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Ademe M, Osorio Y, Howe R, Atnafu S, Mulaw T, Fikre H, Travi BL, Hailu A, Melby PC, Abebe T. Hematological and Clinical Features Associated with Initial Poor Treatment Outcomes in Visceral Leishmaniasis Patients with and without HIV Coinfection in Gondar, Northwest Ethiopia. Trop Med Infect Dis 2023; 8:36. [PMID: 36668943 PMCID: PMC9867226 DOI: 10.3390/tropicalmed8010036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 12/26/2022] [Accepted: 12/31/2022] [Indexed: 01/06/2023] Open
Abstract
Ethiopia is among the countries with a high leishmaniasis burden. In this retrospective review, we aimed to determine hematological and clinical features associated with initial poor treatment outcomes of visceral leishmaniasis (VL) patients. The majority of VL cases in this study had leucopenia (94.3%), thrombocytopenia (87.1%), and anemia (85.9%). HIV coinfection was present in 7.0% (n = 23) of VL cases. At the center, VL patients without HIV coinfection were treated with sodium stibogluconate and paromomycin combination, whereas HIV coinfected cases were treated with AmBisome and miltefosine combination therapy. End-of-treatment cure rates among HIV-positive and HIV-negative visceral leishmaniasis cases, respectively, were 52.2% and 96.9%. Case fatality rates were 34.8% and 2.7% in HIV-positive and HIV-negative cases, respectively. Overall, non-survivors in this study were more likely to have HIV (55.0% vs. 4.1%, p < 0.001), sepsis (15.0% vs. 1.4%, p = 0.019), and dyspnea (40.0% vs. 2.7%, p < 0.001) at admission. In this regard, particular attention to the management of superimposed disease conditions at admission, including sepsis, HIV, and dyspnea, is needed to improve VL patients’ treatment outcomes. The inadequacy of the current treatments, i.e., AmBisome and miltefosine combination therapy, for HIV coinfected visceral leishmaniasis patients requires further attention as it calls for new treatment modalities.
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Affiliation(s)
- Muluneh Ademe
- Department of Microbiology, Immunology & Parasitology, College of Health Sciences, Addis Ababa University, Addis Ababa P.O. Box 9086, Ethiopia
| | - Yaneth Osorio
- Division of Infectious Diseases, Department of Internal Medicine, University of Texas Medical Branch, 301 University Boulevard, Route 0435, Galveston, TX 77555, USA
| | - Rawliegh Howe
- Aramuer Hanson Research Institute (AHRI), Addis Ababa P.O. Box 1005, Ethiopia
| | - Saba Atnafu
- Leishmaniasis Research and Treatment Center, University of Gondar, Gondar P.O. Box 196, Ethiopia
| | - Tadele Mulaw
- Leishmaniasis Research and Treatment Center, University of Gondar, Gondar P.O. Box 196, Ethiopia
| | - Helina Fikre
- Leishmaniasis Research and Treatment Center, University of Gondar, Gondar P.O. Box 196, Ethiopia
| | - Bruno L. Travi
- Division of Infectious Diseases, Department of Internal Medicine, University of Texas Medical Branch, 301 University Boulevard, Route 0435, Galveston, TX 77555, USA
| | - Asrat Hailu
- Department of Microbiology, Immunology & Parasitology, College of Health Sciences, Addis Ababa University, Addis Ababa P.O. Box 9086, Ethiopia
| | - Peter C. Melby
- Division of Infectious Diseases, Department of Internal Medicine, University of Texas Medical Branch, 301 University Boulevard, Route 0435, Galveston, TX 77555, USA
| | - Tamrat Abebe
- Department of Microbiology, Immunology & Parasitology, College of Health Sciences, Addis Ababa University, Addis Ababa P.O. Box 9086, Ethiopia
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Alemu AY, Endalamaw A, Belay DM, Mekonen DK, Birhan BM, Bayih WA. Healthcare-associated infection and its determinants in Ethiopia: A systematic review and meta-analysis. PLoS One 2020; 15:e0241073. [PMID: 33095807 PMCID: PMC7584210 DOI: 10.1371/journal.pone.0241073] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 10/07/2020] [Indexed: 01/23/2023] Open
Abstract
