Bilharzia Induced Pathologies and Techniques of Detection in Uganda: A review

Background: Schistosoma S. mansoni was observed and reported in Uganda in 1902. Schistosoma S. mansoni is widely distributed in Uganda along permanent water bodies. Objective: To review the literature on previous techniques and conventional ones used for the assessment and comparison of morbidity due to schistosomiasis in Uganda. Design: Retrospective study. Setting: Gulu University, Faculty of Medicine, Department of Microbiology and Immunology. Results: Since its first detection in 1902 Schistosomiasis mansoni and later Schistosomiasis haematobium in Uganda, morbidity assessment was based on physical examination and intensity of eggs excretion. The first field study in Uganda of schistosomiasis pathologies using ultrasound was that conducted in West Nile in Obongi, Rhino Camp and Pundu in 1991 and reviewed in 1992. These armless and none invasive method of pathologies detection has the advantage of repeatability. It showed that after treatment there was reversibility of pathological conditions introduced by the parasites in the hosts. Conclusion: Schistosomiasis mansoni pathologies as detected by the none invasive ultrasound findings compared well with those of the more risky invasive liver biopsy. The detection of pathologies by clinical examination was less sensitive. Pathological lesions due to S. haematobium correlated with abnormalities of the urinary tract and intensity of eggs in urine.East African Medical Journal Vol. 87 No. 7 July 201

Knowledge and attitude towards Buruli ulcer disease in Adjumani district, Northwestern Uganda

Background: Buruli ulcer is a devastating skin disease caused by Mycobacterium ulcerans. It produces a necrotissing toxin, which destroys the skin, subcutaneous tissue and bone, often leaving the patients with debilitating deformities. The mode of transmission of the disease is unclear, but water borne vectors may transmit M. ulcerans. Treatment is difficult and often involves extensive surgery, which is the current standard treatment, but it may result in scarring and subsequent physical limitations due to scar retraction. These physical limitations may result in psychosocial and economic problems. It was hypothesised that superstitious beliefs about the illness, and stigma were important determinants for health seeking behaviour. The consequences of the disease include social isolation and economic problems in family life.Objective: To explore the knowledge and attitude of the people affected by Buruli ulcer disease in Adjumani district, in northwestern Uganda.Design: A semi-structured questionnaire was administered to all the selected patients.Setting: Selected Health centres in Adjumani district, which included Adjumani hospital, Pakele HCIII, Dzaipi HCIII, Mungula HCIII and Opinjinji HCIII.Subjects: A total of Nineteen (19) clinically diagnosed patients with Buruli ulcer were consented and interviewed for this study.Results: A total of nineteen (19) patients were interviewed for this study. Of these, 10 (52.6%) were female and nine (47.4%) were male. Majority of the respondents were peasant farmers (N=9, 47.4%), mainly undertaking subsistence farming for home consumption. Most of the patients (N=16, 84.2%) had their lesions on either the upper or lower limbs. The majority (N=13, 68.4%) said they know the disease affecting them and only 6 (31.6%) patients did not know. Majority of patients 17 (89.5%) sought for medical and/or traditional therapy, while only two (10.5%) did not do anything about it. Of those who sought for help, nine (52.9%) opted for traditional herbal treatment, while 8 (47.1%) went for conventional medical treatment at a health unit. Most patients reported a wide range of stigma labeled against them, and these included; fear that they may infect others (N=2, 10.5%), fear that they have been bewitched or cursed (N=2, 10.5%), discrimination at school to the extent that he dropped out of school, and avoidance by others.Conclusion: This study has shown that patients with Buruli ulcer are still stigmatised as members of the community. It is important that educational programme on Buruli ulcer be developed which increases awareness of the disease and may also lower the level of stigma. These programme will also help in disease detection and hopefully improve the health seeking behaviour of patients

Evaluation of Schistosoma mansoni morbidity one year after praiquantel treatment in rhino camp and Obongi in West Nile, Uganda

