Fungal Infections among Diabetic Foot Ulcer- Patients Attending Diabetic Clinic in Kenyatta National Hospital, Kenya

Objective: To isolate and identify fungal pathogens associated with dermatophytoses in diabetic patients and identify the spectrum of yeasts colonising diabetic foot ulcers at Kenyatta National Hospital.Design: A cross sectional Laboratory based study.Setting: The Kenyatta National Hospital diabetic clinic.Subjects: Sixty one patients with diabetic foot ulcers from August to November 2009.Results: The five most occurring pathogens were Biopolaris hawaiiensis (5.5%), Trichophyton schoenleinii (3.7%), Aspergillus niger (3.0%), Trichophyton rubrum (3.0%), Fusarium oxysporum (3.0%). Other moulds accounted for less than 3.0%. One suspected case (0.6%) of Penicilium marneffei was isolated although it could not be ascertained due to its high containment requirement. Among the dermatophytes, the most occurring mould was Trichophyton schoenleinii (3.7%) while in non-dermatophyte was Biopolaris hawaiiensis (5.5%). Eight pathogenic yeasts were identified with C. parapsilosis (6.1 %) being the most common followed by C. famata (3.0%). Fungal infestation was highest in callus formation (78.6%).Conclusion: Fungal aetiological agents are significant cause of diabetic wound infection and may require antifungal intervention for successful management of diabetic foot ulcers

SARS-CoV-2 seroprevalence in three Kenyan health and demographic surveillance sites, December 2020-May 2021

Background Most of the studies that have informed the public health response to the COVID-19 pandemic in Kenya have relied on samples that are not representative of the general population. We conducted population-based serosurveys at three Health and Demographic Surveillance Systems (HDSSs) to determine the cumulative incidence of infection with SARS-CoV-2. Methods We selected random age-stratified population-based samples at HDSSs in Kisumu, Nairobi and Kilifi, in Kenya. Blood samples were collected from participants between 01 Dec 2020 and 27 May 2021. No participant had received a COVID-19 vaccine. We tested for IgG antibodies to SARS-CoV-2 spike protein using ELISA. Locally-validated assay sensitivity and specificity were 93% (95% CI 88–96%) and 99% (95% CI 98–99.5%), respectively. We adjusted prevalence estimates using classical methods and Bayesian modelling to account for the sampling scheme and assay performance. Results We recruited 2,559 individuals from the three HDSS sites, median age (IQR) 27 (10–78) years and 52% were female. Seroprevalence at all three sites rose steadily during the study period. In Kisumu, Nairobi and Kilifi, seroprevalences (95% CI) at the beginning of the study were 36.0% (28.2–44.4%), 32.4% (23.1–42.4%), and 14.5% (9.1–21%), and respectively; at the end they were 42.0% (34.7–50.0%), 50.2% (39.7–61.1%), and 24.7% (17.5–32.6%), respectively. Seroprevalence was substantially lower among children (&lt;16 years) than among adults at all three sites (p≤0.001). Conclusion By May 2021 in three broadly representative populations of unvaccinated individuals in Kenya, seroprevalence of anti-SARS-CoV-2 IgG was 25–50%. There was wide variation in cumulative incidence by location and age. </jats:sec

Frequency of thyroid dysfunction among rheumatoid arthritis patients at the Kenyatta National Hospital, Nairobi, Kenya

Background: Rheumatoid Arthritis (RA) affects 0.5-1% of the adult population. A higher prevalence of thyroid dysfunction is observed in patients with RA compared to the general population.Objectives: To establish the frequency of thyroid dysfunction among ambulatory RA patients and to describe the association between thyroid dysfunction and the patients’ socio-demographic characteristics, clinical characteristics, level of disease activity, and their functional status.Design: This was a cross-sectional descriptive study.Methods: Adult patients on follow up for RA at the outpatient clinic were sampled. Sociodemographic data was recorded. The Clinical Disease Activity Index (CDAI) and Health Assessment Questionnaire (HAQ) scores were computed from examination findings and questionnaires respectively. A venous blood sample was analyzed for Thyroid Stimulating Hormone (TSH), free triidothyronine (fT3), and free tetraiodothyronine (fT4). This data was analyzed to determine frequencies and associations.Results: Seventy-six patients were recruited into the study. Sixty-one participants were female. The mean TSH level was 5.8Miu/L. The frequency of thyroid dysfunction was 47.4%. Overt hypothyroidism was the most common form of thyroid dysfunction at 39.5% while 6.6% had Sick Euthyroid. Majority of the participants, 75%, had low disease activity, mean CDAI was 11.6. Forty-one (53.9%) participants had no disability, mean HAQ was 0.5. Correlations between thyroid dysfunction and advancing age, duration of disease, level of disease activity, and functional disability did not attain statistical significance.Conclusion: Thyroid dysfunction is common among patients with RA with no significant association found between thyroid dysfunction socio-demographic characteristics, clinical characteristics, level of disease activity, and functional status. Key words: Thyroid dysfunction, Rheumatoid arthritis, Disease activity, Functional disabilit

The importance of supplementary immunisation activities to prevent measles outbreaks during the COVID-19 pandemic in Kenya

BACKGROUND: The COVID-19 pandemic has disrupted routine measles immunisation and supplementary immunisation activities (SIAs) in most countries including Kenya. We assessed the risk of measles outbreaks during the pandemic in Kenya as a case study for the African Region. METHODS: Combining measles serological data, local contact patterns, and vaccination coverage into a cohort model, we predicted the age-adjusted population immunity in Kenya and estimated the probability of outbreaks when contact-reducing COVID-19 interventions are lifted. We considered various scenarios for reduced measles vaccination coverage from April 2020. RESULTS: In February 2020, when a scheduled SIA was postponed, population immunity was close to the herd immunity threshold and the probability of a large outbreak was 34% (8–54). As the COVID-19 contact restrictions are nearly fully eased, from December 2020, the probability of a large measles outbreak will increase to 38% (19–54), 46% (30–59), and 54% (43–64) assuming a 15%, 50%, and 100% reduction in measles vaccination coverage. By December 2021, this risk increases further to 43% (25–56), 54% (43–63), and 67% (59–72) for the same coverage scenarios respectively. However, the increased risk of a measles outbreak following the lifting of all restrictions can be overcome by conducting a SIA with ≥ 95% coverage in under-fives. CONCLUSION: While contact restrictions sufficient for SAR-CoV-2 control temporarily reduce measles transmissibility and the risk of an outbreak from a measles immunity gap, this risk rises rapidly once these restrictions are lifted. Implementing delayed SIAs will be critical for prevention of measles outbreaks given the roll-back of contact restrictions in Kenya