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Oludele J, Alho P, Chongo I, Maholela P, Magaia V, Muianga A, Melchior B, Isaías T, Gatambire A, Zimba E, Nhavoto E, Notiço P, Inguana P, Cantoria J, António V, Monteiro V, Ali S, Inlamea O, Samo Gudo E. Emerging Zoonotic Diseases among Pastoral Communities of Caia and Búzi Districts, Sofala, Mozambique: Evidence of Antibodies against Brucella, Leptospira, Rickettsia, and Crimean-Congo Hemorrhagic Fever Virus. Viruses 2023; 15:2379. [PMID: 38140620 PMCID: PMC10748219 DOI: 10.3390/v15122379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 09/28/2023] [Accepted: 10/09/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND Emerging zoonotic diseases are an increasing threat to public health. There is little data on the seroprevalence of zoonotic diseases among pastoralists in the country. We aim to carry out a cross-sectional study on the prevalence of major zoonotic diseases among pastoral communities in the Caia and Búzi districts. METHODS Between January and December 2018, a questionnaire was used to solicit socio-demographic data from consenting pastoralists with the collection of blood samples in the Caia and Búzi districts of the Sofala province. All samples were tested using ELISA commercial reagents for the detection of IgM antibodies against Brucella and Leptospira. Likewise, IgM and IgG antibodies against Rickettsia and CCHFV were determined using ELISA kits. RESULTS A total of 218 samples were tested, of which 43.5% (95/218) were from the district of Caia and 56.4% (123/218) from the Búzi district. Results from both districts showed that the seroprevalence of IgM antibodies against Brucella and Leptospira was 2.7% (6/218) and 30.3% (67/218), respectively. Positivity rates for IgM and IgG anti-Rickettsia and CCHFV were 8.7% (19/218), 2.7% (6/218), 4.1% (9/218), and 0.9% (2/218), respectively. CONCLUSIONS Results from our study showed evidence of antibodies due to exposure to Brucella, Leptospira, Rickettsia, and CCHFV with antibodies against Leptospira and Rickettsia being the most prevalent. Hence, laboratory diagnosis of zoonotic diseases is essential in the early detection of outbreaks, the identification of silent transmission, and the etiology of non-febrile illness in a pastoral community. There is a need to develop public health interventions that will reduce the risk of transmission.
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Affiliation(s)
- John Oludele
- Instituto Nacional de Saúde, Marracuene 3943, Mozambique; (P.A.); (I.C.); (P.M.); (A.M.); (B.M.); (T.I.); (A.G.); (E.Z.); (E.N.); (P.N.); (P.I.); (J.C.); (V.A.); (V.M.); (S.A.); (O.I.); (E.S.G.)
| | - Pascoal Alho
- Instituto Nacional de Saúde, Marracuene 3943, Mozambique; (P.A.); (I.C.); (P.M.); (A.M.); (B.M.); (T.I.); (A.G.); (E.Z.); (E.N.); (P.N.); (P.I.); (J.C.); (V.A.); (V.M.); (S.A.); (O.I.); (E.S.G.)
| | - Inocêncio Chongo
- Instituto Nacional de Saúde, Marracuene 3943, Mozambique; (P.A.); (I.C.); (P.M.); (A.M.); (B.M.); (T.I.); (A.G.); (E.Z.); (E.N.); (P.N.); (P.I.); (J.C.); (V.A.); (V.M.); (S.A.); (O.I.); (E.S.G.)
| | - Plácida Maholela
- Instituto Nacional de Saúde, Marracuene 3943, Mozambique; (P.A.); (I.C.); (P.M.); (A.M.); (B.M.); (T.I.); (A.G.); (E.Z.); (E.N.); (P.N.); (P.I.); (J.C.); (V.A.); (V.M.); (S.A.); (O.I.); (E.S.G.)
| | - Vlademiro Magaia
- Centro de Biotecnologia, Universidade Eduardo Mondlane, Maputo CP 257, Mozambique;
| | - Argentina Muianga
- Instituto Nacional de Saúde, Marracuene 3943, Mozambique; (P.A.); (I.C.); (P.M.); (A.M.); (B.M.); (T.I.); (A.G.); (E.Z.); (E.N.); (P.N.); (P.I.); (J.C.); (V.A.); (V.M.); (S.A.); (O.I.); (E.S.G.)
| | - Bibiana Melchior
- Instituto Nacional de Saúde, Marracuene 3943, Mozambique; (P.A.); (I.C.); (P.M.); (A.M.); (B.M.); (T.I.); (A.G.); (E.Z.); (E.N.); (P.N.); (P.I.); (J.C.); (V.A.); (V.M.); (S.A.); (O.I.); (E.S.G.)
| | - Telma Isaías
- Instituto Nacional de Saúde, Marracuene 3943, Mozambique; (P.A.); (I.C.); (P.M.); (A.M.); (B.M.); (T.I.); (A.G.); (E.Z.); (E.N.); (P.N.); (P.I.); (J.C.); (V.A.); (V.M.); (S.A.); (O.I.); (E.S.G.)
| | - Aline Gatambire
- Instituto Nacional de Saúde, Marracuene 3943, Mozambique; (P.A.); (I.C.); (P.M.); (A.M.); (B.M.); (T.I.); (A.G.); (E.Z.); (E.N.); (P.N.); (P.I.); (J.C.); (V.A.); (V.M.); (S.A.); (O.I.); (E.S.G.)
| | - Edna Zimba
- Instituto Nacional de Saúde, Marracuene 3943, Mozambique; (P.A.); (I.C.); (P.M.); (A.M.); (B.M.); (T.I.); (A.G.); (E.Z.); (E.N.); (P.N.); (P.I.); (J.C.); (V.A.); (V.M.); (S.A.); (O.I.); (E.S.G.)
