Increased Vascularity in Cervicovaginal Mucosa with Schistosoma haematobium Infection

Schistosomiasis is a fresh water parasite infection that affects millions of people, especially in Africa. Recent knowledge about the genital manifestations of schistosomiasis; especially its possible association with human immunodeficiency virus (HIV) infection, has led to increased focus on this neglected tropical disease. Millions of women remain undiagnosed for genital schistosomiasis, and may suffer from abnormal mucosal blood vessels, contact bleeding and lesions named sandy patches. This study analyses a unique selection of female genital biopsies containing parasite eggs. Protein detection and standard histopathological assessment are combined to quantify and study the characteristics of the mucosal blood vessels surrounding the eggs. Our results show that the genital mucosa with parasite eggs is more vascularised compared to healthy tissue, and that viable eggs tend to be surrounded by proliferating blood vessels. These findings have not yet been correlated directly to clinical manifestations. Further studies are needed in order to provide clinical advice on the risks and consequences of mucosal lesions particular to female genital schistosomiasis

Predictors of mortality in HIV-infected patients starting antiretroviral therapy in a rural hospital in Tanzania

\ud \ud Studies of antiretroviral therapy (ART) programs in Africa have shown high initial mortality. Factors contributing to this high mortality are poorly described. The aim of the present study was to assess mortality and to identify predictors of mortality in HIV-infected patients starting ART in a rural hospital in Tanzania. This was a cohort study of 320 treatment-naïve adults who started ART between October 2003 and November 2006. Reliable CD4 cell counts were not available, thus ART initiation was based on clinical criteria in accordance with WHO and Tanzanian guidelines. Kaplan-Meier models were used to estimate mortality and Cox proportional hazards models to identify predictors of mortality. Patients were followed for a median of 10.9 months (IQR 2.9-19.5). Overall, 95 patients died, among whom 59 died within 3 months of starting ART. Estimated mortality was 19.2, 29.0 and 40.7% at 3, 12 and 36 months, respectively. Independent predictors of mortality were severe anemia (hemoglobin <8 g/dL; adjusted hazard ratio [AHR] 9.20; 95% CI 2.05-41.3), moderate anemia (hemoglobin 8-9.9 g/dL; AHR 7.50; 95% CI 1.77-31.9), thrombocytopenia (platelet count <150 x 109/L; AHR 2.30; 95% CI 1.33-3.99) and severe malnutrition (body mass index <16 kg/m2; AHR 2.12; 95% CI 1.06-4.24). Estimated one year mortality was 55.2% in patients with severe anemia, compared to 3.7% in patients without anemia (P < 0.001). Mortality was found to be high, with the majority of deaths occurring within 3 months of starting ART. Anemia, thrombocytopenia and severe malnutrition were strong independent predictors of mortality. A prognostic model based on hemoglobin level appears to be a useful tool for initial risk assessment in resource-limited settings.\u

Antiretroviral treatment reverses HIV-associated anemia in rural Tanzania

<p>Abstract</p> <p>Background</p> <p>HIV-associated anemia is common and associated with poor prognosis. However, its response to antiretroviral treatment (ART) in rural Africa is poorly understood.</p> <p>Methods</p> <p>HIV-infected adults (≥15 years) who enrolled in HIV care at Haydom Lutheran Hospital in northern Tanzania were included in the study. The effect of ART (zidovudine/stavudine + lamivudine + efavirenz/nevirapine) on HIV-associated anemia was studied in a subset of patients who were anemic at the time they started ART and had a follow-up hemoglobin measurement 12 months later. Pregnant women were excluded from the study, as were women who had given birth within the past 6 weeks. Anemia was defined as hemoglobin <12 g/dL in women and <13 g/dL in men. We applied paired sample T-tests to compare hemoglobin levels before and one year after ART initiation, and logistic regression models to identify predictors of persistent anemia.</p> <p>Results</p> <p>At enrollment, mean hemoglobin was 10.3 g/dL, and 649 of 838 patients (77.4%) were anemic. Of the anemic patients, 254 (39.1%) had microcytosis and hypochromia. Among 102 patients who were anemic at ART initiation and had a follow-up hemoglobin measurement after 12 months, the mean hemoglobin increased by 2.5 g/dL (<it>P </it>< 0.001); however, 39 patients (38.2%) were still anemic after 12 months of ART. Independent predictors of persistent anemia were mean cell volume in the lower quartile (<76.0 fL; Odds Ratio [OR] 4.34; 95% confidence interval [CI] 1.22-15.5) and a zidovudine-containing initial regimen (OR 2.91; 95% CI 1.03-8.19).</p> <p>Conclusions</p> <p>Most patients had anemia at enrollment, of whom nearly 40% had microcytosis and hypochromia suggestive of iron deficiency. The mean hemoglobin increased significantly in patients who received ART, but one third were still anemic 12 months after ART initiation indicating that additional interventions to treat HIV-associated anemia in rural Africa might be warranted, particularly in patients with microcytosis and those treated with zidovudine.</p

