Pathology Commons^™

Alteration Of Micrornas Regulated By C-Myc In Burkitt Lymphoma, Anna Onnis1, Giulia De Falco, Giuseppina Antonicelli, Monica Onorati, Cristiana Bellan, Omar Sherman, Shahin Sayed, Lorenzo Leoncini

Pathology, East Africa

Background: Burkitt lymphoma (BL) is an aggressive B-cell lymphoma, with a characteristic clinical presentation, morphology and immunophenotype. Over the past years, the typical translocation t(8;14) and its variants have been considered the molecular hallmark of this tumor. However, BL cases with no detectable MYC rearrangement have been identified. Intriguingly, these cases express MYC at levels comparable with cases carrying the translocation. In normal cells c-Myc expression is tightly regulated through a complex feedback loop mechanism. In cancer, MYC is often dysregulated, commonly due to genomic abnormalities. It has recently emerged that this phenomenon may rely on an alteration of post-transcriptional …

Trends In Salmonella Enteric Serovar Typhi In Nairobi, Kenya From 2004 To 2006, Doris M. Mengo1, Sam Kariuki, Ann W. T. Muigai, Gunturu Revathi

Pathology, East Africa

Background: Typhoid fever is a global health problem. The World Health Organization (WHO) estimates that the current annual global burden of typhoid is approximately 22 million new cases, 5% of which are fatal.

Methodology: To assess the trends in antibiotic resistance in 100 Salmonella enterica serovar Typhi strains were isolated from the blood of patients in Nairobi, Kenya, from 2004 to 2006. All isolates were tested against ampicilin, chloramphenic, nalidixic acid, ciprofloxacin, cotrimoxazole, cefuroxime, cefriaxone, amoxycillin/clavulanic acid, tetracycline and gentamycin. Susceptibility and resistance were determined using MIC and disk diffusion tests.

Results: From 2004 to 2006 a total of 100 …

Population Pharmacokinetics And Pharmacodynamics Of Artemether And Lumefantrine During Combination Treatment In Children With Uncomplicated Falciparum Malaria In Tanzania, S.F. Hietala, A. Martensson, B. Ngasala, S. Dahlstrom, N. Lindegardh, A. Annerberg, Zul Premji, A. Farnert, P. Gil, A. Bjorkman, M. Ashton

Pathology, East Africa

The combination of artemether (ARM) and lumefantrine is currently the first-line treatment of uncomplicated falciparum malaria in mainland Tanzania. While the exposure to lumefantrine has been associated with the probability of adequate clinical and parasitological cure, increasing exposure to artemether and the active metabolite dihydroartemisinin (DHA) has been shown to decrease the parasite clearance time. The aim of this analysis was to describe the pharmacokinetics and pharmacodynamics of artemether, dihydroartemisinin, and lumefantrine in African children with uncomplicated malaria. In addition to drug concentrations and parasitemias from 50 Tanzanian children with falciparum malaria, peripheral parasite densities from 11 asymptomatic children were …

Bone Marrow Examination Findings At Aga Khan University Hospital, Nairobi, Nancy Okinda, Riyat Malkit

Pathology, East Africa

Objective: To establish the bone marrow examination findings and determine the indication for bone marrow examination.

Design: A retrospective audit.

Setting: Aga Khan University Hospital, Nairobi.

Subjects: All bone marrow aspirates done at Aga Khan University for the period comprising February 2003 to February 2006 were retrieved and analysed.

Results: A total of 356 patient’s case histories including bone marrow examination results were analysed. Ages of the patients ranged from 18 months to 91 years. Males were 180 (50.6%) and females were 176 (49.4%). Nutritional anaemia as a group was the most common haematological disorder found on bone marrow …

Helicobacter Pylori: Prevalence And Antibiotic Susceptibility Among Kenyans, Andrew Nyerere Kimang’A, Gunturu Revathi, Samuel Kariuki, Shahin Sayed, Smita Devani

Pathology, East Africa

Background. Helicobacter pylori infection in Kenya is staggeringly high. Evidence links infection of the gastric mucosa by H. pylori with subsequent development of gastric pathologies.

