Population-based Screening for Pulmonary Tuberculosis utilizing Community Health Workers in Ethiopia

Objective To evaluate the utility of a volunteer health development army in conducting population screening for active TB in a rural community in Southern Ethiopia. Methods A population-based cross-sectional survey was conducted in sixKebeles (the lowest administrative units).Volunteer women community workers led a symptom screening program to identify adults ≥15 years with TB in the community. Individuals with cough ≥ 2 weeks had spot and morning sputum samples and were examined using AFB smear microscopy, culture and Xpert MTB/RIF. Results All 24,517 adults in the study area had a symptom screen performed; 544 (2.2%) had cough ≥ 2 weeks. Among a positive symptom screen, 13 (2.4%) had a positive sputum AFB smear microscopy, 13 (2.4%) a positive culture and 32 (5.8%) a positive Xpert MTB/RIF test. Overall, 34 TB cases (6%) were identified by culture and/or Xpert which corresponds to a prevalence of 139 per 100,000 persons. Conclusion We demonstrate the capability of community health workers (volunteer and paid) to rapidly conduct a large-scale population TB screening evaluation and highlight the high yield of such a program to detect previously undiagnosed cases when combined with Xpert MTB/RIF testing. This could be a model to implement in other similar settings

Can Interferon-Gamma or Interferon-Gamma-Induced-Protein-10 Differentiate Tuberculosis Infection and Disease in Children of High Endemic Areas?

Diagnosis of childhood tuberculosis (TB) is difficult in high TB burden settings. Interferon-gamma-induced protein 10 (IP10) has been suggested as a marker of TB infection and disease, but its ability to differentiate the two conditions remains uncertain.To describe Interferon-gamma (INFγ) and IP10 expression in children with TB infection and disease and controls to assess their potential to differentiate latent and active TB. TB), 335 children in contact with adults with pulmonary TB and 156 community controls in Southern Ethiopia. The Tuberculin Skin Test (TST) and Quantiferon-In-Tube (QFT-IT) were performed. INFγ and IP10 were measured in plasma supernatants.INFγ and IP10 can identify children with TB infection and disease, but cannot differentiate between the two conditions. HIV status did not affect the expression of IP10

Robust barcoding and identification of Mycobacterium tuberculosis lineages for epidemiological and clinical studies.

BACKGROUND: Tuberculosis, caused by bacteria in the Mycobacterium tuberculosis complex (MTBC), is a major global public health burden. Strain-specific genomic diversity in the known lineages of MTBC is an important factor in pathogenesis that may affect virulence, transmissibility, host response and emergence of drug resistance. Fast and accurate tracking of MTBC strains is therefore crucial for infection control, and our previous work developed a 62-single nucleotide polymorphism (SNP) barcode to inform on the phylogenetic identity of 7 human lineages and 64 sub-lineages. METHODS: To update this barcode, we analysed whole genome sequencing data from 35,298 MTBC isolates (~ 1 million SNPs) covering 9 main lineages and 3 similar animal-related species (M. tuberculosis var. bovis, M. tuberculosis var. caprae and M. tuberculosis var. orygis). The data was partitioned into training (N = 17,903, 50.7%) and test (N = 17,395, 49.3%) sets and were analysed using an integrated phylogenetic tree and population differentiation (FST) statistical approach. RESULTS: By constructing a phylogenetic tree on the training MTBC isolates, we characterised 90 lineages or sub-lineages or species, of which 30 are new, and identified 421 robust barcoding mutations, of which a minimal set of 90 was selected that included 20 markers from the 62-SNP barcode. The barcoding SNPs (90 and 421) discriminated perfectly the 86 MTBC isolate (sub-)lineages in the test set and could accurately reconstruct the clades across the combined 35k samples. CONCLUSIONS: The validated 90 SNPs can be used for the rapid diagnosis and tracking of MTBC strains to assist public health surveillance and control. To facilitate this, the SNP markers have now been incorporated into the TB-Profiler informatics platform ( https://github.com/jodyphelan/TBProfiler )

antimicrobial resistance in Hawassa University Referral

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Intestinal helminthic infection among children at Lake Awassa Area, South Ethiopia

Background: The habit of raw fish eating is common among fishermen and people around lakes. Thus periodic assessment to determine fish tapeworm and helminthic infection is important. Objective: To determine the presence of fish tape worm and other helminthic parasites. Methods: A cross sectional coproparasitologic study was conducted during the month of November, 1998 among 150 children under the age of 15 engaged in fishing, and fish processing in Awassa Southern Ethiopia. All study subjects were screened for fish tape worm and other intestinal helminthic infections. Stool samples were examined microscopically using direct smear, Formol ether concentration and Zinc Sulphate flotation techniques. Results: The over all prevalence for at least one helminthic infection was 92.7%. The most prevalent parasites were A.lumbricoides (76%), Hook worm species (62.5%) T.trichuria (60%) and S.mansoni (33%). Three cases of Hetrophid infections transmitted by eating raw fish were also recorded. Conclusion: The public health implication of intestinal parasites among the study groups is discussed and necessary recommendations are suggested. (Ethiopian Journal of Health Development, 2001, 15(1): 31-37

Prevalence of Hookworm infection and haemoglobin status among rural elementary school children in Southern Ethiopia

[Ethiop. J. Health Dev. 2002;16(1): 113-115

Molecular studies of meningococcal and pneumococcal meningitis patients in Ethiopia

Neisseria meningitidis infections in sub-Saharan Africa usually present with distinct symptoms of meningitis but very rarely as fulminant septicemia when reaching hospitals. In Europe, development of persistent meningococcal shock and multiple organ failure occurs in up to 30% of patients and is associated with a bacterial load of >106/ml plasma or serum. We have prospectively studied 27 Ethiopian patients with meningococcal infection as diagnosed and quantified with real-time PCR in the cerebrospinal fluid (CSF) and serum. All presented with symptoms of meningitis and none with fulminant septicemia. The median N. meningitidis copy number (NmDNA) in serum was < 3.5 × 103/ml, never exceeded 1.8 × 105/ml, and was always 10–1000 times higher in CSF than in serum. The levels of LPS in CSF as determined by the limulus amebocyte lysate assay were positively correlated to NmDNA copy number (r = 0.45, P = 0.030), levels of IL-1 receptor antagonist, (r = 0.46, P = 0.017), and matrix metallopeptidase-9 (MMP-9; r = 0.009). We also compared the inflammatory profiles of 19 mediators in CSF of the 26 meningococcal patients (2 died and 2 had immediate severe sequelae) with 16 patients with Streptococcus pneumoniae meningitis (3 died and 3 with immediate severe sequelae). Of 19 inflammatory mediators tested, 9 were significantly higher in patients with pneumococcal meningitis and possibly linked to worse outcome