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

Gastric Cancer in Kenya

Introduction: Less than a century ago, Gastric cancer was the most common cancer in the world. Despite its worldwide decline over the past century, it remains a major killer across the globe. Information on gastric cancer in developing countries and especially Africa remains low.Aim: Assess prevalence of gastric cancer among patients presenting with dyspepsia Methodology: This was a retrospective study to determine the prevalence of gastric cancer among patients with dyspepsia referred for upper GI Endoscopy between June 2014 and June 2016. Source of information was reports made at endoscopy. Patient reports included Age, Gender, reason for referral [presenting symptoms], and findings on oesophagus, OG junction, stomach and Duodenum. Biopsy specimens were taken from any swellings, erosions, erythematous areas, ulcers and any other abnormal looking areas. They were preserved in 10% formal saline and sent for histology. Reports from histology were then linked to the endoscopy reports after reporting.Data analysis: Data was analyzed using SPSS version 21. The analysis included running of frequency tables [Descriptive statistics] and cross correlations were calculated using Fishers exact chi square test owing to the small sample size. Results: One thousand two hundred patients underwent OGD over the 2 years. Forty four patients seen over the 2 years had gastric cancer giving a prevalence of 3.67%. Twenty seven of the patients with gastric cancer were males and 17 were females giving female to male ration of 1.1.8. Diffuse gastric cancer was the most common followed by intestinal type. Females tended to get gastric cancer at a younger age than males. Conclusion: The prevalence of gastric cancer is relatively high. Males are affected more than females. Diffuse gastric cancer is more common like other parts of the world

A Critical Role for Induced IgM in the Protection against West Nile Virus Infection

In humans, the elderly and immunocompromised are at greatest risk for disseminated West Nile virus (WNV) infection, yet the immunologic basis for this remains unclear. We demonstrated previously that B cells and IgG contributed to the defense against disseminated WNV infection (Diamond, M.S., B. Shrestha, A. Marri, D. Mahan, and M. Engle. 2003. J. Virol. 77:2578–2586). In this paper, we addressed the function of IgM in controlling WNV infection. C57BL/6J mice (sIgM−/−) that were deficient in the production of secreted IgM but capable of expressing surface IgM and secreting other immunoglobulin isotypes were vulnerable to lethal infection, even after inoculation with low doses of WNV. Within 96 h, markedly higher levels of infectious virus were detected in the serum of sIgM−/− mice compared with wild-type mice. The enhanced viremia correlated with higher WNV burdens in the central nervous system, and was also associated with a blunted anti-WNV IgG response. Passive transfer of polyclonal anti-WNV IgM or IgG protected sIgM−/− mice against mortality, although administration of comparable amounts of a nonneutralizing monoclonal anti-WNV IgM provided no protection. In a prospective analysis, a low titer of anti-WNV IgM antibodies at day 4 uniformly predicted mortality in wild-type mice. Thus, the induction of a specific, neutralizing IgM response early in the course of WNV infection limits viremia and dissemination into the central nervous system, and protects against lethal infection

Epidemiology of ROP update - Africa is the new frontier.

Several epidemics of blindness due to retinopathy of prematurity (ROP) have been described, with the most recent (the third) occurring in middle income countries in Latin America and Eastern Europe initially, and more recently in the more advanced economies in Asia. In these settings, which are characterized by variation in the quality of neonatal care and inadequate coverage of ROP screening and treatment, larger, more mature infants are affected as well as extremely preterm infants. In 2010 the annual incidence of blindness and visual impairment from ROP globally was estimated to be 32,300, with the lowest incidence in sub-Saharan countries. However, ROP is likely to become an increasingly important cause of blindness in children in sub-Saharan Africa as neonatal care expands unless policies and programmes for control are included at the outset

Climate change adaptation in conflict-affected countries:A systematic assessment of evidence

People affected by conflict are particularly vulnerable to climate shocks and climate change, yet little is known about climate change adaptation in fragile contexts. While climate events are one of the many contributing drivers of conflict, feedback from conflict increases vulnerability, thereby creating conditions for a vicious cycle of conflict. In this study, we carry out a systematic review of peer-reviewed literature, taking from the Global Adaptation Mapping Initiative (GAMI) dataset to documenting climate change adaptation occurring in 15 conflict-affected countries and compare the findings with records of climate adaptation finance flows and climate-related disasters in each country. Academic literature is sparse for most conflict-affected countries, and available studies tend to have a narrow focus, particularly on agriculture-related adaptation in rural contexts and adaptation by low-income actors. In contrast, multilateral and bilateral funding for climate change adaptation addresses a greater diversity of adaptation needs, including water systems, humanitarian programming, and urban areas. Even among the conflict-affected countries selected, we find disparity, with several countries being the focus of substantial research and funding, and others seeing little to none. Results indicate that people in conflict-affected contexts are adapting to climate change, but there is a pressing need for diverse scholarship across various sectors that documents a broader range of adaptation types and their results