Treatment of chronic hepatitis B in sub-Saharan Africa: 1-year results of a pilot program in Ethiopia

Background The World Health Organization has set an ambitious goal of eliminating viral hepatitis as a major public health threat by 2030. However, in sub-Saharan Africa, antiviral treatment of chronic hepatitis B (CHB) is virtually unavailable. Herein, we present the 1-year results of a pilot CHB treatment program in Ethiopia. Methods At a public hospital in Addis Ababa, CHB patients were treated with tenofovir disoproxil fumarate based on simplified eligibility criteria. Baseline assessment included liver function tests, viral markers, and transient elastography (Fibroscan). Changes in laboratory markers were analyzed using Wilcoxon signed-rank tests. Adherence to therapy was measured by pharmacy refill data. Results Out of 1303 patients, 328 (25.2%) fulfilled the treatment criteria and 254 (19.5%) had started tenofovir disoproxil fumarate therapy prior to September 1, 2016. Of the patients who started therapy, 30 (11.8%) died within the first year of follow-up (28 of whom had decompensated cirrhosis), 9 (3.5%) self-stopped treatment, 7 (2.8%) were lost to follow-up, and 4 (1.6%) were transferred out. In patients who completed 12 months of treatment, the median Fibroscan value declined from 12.8 to 10.4 kPa (p  1,000,000 IU/mL; adjusted OR 2.41; 95% CI 1.04–5.55) and suboptimal adherence (< 95%; adjusted OR 3.43, 95% CI 1.33–8.88). Conclusions This pilot program demonstrated that antiviral therapy of CHB can be realized in Ethiopia with good clinical and virologic response. Early mortality was high in patients with decompensated cirrhosis, underscoring the need for earlier detection of hepatitis B virus infection and timely initiation of treatment, prior to the development of irreversible complications, in sub-Saharan Africa. Trial registration NCT02344498 (ClinicalTrials.gov identifier). Registered 16 January 2015

Co-infection with Schistosoma haematobium and soil-transmitted helminths in rural South Africa

Schistosomiasis and soil-transmitted helminthiasis are among the most prevalent neglected tropical diseases and may lead to severe consequences. We assessed the extent of co-infection between Schistosoma haematobium and the soil-transmitted helminths (STHs) Ascaris lumbricoides and Trichuris trichiura in schoolgirls in the rural areas of KwaZulu-Natal, South Africa. We also explored if S. haematobium can serve as a predictor for soil-transmitted helminths in this area. From 15 selected schools, 726 primary schoolgirls aged 10–12 years provided both urine and stool samples. The samples were examined for the presence of eggs using the urine sedimentation technique for S. haematobium and the Kato Katz technique for STHs. Pearson’s chi-square test was used to calculate the association and Spearman’s rank correlation was used for the correlation analysis. There was a highly significant correlation between S. haematobium and STHs at a school level (Spearman’s correlation coefficient =0.93; p<0.001). The prevalences were found to be 36.9% and 38.8% for S. haematobium and STHs, respectively. A significant association was found between S. haematobium and STHs (odds ratio =2.05; confidence interval =1.58–2.93; p<0.001). Indirect indicators of urogenital schistosomiasis (e.g. water contact and haematuria) were significantly associated with A. lumbricoides and T. trichiura infection. We have demonstrated a highly significant correlation and overall association between urogenital schistosomiasis and A. lumbricoides and T. trichiura. We cautiously suggest that all S. haematobium endemic areas should be treated for STH infections. Significance:  • The prevalences of urogenital schistosomiasis and soil-transmitted helminth infections were highly significantly correlated. • More than half (60%) of the investigated schools are in need of annual treatment for S. haematobium infection. • Almost half of the infected schoolgirls had a heavy intensity of S. haematobium infection. • Nearly all the schools investigated require treatment for soil-transmitted helminthiasis once or even twice per year. • This study can contribute to the epidemiological planning process of the deworming programme

