The prevalence and antibiotics susceptibility pattern of Neisseria gonorrhoeae in patients attending OPD clinics at St. Mary?s Hospital Lacor Uganda

Introduction. Gonorrhea is one of the most common sexually transmitted infections (STIs) in developing countries, and the emergence of resistance to antimicrobial agents in Neisseria gon- orrhoeae is a major obstacle in the control of gonorrhoea. Peri- odical determination of the prevalence and monitoring of antimi- crobial susceptibility of N. gonorrhoeae is essential for the early detection of emergence of drug resistance. Methods. A total of 640 consecutive patients who attended the Outpatient Department (OPD) Clinics at St. Mary?s Hospital Lacor between Jan 2007-Dec 2011, with gonococcal urethri- tis symptoms and whose urethral swabs and high vagina swabs (HVS) were cultured, were involved in the study. Two hundred and fifty six (256) patients had positive pus swab culture, of which 151 (23.6%) showed growth of Neisseria gonorrhoeae. All the isolates were tested for antimicrobial susceptibility using the Kirby Bauer-Disc diffusion techniques. Results. Gonococcal isolates showed rapid decrease in suscepti- bility to the antimicrobials especially to Ampicillin, Tetracycline and Erythomycin, Ciprofloxacin, and intermediate to chloram- phenicol, however, Gentamicin and cefotaxime have remained as a single dose sensitive treatment for Neisseria gonorrhoeae. Sen- sitization on drug use and adopting preventive measures and con- tinuous education on safer sexual behavior through health care authorities would lead to reduction in the prevalence of Neisseria gonorrhoeae and resistance to antimicrobial. Discussion. Gonorrhea is one of the most common sexually trans- mitted infections (STIs) in developing countries, and the emer- gence of resistance to antimicrobial agents in Neisseria gonor- rhoeae is a major obstacle in the control of gonorrhea. Periodi- cal monitoring of antimicrobial susceptibility of N. gonorrhea is essential for the early detection of emergence of drug resistance

Low CD4 count plus coma predicts cryptococcal meningitis in Tanzania

<p>Abstract</p> <p>Background</p> <p>Largely due to the lack of diagnostic reagents, the prevalence and clinical presentation of cryptococcal meningitis in Tanzania is poorly understood. This in turn is limiting the impact of increased fluconazole availability.</p> <p>Methods</p> <p>We evaluated a cohort of 149 consecutive HIV-infected adult inpatients presenting with headache or altered mental status for clinical features, CD4 count, cryptococcal infection, and outcome. Cryptococcal meningitis was diagnosed via India ink and latex agglutination assay of CSF (<it>n </it>= 24 and 40 positive, respectively). Associations between cryptococcal meningitis and clinical features were evaluated by t-test. The sensitivity, specificity, and positive likelihood ratio of such features were determined.</p> <p>Results</p> <p>Cryptococcal meningitis was associated with confusion, social withdrawal, seizures, fever, tachycardia, meningismus, oral candidiasis, and low Glasgow coma scales and CD4 count. CD4 count < 100/μl provided the highest sensitivity for the diagnosis (93%), coma (Glasgow coma scale ≤ 8) provided the highest specificity (84%), and the combination provided the highest positive likelihood ratio (3.8). All cryptococcal meningitis patients were initiated on 800 milligrams of fluconazole daily and 50% survived to discharge, however no clinical or laboratory findings correlated with prognosis.</p> <p>Conclusion</p> <p>Cryptococcal meningitis is common among Tanzanian HIV inpatients presenting with headache or altered mental status. Purely clinical features are insensitive for establishing the diagnosis or prognosis. We advocate expanding laboratory capacity for cryptococcal antigen testing to maximize survival.</p

Cryptococcal infection in a cohort of HIV-1-infected Ugandan adults

Objective: Despite the recognition of Cryptococcus neoformans as a major cause of meningitis in HIV-infected adults in sub-Saharan Africa, little is known about the relative importance of this potentially preventable infection as a cause of mortality and suffering in HIV-infected adults in this region. Design: A cohort study of 1372 HIV-1-infected adults, enrolled and followed up between October 1995 and January 1999 at two community clinics in Entebbe, Uganda. Methods: Systematic and standardized assessment of illness. episodes to describe cryptococcal disease and death rates. Results: Cryptococcal disease was diagnosed in 77 individuals (rate 40.4/1000 person-years) and was associated with 17% of all deaths (77 out of 444) in the cohort. Risk of infection was strongly associated with CD4 T cell counts 100 days in 11 % of patients). Survival following diagnosis was poor (median survival 26 days; range 0-138). Conclusions: Cryptococcal infection is an important contributor to mortality and suffering in HIV-infected Ugandans. Improvements in access to effective therapy of established disease are necessary. In addition, prevention strategies, in particular chemoprophylaxis, should be evaluated while awaiting the outcome of initiatives to make antiretroviral therapy more widely available. (C) 2002 Lippincott Williams Wilkins

High Pressure Flames with Multicomponent Transport

International audienceThe thermodynamic formulation and the traditional formulation of multicomponent transport fluxes in high pressure fluids are discussed. The impact of high pressure transport models on mixing layers, premixed plane flames and strained diffusion flames is then investigated. Multicomponent fluxes in diffuse-interface transcritical diffusion flames are further addressed