Oesophageal and gastric toxoplasmosis: rare presentation of an emerging zoonotic disease

Background: Toxoplasmosis a Zoonotic disease caused by Toxoplasma gondii. Toxoplasma gondii (T. gondii) is a protozoan parasite that infects most species of warm blooded animals including humans. It is an obligate intracellular parasite with a worldwide distribution. Sporozoites exist in oocysts and are found in the gut walls of definitive hosts the cat family (Felidae). Cats become infected with T.gondii by carnivorism or indigestion of oocysts.Humans can become infected by any of the 4 routes; Eating undercooked meat of animals harbouring tissue cysts, Consuming food or water contaminated with cat feaces or by contaminated environmental samples (such as fecal contaminated soil or changing the litter box of a pet (cat), Blood transfusion or organ transplantation, Transplacentally (from mother to fetus), Accidental inoculation of tachyzoites.Ocular Toxoplasmosis, a major cause of Chorioretinitis , may be as a result of congenital toxoplasmosis or acquired infection. Congenitally infected patients can remain asymptomatic until the second or third decades of life. Congenital Toxoplasmosis is subclinical in about 75% of infected newborn.Case Study: E.K a 62 year old lady presented with a 3 months history of odynophagia that progressed to dysphagia. She had dyspepsia that was non-responsive to proton pump inhibitors. She gave history of slight weight loss due to inadequate food intake, because of the odynophagia, dysphagia and dyspepsia. She was in good general condition a febrile (Temp 37.10 C), not pale, no jaundice, no significant lymphadenopathy, nor oedema.Results: Recent findings have suggested an association between T. gondii infection and various Neurologic diseases or Psychiatric Syndromes such as Schistozophrenia, Alzheimer’s disease and Suicide. 10% to 20% of patients with acute infection may develop cervical lymphadenopathy or flulike illness.Recommendations: Many of these aspects of disease may be delayed or prevented if treatment of toxoplasmosis is initiated antenatally and in the first 1 – 2 months after delivery.Diagnosis and treatment must be different for each clinical category. In general, diagnosis accomplished using serology and histology. Isolation of the parasite can be difficult.Cconclusion: This being the first case in our literature, highliting the fact that; though rare oesophageal and gastric Toxoplasma infection can occur, leading to dysphagia and dyspepsia, Carnivorism of cats makes it difficult to keep them free of disease.Immunodeficiency patients often have Central Nervous System (CNS) disease but may have Pericarditis or Pneumonitis. Toxoplasmosis in immunodeficiency syndrome patients may be due to reactivation of chronic infection or acquired. Toxoplasmosis in patients being treated with immunosuppressive drugs may also be due to newly acquired or reactivated latent infection

CASE REPORT - Reactivated toxoplasmosis presenting with non-tender hepatomegaly in a patient with HIV infection

No Abstract African Journal of Health Sciences Vol. 14 (1-2) 2007: pp. 97-9

Hepatitis B and C virus infections and liver function in AIDS patients at Chris Hani Baragwanath Hospital, Johannesburg

Background: Impaired liver function tests and co-infection with hepatitis viruses in AIDS patients are common in western countries.Objective: To assess liver function and prevalence of co-infection with hepatitis B and hepatitis C viruses in AIDS patients at Chris Hani Baragwanath Hospital.Design: A prospective study.Setting: Chris Hani Baragwanath Hospital, Johannesburg, South Africa.Patients: One hundred consecutive patients with AIDS admitted to Chris Hani Baragwanath Hospital.Results: There were 52 males and 48 females aged 16 to 54 years (mean + SD: 34.6 + 7.5 years). The results of laboratory test were as follows: LFTs: bilirubin 11.8 (+15.6) ìmol/ l; AST: 79.6 (±116.6) iu/L; alkaline phosphatase: 204.3 (±237.4) iì/L; albumin: 23.9 (±6.2) g/l; CD4+ Iymphocytes: 141.5 (±168.6) ìl; CD8+: 666.9 (±618.3) ìl; HBV - HbsAg: 6 (6%); HbsAg + eAg: 3 (3%); previous disease (Anti HBs and/or anti HBc): 35%, HCV: 1(1%).Conclusion: Liver function tests were impaired in the majority of patients with AIDS (93%) in our setting. Evidence of previous and present HBV infection was present in 41%. This is different from what is observed in western countries (90-95%). The results also suggest that patients here acquired HBV infection while still immuno competent. HCV infectionwas rare

Determination of clearance of Helicobacter pylori through bacterial density, Nairobi, Kenya

