Serological profiles of Herpes simplex virus type 2 among HIV negative population in Mwanza City, Tanzania

Herpes simplex virus type-2 (HSV-2) is the major cause of genital ulcer diseases (GUD) consequently a significant factor for the acquisition and transmission of human immunodeficiency virus (HIV). Despite its importance there is paucity of data regarding the magnitude of HSV-2 in non-HIV infected population in middle-and-low income countries. This study was designed to determine the seroprevalence of specific HSV-2 antibodies among non-HIV population in Mwanza City, Tanzania.  A total of 174 non-HIV infected individuals were enrolled and tested for HSV-2 IgM and IgG antibodies using one step HSV-2 rapid Test. The median age of study participants was 28 years (IQR= 23-36 years).  Of the 174 enrolled individuals, 22 (12.6%, 95% CI: 7.6-17.5) were HSV-2 IgG seropositive while none of the participants was HSV-2 IgM seropositive. This study shows that a significant proportion of non-HIV infected population is seropositive for HSV-2 antibodies. This might increase the risk of becoming infected with HIV and other sexually transmitted infections

Rubella virus, Toxoplasma gondii and Treponema pallidum congenital infections among full term delivered women in an urban area of Tanzania: a call for improved antenatal care

Background: A significant proportion of newborns in the developing countries are born with congenital anomalies.Objective: This study investigated congenital infections due to Rubella virus, Toxoplasma gondii, Treponema pallidum among presumed normal neonates from full term pregnant women in Mwanza, Tanzania.Methods: Sera from mothers were tested for Treponema pallidum and Toxoplasma gondii infection while newborns from mothers with acute infections were tested for T. pallidum and T. gondii, and all newborns were tested for Rubella IgM antibodies.Results: A total of 13/300 (4.3 %) mothers had T. pallidum antibodies with 3 of them having acute infection. Two (0.7 %) of the newborns from mothers with acute infection were confirmed to have congenital syphilis. Regarding toxoplasmosis, 92/300 (30.7 %) mothers were IgG seropositive and 7 had borderline positivity, with only 1/99 (1%) being IgM seropositive who delivered IgM seronegative neonate. Only 1/300 (0.3 %) newborn had rubella IgM antibodies indicating congenital rubella infection.Conclusion: Based on these results, it is estimated that in Mwanza city in every 100,000 live births about 300 and 600 newborns have congenital rubella and syphilis infections, respectively. Rubella virus and T. pallidum are likely to be among common causes of congenital infections in developing countries.Keywords: Congenital infections, Mwanza, Tanzania

Predictors of esophageal candidiasis among patients attending endoscopy unit in a tertiary hospital, Tanzania: a retrospective cross-sectional study

Background: Esophageal candidiasis is a common disease among patients with impaired cell mediated immunity. In the current study, we report esophageal candidiasis among patients with various co-morbidities attending the endoscopic unit at the Bugando Medical Centre.Methods: This retrospective study was conducted from June to September 2015. All data of the patients who attended the endoscopic unit between 2009 and 2014 were retrieved and analyzed.Results: A total of 622 patients who underwent oesophagogastroduodenoscopy were analyzed. A slight majority 334/622(53.7%) of patients were female. Out of 622 patients; 35(5.6%) had esophageal candidiasis. Decrease in age (OR 1.1, 95%CI; 1.0-1.1), female sex (OR 3.8, 95%CI; 1.1-13.1), drinking alcohol (OR 17.1, 95%CI; 4.9-58.9), smoking (OR 8.3, 95%CI; 1.7-41.0), antibiotic use (OR 5.7, 95%CI; 2.0-16.4), positive HIV status (OR 10.3, 95%CI; 4.6-6.0) and presence of peptic ulcer disease (OR 13.2, 95%CI; 3.5-49.0) independently predicted esophageal candidiasis.Conclusion: Patients with a history of drinking alcohol, smoking, use of antibiotics and those with chronic diseases such as peptic ulcers were at high risk of developing esophageal candidiasis. Further studies are needed to identify Candida spp. and their anti-fungal susceptibility for proper management of esophageal candidiasis in HIV and non-HIV individuals.Keywords: Esophagogastroduodenoscopy, esophageal candidiasis

Prevalence and Predictors of Dermatophyte Infections Among Primary School Children in Ilemela, Mwanza, Tanzania