Background Healthcare-associated infection is a global threat in healthcare which increases the emergence of multiple drug-resistant microbial infections. Hence, continuous surveillance data is required before or after patient discharge from health institutions though such data is scarce in developing countries. Similarly, ongoing infection surveillance data are not available in Ethiopia. However, various primary studies conducted in the country showed different magnitude and determinants of healthcare-associated infection from 1983 to 2017. Therefore, this systematic review and meta-analysis aimed to estimate the national pooled prevalence and determinants of healthcare-associated infection in Ethiopia. Methods We searched PubMed, Science Direct, Google Scholar, and grey literature deposited at Addis Ababa University online repository. The quality of studies was checked using Joanna Brigg’s Institute quality assessment scale. Then, the funnel plot and Egger’s regression test were used to assess publication bias. The pooled prevalence of healthcare-associated infection was estimated using a weighted-inverse random-effects model meta-analysis. Finally, the subgroup analysis was done to resolve the cause of statistical heterogeneity. Results A total of 19 studies that satisfy the quality assessment criteria were considered in the final meta-analysis. The pooled prevalence of healthcare-associated infection in Ethiopia as estimated from 18 studies was 16.96% (95% CI: 14.10%-19.82%). In the subgroup analysis, the highest prevalence of healthcare-associated infection was in the intensive care unit 25.8% (95% CI: 3.55%-40.06%) followed by pediatrics ward 24.16% (95% CI: 12.76%-35.57%), surgical ward 23.78% (95% CI: 18.87%-29.69%) and obstetrics ward 22.25% (95% CI: 19.71%-24.80%). The pooled effect of two or more studies in this meta-analysis also showed that patients who had surgical procedures (AOR = 3.37; 95% CI: 1.85–4.89) and underlying non-communicable disease (AOR = 2.81; 95% CI: 1.39–4.22) were at increased risk of healthcare-associated infection. Conclusions The nationwide prevalence of healthcare-associated infection has remained a problem of public health importance in Ethiopia. The highest prevalence was observed in intensive care units followed by the pediatric ward, surgical ward and obstetrics ward. Thus, policymakers and program officers should give due emphasis on healthcare-associated infection preventive strategies at all levels. Essentially, the existing infection prevention and control practices in Ethiopia should be strengthened with special emphasis for patients admitted to intensive care units. Moreover, patients who had surgical procedures and underlying non-communicable diseases should be given more due attention.
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Affiliation(s)
- Abebaw Yeshambel Alemu
- Department of Paediatrics and Neonatal Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
- * E-mail:
| | - Aklilu Endalamaw
- Department of Paediatrics and Child Health Nursing, School of Health Sciences, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Demeke Mesfin Belay
- Department of Paediatrics and Neonatal Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Demewoz Kefale Mekonen
- Department of Paediatrics and Neonatal Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Biniam Minuye Birhan
- Department of Paediatrics and Neonatal Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Wubet Alebachew Bayih
- Department of Paediatrics and Neonatal Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
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Hamwi AO, Mohammad AA, Hamwi SO, Mohammad RA, Shahin KY. Pediatric visceral leishmaniasis in Tartous, Syria. Avicenna J Med 2020; 10:223-226. [PMID: 33437694 PMCID: PMC7791284 DOI: 10.4103/ajm.ajm_168_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Visceral leishmaniasis (VL) type in Syria is Lashmania infantum, a fatal incapacitating disease, which is mostly seen in infants. SUBJECTS AND METHODS Hospital records of 19 children with VL were retrospectively reviewed. The period of the study was from June 2016 to July 2019. RESULTS The median age of the patients was 45.5 months. None was coinfected with human immunodeficiency virus or known to be immunocompromised. Pallor and anemia were observed in all cases, fever in 13 (68.42%), splenomegaly in 18 (94.7%), hepatomegaly in 11 (57.9%), thrombocytopenia in 15 (78.95%), and leukopenia in nine (47.4%). A bone marrow aspirate was obtained and Leishmania amastigotes were detected in all patients. All patients were initially treated with meglumine antimonate; one child did not respond and was treated with lipid formulations of amphotericin B. CONCLUSIONS Presentation of VL in the pediatric age group is characterized by pallor, fever, splenomegaly, and hepatomegaly. Hematological and biochemical indices are typical with cytopenias. In all cases, microscopic examination provided a positive diagnosis. Despite recent reports on decreased responses to antimonial drugs of patients with Mediterranean VL, meglumine antimonate treatment appears to be still highly effective in Syria.
