HIV prevalence correlates with high-risk sexual behavior in Ethiopia's regions

BACKGROUND: HIV prevalence varies between 0.9 and 6.5% in Ethiopia's eleven regions. Little has been published examining the reasons for this variation. METHODS: We evaluated the relationship between HIV prevalence by region and a range of risk factors in the 2005 and 2011 Ethiopian Demographic Health Surveys. Pearson's correlation was used to assess the relationship between HIV prevalence and each variable. RESULTS: There was a strong association between HIV prevalence and three markers of sexual risk: mean lifetime number of partners (men: r = 0.87; P < 0.001; women: r = 0.60; P = 0.05); reporting sex with a non-married, non-cohabiting partner (men: r = 0.92; P < 0.001, women r = 0.93; P < 0.001); and premarital sex. Condom usage and HIV testing were positively associated with HIV prevalence, while the prevalence of circumcision, polygamy, age at sexual debut and male migration were not associated with HIV prevalence. CONCLUSION: Variation in sexual behavior may contribute to the large variations in HIV prevalence by region in Ethiopia. Population-level interventions to reduce risky sexual behavior in high HIV incidence regions should be considered

Early Biometric Lag in the Prediction of Small for Gestational Age Neonates and Preeclampsia

OBJECTIVE: An early fetal growth lag may be a marker of future complications. We sought to determine the utility of early biometric variables in predicting adverse pregnancy outcomes. METHODS: In this retrospective cohort study, the crown-rump length at 11 to 14 weeks and the head circumference, biparietal diameter, abdominal circumference, femur length, humerus length, transverse cerebellar diameter, and estimated fetal weight at 18 to 24 weeks were converted to an estimated gestational age using published regression formulas. Sonographic fetal growth (difference between each biometric gestational age and the crown-rump length gestational age) minus expected fetal growth (number of days elapsed between the two scans) yielded the biometric growth lag. These lags were tested as predictors of small for gestational age (SGA) neonates (≤10th percentile) and preeclampsia. RESULTS: A total of 245 patients were included. Thirty-two (13.1%) delivered an SGA neonate, and 43 (17.6%) had the composite outcome. The head circumference, biparietal diameter, abdominal circumference, and estimated fetal weight lags were identified as significant predictors of SGA neonates after adjusted analyses (P \u3c .05). The addition of either the estimated fetal weight or abdominal circumference lag to maternal characteristics alone significantly improved the performance of the predictive model, achieving areas under the curve of 0.72 and 0.74, respectively. No significant association was found between the biometric lag variables and the development of preeclampsia. CONCLUSIONS: Routinely available biometric data can be used to improve the prediction of adverse outcomes such as SGA. These biometric lags should be considered in efforts to develop screening algorithms for adverse outcomes

Strong association between higher-risk sex and HIV prevalence at the regional level: an ecological study of 27 sub-Saharan African countries [version 1; referees: 2 approved]

Background: It is unclear why HIV prevalence varies by nearly two orders of magnitude between regions within countries in sub-Saharan Africa. In this ecological study, we assess if HIV prevalence by region is associated with any of four markers of higher risk sexual behavior: lifetime number of partners, multiple partners in past year, higher risk sex (defined as sex with non-cohabiting, non-marital partners) and age at debut. Methods: We performed Pearson’s correlation between the 4 behavioral risk factors and HIV prevalence by region in 47 nationally representative surveys from 27 sub-Saharan African countries, separately by gender. In addition, principal components analysis was used to reduce the eight risk factors (four for each gender) to two principal components (PCs). Mixed effects linear regression was used to assess the relationship between the resulting two PCs and HIV prevalence after controlling for the prevalence of male circumcision. Results: HIV prevalence varied by a median 3.7 fold (IQR 2.9-7.9) between regions within countries. HIV prevalence was strongly associated with higher risk sex and, to a lesser extent, the other risk factors evaluated. Both PCs were strongly associated with HIV prevalence when assessed via linear regression. Conclusions: Differences in sexual behavior may underpin the large differences in HIV-prevalence between subpopulation within sub-Saharan African countries