An evaluation study on reversibility of Schistosoma mansoni induced periportal fibrosis (PF) morbidity following treatment with praziquantel, 40mg/kg body weight after one year, was carried out in Rhino Camp and Obongi all are West Nile districts in northern Uganda. To assess the reversibility of Schistosoma (S) mansoni induced PFs morbidity following treatment with praziquantel, 40mg/kg body weight after one year. The design was a Prospective cohorts study; and the setting was a busy canoe landing sites along Albert Nile in Schistosoma (S) mansoni hyperendemic areas of Rhino Camp and Obongi fishing village were selected for the study. Previously in 2005, 1562 people including fishermen and women, school pupils, teachers, and civil servants were studied in both fishing villages for S. mansoni using Kato/Katz stool smear method. Abdominal ultrasonography and sonomorphological abnormalities of periportal fibrosis were performed with Aloka portable ultrasound machine (Hellige, Freiburg, Germany) fitted with a convex probe of 3.5 mega Hertz was also performed in the field clinic on all patients who had S. mansoni eggs in their faeces. The sonomorphological abnormalities of periportal fibrosis were categorised and organomorphometry of liver and spleen was done. One thousand two hundred and seventy three 1273 (81.5%) patients in Rhino Camp and Obongi fishing villages were found to be excreting from 100 to ≥ 500 eggs per gram (epg) of faeces of S. mansoni eggs. Two hundred and eighty nine (18.5%) did not have eggs of S.mansoni in their faeces. All the 1273 patients secreting eggs of S.mansoni in their stool in Rhino Camp and Obongi fishing villages had abdominal ultrasonography and sonomorphological abnormalities of periportal fibrosis. Eight hundred and forty 840 (66%) although excreted S. mansoni eggs in their stool had Pf (0); Pf grade (I), n=259 (20.3%); Pf grade (II) n =147 (11.5%); and Pf grade (III) n=27 (2.1%) were observed

Effect Of Seasonal Rainfall And Other Environmental Changes, On Snail Density And Infection Rates With Schistosoma mansoni Fifteen Years After The Last Snails\' Study In Kigungu, Entebbe, Uganda

Background: The last study on snail population density in relation to rainfall pattern in Kigungu canoe landing and recreational sites on Lake Victoria shore was earlier carried out about fifteen years ago. This study also reviewed the influence of other environmental factors on the snails\' infection rate. Objective: To reassess the density dynamic of Biomphalaria (B) choanomphala and Biomphalaria (B) pfeifferi, which act as the intermediate host for S. mansoni and Bulinus (B) globosus, and Bulinus (B) tropicus, which act as intermediate host for S. haematobium. Design: Retrospective study. Setting: Busy canoe landing sites along Lake Victoria in Kigungu fishing village were selected for the snail sampling. Results: Nine thousand one hundred and ninety four B. choanomphala were collected over the study period. The numbers of B. choanomphala collected in each year was 4742 (51.6%) and 4452 (48.4%) in 2004 and 2005 respectively. Of the 4742 B.Choanomphala collected in 2004, 82 (1.7%) shed human cercariae and 329 (6.7%) shed non-human cercariae. Whereas in 2005, out of 4452 B. choanomphala collected 302 (6.85%) shed non-human cercariae and 82 (1.8%) shed human cercariae. Similarly, 4173 B. pfeifferi were also collected in the same period. Out of which 2224 (53.3%) were collected in 2004 and 1949 (46.7%) in 2005. For B. pfeifferi, 42 (1.9%) out of 2224 snails collected in 2004 shed human cercariae and 246 (11.1%) shed non-human cercariae. While in 2005, 33 out of 1949 snails (1.7%) shed human cercariae and 159 (8.2%) shed non-human cercariae. Other snails of medical importance collected included 292 B. globosus and 3094 B. tropicus. None of the Bulinus spp. collected shed any human cercariae but 37 (2.1%) and 30 (2.3%) B. tropicus shed non-human cercariae in 2004 and 2005 respectively. In 2004 and 2005, the area received, 1729mm and 1959mm of rainfall respectively. The mean rainfall during the year was 144.05 mm and 163.3 mm in 2004 and 2005 respectively. There was a negative correlation between rainfalls and snail density dynamic. Conclusion: We have found in this study that in spite of the bush clearing of the papyrus swamps which originally was the major habitats for B. choanomphala, B. pfeifferi and the Bulinus spp the intermediate host for schistosome at all canoe landing sites at Kigungu, these snails are still present. Moreover, that their population density dynamic and infection rate are inversely proportional to the rainfall pattern. East African Medical Journal Vol. 85 (11) 2008: pp. 556-56

Schistosoma mansoni infection and the associated antibody immune response amongst residents of Kigungu Entebbe, Uganda