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Affiliation(s)
- Ali Othman Hamwi
- College of Medicine, University of Tartous, Tartous, Syrian Arab Republic
| | | | - Sara Othman Hamwi
- College of Medicine, University of Tartous, Tartous, Syrian Arab Republic
| | | | - Kayss Younis Shahin
- Department of Paediatrics and Haematology, Tartous Children’s Hospital, Tartous, Syrian Arab Republic
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Alemu AY, Endalamaw A, Bayih WA. The burden of healthcare-associated infection in Ethiopia: a systematic review and meta-analysis. Trop Med Health 2020; 48:77. [PMID: 32939151 PMCID: PMC7487565 DOI: 10.1186/s41182-020-00263-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 08/24/2020] [Indexed: 01/18/2023] Open
Abstract
Background Different primary studies in Ethiopia showed the burden of nosocomial infection across geographical setting and variant period. However, the national level of burden and types of healthcare-associated infections were unknown. Hence, this systematic review and meta-analysis estimated the overall nationwide burden and types of healthcare-associated infections in Ethiopia. Methods We searched PubMed, Science Direct, Google Scholar, African Journal Online, and Addis Ababa University repository by date April 7, 2020. To assess publication bias, Egger’s test regression analysis was applied. Weight-inverse random-effect model meta-analysis was used. Subgroup analysis was conducted based on ward type, study region, study design, sample size and diagnostic method, ward type, and study participants. Results A total of 18 studies with 13,821 patients participated in the overall prevalence estimation. The pooled prevalence of healthcare-associated infection was 16.96% (95% CI 14.10–19.82). Specifically, surgical site infection (39.66%), urinary tract infection (27.69%), bloodstream infection (19.9%), dual infections (SSI and UTI) (14.01%), and respiratory tract (13.51%) were the commonest types of healthcare-associated infection. In subgroup analysis, the highest overall prevalence was observed as surgical, gynecology, and obstetrics ward (22.42%). Conclusions The national prevalence of healthcare-associated infection remains high. The most common type of HCAI was surgical site infection, followed by urinary tract infection, bloodstream infection, SSI and UTI, and respiratory tract infection. The overall prevalence was highest in surgical, gynecology, and obstetrics ward. Hence, infection prevention and control should be a priority agenda in healthcare with due emphasis for surgical patients.
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Affiliation(s)
- Abebaw Yeshambel Alemu
- Department of Paediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Aklilu Endalamaw
- Department of Paediatrics and Child Health Nursing, School of Health Sciences, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Wubet Alebachew Bayih
- Department of Paediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
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Kirstein OD, Skrip L, Abassi I, Iungman T, Horwitz BZ, Gebresilassie A, Spitzova T, Waitz Y, Gebre-Michael T, Volf P, Hailu A, Warburg A. A fine scale eco-epidemiological study on endemic visceral leishmaniasis in north ethiopian villages. Acta Trop 2018; 183:64-77. [PMID: 29621537 PMCID: PMC5956276 DOI: 10.1016/j.actatropica.2018.04.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 03/21/2018] [Accepted: 04/01/2018] [Indexed: 12/03/2022]
Abstract
We conducted fine-scale eco-epidemiological analyses of factors associated with visceral leishmaniasis transmission. The population densities of Phlebotomus orientalis, the vector, were negatively correlated with distance from vertisols. Sero-positivity to Ph. orientalis saliva, was found in people living close to vertisol areas. Apparent clustering of infections indicates that transmission occurs around houses located close to vertisols. Our data suggest that asymptomatic individuals serve as reservoir hosts for anthroponotic transmission inside villages.
