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Characterization Of Invasive And Colonizing Isolates Of Streptococcus Agalactiae In East African Adults, Charlotte Huber, Francis Mcodimba, Valentin Pflueger, Claudia Daubenberger, Gunturu Revathi

Pathology, East Africa

Ninety-five colonizing isolates and 74 invasive isolates of Streptococcus agalactiae from Kenyan adults were characterized by using capsular serotyping and multilocus sequence typing. Twenty-two sequence types clustering into five clonal complexes were found. Data support the view that S. agalactiae isolates belonging to a limited number of clonal complexes are invasive in adults worldwide.

Lymphomas In Sub-Saharan Africa - What Can We Learn And How Can We Help In Improving Diagnosis, Managing Patients And Fostering Translational Research?, Kikkeri N. Naresh, Martine Raphael, Leona Ayers, Nina Hurwitz, Valeria Calbi, Emily Rogena, Shahin Sayed, Omar Sherman, Hazem A.H. Ibrahim, Stefano Lazzi, Vasileios Mourmouras, Patricia Rince, Jessie Githanga, Bessie Byakika, Emma Moshi, Muheez Durosinmi, Babatunde J. Olasode, Olayiwola A. Oluwasola, Effiong E. Akang, Yetunde Akeno` Va,, Melissa Adde, Ian Magrath, Lorenzo Leoncini

Pathology, East Africa

Approximately 30 000 cases of non-Hodgkin lymphoma (NHL) occur in the equatorial belt of Africa each year. Apart from the fact that Burkitt lymphoma (BL) is very common among children and adolescents in Africa and that an epidemic of human immunodeficiency virus (HIV) infection is currently ongoing in this part of the world, very little is known about lymphomas in Africa. This review provides information regarding the current infrastructure for diagnostics in sub-Saharan Africa. The results on the diagnostic accuracy and on the distribution of different lymphoma subsets in sub-Saharan Africa were based on a review undertaken by a team …

Educational Needs And Causes Of False Diagnosis Of Atypical Squamous Cells Of Unknown Significance At A University Hospital, Neeta Kumar, Shahin Sayed, Zahir Moloo

Pathology, East Africa

The entity of atypical squamous cells of undetermined significance (ASCUS) in The Bethesda System 2001 for reporting cervical cytology is characterized by equivocal diagnosis, poor reproducibility and debatable management. This retrospective study was done to analyse the causes of false ASCUS if any and identify the educational needs as part of quality assurance programme. Cervical smears of all ASCUS cases reported over the one-year period were reviewed by the Cytopathologist. Relevant clinical data was retrieved. ASCUS was the most common type of abnormality representing 43.0 % cases among 294 abnormal smears reported during study period. 16.0% cases were found to …

Detection Of Ndm-1-Producing Klebsiella Pneumoniae In Kenya., Laurent Poirel, Gunturu Revathi, Sandrine Bernabeu, Patrice Nordmann

Pathology, East Africa

Seven carbapenem-resistant NDM-1-positive Klebsiella pneumoniae isolates were recovered from patients hospitalized between 2007 and 2009 in different wards at a referral and tertiary care center in Nairobi. Most of the isolates were obtained from urine. All isolates carried the bla_NDM-1 carbapenemase gene previously reported from India, Pakistan, and the United Kingdom. These isolates were clonally related and expressed many other resistance determinants, including β-lactamases CTX-M-15, OXA-1, OXA-9, CMY-6, and aminoglycoside resistance methylase RmtC. This work corresponds to the first report of NDM-1 producers in Africa.

Effectiveness Of Artemether-Lumefantrine Provided By Community Health Workers In Under-Five Children With Uncomplicated Malaria In Rural Tanzania: An Open Label Prospective Study, B.E. Ngasala, M. Malmberg, A.M. Carlsson, P.E. Ferreira, M.G. Petzold, D. Blessborn, Y. Bergqvist, J.P. Gil, Zul Premji, A. Martensson

Pathology, East Africa

Background: Home-management of malaria (HMM) strategy improves early access of anti-malarial medicines to high-risk groups in remote areas of sub-Saharan Africa. However, limited data are available on the effectiveness of using artemisinin-based combination therapy (ACT) within the HMM strategy. The aim of this study was to assess the effectiveness of artemether-lumefantrine (AL), presently the most favoured ACT in Africa, in under-five children with uncomplicated Plasmodium falciparum malaria in Tanzania, when provided by community health workers (CHWs) and administered unsupervised by parents or guardians at home.

