. fumigatus is also implicated in the exacerbation of asthma. The clinical symptoms of aspergillosis depend on the type and the systems affected; respiratory symptoms are more common as the respiratory tract is disproportionately affected in aspergillosis. Diagnostic features and treatment also depends on the type of aspergillosis. Diagnostic testing for aspergillosis includes radiologic tests, culture tests, galactomannan testing in body fluids, immunologic tests to detectAspergilus -specific immunoglobulins. Treatment modalities include surgery, use of antifungals and immunomodulatory therapy with cytokines

A review of the virulence factors of pathogenic fungi

Fungal infections are becoming more prevalent especially with increase in immunodeficiency disorders, immunosuppression following transplantation, cancers and cancer treatment. They are ubiquitous and cause infections which may be trivial or more deep seated and severe infections associated with mortality. The ability of some fungal species to cause disease is due to various virulence factors which help with fungal survival and persistence in the host resulting in tissue damage and disease. This review discusses these virulence factors. These factors include an ability to adhere to hosts’ tissues, production of enzymes that cause tissue damage and direct interference with host defences. Pathogenic fungi produce catalases and Mannitol which protect against reactive oxygen species (ROS). Some fungi notably, dimorphic fungi and C. albicans have the ability to switch from one form to another. Thermotolerance, at least to 370C, is critical for survival in mammalian host and contributes to dissemination. Melanin is produced by a number of pathogenic fungi, and protects against harsh conditions such as UV radiation, increased temperature and ROS. The ability to obtain Iron (Fe) from the storage or transport forms in the host is also a virulence factor and calcineurin acts as a sensor for pathogenic fungi.Keywords: Fungi, virulence, pathogenic, infections, dimorphism, thermotoleranc

A Comprehensive HIV Program by an Indigenous Organization in Nigeria: A 5 Year Progress Report

Background: Nigeria has a high HIV burden with over 3,500,000 infected and more than 200,000 deaths annually. Since 2004, international donor agencies and implementing partners managed HIV programs in Nigeria. Excellence and Friends Management Care Centre (EFMC) was the first local organization to be funded to provide comprehensive HIV services in Nigeria. Aim: To document the need, processes and products of five years of indigenous HIV programming in Nigeria. Materials and Methods: PEPFAR funded EFMC from 2011 to provide comprehensive HIV services in Nasarawa State and Abuja, the Federal Capital Territory (FCT). EFMC engaged staff, assessed and activated sites, trained and empowered healthcare workers, provided consumables, enrolled clients and provided preventive, treatment and support services. EFMC also strengthened healthcare systems and refurbished and equipped facilities for integrated HIV services. Results: EFMC decentralized, commonized and integrated HIV services in over 120 service delivery points with an average cost per target of US$ 273.12. We tested 623,148 people for HIV. The positivity rate was 3.3% (annual range 1.9–4.5%). We placed 10,150 on Highly Active Antiretroviral Therapy. In addition, we tested 164,746 pregnant women for HIV with 5,442 (3.3%) positive and provided 4,189 (77.0%) positive pregnant women with ARV prophylaxis. More than 500 healthcare workers in HIV program management. Conclusions: EFMC’s “commonization” model is cost-effective and efficient. Progressively funding local partners will ensure sustainability of HIV programs. Using program results as national figures will save cost from periodic sentinel studies. Government should support local NGOs to control the HIV epidemic in Nigeria

Visual and Auditory Complications of Chronic Myeloid Leukemia: A Case Report

Hearing loss and visual impairment are not common presentations of Chronic Myeloid Leukemia (CML). We report such a case who presented in the chronic phase with profound hearing loss, visual impairment, progressively enlarging spleen, anaemia, and weight loss. Laboratory evaluation showed Packed Cell Volume – 10%, Total White Cell Count – 1,343 x 109/ L, Platelets – 589 x 109/ L. Blood chemistry showed Uric Acid level of 530mmol/L. Karyotyping showed the Philadelphia chromosome. Chemotherapy was instituted and she improved remarkably with minimal improvement in perception of sound

Improving Access to HIV and Sexual Reproductive Health Services for Key Populations along Nigeria’s Transport Corridors: The STOP Project.

Background: Despite high HIV prevalence amongst key populations in strategic travel corridors in Nigeria, there is still very low access to HIV and Sexual Reproductive Health (SRH) services. Targeting men-who-have-sex-with-men, females who sell sex, long distance truck drivers and those who live along the country’s transport corridors is vital for effective control of the HIV epidemic in Nigeria. Excellence and Friends Management Consult (EFMC) partnered with the Nigerian National Agency for the Control of AIDS (NACA) to improve access to HIV, SRH services educate and test for HIV, and offer referral/treatment to HIV-infected individuals. We report on the need, process and outcome of this project. Methods: The Strategic Travelers Outreach Program (STOP) took place between February and August 2016 in Sagamu/Ogere and Obollo-Afor travel corridors. Through community advocacy and outreach, house-to-house, door-to-door and community/office testing, key populations were provided with targeted HIV, SRH and referral services. Results: Over 50,000 people were contacted with HIV and SRH education/counselling. 19,275 (M: 10,965, 56.9%; F: 8,310, 43.1%) were tested with all receiving their results same day. General positivity rate was 1.3%: female (1.9%). Brothel-based female sex workers had higher positivity rate (3.2%). The study also revealed prostitutes did not use condoms with their husbands or long-term boyfriends and that knowledge of HIV was poor. Conclusion: The results highlight an urgent need to mobilize educational and healthcare resources to mitigate HIV transmission along these corridors. A socio-anthropological approach is required to alter long-held beliefs and change risk-seeking behavior

Is malaria over-diagnosed? A world malaria day 2017 experience by Excellence and Friends Management Care Centre (EFMC) and partners, Abuja Nigeria

Malaria remains a major cause of mortality across the world, but particularly in sub-Saharan Africa. WHO-sponsored World Malaria Day activity has helped to improve education and has contributed to a reduction in mortality globally in the past decade. However, much needs to be done still in Africa. We report on a World Malaria Day scheme in three primary Healthcare Facilities in and around the Abuja Federal Capital Territory in Nigeria in 2017. Activity included educational talks to pregnant women and nursing mothers of young children, with malarial testing, distribution of free mosquito nets and also medical treatment if needed. We found a large clinical over-diagnosis of malaria with simple fevers of any cause being reported as malaria. None of these cases were found to be due to malaria on formal malarial testing. We conclude that efforts should continue into education and prevention of malaria with insecticide-impregnated mosquito nets a key factor. However, over-diagnosis of malaria and the use of unnecessary antimalarial treatment may lead to parasite resistance to antimalarial treatment, morbidity from drug side-effects and potential mortality from not receiving the right treatment for other febrile illnesses. We recommend that malarial testing, particularly with simple blood film microscopy is implemented more widely across Africa, as it is simple to perform and allows effective management plans to be drawn up for individual patients