Visceral Leishmaniasis (VL) is a disseminated protozoan infection caused by Leishmania donovani that affects almost half a million people annually. In Northern Ethiopia, VL is common in migrant agricultural laborers returning from the lowland sesame fields of Metema and Humera. Recent VL foci have emerged in resident rural populations near the town. In the current study, we evaluate multilevel entomological, epidemiological and ecological factors associated with infection and disease through fine-scale eco-epidemiological analyses in three villages. Satellite images showed that villages constructed in or close to vertisols, were likely to become endemic for VL. Vertisols or black-cotton soil, are characterized by high contents of smectitic clay minerals, which swell when hydrated and shrink upon desiccation, causing extensive deep cracking during the dry season. The population densities of Phlebotomus orientalis, the vector, were negatively correlated with distance from vertisols and persons living close to vertisols were more likely to be bitten by sand flies, as evidenced by sero-positivity to Ph. orientalis saliva. Apparent (albeit non-significant) clustering of VL cases and abundant asymptomatic infections close to vertisols, suggest anthroponotic transmission around houses located close to vertisols. Comparable rates of male and female volunteers, mostly under 15 years of age, were infected with L. donovani but a significantly higher proportion of males succumbed to VL indicating a physiological gender-linked male susceptibility. Our data suggest that the abundant infected persons with high parasitemias who remain asymptomatic, may serve as reservoir hosts for anthroponotic transmission inside villages. Only limited insights on the transmission dynamics of L. donovani were gained by the study of environmental factors such as presence of animals, house structure and vegetation cover.
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Affiliation(s)
- Oscar David Kirstein
- Department of Microbiology and Molecular Genetics, The Institute of Medical Research, Israel-Canada [IMRIC], The Kuvin Centre for the Study of Infectious and Tropical Diseases, Faculty of Medicine, The Hebrew University of Jerusalem, Israel, Israel.
| | - Laura Skrip
- Department of Biostatistics, School of Public Health, Yale University,60 College street, New Haven, CT, 06520, USA, USA
| | - Ibrahim Abassi
- Department of Microbiology and Molecular Genetics, The Institute of Medical Research, Israel-Canada [IMRIC], The Kuvin Centre for the Study of Infectious and Tropical Diseases, Faculty of Medicine, The Hebrew University of Jerusalem, Israel, Israel
| | - Tamara Iungman
- Department of Microbiology and Molecular Genetics, The Institute of Medical Research, Israel-Canada [IMRIC], The Kuvin Centre for the Study of Infectious and Tropical Diseases, Faculty of Medicine, The Hebrew University of Jerusalem, Israel, Israel
| | - Ben Zion Horwitz
- Department of Microbiology and Molecular Genetics, The Institute of Medical Research, Israel-Canada [IMRIC], The Kuvin Centre for the Study of Infectious and Tropical Diseases, Faculty of Medicine, The Hebrew University of Jerusalem, Israel, Israel
| | - Araya Gebresilassie
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia, Ethiopia
| | - Tatiana Spitzova
- Department of Parasitology, Faculty of Science, Charles University, Vinicna 7, 128 44, Prague 2, Czech Republic, Czech Republic
| | - Yoni Waitz
- Department of Geography and Environmental Studies, Haifa University, Haifa, Israel, Israel
| | - Teshome Gebre-Michael
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia, Ethiopia
| | - Petr Volf
- Department of Parasitology, Faculty of Science, Charles University, Vinicna 7, 128 44, Prague 2, Czech Republic, Czech Republic