The estimated burden of fungal disease in South Africa

Publication fees were paid via funding from a grant from Fonds.Peer reviewedPublisher PD

Changing trends in β-hemolytic streptococcal bacteremia in Manitoba, Canada:2007-2012

OBJECTIVES: European surveillance studies have reported an increasing incidence of β-hemolytic group G streptococcal bacteremia, but no studies have evaluated trends in β-hemolytic streptococcal bacteremia in North America. METHODS: We reviewed bacteremic episodes and positive throat swab cultures from two tertiary care centers in Manitoba, Canada, from January 2007 to December 2012. RESULTS: During the study period, 19 864 bacteremic episodes, and 9948 positive throat swabs were identified. There were 1025 (5.16%) bacteremic episodes attributable to β-hemolytic streptococci: 425 (2.03%), 339 (1.71%), 62 (0.31%), and 199 (0.95%) to β-hemolytic groups A, B, C, and G streptococci, respectively. From 2007 to 2012, there were significant increases in the proportion of bacteremia attributable to β-hemolytic streptococci in general (6.32% vs. 4.02%; p<0.0001; linear trend test, p<0.0001), and to groups G (1.49% vs. 0.43%; p<0.0001; linear trend test, p<0.0001) and C (0.58% vs. 0.13%; p=0.0068; linear trend test, p=0.0105) β-hemolytic streptococci in particular. Bacteremia attributable to groups A and B β-hemolytic streptococci and Streptococcus pneumoniae were unchanged. There were no changes in the distribution of β-hemolytic streptococcal groups among throat swabs. CONCLUSIONS: Bacteremia attributable to β-hemolytic groups G and C streptococci increased in Manitoba, Canada. Further study of the factors underlying these changes is required

Diagnosis of Breakthrough Fungal Infections in the Clinical Mycology Laboratory: An ECMM Consensus Statement.

Breakthrough invasive fungal infections (bIFI) cause significant morbidity and mortality. Their diagnosis can be challenging due to reduced sensitivity to conventional culture techniques, serologic tests, and PCR-based assays in patients undergoing antifungal therapy, and their diagnosis can be delayed contributing to poor patient outcomes. In this review, we provide consensus recommendations on behalf of the European Confederation for Medical Mycology (ECMM) for the diagnosis of bIFI caused by invasive yeasts, molds, and endemic mycoses, to guide diagnostic efforts in patients receiving antifungals and support the design of future clinical trials in the field of clinical mycology. The cornerstone of lab-based diagnosis of breakthrough infections for yeast and endemic mycoses remain conventional culture, to accurately identify the causative pathogen and allow for antifungal susceptibility testing. The impact of non-culture-based methods are not well-studied for the definite diagnosis of breakthrough invasive yeast infections. Non-culture-based methods have an important role for the diagnosis of breakthrough invasive mold infections, in particular invasive aspergillosis, and a combination of testing involving conventional culture, antigen-based assays, and PCR-based assays should be considered. Multiple diagnostic modalities, including histopathology, culture, antibody, and/or antigen tests and occasionally PCR-based assays may be required to diagnose breakthrough endemic mycoses. A need exists for diagnostic tests that are effective, simple, cheap, and rapid to enable the diagnosis of bIFI in patients taking antifungals.S

50 years of Emmonsia disease in humans: the dramatic emergence of a cluster of novel fungal pathogens

New species of Emmonsia-like fungi, with phylogenetic and clinical similarities to Blastomyces and Histoplasma, have emerged as causes of systemic human mycoses worldwide. They differ from classical Emmonsia species by producing a thermally-dependent, yeast-like phase rather than adiaspores, and by causing disseminated infections, predominantly in immunocompromised patients and often with high case-fatality rates. Such differences will be important for clinicians to consider in diagnosis and patient management, and for microbiologists who may encounter these fungi with increasing frequency