Background: There are many foci endemic for Schistosoma (S.) mansoni in Uganda. The immune responses to infection with the parasites in these areas have been found to vary with host sex, age and infection intensity.Objective: To determine the profile of antibody isotypes responses against S. mansoni crude soluble egg antigens (SEA) and soluble adult worm protein (SWAP) antigens that determine the host resistance or susceptibility to reinfection.Design: Cross Sectional, cohort study.Setting: Kigugu fishing village in Entebbe, Uganda.Subjects: Nine hundred and forty five (945) Kigungu residents reported for pre-treatment screening and enrolment and 626 cohorts report for post-treatment screening and enrolment 18 months later.Results: Pearson’s Chi-sq2 showed that increase in titres of anti (SWAP IgE, SEA IgE, and SEA IgG2) was not significant, but increase in anti SEA IgG3 was significant. Decrease in titres of anti (SWAP IgG1, SEA IgG1, and SEA IgG4) was not significant but decrease of anti (SWAP IgG2, SWAP IgG3 and SWAP IgG4) was significant. Positive correlation existed between age and anti SWAP IgE in before and after treatment sera. On the contrary, age was positively correlated with anti SWAP IgG4 in pre-treatment sera but was negatively correlated with anti SWAP IgG4 in the post-treatment sera. In addition there were positive correlation between higher egg counts and the immunoglobulin levels of anti SWAP IgG4 and anti SEA IgG4 but negative correlations were observed between anti SWAP IgE and anti SEA IgE. Conversely low egg counts were associated with high levels of anti SWAP IgE. Furthermore, IgG1-4, IgE antibody to SEA and SWAP antigens did not differ significantly according to sex.Conclusion: We concluded that praziquantel treatment of S. mansoni infected persons alter the immune responses that are influenced by age and intensity. A phenomenon that is useful in the effort to produce vaccine against schistosome

Detection of Cryptococcus neoformans in Cerebrospinal Fluid from Meningitis Patients Associated with HIV/AIDS in Uganda

The significance of Cryptococcus var. neoformans meningitis fatality in human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) patients was confirmed in ten cerebrospinal fluids (CSFs) from Entebbe hospitals in Uganda. All ten CSF specimens were turbid, but on centrifugation, their supernatants were clear and colourless. The protein content of the specimens ranged from 20 to 50mg per 100ml of CSF (normal range is 10 to 40mg/100ml). Sugar content ranged between 20 to 60mg per 100ml CFS (normal range 45 to 72mg/100ml). The white blood cell (WBC) counts in the ten specimens ranged from 15 to 40 WBC/mm^3 of CSF (normal range up to 5 WBC/mm^3). Gram stain on the deposits, showed capsulated Cryptococcus (Cr.) neoformans var. neoformans which were further demonstrated in Odongo-Aginya stain using 5% eosin in 10% formalin mixed in equal volume with 7.5% nigrosin in 10% formalin (Odongo-Aginya et al., 1995). Ziehl Neelsen stain on the deposits, for acid alcohol fast bacilli was negative. Cr. neoformans var. neoformans were isolated from all CSF specimens and all patients investigated, died within one week from the time of admission to the hospitals

Evidence of Long Term Benefit of Praziquantel Treatment Against Schistosoma mansoni in Kigungu Fishing Village of Entebbe, Uganda

Praziquantel (PZQ) is efficacious against all species of schistosome: Schistosoma mansoni; Schistosoma haematobium; Schistosoma japonicum and other parasites like the Taenia species. This cross-sectional cohorts study was carried out in Kigungu fishing village along Lake Victoria shore in Entebbe Uganda. Our analysis was based on examining microscopically three slides from a single stool specimen from each of base line cohorts 945.These included children and adults, participants from both sexes in Kigungu fishing village in Entebbe Uganda. Nine hundred and one (901) of the cohorts were re-examined after six months and 625 of the same cohorts who were examined at the baseline and after six months were re-examined 18 months later. The slides were prepared using modified Kato/Katz (Odongo-Aginya) method. The infection proportion with Schistosoma mansoni at baseline was 448 (47.5%) but this was reduced to 244 (25.8%) 18 months after treatment with a single oral dose of praziquantel at 40mg/kg. However 495 (52.5%) were negative at the baseline study. The cure proportion after six was significant {(P=0.00), (OR4.63) CI at 95% (3.53-6.06)}. Similarly the cure proportion after 18 months was significant {(P=0.00), (OR2.2) CI at 95% (1.87-3.34)}. The force of re-infection after six months was significant {(P=0.0001), (OR 0.47) CI at 95% (0.31-0.71)}. Nevertheless the force of re-infection was not significant after 18 months {(P=0.766), (OR 0.95) CI at 95% (0.68-1.34)} eggs excretion did not reach the level of the pre-treatment intensity. The egg reduction was 69.3%. This was associated with age and pre-treatment intensity < 400 eggs per gram (epg) of faeces and age groups ≥ 30 years. The egg reduction also resulted in marked decrease in clinical symptoms in the participants. Our study suggests evidence of long-term benefit of praziquantel in Kigungu and that the re-infection occurred more commonly in younger age group than in the older patients.Key words: Praziquantel; Schistosoma mansoni; Kigungu; Entebbe; Uganda