| | - Asrat Hailu
- Dept. of Microbiology, Immunology and Parasitology, Faculty of Medicine, Addis Ababa University, Addis Ababa, Ethiopia, Ethiopia
| | - Alon Warburg
- Department of Microbiology and Molecular Genetics, The Institute of Medical Research, Israel-Canada [IMRIC], The Kuvin Centre for the Study of Infectious and Tropical Diseases, Faculty of Medicine, The Hebrew University of Jerusalem, Israel, Israel
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Yehia HM, Al-Olayan EM, El-Khadragy MF, Metwally DM. In Vitro and In Vivo Control of Secondary Bacterial Infection Caused by Leishmania major. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:E777. [PMID: 28703780 PMCID: PMC5551215 DOI: 10.3390/ijerph14070777] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 07/08/2017] [Accepted: 07/10/2017] [Indexed: 12/13/2022]
Abstract
Bacterial infections of cutaneous leishmaniasis cause skin ulcers on mice, resulting in increased tissue deterioration, and these infections can be controlled with liquid allicin. To isolate and identify the incidences of real secondary bacterial infections in mice, we performed the current study by injecting mice (n = 50) with Leishmania major. L. major infections were initiated by an intramuscular injection of 0.1 mL Roswell Park Memorial Institute (RPMI 1640 media/mouse (107 promastigote/mL)). Scarring appeared 2-6 weeks after injection, and the bacteria were isolated from the skin ulcer tissues. Allicin (50 µL/mL) and ciprofloxacin (5 μg; Cip 5) were used for controlling L. major and bacteria. One hundred samples from skin ulcers of mice were examined, and 200 bacterial colonies were isolated. Forty-eight different genera and species were obtained and identified by Gram staining and physiological and biochemical characterization using identification kits. All samples were positive for secondary bacterial infections. Of the isolates, 79.16% were identified as Gram-negative bacteria, and 28.84% were identified as Gram-positive bacteria; only one yeast species was found. Interestingly, pure allicin liquid at a concentration 50 µL/mL exhibited antibacterial activity against a wide range of Gram-negative and some Gram-positive bacteria, in addition to yeast, and was 71.43% effective. Antimicrobial resistance patterns of all genera and species were determined using 15 different antibiotics. Allicin (50 µL/mL) and Cip 5 were the most effective against L. major and 92.30% of isolated bacteria. Stenotrophomonas maltophilia was the most resistant bacterium to the tested antibiotics with a survival rate of 73.33%, and it exhibited resistance to allicin.
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Affiliation(s)
- Hany M Yehia
- Department of Food Science and Nutrition, College of Food and Agriculture Sciences, King Saud University, Riyadh 11451, Saudi Arabia.
- Department of Food Science and Nutrition, Faculty of Home Economics, Helwan University, Cairo 11221, Egypt.
| | - Ebtesam M Al-Olayan
- Zoology Department, Faculty of Science, King Saud University, Riyadh 11495, Saudi Arabia.
- Chair Vaccines Research of Infectious Diseases, King Saud University, Riyadh 11495, Saudi Arabia.
| | - Manal F El-Khadragy
- Zoology Department, Faculty of Science, King Saud University, Riyadh 11495, Saudi Arabia.
- Chair Vaccines Research of Infectious Diseases, King Saud University, Riyadh 11495, Saudi Arabia.
- Zoology Department, Faculty of Science, Helwan University, Cairo 11790, Egypt.
| | - Dina M Metwally
- Zoology Department, Faculty of Science, King Saud University, Riyadh 11495, Saudi Arabia.
- Chair Vaccines Research of Infectious Diseases, King Saud University, Riyadh 11495, Saudi Arabia.
- Parasitology Department, Faculty of Veterinary Medicine, Zagazig University, Zagazig 12878, Egypt.