Aim. We investigated the prevalence of H. pylori in dyspeptic patients, its relationship with gastric pathologies, and associated antibiotic susceptibility profiles, and compared two media to find the appropriate medium that enhances growth and expedites culture and isolation.

Methods. Rapid urease and histological tests were used to screen for H. pylori. Culture was performed to test sensitivity and evaluate media. Selective and nutritional supplements were added to culture media (Colombia blood agar and brainheart infusion …

Who Gets Prompt Access To Artemisinin-Based Combination Therapy? A Prospective Community-Based Study In Children From Rural Kilosa, Tanzania, D.O. Simba, M. Warsame, D. Kakoko, Z. Mrango, G. Tomson, Zul Premji, M. Petzold

Pathology, East Africa

Background: Effective and timely case management remains one of the fundamental pillars for control of malaria. Tanzania introduced artemisinin-combination therapy [ACT] for uncomplicated malaria; however, the policy change is challenged by limited availability of ACTs due to high cost. This study aimed to determine factors influencing prompt access to ACTs among febrile children in rural Kilosa, Tanzania.

Methods and Findings: In a community-based study, 1,235 randomly selected children under five were followed up weekly for six months, in 2008. Using a structured questionnaire, children's caretakers were asked about the child's febrile history in the last seven days, and treatment …

Understanding Caretakers' Dilemma In Deciding Whether Or Not To Adhere With Referral Advice After Pre-Referral Treatment With Rectal Artesunate, D.O. Simba, D.C. Kakoko, M. Warsame, Zul Premji, M.F. Gomes, G. Tomson, E. Johansson

Pathology, East Africa

Background: Malaria kills. A single rectal dose of artesunate before referral can reduce mortality and prevent permanent disability. However, the success of this intervention depends on caretakers' adherence to referral advice for follow-up care. This paper explores the dilemma facing caretakers when they are in the process of deciding whether or not to transit their child to a health facility after pre-referral treatment with rectal artesunate.

Methods: Four focus group discussions were held in each of three purposively selected villages in Mtwara rural district of Tanzania. Data were analysed manually using latent qualitative content analysis.

Results: The theme «Caretakers dilemma …

Population Genetic Analysis Of Large Sequence Polymorphisms In Plasmodium Falciparum Blood-Stage Antigens, A.D. Ahouidi, A.K. Bei, D.E. Neafsey, O. Sarr, S. Volkman, D. Milner, J. Cox-Singh, M.U. Ferreira, O. Ndir, Zul Premji, S. Mboup, M.T. Duraisingh

Pathology, East Africa

Plasmodium falciparum, the causative agent of human malaria, invades host erythrocytes using several proteins on the surface of the invasive merozoite, which have been proposed as potential vaccine candidates. Members of the multi-gene PfRh family are surface antigens that have been shown to play a central role in directing merozoites to alternative erythrocyte receptors for invasion. Recently, we identified a large structural polymorphism, a 0.58 Kb deletion, in the C-terminal region of the PfRh2b gene, present at a high frequency in parasite populations from Senegal. We hypothesize that this region is a target of humoral immunity. Here, by analyzing 371 …

Treatment Of Asymptomatic Carriers With Artemether-Lumefantrine: An Opportunity To Reduce The Burden Of Malaria?, B. Ogutu, A.B. Tiono, M. Makanga, Zul Premji, A.D. Gbadoe, D. Ubben, A.C. Marrast, O. Gaye

Pathology, East Africa

Background: Increased investment and commitment to malaria prevention and treatment strategies across Africa has produced impressive reductions in the incidence of this disease. Nevertheless, it is clear that further interventions will be necessary to meet the international target of a reversal in the incidence of malaria by 2015. This article discusses the prospective role of an innovative malaria control strategy - the community-based treatment of asymptomatic carriers of Plasmodium falciparum, with artemisinin-based combination therapy (ACT). The potential of this intervention was considered by key scientists in the field at an Advisory Board meeting held in Basel, in April 2009. …

Geographic Variation And Environmental Conditions As Cofactors In Chlamydia Psittaci Association With Ocular Adnexal Lymphomas: A Comparison Between Italian And African Samples, Alessandro Carugi, Anna Onnis, Giuseppina Antonicelli, Benedetta Rossi, Susanna Mannucci, Anna Luzzi, Stefano Lazzi, Cristiana Cristiana Bellan, Gian Marco Tosi, Shahin Sayed, Giulia De Falco, Lorenzo Leoncini

