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Biomedical subjects

G B Okelo

Publications and source records attributed to G B Okelo.

At least 19 recordsLinked to original sources

Blackwater fever at the Kenyatta National Hospital in Kenya: a case report.

Blackwater fever was an important cause of morbidity and mortality in the beginning of this century particularly in West and Central Africa. There has been a marked reduction in the incidence of blackwater fever since 1950 and only sporadic cases occur nowadays. At the Kenyatta National Hospital, three cases of blackwater fever have been seen in the past four years whereas not a single case had been reported between 1975 and 1988. Two of the patients fit into the classical description of blackwater fever and one was possibly due to drug induced haemolysis in a G6PD deficiency patient.

Adult↗

Cutaneous leishmaniasis due to Leishmania aethiopica, on Mount Elgon, Kenya.

A survey of cutaneous leishmaniasis was carried out on the slopes of Mount Elgon, Kenya, including a detailed study of two villages in which cases were known to occur. The disease appeared to be restricted to altitudes between 1750 and 1900 metres, which coincides with an escarpment region. Vector sandflies were not found in houses and transmission appeared to be predominantly associated with caves found in the escarpment region. The parasites which were isolated were identified as Leishmania aethiopica.

Adolescent↗

Pharmacokinetics of albendazole in children with hydatid disease.

The pharmacokinetics of albendazole were investigated in five children who were hospitalized at the Kenyatta National Hospital for the treatment of hydatid disease. Unchanged albendazole was below detectable level in plasma. The major metabolite present was albendazole sulphoxide. In one of the patients, the concentration of albendazole sulphone in plasma was significantly high, whereas in the other four children, only trace amounts were detected. Maximum concentrations of albendazole sulphoxide in these five children were variable and generally higher than those reported in adults by other workers. Other pharmacokinetic parameters were comparable to those found in other studies.

Administration, Oral↗

Disseminated histoplasmosis in a patient with acquired immunodeficiency syndrome (AIDS): a case report.

A 27 year old female with AIDS and disseminated histoplasmosis is presented. The clinical features include fever, weight loss, productive cough, splenomegaly and moderate pallor. The initial working diagnosis was pulmonary tuberculosis. The diagnosis of disseminated histoplasmosis was made terminally from bone marrow aspirate examination. Disseminated histoplasmosis with its varied clinical picture is likely to be missed in a patient with AIDS, and therefore a high index of suspicion is necessary for diagnosis.

AIDS-Related Opportunistic Infections↗

Tryptophan metabolism and vitamin B6 nutritional status in patients with schistosomiasis mansoni and in infected mice.

Patients infected with Schistosoma mansoni showed an abnormal response to a test dose of tryptophan, with little increase in the urinary excretion of kynurenine, hydroxykynurenine, xanthurenic and kynurenic acids, N1-methyl nicotinamide, methyl pyridone carboxamide, 5-hydroxytryptamine or 5-hydroxyindoleacetic acid. In contrast to previous reports, this is different from the pattern of tryptophan metabolism seen in vitamin B6 deficiency. Furthermore, the patients' plasma concentrations of pyridoxal phosphate were within the reference range, and supplementation for 5 days with 20 mg vitamin B6/day did not affect tryptophan metabolism. Treatment with a single dose of Praziquantel resulted in a substantial restoration of normal tryptophan metabolism. In mice infected with S. mansoni there was a similar impairment of tryptophan metabolism, as shown by considerably reduced formation of 14CO2 after the administration of a tracer dose of [14C]tryptophan. Again, the administration of vitamin B6 supplements did not correct tryptophan metabolism in the mice. Treatment with Praziquantel resulted in substantial restoration of the production of 14CO2 from [14C]tryptophan. There was no evidence of vitamin B6 deficiency (as determined by erythrocyte aspartate aminotransferase activation coefficient) associated with infection in the mice, although there was a redistribution of pyridoxal phosphate between tissues, with a reduction in the concentration of liver, spleen and kidney, and an increase in skeletal muscle.

Adolescent↗

The presentation and outcome of HIV-related disease in Nairobi.