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d'Alessandro E. Human activities and microbial geographies. An anthropological approach to the risk of infections in West African hospitals. Soc Sci Med 2015; 136-137:64-72. [PMID: 25988999 DOI: 10.1016/j.socscimed.2015.05.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
In hospital care, management of the risk of infection represents a crucial issue. Nevertheless, this question remains a neglected area in anthropological research, especially in African countries. To shed new light on this question, we conducted an anthropological investigation in the infectious disease department of a hospital in Niger. Daily observation of the work of the hospital staff for a total period of 6 months was spread out over 2008 and 2009. During our prolonged stay, we also collected 64 in-depth interviews of health care workers and attendants in the department. This study method made it possible to describe many of the practices and discourses related to the issues of medical and personal care and hospital hygiene and to compare the practices observed to standard principles for preventing hospital-acquired infections. Our ethnographic attention to the behavior of the actors showed the absence of formal spatial segmentations between different activities. The care provided by the untrained relatives serving as personal attendants introduced territorial enclaves governed by home hygiene standards into the interior of technical spaces. At the same time, privatizing equipment and space for their diverse activities, the medical staff disrupted technical chains and generated the recurrent crossing of microbial geographies. These results allow us to offer two principal guidelines for improving the quality of care and the management of risks of infection in hospitals in West Africa: (1) the essential role of the attendants in the care provided to hospital inpatients must be officially taken into account, especially by including them in the organization of medical hygiene procedures; (2) the different overlapping technical activities and social activities in the work space must be limited by their geographic and architectural segmentation.
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Affiliation(s)
- Eugénie d'Alessandro
- Ecole des Hautes Etudes en Sciences Sociales, Centre Norbert Elias, La Vieille Charité, 13002, Marseille, France.
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Endris M, Takele Y, Woldeyohannes D, Unakal C, Moges F, Tiruneh M, Diro E. Characteristics of bacterial sepsis among patients with visceral leishmaniasis. Asian Pac J Trop Biomed 2014. [DOI: 10.12980/apjtb.4.2014c1133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Endris M, Takele Y, Woldeyohannes D, Tiruneh M, Mohammed R, Moges F, Lynen L, Jacobs J, van Griensven J, Diro E. Bacterial sepsis in patients with visceral leishmaniasis in Northwest Ethiopia. BIOMED RESEARCH INTERNATIONAL 2014; 2014:361058. [PMID: 24895569 PMCID: PMC4033396 DOI: 10.1155/2014/361058] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/09/2014] [Accepted: 04/21/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVES Visceral leishmaniasis (VL) is one of the neglected diseases affecting the poorest segment of world populations. Sepsis is one of the predictors for death of patients with VL. This study aimed to assess the prevalence and factors associated with bacterial sepsis, causative agents, and their antimicrobial susceptibility patterns among patients with VL. METHODS A cross-sectional study was conducted among parasitologically confirmed VL patients suspected of sepsis admitted to the University of Gondar Hospital, Northwest Ethiopia, from February 2012 to May 2012. Blood cultures and other clinical samples were collected and cultured following the standard procedures. RESULTS Among 83 sepsis suspected VL patients 16 (19.3%) had culture confirmed bacterial sepsis. The most frequently isolated organism was Staphylococcus aureus (68.8%; 11/16), including two methicillin-resistant isolates (MRSA). Patients with focal bacterial infection were more likely to have bacterial sepsis (P < 0.001). CONCLUSIONS The prevalence of culture confirmed bacterial sepsis was high, predominantly due to S. aureus. Concurrent focal bacterial infection was associated with bacterial sepsis, suggesting that focal infections could serve as sources for bacterial sepsis among VL patients. Careful clinical evaluation for focal infections and prompt initiation of empiric antibiotic treatment appears warranted in VL patients.