Co-infection with Schistosoma haematobium and soil-transmitted helminths in rural South Africa

Schistosomiasis and soil-transmitted helminthiasis are among the most prevalent neglected tropical diseases and may lead to severe consequences. We assessed the extent of co-infection between&nbsp;Schistosoma haematobium&nbsp;and the soil-transmitted helminths (STHs)&nbsp;Ascaris lumbricoides&nbsp;and&nbsp;Trichuris trichiura&nbsp;in schoolgirls in the rural areas of KwaZulu-Natal, South Africa. We also explored if&nbsp;S. haematobium&nbsp;can serve as a predictor for soil-transmitted helminths in this area. From 15 selected schools, 726 primary schoolgirls aged 10–12 years provided both urine and stool samples. The samples were examined for the presence of eggs using the urine sedimentation technique for&nbsp;S. haematobium&nbsp;and the Kato Katz technique for STHs. Pearson’s chi-square test was used to calculate the association and Spearman’s rank correlation was used for the correlation analysis. There was a highly significant correlation between&nbsp;S. haematobium&nbsp;and STHs at a school level (Spearman’s correlation coefficient =0.93;&nbsp;p&lt;0.001). The prevalences were found to be 36.9% and 38.8% for&nbsp;S. haematobium&nbsp;and STHs, respectively. A significant association was found between&nbsp;S. haematobium&nbsp;and STHs (odds ratio =2.05; confidence interval =1.58–2.93;&nbsp;p&lt;0.001). Indirect indicators of urogenital schistosomiasis (e.g. water contact and haematuria) were significantly associated with&nbsp;A. lumbricoides&nbsp;and&nbsp;T. trichiura&nbsp;infection. We have demonstrated a highly significant correlation and overall association between urogenital schistosomiasis and&nbsp;A. lumbricoides&nbsp;and&nbsp;T. trichiura. We cautiously suggest that all&nbsp;S. haematobium&nbsp;endemic areas should be treated for STH infections. Significance:&nbsp; The prevalences of urogenital schistosomiasis and soil-transmitted helminth infections were highly significantly correlated. More than half (60%) of the investigated schools are in need of annual treatment for&nbsp;S. haematobium&nbsp;infection. Almost half of the infected schoolgirls had a heavy intensity of&nbsp;S. haematobium&nbsp;infection. Nearly all the schools investigated require treatment for soil-transmitted helminthiasis once or even twice per year. This study can contribute to the epidemiological planning process of the deworming programme.&nbsp

Reproductive health problems in rural South African young women: risk behaviour and risk factors

