Tuberculosis in prisons in sub-Saharan Africa--a potential time bomb.

No Abstrac

Why we should decolonise the narrative on zoonosis for sustainable health, wildlife, livestock and economic growth in Africa

Africa is often framed as a “hot spot” of emerging infectious diseases, based on ill-informed and colonial understandings of zoonoses and their origins. A more accurate picture of what drives a virus with pandemic potential should instead focus on global financial centres that promote destructive forms of development. To better address known and future health concerns in Africa, a narrative change is needed that links evidenced research to the relationship between the environment, livestock, wildlife and growing economies

Human Cytomegalovirus (HCMV) Infection in Sub-Saharan Africa

In sub-Saharan Africa, HCMV infection is endemic in young infants where it is linked with impaired physical and mental development, giving the infection a unique epidemiology across the region, with a potentially broad-reaching impact on the health of southern African populations. Studies conducted in sub-Saharan Africa and elsewhere, have shown that HCMV is a serious cause or morbidity and mortality, in both immunocompromised groups and congenitally infected children. In a region where 23.2 million people are living with HIV and most of the population are infected with HCMV in infancy, more prospective studies are required to better characterise the impact of HCMV in sub-Saharan Africa. This will lay the foundations for future clinical trials of anti-HCMV drugs in patient sub-sets in whom there is strong evidence that they might be effective. Drugs such as ganciclovir are already used in South Africa as life-saving treatment for HIV-infected children with severe pneumonia that is not responsive to antibiotic or anti-mycobacterial therapy. Furthermore, the clinical impact and importance of HCMV infections in sub-Saharan Africa may increase over the next decade for several reasons: Wider access to ART is resulting in increasing numbers of older HIV infected patients; Cancer incidence is forecast to increase by 32% across sub-Saharan Africa between 2010 and 2020; The number of transplant recipients is also set to increase, as the capacity of tertiary care centres develops and improves

Tuberculosis comorbidity with communicable and noncommunicable diseases

The 18th WHO Global Tuberculosis Annual Report indicates that there were an estimated 8.6 million incident cases of tuberculosis (TB) in 2012, which included 2.9 million women and 530,000 children. TB caused 1.3 million deaths including 320,000 human immunodeficiency virus (HIV)-infected people; three-quarters of deaths occurred in Africa and Southeast Asia. With one-third of the world's population latently infected with Mycobacterium tuberculosis (Mtb), active TB disease is primarily associated with a break down in immune surveillance. This explains the strong link between active TB disease and other communicable diseases (CDs) or noncommunicable diseases (NCDs) that exert a toll on the immune system. Comorbid NCDrisk factors include diabetes, smoking, malnutrition, and chronic lung disease, all of which have increased relentlessly over the past decade in developing countries. The huge overlap between killer infections such as TB, HIV, malaria, and severe viral infections with NCDs, results in a ``double burden of disease'' in developing countries. The current focus on vertical disease programs fails to recognize comorbidities or to encourage joint management approaches. This review highlights major disease overlaps and discusses the rationale for better integration of tuberculosis care with services for NCDs and other infectious diseases to enhance the overall efficiency of the public health responses

Differential susceptibility of PCR reactions to inhibitors: an important and unrecognised phenomenon

PCR inhibition by nucleic acid extracts is a well known yet poorly described phenomenon. Inhibition assessment generally depends on the assumption that inhibitors affect all PCR reactions to the same extent; i.e. that the reaction of interest and the control reaction are equally susceptible to inhibition. To test this assumption we performed inhibition assessment on DNA extracts from human urine samples, fresh urine and EDTA using different PCR reactions

New tuberculosis diagnostics and rollout.

Early detection and effective treatment are crucial for tuberculosis control, but global case detection rates remain low. The diagnosis of paediatric and extrapulmonary disease is problematic and there are, as yet, no rapid screening tests to assist active case finding in the community. Progress has been made in clinic-based detection tools with the introduction of Xpert MTB/RIF, a nucleic acid amplification test that combines sample processing and analysis in a single instrument to provide a diagnostic result and detection of resistance to rifampicin in under 2h. Enthusiasm for Xpert MTB/RIF has been high and global rollout has been facilitated by donor agencies. However, concerns remain about access and sustainability due to the high cost and infrastructure requirements. Although more sensitive than smear microscopy, early studies suggest the impact of the new test on case detection rates and patient survival has been limited. Alternative technologies are being developed, including non-sputum-based tests to assist the detection of extrapulmonary disease. Evaluation studies are needed to provide evidence of the impact of the new technologies on patient outcomes. This will enable appropriate placement of new diagnostic products in the healthcare system to support the control and eventual eradication of tuberculosis disease