Background: Eradication of Helicobacter pylori (H. pylori) is a challenge to physicians and gastroenterologists worldwide and has led to change of drug regimens and their durations to ensure cure. H. pylori density has been considered as a factor which may influence eradication failure. Objective: To establish whether bacterial density found during diagnosis is a determinant of clearance of H. pylori after treatment. Design: A retrospective study was carried out to establish clearance of H. pylori through stool antigen testing on those patients who were positive for H. pylori on rapid urease test, and had bacterial density reported on histology. Setting: Centre for Clinical Research (CCR), Kenya Medical Research Institute (KEMRI). Methods: Biopsy samples taken on endoscopy were used for rapid urease testing and histology. Giemsa stain was used on histology to identify H. pylori. At the end of triple therapy treatment, stool antigen testing was done using the enzyme linked immunosorbent assay (ELISA) method to detect the presence or absence of H. pylori. Results: 150 patients were positive for H. pylori on rapid urease testing. 42/150 (28%) patients had results for histology after completion of the study. Those who reported no H. pylori on histology were 24.4%, slight H. pylori 41.5%, moderate H. pylori 14.6%, numerous H. pylori 19.5%. This was compared to clearance of H. pylori on stool antigen testing after treatment. Those with no H. pylori on histology had a 70% cure rate after treatment; mild H. pylori - a 47% cure rate; moderate H. pylori on - 100% cure rate and those with numerous H. pylori - a 50% cure rate. There was no statistical significance noted in all categories (P>0.05). There was no relation of patients positive for H. pylori with bacterial density noted on histology and clearance of H. pylori at the end of treatment. Conclusion: H. pylori bacterial density cannot be used as an indication for clearance of H. pylori after treatment. One may need a larger sample or other diagnostic test to determine bacterial density and clearance of H. pylori

Colonic Pathology in Nairobi, Kenya: A review of colonoscopic and HistopathologicaL Profiles of 418 patients

Background: Symptoms of digestive disorders are among the most common causes of consultations to health workers worldwide. But from Sub.Saharan African there is a shortage of information on morphological profiles, morbidity, mortality and epidemiology of digestive disease. The aim of this study was to do a retrospective analysis of records on colonoscopic findings and histological examination of patients evaluated between 2005 and 2011 with aim of establishing the profiles and characteristics of colonic lesions seen in Kenya. Methodology: Records of patients sent for colonoscopy in a busy private clinic were reviewed retrospectively. The records reviewed included patients demographic data, appearance of colon at colonoscopy and histological findings of biopsied samples. The records were retrieved from the clinic and the laboratory files and entered into an EXEL spread sheet. The data was cleaned and analyzed using SPSS Version 17. The patients had been referred from both public and private hospitals countrywide. Results: Four hundred and eighteen patients were seen over the 6 years; 247 male and 171 female (ratio 1.4:1) mean age for the entire group population was 45± 20 years. Of these 10.8% were normal, 51.9% were non.specific colitis, 12.7% Adenocarcinoma, 9.3% Ulcerative colitis and 7.7% amoebic colitis. Well differentiated adenocarcinoma was the commonest neoplasm, the most frequent histopathological pattern in this category. Conclusion: Ulcerative colitis and Amoeabic colitis and cancer of the colon are frequent and appear to be on the increase

Hepatitis B and C virus infection and liver function in aids patients: research

Backround: Impaired liver function tests and co-infection with hepatitis viruses in AIDS patients are common in western countries. Objective: To asses liver function and prevalence of co-infection with hepatitis B and hepatitis C viruses in AIDS patients at Chris Hani Baragwanath Hospital. Design: A prospective study. Setting: Chris Hani Baragwanath Hospital, Johannesburg, South Africa. Patients: One hundred consecutive patients with AIDS admitted to Chris Hani Baragwanath Hospital. Results: There were 52 males and 48 females aged 16 to 54 years (mean + SD: 34.6 + 7.5 years). The results of laboratory test were as follows: LFTs: bilirubin 11.8 (+15.6)mmol/L; AST: 79.6 (+116.6) im/L; alkaline phosphatase: 204.3 (+237.4) Im/L; albumin: 23.9 (+6.2) g/Ll; CD4+ lymphocytes: 141.6 (+168.6) mL; CD8+: 666.9 (+618.3) mL; HBV - HbsAg: 6 (6%); HbsAg + eAg: 3 (3%); previous disease (AntiHBs and/or anti HBc): 35%. HCV: 1 (1%). Conclusion: Liver function tests were impaired in the majority of patients with AIDS (93%) in our setting. Evidence of previous and present HBV infection was present in 41%. This is different from what is observed in western countries (90-95%). The results also suggest that patients here acquired HBV infection while still immuno competent. HCV infection was rare. SA Gastroenterology Rev. Vol.1(2) 2003: 12-1