Detection of Cryptococcus neoformans in Cerebrospinal Fluid from Meningitis Patients Associated with HIV/AIDS in Uganda

The significance of Cryptococcus var. neoformans meningitis fatality in human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) patients was confirmed in ten cerebrospinal fluids (CSFs) from Entebbe hospitals in Uganda. All ten CSF specimens were turbid, but on centrifugation, their supernatants were clear and colourless. The protein content of the specimens ranged from 20 to 50mg per 100ml of CSF (normal range is 10 to 40mg/100ml). Sugar content ranged between 20 to 60mg per 100ml CFS (normal range 45 to 72mg/100ml). The white blood cell (WBC) counts in the ten specimens ranged from 15 to 40 WBC/mm^3 of CSF (normal range up to 5 WBC/mm^3). Gram stain on the deposits, showed capsulated Cryptococcus (Cr.) neoformans var. neoformans which were further demonstrated in Odongo-Aginya stain using 5% eosin in 10% formalin mixed in equal volume with 7.5% nigrosin in 10% formalin (Odongo-Aginya et al., 1995). Ziehl Neelsen stain on the deposits, for acid alcohol fast bacilli was negative. Cr. neoformans var. neoformans were isolated from all CSF specimens and all patients investigated, died within one week from the time of admission to the hospitals

EVIDENCE OF LONG TERM BENEFIT OF MORBIDITY REDUCTION DUE TO PRAZIQUANTEL TREATMENT AGAINST SCHISTOSOMA MANSONI IN KIGUNGU FISHING VILLAGE IN ENTEBBE, UGANDA

Praziquantel (PZQ) is efficacious against Schistosoma mansoni. This was prospective cohort study. This study was carried out at Kigungu fishing village, Entebbe, Uganda. The goal of the study was to establish cost effective regiment for mass drug administration (MDA) of Praziquentel in the morbidity reduction of S.mansoni infection. In January 2004, nine hundred and forty five (945) participants were registered in this study. Our analysis was based on examining microscopically three slides prepared from each of 945 stool specimens delivered by each of the participant using modified Kato/Katz method. These included male and female, children and adults living in Kigungu fishing village in Entebbe Uganda. In total 901, cohorts were re-examined for infections clearance six months later in July 2004 and 18 months later in June 2005, 625 cohorts were again re-evaluated for S.mansoni infections after the baseline study. At baseline, (448) of 945 (47.5%) cohorts were S. mansoni positive. All these participants were treatment with a single oral dose of praziquantel at 40mg/kg. At the same time, 495 (52.5%) were S. mansoni negative. Of the 625 (66.3%) cohorts who came back for final review, 80 (12.8%) were still positive for S. mansoni while 210 (33.6%) remained negative after the base line treatment with praziquantel. On the other hand 103 (16.3%) of cohorts who were initially negative at the base line became S.mansoni positive after 18 months and 213(34.1%) remained negative for S.mansoni. The force of re-infection after six months was significant {(P=0.0001), (OR 0.47) CI at 95% (0.31-0.71)}. Nevertheless the force of reinfection was not significant after 18 months {(P=0.766), (OR 0.95) CI at 95% (0.68-1.34)}.The geometric mean eggs excretion of the 80 cohorts who were S.mansoni positive at 18 months was 151.967.This did not reach the geometric mean egg excreted by the same cohorts at baseline which was 285.05. The egg excretion was reduced by 46.8%. Similarly there was marked decrease in clinical symptoms amongst the cohorts. Our study suggests evidence of long-term benefit of praziquantel in Kigungu and that a yearly administration of praziquantel to the community could be a regiment for mass drug administration (MAD) for this community to control schistosomiasis morbidity

Epidemiology, of bilharzias (schistosomiasis) in Uganda from 1902 until 2005

Background: Schistosoma mansoni was observed and reported in Kuluva hospital Arua District in north western Uganda as early as 1902. S. mansoni is widely distributed in Uganda along permanent water bodies. Objective: To review the litreture on scistosomiasis in Uganda, since 1902. Method: The core literature for this short review was searched from reports and publications by the British colonial Ministry of Health Districts Medical officers and Entomologists. Additional information was obtained from Makerere University Medical School library archives, London School of Hygiene and Tropical Medicine library archives, University of Antrwap, and post independence publications on schistosomiasis in Uganda in various journals. Results: Since it was first detected in 1902 Schistosoma (S) mansoni is more widely distributed in Uganda than S. haematobium. However Schistosoma mansoni and S. haematobium are of public health importance in Uganda and the importance of migrants and fishermen in disseminating infections into non-infested areas and intensifying infection in areas already infested have been reported. Conclusion: S. mansoni has been on the increase in Uganda whereas S. haematobium is localized in sporadic foci in the north of Uganda. Treatment with praziquantel the drug of choice in Uganda used in schistosomiasis control programme has reduced development of severe schistosomiasis