Science for loss and damage. Findings and propositions

The debate on “Loss and Damage” (L&D) has gained traction over the last few years. Supported by growing scientific evidence of anthropogenic climate change amplifying frequency, intensity and duration of climate-related hazards as well as observed increases in climate-related impacts and risks in many regions, the “Warsaw International Mechanism for Loss and Damage” was established in 2013 and further supported through the Paris Agreement in 2015. Despite advances, the debate currently is broad, diffuse and somewhat confusing, while concepts, methods and tools, as well as directions for policy remain vague and often contested. This book, a joint effort of the Loss and Damage Network—a partnership effort by scientists and practitioners from around the globe—provides evidence-based insight into the L&D discourse by highlighting state-of-the-art research conducted across multiple disciplines, by showcasing applications in practice and by providing insight into policy contexts and salient policy options. This introductory chapter summarises key findings of the twenty-two book chapters in terms of five propositions. These propositions, each building on relevant findings linked to forward-looking suggestions for research, policy and practice, reflect the architecture of the book, whose sections proceed from setting the stage to critical issues, followed by a section on methods and tools, to chapters that provide geographic perspectives, and finally to a section that identifies potential policy options. The propositions comprise (1) Risk management can be an effective entry point for aligning perspectives and debates, if framed comprehensively, coupled with climate justice considerations and linked to established risk management and adaptation practice; (2) Attribution science is advancing rapidly and fundamental to informing actions to minimise, avert, and address losses and damages; (3) Climate change research, in addition to identifying physical/hard limits to adaptation, needs to more systematically examine soft limits to adaptation, for which we find some evidence across several geographies globally; (4) Climate risk insurance mechanisms can serve the prevention and cure aspects emphasised in the L&D debate but solidarity and accountability aspects need further attention, for which we find tentative indication in applications around the world; (5) Policy deliberations may need to overcome the perception that L&D constitutes a win-lose negotiation “game” by developing a more inclusive narrative that highlights collective ambition for tackling risks, mutual benefits and the role of transformation

Destructive arthritis in a patient with chikungunya virus infection with persistent specific IgM antibodies

<p>Abstract</p> <p>Background</p> <p>Chikungunya fever is an emerging arboviral disease characterized by an algo-eruptive syndrome, inflammatory polyarthralgias, or tenosynovitis that can last for months to years. Up to now, the pathophysiology of the chronic stage is poorly understood.</p> <p>Case presentation</p> <p>We report the first case of CHIKV infection with chronic associated rheumatism in a patient who developed progressive erosive arthritis with expression of inflammatory mediators and persistence of specific IgM antibodies over 24 months following infection.</p> <p>Conclusions</p> <p>Understanding the specific features of chikungunya virus as well as how the virus interacts with its host are essential for the prevention, treatment or cure of chikungunya disease.</p

IL-10 Signaling Blockade Controls Murine West Nile Virus Infection

West Nile virus (WNV), a mosquito-borne single-stranded RNA flavivirus, can cause significant human morbidity and mortality. Our data show that interleukin-10 (IL-10) is dramatically elevated both in vitro and in vivo following WNV infection. Consistent with an etiologic role of IL-10 in WNV pathogenesis, we find that WNV infection is markedly diminished in IL-10 deficient (IL-10−/−) mice, and pharmacologic blockade of IL-10 signaling by IL-10 neutralizing antibody increases survival of WNV-infected mice. Increased production of antiviral cytokines in IL-10−/− mice is associated with more efficient control of WNV infection. Moreover, CD4+ T cells produce copious amounts of IL-10, and may be an important cellular source of IL-10 during WNV infection in vivo. In conclusion, IL-10 signaling plays a negative role in immunity against WNV infection, and blockade of IL-10 signaling by genetic or pharmacologic means helps to control viral infection, suggesting a novel anti-WNV therapeutic strategy

A Recombinant Influenza A Virus Expressing Domain III of West Nile Virus Induces Protective Immune Responses against Influenza and West Nile Virus

West Nile virus (WNV) continues to circulate in the USA and forms a threat to the rest of the Western hemisphere. Since methods for the treatment of WNV infections are not available, there is a need for the development of safe and effective vaccines. Here, we describe the construction of a recombinant influenza virus expressing domain III of the WNV glycoprotein E (Flu-NA-DIII) and its evaluation as a WNV vaccine candidate in a mouse model. FLU-NA-DIII-vaccinated mice were protected from severe body weight loss and mortality caused by WNV infection, whereas control mice succumbed to the infection. In addition, it was shown that one subcutaneous immunization with 105 TCID50 Flu-NA-DIII provided 100% protection against challenge. Adoptive transfer experiments demonstrated that protection was mediated by antibodies and CD4+T cells. Furthermore, mice vaccinated with FLU-NA-DIII developed protective influenza virus-specific antibody titers. It was concluded that this vector system might be an attractive platform for the development of bivalent WNV-influenza vaccines

Earliest evidence for the ivory trade in southern Africa : isotopic and ZooMS analysis of seventh-tenth century AD ivory from KwaZulu-Natal

KwaGandaganda, Ndondondwane and Wosi were major Early Farming Community settlements in what is today the KwaZulu-Natal province of South Africa. These sites have yielded, among other remains, abundant evidence of ivory and ivory working dating to the seventh–tenth centuries ad, pre-dating by approximately 200 years the better-known ivory artefacts from sites in the Limpopo River Valley and surrounding regions. We report the results of carbon, nitrogen and strontium isotope analysis to explore the origins and procurement of this ivory, in combination with Zooarchaeology by Mass Spectrometry (ZooMS) to identify the species of animals from which it was derived. All of the ivory studied using ZooMS was elephant, despite the presence of hippopotamus remains on all three sites. Some ivory was probably obtained from elephant herds that lived close to the sites, in the densely wooded river valleys favoured by both elephants and early farmers. Other material came from savannah environments further afield. Ivory found at these three sites was drawn from different catchments, implying a degree of landscape/resource partitioning even at this early stage. These communities clearly invested substantial effort in obtaining ivory from across the region, which speaks to the importance of this commodity in the economy of the time. We suggest that some ivory items were for local use, but that some may have been intended for more distant markets via Indian Ocean trade