Methods: An open label, single arm prospective study was conducted in two rural villages …

Community Screening And Treatment Of Asymptomatic Carriers Of Plasmodium Falciparum With Artemether-Lumefantrine To Reduce Malaria Disease Burden: A Modelling And Simulation Analysis, S.E. Kern, A.B. Tiono, M. Makanga, A. Gbadoe, Zul Premji, O. Gaye, I. Sagara, D. Ubben, M. Cousin, F. Oladiran, O. Sander, B. Ogutu

Pathology, East Africa

Background: Asymptomatic carriers of Plasmodium falciparum serve as a reservoir of parasites for malaria transmission. Identification and treatment of asymptomatic carriers within a region may reduce the parasite reservoir and influence malaria transmission in that area.

Methods: Using computer simulation, this analysis explored the impact of community screening campaigns (CSC) followed by systematic treatment of P. falciparum asymptomatic carriers (AC) with artemether-lumefantrine (AL) on disease transmission. The model created by Okell et al (originally designed to explore the impact of the introduction of treatment with artemisinin-based combination therapy on malaria endemicity) was modified to represent CSC and treatment of …

A Ten-Year Review Of Neonatal Bloodstream Infections In A Tertiary Private Hospital In Kenya, Ruchika Kohli-Kochhar, Geoffrey Omuse, Gunturu Revathi

Pathology, East Africa

Introduction: Neonatal mortality in developing countries is usually due to an infectious cause. The gold standard of investigation in developing countries is a positive blood culture. It is important to know the aetiology of neonatal bloodstream infections so that empiric treatment can be effective.

Methodology: We conducted a retrospective clinical audit over ten years between January 2000 until December 2009, looking at the aetiology of both early and late onset neonatal sepsis. We analysed data from 152 (23%) patient isolates out of 662 suspected cases of neonatal sepsis.

Results: Our study revealed that Gram-positive organisms were the predominant cause of …

Plasmodium Falciparum Population Dynamics During The Early Phase Of Anti-Malarial Drug Treatment In Tanzanian Children With Acute Uncomplicated Malaria, A.M. Carlsson, B.E. Ngasala, S. Dahlstrom, C. Membi, I.M. Veiga, L. Rombo, S. Abdulla, Zul Premji, J.P. Gil, A. Bjorkman, A. Martensson

Pathology, East Africa

Background: This study aimed to explore Plasmodium falciparum population dynamics during the early phase of anti-malarial drug treatment with artemisinin-based combination therapy in children with clinical malaria in a high transmission area in Africa.

Methods: A total of 50 children aged 1-10 years with acute uncomplicated P. falciparum malaria in Bagamoyo District, Tanzania, were enrolled. Participants were hospitalized and received supervised standard treatment with artemether-lumefantrine according to body weight in six doses over 3 days. Blood samples were collected 11 times, i.e. at time of diagnosis (-2 h) and 0, 2, 4, 8, 16, 24, 36, 48, 60 and 72 …

Population Health Metrics Research Consortium Gold Standard Verbal Autopsy Validation Study: Design, Implementation, And Development Of Analysis Datasets, C.J.L. Murray, A.D. Lopez, R. Black, R. Ahuja, S.M. Ali, A. Baqui, L. Dandona, E. Dantzer, Vinita Das, U. Dhingra, A. Dutta, W. Fawzi, A.D. Flaxman, S. Gomez, B. Hernandez, R. Joshi, H. Kalter, A. Kumar, V. Kumar, R. Lozano, M. Lucero, S. Mehta, B. Neal, S.L. Ohno, R. Prasad, D. Praveen, Zul Premji, D. Ramirez-Villalobos, H. Remolador, I. Riley, M. Romero, M. Said, D. Sanvictores

Pathology, East Africa

Background: Verbal autopsy methods are critically important for evaluating the leading causes of death in populations without adequate vital registration systems. With a myriad of analytical and data collection approaches, it is essential to create a high quality validation dataset from different populations to evaluate comparative method performance and make recommendations for future verbal autopsy implementation. This study was undertaken to compile a set of strictly defined gold standard deaths for which verbal autopsies were collected to validate the accuracy of different methods of verbal autopsy cause of death assignment.