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Affiliation(s)
- Mengistu Endris
- Department of Medical Microbiology, University of Gondar, Ethiopia
| | - Yegnasew Takele
- Leishmaniasis Research and Treatment Center, University of Gondar Hospital, Ethiopia
| | - Desalegn Woldeyohannes
- Department of Immunology and Molecular Biology, University of Gondar, Ethiopia
- Department of Public Health, Addis Ababa Science and Technology University, Ethiopia
| | - Moges Tiruneh
- Department of Medical Microbiology, University of Gondar, Ethiopia
| | - Rezika Mohammed
- Leishmaniasis Research and Treatment Center, University of Gondar Hospital, Ethiopia
| | - Feleke Moges
- Department of Medical Microbiology, University of Gondar, Ethiopia
| | - Lutgarde Lynen
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Jan Jacobs
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Johan van Griensven
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Ermias Diro
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
- Department of Internal Medicine, University of Gondar, Ethiopia
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Kalayou S, Tadelle H, Bsrat A, Abebe N, Haileselassie M, Schallig HDFH. Serological evidence of Leishmania donovani infection in apparently healthy dogs using direct agglutination test (DAT) and rk39 dipstick tests in Kafta Humera, north-west Ethiopia. Transbound Emerg Dis 2011; 58:255-62. [PMID: 21371289 DOI: 10.1111/j.1865-1682.2011.01209.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Leishmania (Kinetoplastida: Trypanosomatidae) are protozoan parasites of significant medical and veterinary importance. Over the last decade, visceral leishmaniasis (VL) has emerged as a major opportunistic infection associated with HIV/AIDS in North Western Ethiopia. This paper reports on serological evidence of possible Leishmania donovani (L. donovani) infection in dogs using two serological tests: direct agglutination test (DAT) and Kalazar detect rapid test (KDRT). Two hundred and seventeen asymptomatic local breed dogs were examined for L. donovani antibodies. Performance of the DAT and KDRT was assessed in 162 matching samples of blood collected on filter paper and serum, respectively. Using DAT and KDRT testing in parallel, the overall seroprevalence of L. donovani infection was 27.7% and 14.8%, respectively. The degree of agreement was found to be fair (68.8%, k = 0.234). Univariable logistic regression analysis of some risk factors for L. donovani infection in dogs using DAT indicates that place of residence, sex, age, dog keeping purpose and dog housing condition were not significantly associated with seropositivity. The high proportion of positive dogs suggests the exposure of these animals to L. donovani infection and needs further investigation. Isolation and typing of the parasite aiming at confirming the role of these animals in maintenance and transmission of kala-azar is advocated.
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Affiliation(s)
- S Kalayou
- Mekelle University College of Veterinary Medicine, Mekelle, Ethiopia.
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Safety and effectiveness of meglumine antimoniate in the treatment of Ethiopian visceral leishmaniasis patients with and without HIV co-infection. Trans R Soc Trop Med Hyg 2010; 104:706-12. [DOI: 10.1016/j.trstmh.2010.07.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2009] [Revised: 07/22/2010] [Accepted: 07/23/2010] [Indexed: 11/19/2022] Open
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Hurissa Z, Gebre-Silassie S, Hailu W, Tefera T, Lalloo DG, Cuevas LE, Hailu A. Clinical characteristics and treatment outcome of patients with visceral leishmaniasis and HIV co-infection in northwest Ethiopia. Trop Med Int Health 2010; 15:848-55. [DOI: 10.1111/j.1365-3156.2010.02550.x] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Abstract
BACKGROUND Visceral Leishmaniasis (VL) type in Turkey is consistent with the Mediterranean type of VL, a fatal debilitating disease, which is mostly seen in infants. METHODS Hospital records of 19 children with VL were retrospectively reviewed. The period of the study was from January 2000 to December 2003. RESULTS The median age of the patients was 36 months. None was coinfected with human immunodeficiency virus or known to be immunocompromised. Fever, pallor, hepatomegaly, splenomegaly, thrombocytopenia and elevated C-reactive protein were observed in all cases, anemia in 18 (95%), leucopenia in 17 (89.4%) and elevated erythrocyte sedimentation rate in 14 (77.7%) of the cases. A bone marrow aspirate was obtained in all cases and Leishmania amastigotes were detected in 15 (78.9%). Fifteen patients (78.9%) were treated initially with meglumine antimonate and four (21%) with sodium stibogluconate. The four patients who received sodium stibogluconate suffered from adverse side-effects during treatment and were subsequently treated with lipid formulations of amphotericin B. CONCLUSIONS Presentation of VL in the pediatric age group in Turkey is characterized by pallor, fever, splenomegaly and hepatomegaly. Hematological and biochemical indices are typical with cytopenias, hypoalbuminemia, and hyperproteinemia. In most of the cases, microscopic examination provided a positive diagnosis and the remaining patients were diagnosed by serology. Lipid formulations of amphotericin B may be useful in cases of treatment failure with antimonials or significant adverse effects of the drug.
