Genotypic status of the TbAT1/P2 adenosine transporter of Trypanosoma brucei gambiense isolates from northwestern Uganda following melarsoprol withdrawal

Human African trypanosomiasis (HAT) manifests as a chronic infection caused by <i>Trypanosoma brucei gambiense</i>, or as a more acute form due to <i>T. b. rhodesiense</i>. Both manifestations occur in Uganda and melarsoprol use against the former was jeopardised in the 1990s as reports of reduced efficacy increased to the point where it was dismissed as first-line treatment at some treatment centers. Previous work to elucidate possible mechanisms leading to melarsoprol resistance pointed to a P2 type adenosine transporter known to mediate melarsoprol uptake and previously shown to be mutated in significant numbers of patients not responding to the drug. Our present findings indicate that there is a low prevalence of mutants in foci where melarsoprol relapses are infrequent. In addition we observe that at the Omugo focus where the drug was withdrawn as first line over 6 years ago, the mutant alleles have disappeared, suggesting that drug pressure is responsible for fuelling their spread. Thus constant monitoring for mutants could play a key role in cost-effective HAT management by identifying which foci can still use the less logistically demanding melarsoprol as opposed to the alternative drug eflornithine. What is required now is a simple method for identifying such mutants at the point of care, enabling practitioners to make informed prescriptions at first diagnosis

Role of Cytokines in Trypanosoma brucei-Induced Anaemia: A Review of the Literature

Background: Anaemia is an important complication of trypanosomiasis. The mechanisms through which trypanosomal infection leads to anaemia are poorly defined. A number of studies have implicated inflammatory cytokines, but these data are limited and inconsistent. In this article, we reviewed the published literature on cytokines associated with Trypanosoma brucei infections and their role in the immunopathology leading to anaemia.Methodology: Articles were searched in PubMed through screening of titles and abstracts with no limitation on date of publishing and study design. Articles in English were searched using keywords “African trypanosomiasis”, “sleeping sickness”, “Trypanosoma brucei”, in all possible combinations with “anaemia” and/or “cytokines”.Results: Twelve articles examining cytokines and their role in trypanosomeinduced anaemia were identified out of 1095 originally retrieved from PubMed. None of the articles identified were from human-based studies. A total of eight cytokines were implicated, with four cytokines (IFN-γ, IL-10, TNF-α, IL-12) showing an association with anaemia. These articles reported that mice lacking TNF-α were able to control anaemia, and that IFN-γ was linked to severe anaemia given its capacity to suppress erythropoiesis, while IL-10 was shown to regulate IFN-γ and TNF-α, providing a balance that was associated with severity of anaemia. IFN-γ and TNF-α have also been reported to work in concert with other factors such as nitric oxide and iron in order to induce anaemia.Conclusion: IFN-γ, IL-10, and TNF-α were the three major cytokines identified to beheavily involved in anaemia caused by Trypanosoma brucei infection. The anti-inflammatory cytokine, IL-10, was shown to counter the effects of proinflammatory cytokines in order to balance the severity of anaemia. The mechanism of anaemia is multifactorial and therefore requires further, more elaborate research. Data from human subjects would also shed more light

Thirty-day stroke mortality and associated clinical and laboratory factors among adult stroke patients admitted at Mulago hospital (Uganda)

BackgroundAlthough stroke mortality in developing countries is more than 85%, the case fatality in Uganda is not known.ObjectiveWe determined 30 day case fatality, associated clinical and laboratory presentations among adult stroke patients admitted to Mulago Hospital.DesignProspective descriptive studySettingMulago national referral hospital, Kampala, UgandaParticipantsStroke patients presenting from July 2010 to January 2011.InterventionPatients presenting to the accident and emergency with stroke confirmed on brain computerised tomography (CT) scan were recruited consecutively and subsequently transferred to the neurology unit. Selected social demographics, clinical and laboratory presentations were obtained. Supportive care, specific treatment and rehabilitation services were offered to the participants.Main Outcome MeasuresCase fatality rate at 30 daysResultsOut of 150 eligible participants, 17 declined, 133 were enrolled into the study but 5 were lost to follow up. Data from 128 participants were analysed. The mean age was 62.3+15.7 years and 58.0% were females. Ischemic and haemorrhagic stroke contributed 79% and 21% respectively. Majority of participants 97 (76%) had only motor deficits and 78 (61%) had impaired consciousness. More than half of participants had high blood pressure at admission, with diastolic and systolic hypertension among 106 (83%) and 68 (53%) respectively. Forty eight (38%) participants had hyperglycemia, 42 (33%) leucocytosis, 13% elevated low density lipoprotein and 9% high triglycerides. No participant with ischemic stroke presented in time for thrombolysis. The 30 day case fatality was 43.8% and factors independently associated with it were Glasgow coma scale (GCS) < 9 p = 0.001and age 51-60 years P=0.044.Conclusion Thirty-day case fatality was high. Poor prognostic factors were GCS of <9 and age 51-60 years. Early presentation to hospital, intensive management, implementation of treatment guidelines and measures to prevent stroke should be emphasised.Key words: Mortality, Stroke, Uganda

Application of loop-mediated isothermal amplification (LAMP) of the random insertion mobile element (RIME - LAMP) to diagnose camel Trypanosomiasis in Sudan