Background South African young women continue to be vulnerable, with high prevalence of teenage pregnancy, HIV, sexually transmitted infections (STIs) and female genital schistosomiasis (FGS). This study seeks to examine the underlying factors that may be associated with these four adverse reproductive health outcomes. Methods In a cross-sectional study of 1413 sexually active of young women, we explored these four adverse reproductive health outcomes by considering socio-demographic factors, socio-economic factors, sexual risk behaviour, substance abuse and knowledge about reproductive health by using a questionnaire. Consenting participants were asked about previous pregnancies and were tested for HIV, STIs and FGS. Multivariable regression analyses were used to explore the factors associated with these four reproductive health outcomes. Results 1. Early pregnancy: Among the young women, 44.4% had already been pregnant at least once. Associated factors were hormonal contraceptives, (adjusted odds ratio (AOR): 17.94, 95% confidence interval (CI): 12.73–25.29), and sexual debut < 16 years (AOR: 3.83, 95% CI: 2.68–5.47). Living with both parents (AOR 0.37, 95% CI: 0.25–0.57) and having a steady partner (AOR: 0.43, 95% CI: 0.24–0.76) were identified as protective factors against pregnancy. 2. HIV: HIV prevalence was 17.1%. The odds of having HIV were higher in intergenerational (AOR: 2.06, 95% CI: 1.05–4.06) and intragenerational relationships (AOR: 1.51 95% CI: 1.06–2.15), compared to age-homogenous relationships. Other associated factors were: condom use (AOR: 1.60, 95% CI: 1.16–2.20), number of times treated for an STI (AOR: 1.32, 95% CI: 1.02–1.71), and total number of partners (AOR: 1.14, 95% CI: 1.03–1.28). 3. STIs: Participants who had at least one STI (40.5%) were associated with total partner number (AOR 1.17, 95% CI: 1.06–1.30), and testing HIV positive (AOR: 1.88, 95% CI 1.41–2.50). 4. FGS: FGS prevalence (19.7%) was associated with previous anti-schistosomal treatment (AOR: 2.18, 95% CI: 1.57–3.05). Conclusion There is a high prevalence of pregnancy, HIV, STIs and FGS among sexually active young women in rural KwaZulu-Natal. Multidisciplinary approaches are urgently needed for educational and health literacy programs prior to sexual debut, and health care facilities, which should be made accessible for young women

Effects of a 7-day military training exercise on inflammatory biomarkers, serum hepcidin, and iron status

BACKGROUND: Hepcidin, a peptide that is released into the blood in response to inflammation, prevents cellular iron export and results in declines in iron status. Elevated serum and urinary levels of hepcidin have been observed in athletes following exercise, and declines in iron status have been reported following prolonged periods of training. The objective of this observational study was to characterize the effects of an occupational task, military training, on iron status, inflammation, and serum hepcidin. FINDINGS: Volunteers (n = 21 males) included Norwegian Soldiers participating in a 7-day winter training exercise that culminated in a 3-day, 54 km ski march. Fasted blood samples were collected at baseline, on day 4 (PRE, prior to the ski march), and again on day 7 (POST, following the ski march). Samples were analyzed for hemoglobin, serum ferritin, soluble transferrin receptor (sTfR), interleukin-6 (IL-6), and serum hepcidin. Military training affected inflammation and serum hepcidin levels, as IL-6 and hepcidin concentrations increased (P < 0.05) from the baseline to POST (mean ± SD, 9.1 ± 4.9 vs. 14.5 ± 8.4 pg/mL and 6.5 ± 3.5 vs. 10.2 ± 6.9 ng/mL, respectively). Iron status was not affected by the training exercise, as sTfR levels did not change over the course of the 7-day study. CONCLUSIONS: Military training resulted in significant elevations in IL-6 and serum hepcidin. Future studies should strive to identify the role of hepcidin in the adaptive response to exercise, as well as countermeasures for the prevention of chronic or repeated elevations in serum hepcidin due to exercise or sustained occupational tasks which may result in longer term decrements in iron status

Profile of the study cohort, Haydom Lutheran Hospital, Tanzania (October 2003–November 2006)

<p><b>Copyright information:</b></p><p>Taken from "Predictors of mortality in HIV-infected patients starting antiretroviral therapy in a rural hospital in Tanzania"</p><p>http://www.biomedcentral.com/1471-2334/8/52</p><p>BMC Infectious Diseases 2008;8():52-52.</p><p>Published online 22 Apr 2008</p><p>PMCID:PMC2364629.</p><p></p