Pathology, East Africa

A particular extra-nodal lymphoma type arises from B cells of the marginal zone (MZ) of mucosa-associated lymphoid tissue (MALT). The aetiology ofMZ lymphomas suggests that they are associated with chronic antigenic stimulation by microbial pathogens, among which Helicobacter pylori-associated gastricMALT lymphoma is the best studied. Recently, MALT lymphomas have been described in the context of chronic conjunctivitis, which can be associated with Chlamydia spp. infection. Studies from Italy showed the presence of Chlamydia psittaci in 87% of ocular adnexal lymphomas (OAL), and C. psittaci has been described in a large part of samples from Austria and Korea as well. However, …

Cancer Of The Penis: Case Report, D. K. Kiptoon, P. M. Ngugi, F. S. Rana

Pathology, East Africa

Two patients with penile carcinoma are presented after management at a district hospital in Kenya. Both had undergone ritual circumcision as teenagers and presented late. HR was a 73 year old who presented with a fungating penile mass for which a partial penectomy was performed after wedge biopsy confirmed malignancy. He thereafter declined to have the surgical specimen sent for histology and took the amputated stump for burial in his compound to avoid bad omen. GK was 25 years old and presented with a fungating mass and underwent partial penectomy after a histological diagnosis was made. He absconded from follow-up …

Prevalence Of Gastric Mucosal Interleukin-1 Polymorphisms In Kenyan Patients With Advanced Gastric Cancer, Kimang’A Nyerere, Shahin Sayed, Gunturu Revathi, Peter Ojwang, Viviene Matiru, Smita Devani, Mahesh Shah, Samuel Kariuki

Pathology, East Africa

Helicobacter pylori is the main cause of peptic ulceration, distal gastric adenocarcinoma, and gastric lymphoma.1 Worldwide, gastric cancer is the second most common malignancy in men and women.1 According to data from the Nairobi Cancer Registry, gastric cancer is the fourth most common malignancy in adult males and the fifth most common in adult females. However, this may not represent the true situation because of under-reporting of cases. In the development of gastric cancer, environmental factors such as smoking, diet and, in particular, infection with H. pylori are significant.1 Based on epidemiological studies, the International Agency for Research on Cancer …

Efficacy And Safety Of Intermittent Preventive Treatment With Sulfadoxine-Pyrimethamine For Malaria In African Infants: A Pooled Analysis Of Six Randomised, Placebo-Controlled Trials, J.J. Aponte, D. Schellenberg, A. Egan, A. Breckenridge, I. Carneiro, J. Critchley, I. Danquah, A. Dodoo, R. Kobbe, B. Lell, J. May, Zul Premji, S. Sanz, E. Sevene, R. Soulaymani-Becheikh, P. Winstanley, S. Adjei, S. Anemana, D. Chandramohan, S. Issifou, F. Mockenhaupt F., S. Owusu-Agyei, B. Greenwood, M.P. Grobusch, P.G. Kremsner, E. Macete, H. Mshinda, R.D. Newman, L. Slutsker, M. Tanner, P. Alonso, C. Menendez