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Affiliation(s)
- Gönül Tanir
- Department of Pediatrics, Sami Ulus Children's Hospital, Ankara, Turkey.
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15
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Isaac-Márquez AP, Lezama-Dávila CM. Detection of pathogenic bacteria in skin lesions of patients with chiclero's ulcer. Reluctant response to antimonial treatment. Mem Inst Oswaldo Cruz 2004; 98:1093-5. [PMID: 15049096 DOI: 10.1590/s0074-02762003000800021] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
We investigated the bacterial flora present in skin lesions of patients with chiclero's ulcer from the Yucatan peninsula of Mexico using conventional culture methods (11 patients), and an immunocolorimetric detection of pathogenic Streptococcus pyogenes (15 patients). Prevalence of bacteria isolated by culture methods was 90.9% (10/11). We cultured, from chiclero's ulcers (60%), pathogenic bacterial such as Staphylococcus aureus (20%), S. pyogenes (1.6%), Pseudomonas aeruginosa (1.6%), Morganella morganii (1.6%), and opportunist pathogenic bacteria such as Klebsiella spp. (20.0%), Enterobacter spp. (20%), and Enterococcus spp. (20%). We also cultured coagulase-negative staphylococci in 40% (4/10) of the remaining patients. Micrococcus spp. and coagulase-negative staphylococci constituted the bacterial genuses more frequently isolated in the normal skin of patients with chiclero's ulcer and healthy individuals used as controls. We also undertook another study to find out the presence of S. pyogenes by an immunocolorimetric assay. This study indicated that 60% (9/15) of the ulcerated lesions, but not normal controls, were contaminated with S. pyogenes. Importantly, individuals with purulent secretion and holding concomitant infections with S. pyogenes, S. aureus, P. aeruginosa, M. morganii, and E. durans took longer to heal Leishmania (L.) mexicana infections treated with antimonial drugs. Our results suggest the need to eliminate bacterial purulent infections, by antibiotic treatment, before starting antimonial administration to patients with chiclero's ulcer.
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Affiliation(s)
- Angélica Patricia Isaac-Márquez
- Centro de Investigaciones en Enfermedades Tropicales, Universidad Autónoma de Campeche, Av. Agustín Melgar s/n, 24030 Campeche, México
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Abstract
OBJECTIVES To identify characteristics that increased the risk of mortality in Ethiopian visceral leishmaniasis patients in a treatment programme managed by Médecins sans Frontières, in Tigray, Northern Ethiopia. METHODS Retrospective review of a cohort of 791 patients treated for visceral leishmaniasis. RESULTS The cohort displayed all the classical signs and symptoms of the disease. The case fatality rate was 18.5% (146) (95% CI: 15.8-21.3%). Logistic regression showed that individuals who experienced at least one episode of vomiting or haemorrhage were more likely to die than those who did not. A subcohort of individuals who tested human immunodeficiency virus (HIV)-positive were more than four times more likely to die than those who tested HIV-negative (OR 4.5, 95% CI: 1.8-11.4). CONCLUSION This study identifies characteristics associated with death in this population and highlights the devastating effect of co-infection with visceral leishmaniasis and HIV in the African context.
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Affiliation(s)
- Suzi Lyons
- Department of Public Health and Epidemiology, UCD, National University of Ireland, Dublin, Ireland.
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