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PubMed2006

Viability and effectiveness of large-scale HIV treatment initiatives in sub-Saharan Africa: experience from western Kenya.

OBJECTIVES: To determine the clinical and immunological outcomes of a cohort of HIV-infected patients receiving antiretroviral therapy. DESIGN: Retrospective study of prospectively collected data from consecutively enrolled adult HIV-infected patients in eight HIV clinics in western Kenya. METHODS: CD4 cell counts, weight, mortality, loss to follow-up and adherence to antiretroviral therapy were collected for the 2059 HIV-positive non-pregnant adult patients treated with antiretroviral drugs between November 2001 and February 2005. RESULTS: Median duration of follow-up after initiation of antiretroviral therapy was 40 weeks (95% confidence interval, 38-43); 111 patients (5.4%) were documented as deceased and 505 (24.5%) were lost to follow-up. Among 1766 (86%) evaluated for adherence to their antiretroviral regimen, 78% reported perfect adherence at every visit. Although patients with and without perfect adherence gained weight, patients with less than perfect adherence gained 1.04 kg less weight than those reporting perfect adherence (P = 0.059). CD4 cell counts increased by a mean of 109 cells/microl during the first 6 weeks of therapy and increased more slowly thereafter, resulting in overall CD4 cell count increases of 160, 225 and 297 cells/microl at 12, 24, and 36 months respectively. At 1 year, a mean increase of 170 cells/microl was seen among patients reporting perfect adherence compared with 123 cells/microl among those reporting some missed doses (P < 0.001). CONCLUSIONS: Antiretroviral treatment of adult Kenyans in this cohort resulted in significant and persistent clinical and immunological benefit. These findings document the viability and effectiveness of large-scale HIV treatment initiatives in resource-limited settings.

Adult↗
PubMed1999

Molecular epidemiology of Nigerian and Ghanaian measles virus isolates reveals a genotype circulating widely in western and central Africa.

Sub-Saharan Africa is one of the regions of the globe with the highest measles-related morbidity and mortality. Yet only seven virus isolates from this vast region have been phylogenetically characterized on the basis of their nucleoprotein, the last one in 1991. To characterize the prevalent wild-type viruses and to understand their circulation pattern, a large panel (n = 45) of isolates was collected in Ghana and Nigeria in 1997 and 1998. On the basis of their nucleoprotein sequence, the viruses clearly belong to clade B but a reshuffling of the structure of this clade was proposed, tentatively extending the number of genotypes from two to three on the basis of quantitative criteria. The sequences revealed the co-circulation of at least two distinct viruses in the cities of Lagos and Ibadan, suggesting that the number of susceptible individuals seems to be high enough to support endemic circulation of at least two distinct viruses. The endemic co-circulation of several viruses may well be a characteristic of communities with low vaccination rates. One of these viruses was also found in Accra in 1998 as well as in a 1994 case linked to distant Kenya, suggesting that clade B viruses are prevalent in sub-Saharan Africa while non-B viruses seem to dominate the south of Africa.

Base Sequence↗
PubMed1992

[Malaria in the Dunkerque hospital center from December 1979 to December 1990].

Seventy-one cases of malaria were diagnosed in the hospital of Dunkerque from 1979 to 1990. Forty-five patients have been infected in the Comores islands. Among the 24 other imported cases, 17 (71%) have been contaminated in Western or Central Africa. One case of congenital malaria and one of malaria acquired by blood transfusion are also reported. Plasmodium falciparum was detected in 84.5% of the patients. The four human species were found among the Comorians. Two cases with abnormal forms of Plasmodium vivax were observed.

Adolescent↗
PubMed2006

An outbreak of drug-resistant tuberculosis caused by a Beijing strain in the western Cape, South Africa.

During October 2005, four children in a school in Cape Town were identified with multidrug-resistant tuberculosis (MDR-TB). Genetic analysis confirmed that these isolates belonged to a single cluster (Beijing cluster 220) and that all harboured a -15 inhA(C-T) promoter mutation demonstrating transmission. Genetic analysis of isolates cultured from patients from the Boland-Overberg-South Cape-Karoo and Cape Town regions showed that 28% (58/209) of patients infected with a Beijing strain had the cluster 220 genotypes and that all harboured the same -15 inhA(C-T) promoter mutation. The presence of these transmissible MDR-TB strains may pose a threat to the community, and rigorous infection control measures are needed to ensure the safety of those exposed.

Bacterial Proteins↗
PubMed1990

[Infections caused by Mycobacterium africanum].

Mycobacterium africanum is a bacterial species that was singled out in 1969. Its biochemical and cultural characteristics are intermediary between those of Mycobacterium tuberculosis and Mycobacterium bovis. This bacteria is responsible for tuberculosis in both western and central Africa. We can distinguish between four different types dependent upon the geographical origins of the patients. The extent of this case, with multiple cutaneous and visceral lesions, could not be explained by a past or associated disease or by an immunological defect, be it congenital or acquired.

Adolescent↗
PubMed1988

[Human monkey pox: its clinico-epidemiological characteristics].

During the course of the smallpox eradication programme, a new eruptive disease clinically resembling smallpox was discovered in Zaire. The disease, which was named monkeypox after the virus, is a zoonosis occurring sporadically in countries of western and central Africa with tropical rain forest. The studies carried out in Zaire from 1980 through 1985 showed that monkeypox affects mainly children in relatively small remote villages whose population has traditionally frequent contacts with wild animals. Apart from the wildlife, the virus can be transmitted from man to man, but among other sources of infection sick persons did not exceed 20%. Presumed human transmission has occurred in 38 out of 61 outbreaks of human monkeypox and only once reached the third and once the fourth generation; the transmission in all affected villages under observation has extinguished itself. Considering the sporadic and relatively rare occurrence of the disease and expected complications following the immunization with vaccinia which protects from monkeypox, introduction of mass vaccination in the areas at risk is hardly justified at present.

Africa, Central↗
PubMed1979

Loiasis: report of three cases and literature review.

Loiasis is a tropical infection caused by the microfilarial nematode Loa loa. Increased numbers of cases of loiasis have been diagnosed outside of the endemic areas in Western and Central Africa because of widespread international travel. The author presents three cases of loiasis discovered at Howard University followed by a review of the literature.

Adult↗
PubMed1990

Tuberculosis in commerce and industry in a Western Cape suburb, South Africa, 1987.

A postal questionnaire of 557 industries in a defined area of the Western Cape, South Africa, aimed to determine the incidence of pulmonary tuberculosis (TB) in 1987 as well as the provision of health services. A 65% response rate was obtained. A random sample of non-respondents did not differ from respondents with respect to factory size or sector. The overall incidence rate for 1987 was 472 per 100,000 workers (95% confidence interval 386-558). Tuberculosis rates of Africans and "coloureds" were substantially higher than those of Asians and whites. There was considerable variation in the rates by employment sector. We found highest rates of TB in the textile and iron and steel industries and the lowest rates are reported among the printing and paper industry, in trade and commerce, and in the transport sectors. It is likely that the differences in the rates by sector reflect the different social class composition of their work force. TB incidence rates also varied by factory size, with the highest rates being reported in the smallest factories. The implications of the study are that the current policy of not screening workers in industry on a routine basis for TB needs to be urgently reviewed. The provision of health services, shown to vary according to factory size, was found to be inadequate in the smaller factories. Alternative methods of providing such care to workers need to be implemented.

Adult↗