Methods: Data collection was implemented in six sites in four …

Malaria Rapid Testing By Community Health Workers Is Effective And Safe For Targeting Malaria Treatment: Randomised Cross-Over Trial In Tanzania, M. Mubi, A. Janson, M. Warsame, A. Martensson, K. Kallander, M.G. Petzold, B. Ngasala, G. Maganga, L.L. Gustafsson, A. Massele, G. Tomson, Zul Premji, A. Bjorkman

Pathology, East Africa

Background: Early diagnosis and prompt, effective treatment of uncomplicated malaria is critical to prevent severe disease, death and malaria transmission. We assessed the impact of rapid malaria diagnostic tests (RDTs) by community health workers (CHWs) on provision of artemisinin-based combination therapy (ACT) and health outcome in fever patients.

Methodology/Principal Findings: Twenty-two CHWs from five villages in Kibaha District, a high-malaria transmission area in Coast Region, Tanzania, were trained to manage uncomplicated malaria using RDT aided diagnosis or clinical diagnosis (CD) only. Each CHW was randomly assigned to use either RDT or CD the first week and thereafter alternating weekly. …

Efficacy And Safety Of Artemether-Lumefantrine In The Treatment Of Acute, Uncomplicated Plasmodium Falciparum Malaria: A Pooled Analysis, M. Makanga, Q. Bassat, C.O. Falade, Zul Premji, S. Krudsood, P. Hunt, V. Walter, H.-P. Beck, A.-C. Marrast, M. Cousin, P.J. Rosenthal

Pathology, East Africa

Randomized trials have confirmed the efficacy and safety of artemether-lumefantrine (AL) for treatment of uncomplicated Plasmodium falciparum malaria. Data from seven studies supported by Novartis (1996-2007), including 647 adults (> 16 years of age, 83.3% completed the study) and 1,332 children (≤ 16 years of age, 89.3% completed the study) with microscopically confirmed uncomplicated P. falciparum malaria and treated with the recommended regimen of AL, were pooled. The 28-day polymerase chain reaction-corrected parasitologic cure rate (primary efficacy endpoint) was 97.1% (495 of 510) in adults and 97.3% (792 of 814) in children (evaluable population). Gametocytemia prevalence after day was 4.2% …

Pre-Referral Rectal Artesunate In Severe Malaria: Flawed Trial, K.F. Hirji, Zul Premji

Pathology, East Africa

Background:Immediate injectable treatment is essential for severe malaria. Otherwise, the afflicted risk lifelong impairment or death. In rural areas of Africa and Asia, appropriate care is often miles away. In 2009, Melba Gomes and her colleagues published the findings of a randomized, placebo-controlled trial of rectal artesunate for suspected severe malaria in such remote areas. Enrolling nearly 18,000 cases, the aim was to evaluate whether, as patients were in transit to a health facility, a pre-referral artesunate suppository blocked disease progression sufficiently to reduce these risks. The affirmative findings of this, the only trial on the issue thus far, …

Diagnosis Of Langerhans Cell Histiocytosis On Fine Needle Aspiration Cytology: A Case Report And Review Of The Cytology Literature, Neeta Kumar, Shahin Sayed, Sudhir Vinayak

Pathology, East Africa

A case of multifocal Langerhans cell histiocytosis in a two-year-old child is presented where fine needle aspiration was helpful in achieving a rapid and accurate diagnosis in an appropriate clinical and radiological setting. This can avoid unnecessary biopsy and guide the management especially where access to histopathology is limited. The highly characteristic common and rare cytological features are highlighted with focus on differential diagnoses and causes of pitfalls.