Pathology, East Africa

Background: Intermittent preventive treatment (IPT) is a promising strategy for malaria control in infants. We undertook a pooled analysis of the safety and efficacy of IPT in infants (IPTi) with sulfadoxine-pyrimethamine in Africa. Methods: We pooled data from six double-blind, randomised, placebo-controlled trials (undertaken one each in Tanzania, Mozambique, and Gabon, and three in Ghana) that assessed the efficacy of IPTi with sulfadoxine-pyrimethamine. In all trials, IPTi or placebo was given to infants at the time of routine vaccinations delivered by WHO's Expanded Program on Immunization. Data from the trials for incidence of clinical malaria, risk of anaemia (packed-cell volume <25% or haemoglobin <80 g/L), and incidence of hospital admissions and adverse events in infants up to 12 months of age were reanalysed by use of standard outcome definitions and time periods. Analysis was by modified intention to treat, including all infants who received at least one dose of IPTi or placebo. Findings: The six trials provided data for 7930 infants (IPTi, n=3958; placebo, n=3972). IPTi had a protective efficacy of 30·3% (95% CI 19·8-39·4, p<0·0001) against clinical malaria, 21·3% (8·2-32·5, p=0·002) against the risk of anaemia, 38·1% (12·5-56·2, p=0·007) against hospital admissions associated with malaria parasitaemia, and 22·9% (10·0-34·0, p=0·001) against all-cause hospital admissions. There were 56 deaths in the IPTi group compared with 53 in the placebo group (rate ratio 1·05, 95% CI 0·72-1·54, p=0·79). One death, judged as possibly related to IPTi because it occurred 19 days after a treatment dose, was subsequently attributed to probable sepsis. Four of 676 non-fatal hospital admissions in the IPTi group were deemed related to study treatment compared with five of 860 in the placebo group. None of three serious dermatological adverse events in the IPTi group were judged related to study treatment compared with one of 13 in the placebo group. Interpretation: IPTi with sulfadoxine-pyrimethamine was safe and efficacious across a range of malaria transmission settings, suggesting that this intervention is a useful contribution to malaria control. Funding: Bill & Melinda Gates Foundation. © 2009 Elsevier Ltd. All rights reserved.

Chlorproguanil - Dapsone - Artesunate Versus Artemether - Lumefantrine: A Randomized, Double-Blind Phase Iii Trial In African Children And Adolescents With Uncomplicated Plasmodium Falciparum Malaria, Zul Premji, R.E. Umeh, S. Owusu-Agyei, F. Esamai, E.U. Ezedinachi, S. Oguche, S. Borrmann, A. Sowunmi, S. Duparc, P.L. Kirby, A. Pamba, L. Kellam, R. Guiguemde, B. Greenwood, S.A. Ward, P.A. Winstanley

Pathology, East Africa

Background: Chlorproguanil-dapsone-artesunate (CDA) was developed as an affordable, simple, fixed-dose artemisinin-based combination therapy for use in Africa. This trial was a randomized parallel-group, double-blind, double-dummy study to compare CDA and artemether-lumefantrine (AL) efficacy in uncomplicated Plasmodium falciparum malaria and further define the CDA safety profile, particularly its hematological safety in glucose-6-phosphate dehydrogenase (G6PD) -deficient patients. Methods and Findings: The trial was conducted at medical centers at 11 sites in five African countries between June 2006 and August 2007. 1372 patients (≥1 to <15 years>old, median age 3 years) with acute uncomplicated P. falciparum malaria were randomized (2:1) to receive CDA 2/2.5/4 …

Factors Influencing Adherence To Referral Advice Following Pre-Referral Treatment With Artesunate Suppositories In Children In Rural Tanzania, Daudi Simba, Marian Warsame, Omari Kimbute, Deodatus Kakoko, Max Petzold, Goran Tomson, Zul Premji, Melba Gomes

Pathology, East Africa

Objective: WHO recommends artemisinin suppository formulations as pre-referral treatment for children who are unable to take oral medication and cannot rapidly reach a facility for parenteral treatment. We investigated factors influencing caretakers’ adherence to referral advice following pre-referral treatment of their children with rectal artesunate suppositories.

Methods: The study was nested within an intervention study that involved pre-referral treatment of all children who came to a community dispenser for treatment because they were unable to take oral medications because of repeated vomiting, lethargy, convulsions or altered consciousness. All patients who did not comply with referral advice were stratified by actions …

In Vivo Selection Of Plasmodium Falciparum Parasites Carrying The Chloroquine-Susceptible Pfcrt K76 Allele After Treatment With Artemether-Lumefantrine In Africa, C. Sisowath, I. Petersen, M.I. Veiga, A. Martensson, Zul Premji, A. Bjorkman, D.A. Fidock, J.P. Gil

Pathology, East Africa

Background: Artemether-lumefantrine (AL) is a major and highly effective artemisinin-based combination therapy that is becoming increasingly important as a new first-line therapy against Plasmodium falciparum malaria. However, recrudescences occurring after AL treatment have been reported. Identification of drug-specific parasite determinants that contribute to treatment failures will provide important tools for the detection and surveillance of AL resistance.

