4 research outputs found
How Human Brucellosis Incidence in Urban Kampala Can Be Reduced Most Efficiently? A Stochastic Risk Assessment of Informally-Marketed Milk
In Kampala, Uganda, studies have shown a significant incidence of human brucellosis. A stochastic risk assessment involving two field surveys (cattle farms and milk shops) and a medical record survey was conducted to assess the risk of human brucellosis infection through consumption of informally marketed raw milk potentially infected with Brucella abortus in Kampala and to identify the best control options.In the cattle farm survey, sera of 425 cows in 177 herds in the Kampala economic zone were sampled and tested for brucellosis using a competitive enzyme-linked immunosorbent assay (CELISA). Farmers were interviewed for dairy information. In the milk shop surveys, 135 milk sellers in the urban areas were interviewed and 117 milk samples were collected and tested using an indirect enzyme-linked immunosorbent assay (IELISA). A medical record survey was conducted in Mulago National Referral Hospital for serological test results. A risk model was developed synthesizing data from these three surveys. Possible control options were prepared based on the model and the reduction of risk was simulated for each scenario. Overall, 12.6% (6.8-18.9: 90%CI) of informally marketed milk in urban Kampala was contaminated with B.abortus at purchase and the annual incidence rate was estimated to be 5.8 (90% CI: 5.3-6.2) per 10,000 people. The best control option would be the construction of a milk boiling centre either in Mbarara, the largest source of milk, or in peri-urban Kampala and to ensure that milk traders always sell milk to the boiling centre; 90% success in enforcing these two options would reduce risk by 47.4% (21.6-70.1: 90%CI) and 82.0% (71.0-89.0: 90%CI), respectively.This study quantifies the risk of human brucellosis infection through informally marketed milk and estimates the incidence rate in Kampala for the first time; risk-based mitigation strategies are outlined to assist in developing policy
Neurosyphilis masquerading as hemiparesis and Jacksonian epilepsy in an HIV positive patient: a case report
Background: Neurosyphilis is a common but often missed disease
worldwide, mainly because it has many manifestations making its
diagnosis difficult. It is often missed among HIV patients as the
search for other co-infections such as toxoplasmosis often overshadows
its consideration. Objectives: To describe one of our cases of
neurosyphilis in HIV, raise awareness about the reality of
neurosyphilis in Africa and share our experiences in diagnosis and
management of the disease. Methods: A 40 year old, HIV positive female
was admitted with a 2 month history of left sided facial and limb
weakness followed by delirium, aphasia and Jacksonian epilepsy. She
underwent clinical and laboratory evaluation. Results: On examination
she had a maculo-papular rash and left sided paresis. Rapid Plasma
Reagin(RPR) was reactive(titre 1:16). Treponema Pallidum
Haemoaggluttination Assay(TPHA) was also reactive. Cerebrospinal fluid
(CSF) analysis revealed: protein 56 mg per dl, glucose 71 mg per dl,
cells 14 per high power field (predominantly lymphocytes).The VDRL on
the CSF was positive. The CD4 cell count was 320 per ml. She was
treated with intravenous penicillin G, 4 mega-units 6 hourly for 14
days, with a very good response. Conclusion: Neurosyphilis still occurs
in Uganda. It should be considered in all patients with
neurological/ophthalmic illness, including those with HIV. Most cases
respond well to intravenous penicillin G