Control of Trypanosomiasis is dependent on accurate diagnosis and treatment of infected patients or animals. Highly sensitive tests are available for serological screening but the sensitivity of parasitological confirmatory tests remains insufficient and needs to be improved. Ongoing research is opening perspectives for a new generation of field diagnostics. This study aimed to apply and investigate new diagnostic technique loop-mediated isothermal amplification (LAMP) of the random insertion mobile element (RIME - LAMP) to diagnose camel Trypanosomiasis in Sudan. Extracted DNA from camels was used to detect Trypanosoma evansi infection in camels using RIME-LAMP technique. A total of 368 DNA samples positive reactor with card agglutination test for Trypanosomiasis (CATT T. evansi) was tested using RIME-LAMP. A total of 208 samples reacted positive (56.52%) using RIME – LAMP whereas only 17 samples were positive (6.34%) using parasitological methods. RIME-LAMP helps increase the probability of detecting the positive cases of camel Trypanosomiasis and it was found to be one useful and alternative molecular diagnostic tool for the detection of T. evansi infections.Key words: Sudan, loop-mediated isothermal amplification (LAMP) - random insertion mobile element (RIME - LAMP), camel, Trypanosoma evansi

Radiation Safety Awareness among Radiation Workers and Clientele At Mulago Hospital, Kampala, Uganda.

Background: All x-ray utilization in human medicine leads to exposure of the patient and personnel to radiation. Although the quantity is low in diagnostic examinations, special attention should be given to this fact in order to minimize unnecessary exposure for both groups. Exposureto ionizing radiation cannot be avoided in a medical imaging facility. Twenty-two radiation workers and fifty patients responded. The main objective of the study was to determine the level of radiation safety awareness among radiation workers (Personnel) and clientele at Mulago hospital.Methods: Subjects were interviewed using two different questionnaires each one tailored to the radiation workers and the patient (clientele). Fifty patients and twenty-two radiation workers responded. Their views were assessed using structured questionnaires. The data was analysedusing SSPS package.Results: Fifteen (68.2%) reported that they had had a sensitization introduction about radiation safety before they started working with radiation. . 18 (81.8%) thought that the radiation safetymeasures taken at the work place were inadequate. It was noted that radiation workers were well informed about radiation safety, but that the patients expressed ignorance on the subject and many were convinced that x-rays were dangerous.Conclusion: There is need for sensitization of the public on radiation safety and to allay their fears about radiation. The radiation workers should do this before patients are worked on. This requires good communication skills on the part of the radiation workers. There is also need for radiation workers to have introductory seminars on radiation safety before they start working with radiation. They also need continuous education and update on radiation safet

A Search for Trypanosoma brucei rhodesiense Diagnostic Antigens by Proteomic Screening and Targeted Cloning

Background: The only available diagnostic method for East African trypanosomiasis is light microscopy of blood samples. A simple immunodiagnostic would greatly aid trypanosomiasis control. Methodology and Principal Findings: To find trypanosome proteins that are specifically recognised by sera from human sleeping sickness patients, we have screened the Trypanosoma brucei brucei proteome by Western blotting. Using cytosolic, cytoskeletal and glycosomal fractions, we found that the vast majority of abundant trypanosome proteins is not specifically recognised by patient sera. We identified phosphoglycerate kinase (PGKC), heat shock protein (HSP70), and histones H2B and H3 as possible candidate diagnostic antigens. These proteins, plus paraflagellar rod protein 1, rhodesain (a cysteine protease), and an extracellular fragment of the Trypanosoma brucei nucleoside transporter TbNT10, were expressed in E. coli and tested for reactivity with patient and control sera. Only TbHSP70 was preferentially recognized by patient sera, but the sensitivity and specificity were insufficient for use of TbHSP70 alone as a diagnostic. Immunoprecipitation using a native protein extract revealed no specifically reacting proteins. Conclusions: No abundant T. brucei soluble, glycosomal or cytoskeletal protein is likely to be useful in diagnosis. To find useful diagnostic antigens it will therefore be necessary to use more sophisticated proteomic methods, or to test a ver

Expanding access to voluntary HIV counselling and testing in sub-Saharan Africa: alternative approaches for improving uptake, 2001–2007

This article reports The changing face of the HIV ⁄ AIDS epidemic has resulted in new opportunities to increase access to voluntary HIV counselling and testing (VCT), especially during the past 7 years (2001–2007).The changing face of the HIV ⁄ AIDS epidemic has resulted in new opportunities to increase access to voluntary HIV counselling and testing (VCT), especially during the past 7 years (2001–2007). As access to HIV treatment becomes more widely available in sub-Saharan Africa, the need for enhanced access to VCT would become even greater. When given the opportunity, many more adults in sub-Saharan African would accept VCT, and many clearly express the desire to learn their HIV sero-status. However, in most parts of sub-Saharan Africa, fewer than one in 10 people know their HIV status. Stigma, fear of receiving an HIV-positive status, lack of confidentiality, long distances to VCT sites, and long delays in returning HIV test results limit people’s access to traditional VCT systems. Alternative VCT delivery models, such as mobile VCT, routine offer of VCT and home-based VCT increase access to and uptake of VCT. We recommend that these alternative models be implemented in more settings and on a much larger scale in sub-Saharan Africa, where VCT uptake rates remain low

Manual: fresh cassava roots handling for waxing and relative humidity storage

European Union and technical support of International Fund for Agricultural DevelopmentPeer Revie

Uptake of home-based voluntary HIV testing in sub-Saharan Africa: a systematic review and meta-analysis

Improving access to HIV testing is a key priority in scaling up HIV treatment and prevention services. Home-based voluntary counselling and testing (HBT) as an approach to delivering wide-scale HIV testing is explored here

Training report: capacity building in entrepreneurial and business skills for operationalizing fresh cassava roots packhouse.

This report describes the capacity building process and activities that were done to enhance the business and entrepreneurial skills of packhouse operators