Methods: The findings from a 42-day follow-up efficacy trial in Tanzania that compared AL with sulfadoxinepyrimethamine (SP) were analyzed to identify candidate markers for lumefantrine tolerance/resistance in the chloroquine resistance transporter gene (pfcrt) and multidrug resistance gene 1 (pfmdr1). The findings were corroborated …

Coartem°: The Journey To The Clinic, Zul Premji

Pathology, East Africa

Artemisinin, from which the artemether component of Coartem° (artemether/lumefantrine, AL) is derived, is obtained from the plant sweet wormwood (Artemisia annua) which has been used for over 2,000 years as a Chinese herbal remedy. Artemisinin was first identified by Chinese researchers as the active anti-malarial constituent of A. annua and its derivatives were found to be the most potent of all anti-malarial drugs. Artemether acts rapidly, reducing the infecting parasite biomass by approximately 10,000-fold per asexual life cycle. Lumefantrine, the other active constituent of AL, acts over a longer period to eliminate the residual 100-100,000 parasites that remain after artemether …

Utility Of Liver Biopsy In Hiv-Infected Patients Presenting With Febrile Illnesses And Inconclusive Evaluation, J. Shavadia, Sitna Mwanzi, F. Rana, Majid Twahir

Pathology, East Africa

Objectives: To determine the utility of liver biopsy in providing a diagnosis in HIVinfected patients presenting with febrile illnesses and inconclusive initial investigative work up.

Design: A retrospective descriptive study.

Setting: The Aga Khan University Hospital, Nairobi.

Subjects: Twelve in-patients with HIV disease who underwent liver biopsy following inconclusive initial investigative work up for febrile illnesses between January and December 2007.

Results: Seven out of 12 patients had granulomatous hepatitis reported on histology with characteristic tuberculous epitheloid granulomas all having stainable acid-alcohol fast bacilli on Ziehl-Nielsen (ZN) stain. The mean alkaline phosphatase (ALP) and gamma glutamyl transpeptidase (GGT) levels in …

Genetic Analysis Of Hiv-1 Subtypes In Nairobi, Kenya, Suhail Khoja, Peter Ojwang, Saeed Khan, Nancy Okinda, Reena Harania, Syed Ali

Pathology, East Africa

Background: Genetic analysis of a viral infection helps in following its spread in a given population, in tracking the routes of infection and, where applicable, in vaccine design. Additionally, sequence analysis of the viral genome provides information about patterns of genetic divergence that may have occurred during viral evolution.

Objective: In this study we have analyzed the subtypes of Human Immunodeficiency Virus -1 (HIV-1) circulating in a diverse sample population of Nairobi, Kenya.

Methodology: 69 blood samples were collected from a diverse subject population attending the Aga Khan University Hospital in Nairobi, Kenya. Total DNA was extracted from peripheral blood …

Primary Cerebral Angitis Of The Central Nervous System: Case Report, S. Das, J. O. Jowi, K. Hameed, F. S. Rana

Pathology, East Africa

We report a case of a 28 year old female who presented with variedly progressive stroke like illness and raised intracranial pressure. Brain MRI scans revealed pericallosal and periventricular hyperintensities with oedema. Various medications like intravenous immunoglobulin, antibiotics, acyclovir, methyl prednisolone and management for raised intracranial pressure were instituted. She rapidly deteroriated and died on tenth hospital day. Only at autopsy was the diagnosis of primary angitis of central nervous system established.

Conclusions And Recommendations Of A Who Expert Consultation Meeting On Iron Supplementation For Infants And Young Children In Malaria Endemic Areas [Conclusions Et Recommandations À L'Issue De La Consultation De L'Oms Sur La Lutte Contre La Carence Martiale Chez Le Nourrisson Et Le Jeune Enfant Dans Les Pays D'Endémie Palustre], L. Allen, R.E. Black, N. Brandes, G. Brittenham, G. Chazot, C Chunming, J. Crawley, B. De Benoist, N. Dalmiya, I. Darnton-Hill, K. Dewey, S. El-Arifeen, O. Fontaine, C. Geissler, H. Haberle, P. Harvey, J. Hasler, C. Hershko, R. Hurrell, M.A. Juma, B. Lonnerdal, B. Lozoff, S. Lynch, H. Martines Salgado, E. Mclean, J. Metz, S. Oppenheimer, Zul Premji, A. Prentice, M. Ramsan, C. Ratledge, R. Stoltzfus, J. Tielsch

Pathology, East Africa

This article presents the results of an expert consultation meeting aimed at evaluating the safety and public health implications of administering supplemental iron to infants and young children in malaria-endemic areas. Participants at this meeting that took place in Lyon, France on June 12-14, 2006 reached consensus on several important issues related to iron supplementation for infants and young children in malaria-endemic areas. The conclusions in this report apply specifically to regions where malaria is endemic.