EVALUATION OF SCHISTOSOMA MANSONI MORBIDITY ONE YEAR AFTER PRAZIQUANTEL TREATMENT IN RHINO CAMP AND OBONGI IN WEST NILE, UGANDA

An evaluation study on reversibility of Schistosoma mansoni induced periportal fibrosis (PF) morbidity following treatment with praziquantel, 40mg/kg body weight after one year, was carried out in Rhino Camp and Obongi all are West Nile districts in northern Uganda. To assess the reversibility of Schistosoma (S) mansoni induced PFs morbidity following treatment with praziquantel, 40mg/kg body weight after one year. The design was a Prospective cohorts study; and the setting was a busy canoe landing sites along Albert Nile in Schistosoma (S) mansoni hyperendemic areas of Rhino Camp and Obongi fishing village were selected for the study. Previously in 2005, 1562 people including fishermen and women, school pupils, teachers, and civil servants were studied in both fishing villages for S. mansoni using Kato/Katz stool smear method. Abdominal ultrasonography and sonomorphological abnormalities of periportal fibrosis were performed with Aloka portable ultrasound machine (Hellige, Freiburg, Germany) fitted with a convex probe of 3.5 mega Hertz was also performed in the field clinic on all patients who had S. mansoni eggs in their faeces. The sonomorphological abnormalities of periportal fibrosis were categorised and organomorphometry of liver and spleen was done. One thousand two hundred and seventy three 1273 (81.5%) patients in Rhino Camp and Obongi fishing villages were found to be excreting from 100 to ≥ 500 eggs per gram (epg) of faeces of S. mansoni eggs. Two hundred and eighty nine (18.5%) did not have eggs of S.mansoni in their faeces. All the 1273 patients secreting eggs of S.mansoni in their stool in Rhino Camp and Obongi fishing villages had abdominal ultrasonography and sonomorphological abnormalities of periportal fibrosis. Eight hundred and forty 840 (66%) although excreted S. mansoni eggs in their stool had Pf (0); Pf grade (I), n=259 (20.3%); Pf grade (II) n =147 (11.5%); and Pf grade (III) n=27 (2.1%) were observed

Knowledge, attitudes and practices of prevention of mother to child transmision of HIV among women in Laroo Division Gulu Municipality, Uganda

This study is exploring the knowledge, attitudes and practices of Prevention of Mother to Child Transmission (PMTCT) of Human Immunodeficiency Virus (HIV) among child bearing women aged between 15- 45 years old in Laroo division in Gulu municipality. The goal of the study was to determine the level of attitude as well as of knowledge and belief about PMTCT and proportion of women practicing it among the child bearing women of Laroo Division. The Cross-sectional and Descriptive study design was applied in multistage sampling method with random selection of a parish followed by random selection of a village within the parish from which a sample of homesteads was randomly selected. From each homesteads, a single respondent was randomly selected and registered in the study. Questionnaires were given to respondents that had consented to take part in the study. A total of 208 respondents were registered and interviewed in a period of February to march 2011. There were 165 (79.3%) of the mothers who had knowledge about various PMTCT methods. Of these 86(52%) heard about PMTCT first from hospital. 50 (30%) knew about exclusive breast feeding, while another 50(30%) use of ART, 45(27%) knew about replacement feedings and only 21(13%) knew of elective caesarean section as method of PMTCT. However the majority of the mothers 159(96.5%) thought that PMTCT was beneficial. Nevertheless some mothers thought that PMTCT causes various counter indications including infertility 17 (10.5%) and abnormalities in children at birth 27 (16.7). Their HIV serostatus also varied. Of the 135(81.7%) screened for HIV 42(31.2%) tested HIV positive and only 27 (64.2%) used contraceptives to prevent pregnancy while they were HIV positive. However of the correspondents who tested positive in their last HIV tests, the majority (83%) had had at least a pregnancy after testing HIV positive of which 6.8% did not practice PMTCT. Our study suggests evidence that Knowledge, attitude and practice of PMTCT among women of reproductive age in Laroo Division in Gulu municipality in Northern Uganda is adequate.Nevertheless with the infection rate of 31.2% among them points out that there is a substantial burden of HIV in the women community