Background: Dermatophytes are highly contagious organisms of public health importance, particularly among primary school children in the resource-limited settings with a prevalence of 10% to 20% in East Africa. Here, we report the prevalence and associated factors of dermatophyte infections among primary school children in Ilemela, Mwanza - Tanzania.   Methods: A cross-sectional study was conducted involving 323 children aged between 4 and 10 years from 10 randomly selected primary schools. The study was conducted between July 2017 and September 2017. Pretested interviewer-administered semi-structured questionnaire was used to collect relevant social-demographic information followed by clinical examination to establish the diagnosis of dermatophyte infections. Data were analysed using Stata version 13.   Results: The mean age of the study participants was 7.63±1.27 years, with the slightl majority (n=183, 56.7%) of participants being girls. The majority (n=277, 70.3%) of the study participants were from public schools. A total of 299 (92.6%) children reported using tap water at home. Using clinical diagnosis, 94 (29.1%) children had dermatophyte infections with 92 (97.9%) of them having tinea capitis. By multivariate logistic regression analysis: being a boy (odds ratio [OR] 1.98; 95% confidence interval [CI], 1.22 to 3.22; P=.01); using lake, river, or well water (OR 3.18; 95% CI, 1.36 to 7.38; P<.01); playing in a dusty environment (OR 2.65; 95% CI, 1.28 to 5.47; P<.01); playing with animals (OR 2.13; 95% CI, 1.28 to 3.56; P<.003); and having family members with dermatophyte infections (OR 10.56; 95% CI, 4.57 to 24.41; P<.001) predicted dermatophyte infections.   Conclusion: The prevalence of dermatophyte infection is high in the study population and is associated with poor hygiene. Improved hygiene will reduce the prevalence of dermatophyte infections among primary school children in low-income countries. Further studies to identify the species and susceptibility patterns of these dermatophytes are recommended to establish empirical treatment guidelines

HIV seroprevalence and factors affecting clinical outcomes among patients with surgical acute abdomen in selected hospitals in Mwanza, north-western in Tanzania

Background:  HIV infection has been reported to be prevalent in patients with surgical acute abdomen. This study aimed to establish HIV seroprevalence among patients with surgical acute abdomen and to identify factors affecting clinical outcomes among these patients at a tertiary care hospital in Tanzania Methods: This was a prospective cross-sectional study of patients with surgical acute abdomen admitted to three selected hospitals in Mwanza between February 2016 and July 2016.Results: Out of the 106 patients (M: F = 1.5:1) included in the study, 15 (14.2%) were HIV positive. Of these, nine were males and 6 were females. Surgical site infection was the most common postoperative compilation and was found to be significantly higher in HIV positive patients with CD 4+ count below 200 cells/μl (p<0.001). The median length of hospital stay (LOS) was 16 days. There was no significant difference in LOS between HIV positive and negative patients (p=0.791). Mortality rate was 13.2% and it was significantly higher in patients with advanced age (> 65 years), pre-existing medical illness, delayed presentation (>48 hours), HIV positivity, high American Society of Anesthetists class, surgical site infections (p< 0.001).Conclusion: This study has shown that HIV infection is prevalent among patients with surgical acute abdomen in our setting. Factors influencing the clinical outcome of these patients need to be addressed, in order to deliver optimal patient care and improve their treatment outcome

Letter to the editor 2: Predictors of oesophageal candidiasis in persons with or without HIV infection

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Clinical presentation and precipitating factors of diabetic ketoacidosis among patients admitted to intensive care unit at a tertiary hospital in Mwanza, Tanzania

Background: Diabetic ketoacidosis (DKA), one of the common emergencies in patient with diabetes mellitus is associated with considerable morbidity and mortality.  This study aimed to determine clinical presentation and precipitating factors of DKA among patients admitted at Bugando Medical Centre (BMC) in north-western Tanzania.Methods: This study involved a retrospective review of hospital records of DKA patients admitted to intensive care unit at BMC during 2012. Data on demographics, precipitating factors, clinical presentation, duration of hospital admission and mortality were extracted and analysed.Results: Total records of 1,906 hospitalized patients in 2012 were reviewed. Of this, 29 (1.5%) had DKA. Of the 29 DKA patients, 18(62.1%) and 11 (37.9%) were males and females, respectively. Among them 21(72.4%) were known diabetics and 8(27.6%) were newly diagnosed to be diabetics. Twelve patients (41.1%) presented with polyuria, polydipsia and general body malaise. Eleven (37.9%) patients presented with loss of consciousness while 6(20.7%), 4(13.8%), 3(10.3%) and 1(3.4%) presented with vomiting, abdominal pain, Kussmaul’s breathing and coma, respectively. Nausea, weight loss and polyphagia each were presented by 2(6.9%) patients. The precipitating factors were infection 15 (51.7%), first presentation of diabetes mellitus 6 (20.7%), missed insulin injection 6 (20.7%) and co-morbid conditions 6 (20.7%). Four (13.8%), 1 (3.45%) and 1(3.45%) had stroke, chronic renal failure and hypertension, respectively. Among the DKA patients, 22 (75.9%) improved and were discharged, and 7 (24.1%) died.Conclusion: DKA occurred in about 1.5% of the patients admitted to ICU and it was a major cause of morbidity and mortality. The main precipitating factor was infection. Since the precipitating factors are preventable, health care providers should put emphasis in educating diabetic patients at the diabetes clinic to reduce morbidity and mortality in these patients