Willingness And Ability To Pay For Artemisinin-Based Combination Therapy In Rural Tanzania, E.C. Saulo, B.C. Forsberg, Zul Premji, S.M. Montgomery, A. Bjorkman

Pathology, East Africa

Background: The aim of this study was to analyse willingness to pay (WTP) and ability to pay (ATP) for ACT for children below five years of age in a rural setting in Tanzania before the introduction of artemisinin-based combination therapy (ACT) as first-line treatment for uncomplicated malaria. Socio-economic factors associated with WTP and expectations on anti-malaria drugs, including ACT, were also explored.

Methods: Structured interviews and focus group discussions were held with mothers, household heads, health-care workers and village leaders in Ishozi, Gera and Ishunju wards in north-west Tanzania in 2004. Contingent valuation method (CVM) was used with "take-it-or-leave- it" …

Impact Of Training In Clinical And Microscopy Diagnosis Of Childhood Malaria On Antimalarial Drug Prescription And Health Outcome At Primary Health Care Level In Tanzania: A Randomized Controlled Trial, B. Ngasala, M. Mubi, M. Warsame, M.G. Petzold, A.Y. Massele, L.L. Gustafsson, G. Tomson, Zul Premji, A. Bjorkman

Pathology, East Africa

Background: Prescribing antimalarial medicines based on parasite confirmed diagnosis of malaria is critical to rational drug use and optimal outcome of febrile illness. The impact of microscopy-based versus clinical-based diagnosis of childhood malaria was assessed at primary health care (PHC) facilities using a cluster randomized controlled training intervention trial.

Methods: Sixteen PHC facilities in rural Tanzania were randomly allocated to training of health staff in clinical algorithm plus microscopy (Arm-I, n = 5) or clinical algorithm only (Arm-II, n = 5) or no training (Arm-III, n = 6). Febrile under-five children presenting at these facilities were assessed, treated and scheduled …

Causes, Magnitude And Management Of Burns In Under-Fives In District Hospitals In Dar Es Salaam, Tanzania., M. Justin-Temu, G. Rimoy, Zul Premji, G. Matemu

Pathology, East Africa

Objectives: To determine the causes, magnitude and management of burns in children under five years of age who were admitted in the district hospitals of Dar es Salaam City, Tanzania.

Methods: In this study, a total of 204 under fives were enrolled. Questionnaires were used to elicit if the parent/caretaker had the knowledge of the cause of the burns, what was done immediately after burn injury, first aid given immediately after burn, source of the knowledge of first aid and when the child was taken to the hospital. Also the questionnaire was cited with data on the management of burns …

The Content Of African Diets Is Adequate To Achieve Optimal Efficacy With Fixed-Dose Artemether-Lumefantrine: A Review Of The Evidence, Zul Premji, S. Abdulla, B. Ogutu, A. Ndong, C.O. Falade, I. Sagara, N. Mulure, O. Nwaiwu, G. Kokwaro

Pathology, East Africa

A fixed-dose combination of artemether-lumefantrine (AL, Coartem®) has shown high efficacy, good tolerability and cost-effectiveness in adults and children with uncomplicated malaria caused by Plasmodium falciparum. Lumefantrine bioavailability is enhanced by food, particularly fat. As the fat content of sub-Saharan African meals is approximately a third that of Western countries, it raises the question of whether fat consumption by African patients is sufficient for good efficacy. Data from healthy volunteers have indicated that drinking 36 mL soya milk (containing only 1.2 g of fat) results in 90% of the lumefantrine absorption obtained with 500 mL milk (16 g fat). African …