The range of clinical presentations of HIV-related disease in Africa has not been adequately described, despite the fact that many hospitals have to rely heavily on clinical diagnosis. Six hundred adult medical patients seen in the Casualty Department of the main Government hospital in Nairobi were enrolled in a study of the presentation and outcome of HIV-related disease: 506 of these patients were admitted, of whom 19 per cent (95) were HIV seropositive. The remaining 94 were dealt with as outpatients: 11 percent (10) of these were seropositive. A history of prior treatment for sexually transmitted disease and, if male, being uncircumcised, were associated with being seropositive. Three presentations were strongly associated with HIV infection: acute fever with no focus except the gastrointestinal tract (enteric fever-like illness), acute cough with fever (community-acquired pneumonia) and chronic diarrhoea with wasting. The WHO clinical case definition (CCD) for AIDS missed a substantial amount of HIV-related morbidity (sensitivity 39 per cent) and misidentified many seronegative patients (positive predictive value 59 per cent). In comparison with the Centers for Disease Control surveillance definition for AIDS, the CCD was specific (91 per cent) and sensitive (79 per cent) but only had a positive predictive values of 30 per cent: the CCD may therefore be a poor surveillance tool for AIDS. Seropositive patients were much more likely to die than were seronegative patients (39 per cent vs. 15 per cent mortality). Enteric fever-like illness was the presentation which most commonly proved fatal. A wider spectrum of disease is associated with underlying HIV immunosuppression than has previously been described in Africa.

Acute Disease↗

Life-threatening bacteraemia in HIV-1 seropositive adults admitted to hospital in Nairobi, Kenya.

During 6 months, 506 consecutive adult emergency admissions to hospital in Nairobi were enrolled in a study of bacteraemia and HIV infection. 19% were HIV-1 antibody positive. Significantly more HIV-seropositive than seronegative patients had bacteraemia (26% vs 6%). The predominant organisms isolated from the seropositive patients were Salmonella typhimurium and Streptococcus pneumoniae. Mortality was higher in the seropositive than in the seronegative bacteraemic patients. The findings suggest that non-opportunistic bacteria are important causes of morbidity and mortality in HIV-infected individuals in Africa.

Acquired Immunodeficiency Syndrome↗

Extrapulmonary and disseminated tuberculosis in HIV-1-seropositive patients presenting to the acute medical services in Nairobi.

We studied 506 consecutive adult acute medical admissions to hospital in Nairobi; 95 (18.8%) were seropositive for HIV-1, and 43 new cases of active tuberculosis (TB) were identified. TB was clearly associated with HIV infection, occurring in 17.9% of seropositive patients compared with 6.3% of seronegatives [odds ratio (OR) 3.2; 95% confidence limits (CL) 1.6-6.5]. Extrapulmonary disease was more common in seropositive than seronegative TB patients (nine out of 17 versus five out of 26; OR 4.7; 95% CL 1.01-23.6); this accounted for most of the excess cases of TB seen in seropositive patients. Mycobacteraemia was demonstrated in two of eight seropositive TB patients but in none of 11 seronegative TB patients. No atypical mycobacteria were isolated. The World Health Organization (WHO) clinical case definition for African AIDS did not discriminate well between seropositive and seronegative TB cases. Five out of seven seropositive women with active tuberculosis had delivered children in the preceding 6 months and were lactating, compared with only one out of eight seronegative tuberculous women. An association between recent childbirth, HIV immunosuppression and the development of TB is suggested.

Adolescent↗

Diagnosis of human hydatid disease in surgically-confirmed cases by the use of the indirect haemagglutination test based on a thermo-stable lipoprotein and on unfractionated hydatid cyst fluid.

A total of 204 sera, taken from healthy individuals or from individuals with various parasitic and bacterial infections, were examined by the indirect haemagglutination test. The tests were carried out using either a thermo-stable lipoprotein or unfractionated hydatid cyst fluid, and a titre of 1:64 or above was considered positive. Sixty-two of 70 sera from individuals with surgically-confirmed hydatid disease showed positive reactions with the thermo-stable lipoprotein--a sensitivity of 88%. No false positive reactions were obtained with sera from healthy individuals or from individuals with parasitic or bacterial infections, and no cross-reactions were observed with sera from individuals with multiple myeloma. The lipoprotein antigen thus showed a specificity of 100%. A sensitivity of 88% was obtained with the indirect haemagglutination test using whole hydatid cyst fluid; but positive reactions were obtained from healthy individuals and from individuals with schistosomiasis, leishmaniasis, taeniasis and malaria. No cross-reactions were obtained with sera from patients with gonorrhoea, syphilis or multiple myeloma. Because of the high sensitivity and specificity shown by the thermo-stable lipoprotein ('Antigen 880'), it is considered that this antigen is more useful than unfractionated hydatid cyst fluid in the diagnosis of human hydatidosis in Kenya.

Animals↗

Purification and partial characterization of a thermo-stable lipoprotein ("antigen 880") of hydatid cyst fluid (HCF).