Prevalence and factor associated with over-the-counter use of antifungal agents’, in Mwanza City, Tanzania

Background: Misuse of antifungal both in clinics and agriculture has been associated with the increased trend of antifungal resistance. In Tanzania, there is limited information regarding the magnitude of antifungal obtained over the counter therefore this study was performed to determine the extent of over the counter (OTC) antifungal use and factors associated to it. Methods:  This was a cross sectional study involving patients buying antifungal agents from community pharmacies between May and July 2015 in Mwanza city, Tanzania. Data were collected by the investigator using interview guided questionnaire and analyzed using STATA version 11.Results: A total of 270 patients were enrolled and interviewed. The mean age was 30 years±12.  Majority of patients (59.6%) were female.   Out of 270 patients, 188(69.3%) had dermatophytes. A total of 150(55.6%, 95%CI 49.6-61) obtained antifungal OTC.  Of 150 patients received antifungal agents OTC, 64(42.3%) received more than one antifungal compared to only 11/120 (9.2%) of those with prescription p<0.001. Clotrimazole was the commonly prescribed antifungal while fluconazole was mostly obtained OTC. On univariate analysis, increase in age was found to be associated with the tendency of obtaining antifungal over the counter (OR 1.03, 95% CI 1.008-1.05, P<0.006).  Having skin fungal infections was the only predictor of obtaining antifungal agents OTC (OR 3.36, 95% CI 2.34-4.81, P<0.001).Conclusion: In Mwanza City, patients receive multiple antifungal agents over the counter and the practice is significantly more for the patients with skin fungal infections. There is a need for the advocacy on appropriate antifungal use so that associated impact of resistance development can be reduce

Rubella virus, Toxoplasma gondii and Treponema pallidum congenital infections among full term delivered women in an urban area of Tanzania: a call for improved antenatal care

Background: A significant proportion of newborns in the developing countries are born with congenital anomalies. Objective: This study investigated congenital infections due to Rubella virus, Toxoplasma gondii, Treponema pallidum among presumed normal neonates from full term pregnant women in Mwanza, Tanzania. Methods: Sera from mothers were tested for Treponema pallidum and Toxoplasma gondii infection while newborns from mothers with acute infections were tested for T. pallidum and T. gondii, and all newborns were tested for Rubella IgM antibodies. Results: A total of 13/300 (4.3 %) mothers had T. pallidum antibodies with 3 of them having acute infection. Two (0.7 %) of the newborns from mothers with acute infection were confirmed to have congenital syphilis. Regarding toxoplasmosis, 92/300 (30.7 %) mothers were IgG seropositive and 7 had borderline positivity, with only 1/99 (1%) being IgM seropositive who delivered IgM seronegative neonate. Only 1/300 (0.3 %) newborn had rubella IgM antibodies indicating congenital rubella infection. Conclusion: Based on these results, it is estimated that in Mwanza city in every 100,000 live births about 300 and 600 newborns have congenital rubella and syphilis infections, respectively. Rubella virus and T. pallidum are likely to be among common causes of congenital infections in developing countries. DOI: https://dx.doi.org/10.4314/ahs.v19i2.8 Cite as: Mirambo MM, Mshana SE, Gro\u3b2 U. Rubella virus, Toxoplasma gondii and Treponema pallidum congenital infections among full term delivered women in an urban area of Tanzania: a call for improved antenatal care. Afri Health Sci.2019;19(2): 1858-1865. https://dx.doi.org/10.4314/ahs.v19i2.

\ud Case Report: Unsuspected Uterine Choriocarcinoma with Lung Metastasis\ud

Choriocarcinoma is a rare form of cancer which commonly occurs in women of reproductive age, rarely in post-menopausal women and in women under 20 years of age. Methods & Results: We report an unsuspected case of uterine choriocarcinoma with lung metastasis in a 27 year-old woman who presented to a medical ward with a history of prominent respiratory, but also genital and gastrointestinal symptoms. Conclusions: The presented case report emphasizes the need for sophisticated diagnostic technology to enable early diagnosis and correct treatment. Furthermore the case highlights the need for healthcare workers to consider rare causes of respiratory signs and symptoms