Cheilitis Glandularis Progressing To Squamous Cell Carcinoma In An Hiv-Infected Patient: Case Report, F. M. A. Butt, M. L. Chindia, F. S. Rana, A. Ashani

Pathology, East Africa

Cheilitis glandularis (CG), is a rare inflammatory minor salivary gland disease affecting the lower lip.The hallmarks of which include progressive enlargement and eversion of the lower labial mucosa resulting in the obliteration of the mucosal vermillion interface. A case is presented of a 47-year-old HIV-infected woman who initially manifested clinical features of CG with a typical histopathology picture of a non-specific sialadenitis while a second biopsy performed six months later revealed well differentiated squamous cell carcinoma (SCC). She is symptom free one year following excision and radiotherapy treatment.

Variant Merozoite Protein Expression Is Associated With Erythrocyte Invasion Phenotypes In Plasmodium Falciparum Isolates From Tanzania, A.K. Bei, C.D. Membi, J.C. Rayner, M. Mubi, B. Ngasala, A.A. Sultan, Zul Premji, M.T. Duraisingh

Pathology, East Africa

[No abstract available]

Influence Of Consecutive-Day Blood Sampling On Polymerase Chain Reaction-Adjusted Parasitological Cure Rates In An Antimalarial-Drug Trial Conducted In Tanzania, Andreas Martensson, Johan Ursing, M. Isabel Veiga, Lisa Wiklund, Christopher Membi, Scott M. Montgomery, Zul Premji, Anna Farnert, Andres Bjorkman, Billy Ngasala

Pathology, East Africa

We assessed the influence that consecutive-day blood sampling, compared with single-day blood sampling, had on polymerase chain reaction (PCR)-adjusted parasitological cure after stepwise genotyping of merozoite surface proteins 2 (msp2) and 1 (msp1) in 106 children in Tanzania who had uncomplicated falciparum malaria treated with either sulfadoxine-pyrimethamine or artemether- lumefantrine; 78 of these children developed recurrent parasitemia during the 42-day follow-up period. Initial msp2 genotyping identified 27 and 33 recrudescences by use of single- and consecutive-day sampling, respectively; in subsequent msp1 genotyping, 17 and 21 of these episodes, respectively, were still classified as recrudescences; these results indicate a similar sensitivity …

Bronchoscopic Study On Aetiology Of Chronic Cough In Hiv-Infected Adults With Negative Sputum Smears For Mycobacterium Tuberculosis At Kenyatta National Hospital, Nairobi, A. M. Siika, J. M. Chakaya, Gunturu Revathi, S. S. Mohamed, K.M .. Bhatt

Pathology, East Africa

Objective: To establish the aetiology of chronic cough in HIV-infected patients with negative sputum smears for Acid Fast Bacilli (AFB).

Design: A cross-sectional descriptive study.

Setting: Kenyatta National Hospital, a tertiary referral centre in Kenya

Subjects: Sixty five HIV-infected adults presenting with chronic cough and negative sputum smears for AFBs.

Results: Sixty-two patients were included in the final analysis. Aetiology of chronic cough was established in 42 (68%) patients. Pneumocystis jiroveci, bacterial pneumonia and Mycobacterium tuberculosis were diagnosed in 22 (35.5%),17 (27.4%) and 14 (22.5%) patients respectively. Majority (98%) of patients with a diagnosis had multiple causes established …

Relationship Between Antipyretic Effects And Cytokine Levels In Uncomplicated Falciparum Malaria During Different Treatment Regimes, Elisabeth Hugosson, Scott M. Montgomery, Zul Premji, Marita Troye-Blomberg, Anders Bjorkman

Pathology, East Africa

We have previously shown that both chloroquine and paracetamol (acetaminophen) have antipyretic activity during treatment of acute uncomplicated Plasmodium falciparum malaria in children 1-4 years old. Here, we studied if this effect was accompanied by changes in plasma cytokine levels. The 104 children were treated with either chloroquine or sulfadoxine/pyrimethamine (SP) alone, SP + chloroquine or SP + paracetamol for 4 days. Cytokine levels were determined days 0, 2 and 3, body temperature every sixth hour until 72 h and parasitemia once daily for 4 days. At admission, body temperature correlated with levels of IL-10, IFN-γ and IL-6, and parasitemia …