A purification procedure for a HCF thermo-stable lipoprotein designated as "Antigen 880" and subsequent characterization are described. The molecular weight and PI of the lipoprotein were shown to be 240,000 daltons and 4.2 respectively. The antigenic activity of "Antigen 880" was not affected by trypsinization, pepsinization and delipidization. This suggested that the antigen activity of the lipoprotein recided in both the protein and lipid moieties. Treatment of the antigen with various concentrations of iodoacetamide and dithiothreital (DTT) and subsequent assay for antigenic activity showed that the two chemicals did not affect antigenic activity. This suggested that the di-suphide bonds were not a pre-requisite to antigenic integrity of the lipoprotein. After heating HCF at temperature between 105-121 degrees C, it was shown that "Antigen 880" was the only HCF antigen which retained activity at these temperatures. Further analysis of the supernate obtained after heating concentrated HCF at a temperature of 110 degrees C for 10 minutes by use of Sephadex G-200 column showed two peaks. Antigenic activity specific for "Antigen 880" was obtained in Peak I, while no antigen activity was found in Peak II. When Peak I was analyzed using step-by-step DEAE 52 ion exchange chromatography, only one peak was eluted with 0.2M phosphate buffer, pH 8.5. This peak had antigenic activity for "Antigen 880". Analysis by disc-gel electrophoresis of the antigenic preparation obtained from the DEAE-cellulose column revealed one protein species. "Antigen 880" was shown to be stable for 10 months after incubation at pH1-11.(ABSTRACT TRUNCATED AT 250 WORDS)

Antigens, Protozoan↗

The amino acid and fatty acid composition of the thermostable lipoprotein ("Antigen 880") of hydatid cyst fluid (HCF).

Analysis for the amino acid composition of "Antigen 880" was carried out by use of double dimension paper chromatography and Biotronik 2,000 automatic amino acid analyzer. By the double dimension paper chromatography, leucine, phenylalanine, tyrosine and alanine were identified as amino acid components of the protein moiety of "Antigen 880". In the Biotronik 2,000 automatic amino acid analyzer showed the concentration of the various amino acids to be as follows: isoleucine, leucine, tyrosine, phenylalanine, lysine and histidine were identified as amino acid constituents of "Antigen 880". Quantitative studies in Biotronik 2,000 analyzer showed the concentration of the various amino acids to be as follows: valine -0.85 mumol/ml; leucine - 0.22 mumol/ml. /ml; iso-leucine - 0.18 mumol/ml; tyrosine - 0.04 mumol/ml, and histidine - 0.02 mumol/ml. The fatty acid composition of the lipid moiety of "Antigen 880" was investigated by use of Gas-Liquid chromatography. In this method, C8:0. C10:0, C12:0, C14:0, C16:0 and C18 were identified as the fatty acid constituents of the lipid moiety of "Antigen 880".

Amino Acids↗

Usefulness of indirect haemagglutination (IHA) and enzyme-linked immunosorbent assay (ELISA) in the diagnosis of human hydatidosis.

This communication reports on the usefulness of the IHA test and the ELISA in the diagnosis of human hydatid disease. The study was conducted on 40 surgically confirmed cases of hydatid disease, 40 normal individuals, and sera from individuals with various parasitic infections and other conditions namely: hook-worm-8, taeniasis-5, schistosomiasis-10, malaria-15, visceral leishmaniasis-12, multiple myeloma-3, syphilis-6, and gonorrhoea-10. The results show a sensitivity of 85% and specificity of 100%. The results indicate that it is no longer scientifically rational to hold the view that the Turkana do not mount adequate immune response against Echinococcus infections.

Echinococcosis↗

Suppression of T-cell proliferative response in Plasmodium falciparum malaria patients--preliminary results.

We report suppression of T-cell proliferative responses to P.falciparum specific antigen and mitogens. T-cells derived from malaria patients were co-cultured with P.falciparum antigen or mitogens and the T-cell activity determined by radioactive thymidine incorporation assay system. We found inhibition of T-cell responses to P.falciparum antigen in 13 out of 24 malaria patients studied. The suppression ranged from 4%-60%. Results of mitogenic responses of T-cells showed a wide variation. Suppression of concanavalin A (Con A) responses ranged from 48%-64% (4 out of 10 patients) while phytohaemagglutinin (PHA) responses varied from 4%-60% (8 out of 10 patients) and those of purified protein derivative (PPD) antigen from 12%-44% (3 out of 6 patients). Together, these preliminary results show a marked impairment in T-cell responses to parasite antigen and mitogens in P. falciparum infected patients.

Adult↗