Online Learning Resources Enhanced Teaching and Learning of Medical Mycology among Medical Students in Gulu University, Uganda

Background. The burden of serious fungal diseases has significantly increased in the past few decades; however, the number of health-care workers with expertise in the management of fungal diseases remains low, especially in low- and middle-income countries (LMICs). This study aimed to evaluate the use of freely available online teaching material to enhance teaching and learning of medical mycology among medical students in Gulu University Medical School, Uganda. Methods. We conducted a cross-sectional study among second year medical students undertaking Medical Mycology course on antifungal agents in the department of Medical Microbiology and Immunology in the academic year 2017-2018. The materials were synthesized and peer-reviewed by experts in fungal diseases and were made freely available on the Leading International Fungal Education website (http://www.LIFE-Worldwide.org). A local faculty in the department delivered the lectures, and pre- and posttest scores were evaluated statistically. Results. Sixty medical students participated in the study of which 78% were male. The average score was 41% for the pretest and 52% for the posttest (p<0.0001). There was no significant difference in the scores of males and females. Majority of the students gave an above-average rating for the course material; however, 54% preferred prerecorded videos. Conclusion. Using freely available online materials on medical mycology can enhance teaching and learning of medical mycology. Because of this, there is need to incorporate up-to-date information about the subject into the curriculums of medical schools especially in LMICs

Substitution of Malachite Green with Nigrosin - Eosin Yellow Stain in the Kato-Katz method: microscopical appearance of the helminth eggs

Background: The Kato-Katz thick smear technique is the standard technique recommended by the World Health Organisation for the quantitative diagnosis of Schistosoma mansoni and other intestinal helminth infections. The major problem of the technique is that a few hours after the preparation of slides hookworm eggs over clear and disappear due glycerin. Objective: To illustrate clear visibility of different helminth eggs microscopically in Odongo-Aginya method, substitution of malachite green with 7.5% nigrosin in 10% formalin and 5% eosin in 10% formalin. Method: Measured, strained stool specimen was stained with mixture of nigrosin/ eosin and covered with cellophane cover slips. The prepared slide was examined immediately microscopically. Result: Slides prepared with Odongo-Aginya method can be examined immediately or later without compromising the visibility of parasite eggs and larvae. Hookworm eggs remain visible for a long time. Conclusion: The present publication shows microscopic appearance of the helminth eggs using the Odongo-Aginya modification Keywords: Kato - Katz method, pictorial illustration, Odongo-aginya modification, helminth eggs, Uganda. African Health Sciences Vol. 7(1) 2007: pp. 33-3

High prevalence and morbidity of Schistosoma mansoni along the Albert Nile in Uganda

An epidemiological cross sectional study of Schistosoma mansoni was conducted in two hyper endemic fishing villages of Rhino Camp and Obongi both in West Nile district in northern Uganda in 1991 and 1992. People with various water contacts were registered. A small group of civil servants and clergies with less water contact in the river Nile were studied for control of infection and morbidity. An overall prevalence of 81.5% of the 1367 people studied in both fishing villages of Rhino Camp and Obongi were excreting from 100 to ≥ 500 Schistosoma mansoni eggs per gram (epg). 253 18.5% did not have Schistosoma mansoni eggs in their faeces. The influence of socioeconomic factors on infections in the study population was high among poorer illiterates who have frequent water contacts activities with River Nile

Artemisinin-Resistant Plasmodium falciparum with High Survival Rates, Uganda, 2014–2016

Because ≈90% of malaria cases occur in Africa, emergence of artemisinin-resistant Plasmodium falciparum in Africa poses a serious public health threat. To assess emergence of artemisinin-resistant parasites in Uganda during 2014–2016, we used the recently developed ex vivo ring-stage survival assay, which estimates ring-stage–specific P. falciparum susceptibility to artemisinin. We conducted 4 cross-sectional surveys to assess artemisinin sensitivity in Gulu, Uganda. Among 194 isolates, survival rates (ratio of viable drug-exposed parasites to drug-nonexposed controls) were high (>10%) for 4 isolates. Similar rates have been closely associated with delayed parasite clearance after drug treatment and are considered to be a proxy for the artemisinin-resistant phenotype. Of these, the PfKelch13 mutation was observed in only 1 isolate, A675V. Population genetics analysis suggested that these possibly artemisinin-resistant isolates originated in Africa. Large-scale surveillance of possibly artemisinin-resistant parasites in Africa would provide useful information about treatment outcomes and help regional malaria control