| | - Emídio Nhavoto
- Instituto Nacional de Saúde, Marracuene 3943, Mozambique; (P.A.); (I.C.); (P.M.); (A.M.); (B.M.); (T.I.); (A.G.); (E.Z.); (E.N.); (P.N.); (P.I.); (J.C.); (V.A.); (V.M.); (S.A.); (O.I.); (E.S.G.)
| | - Paulo Notiço
- Instituto Nacional de Saúde, Marracuene 3943, Mozambique; (P.A.); (I.C.); (P.M.); (A.M.); (B.M.); (T.I.); (A.G.); (E.Z.); (E.N.); (P.N.); (P.I.); (J.C.); (V.A.); (V.M.); (S.A.); (O.I.); (E.S.G.)
| | - Pedro Inguana
- Instituto Nacional de Saúde, Marracuene 3943, Mozambique; (P.A.); (I.C.); (P.M.); (A.M.); (B.M.); (T.I.); (A.G.); (E.Z.); (E.N.); (P.N.); (P.I.); (J.C.); (V.A.); (V.M.); (S.A.); (O.I.); (E.S.G.)
| | - Juma Cantoria
- Instituto Nacional de Saúde, Marracuene 3943, Mozambique; (P.A.); (I.C.); (P.M.); (A.M.); (B.M.); (T.I.); (A.G.); (E.Z.); (E.N.); (P.N.); (P.I.); (J.C.); (V.A.); (V.M.); (S.A.); (O.I.); (E.S.G.)
| | - Virgílio António
- Instituto Nacional de Saúde, Marracuene 3943, Mozambique; (P.A.); (I.C.); (P.M.); (A.M.); (B.M.); (T.I.); (A.G.); (E.Z.); (E.N.); (P.N.); (P.I.); (J.C.); (V.A.); (V.M.); (S.A.); (O.I.); (E.S.G.)
| | - Vanessa Monteiro
- Instituto Nacional de Saúde, Marracuene 3943, Mozambique; (P.A.); (I.C.); (P.M.); (A.M.); (B.M.); (T.I.); (A.G.); (E.Z.); (E.N.); (P.N.); (P.I.); (J.C.); (V.A.); (V.M.); (S.A.); (O.I.); (E.S.G.)
| | - Sádia Ali
- Instituto Nacional de Saúde, Marracuene 3943, Mozambique; (P.A.); (I.C.); (P.M.); (A.M.); (B.M.); (T.I.); (A.G.); (E.Z.); (E.N.); (P.N.); (P.I.); (J.C.); (V.A.); (V.M.); (S.A.); (O.I.); (E.S.G.)
- Center for International Health, Division of Infectious Diseases and Tropical Medicine, LMU University Hospital, Ludwig Maximilian University of Munich, 80802 München, Germany
| | - Osvaldo Inlamea
- Instituto Nacional de Saúde, Marracuene 3943, Mozambique; (P.A.); (I.C.); (P.M.); (A.M.); (B.M.); (T.I.); (A.G.); (E.Z.); (E.N.); (P.N.); (P.I.); (J.C.); (V.A.); (V.M.); (S.A.); (O.I.); (E.S.G.)
| | - Eduardo Samo Gudo
- Instituto Nacional de Saúde, Marracuene 3943, Mozambique; (P.A.); (I.C.); (P.M.); (A.M.); (B.M.); (T.I.); (A.G.); (E.Z.); (E.N.); (P.N.); (P.I.); (J.C.); (V.A.); (V.M.); (S.A.); (O.I.); (E.S.G.)
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Gwakisa P, George J, Sindato C, Ngonyoka A, Nnko H, Assenga J, Kimera S, Nessele MO. Pillars for successful operationalization of one health as an ecosystem approach: experience from a human-animal interface in the Maasai steppe in Tanzania. ONE HEALTH OUTLOOK 2023; 5:11. [PMID: 37649116 PMCID: PMC10469404 DOI: 10.1186/s42522-023-00087-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 07/03/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND Solving complex public health challenges requires integrated approaches to health, such as One Health. A key element of the One Health approach is the interrelationship between human, animal and environmental health and the associated multistakeholder collaboration across many cultural, disciplinary, institutional and sectoral boundaries. Here we describe a pragmatic approach for One Health operationalisation basing on our long-term engagement with communities faced with health challenges in a human-livestock-wildlife interface in the Maasai steppe in northern Tanzania. METHODS Using a qualitative study design we performed an outcome mapping to document insights on results integration from our previous project. Data were collected through participatory community meetings, in-depth interviews and field observations. Field notes were coded and analysed using inductive thematic analysis. RESULTS We found that effective implementation of One Health interventions in complex ecosystems works best by understanding local conditions and their context and by working closely with the local people and relevant disciplinary players as one complex adaptive system. Community engagement, systems analysis, transdisciplinarity as well as political commitment played critical roles in successful operationalization of One Health. We have further emphasized that project ownership is as important to the local community as it is to the researchers. When used in combination, these elements (community engagement, systems analysis, transdisciplinarity) provide essential pillars for co-creation and maintaining collective action to set a common vision across disciplines, serving as inputs for a metrics-based toolbox for One Health operationalisation. CONCLUSION Considering the novelty and complexity of One Health operationalisation, there is need also to develop scorecard-based guidance for assessment of One Health programs at local and national level. This paper proposes a framework for the optimization of an ecosystems-based One Health approach for prevention and control of Vector-Borne Diseases implemented at the local, sub-national or national level.
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Affiliation(s)
- Paul Gwakisa
- College of Veterinary Medicine and Biomedical Sciences, Sokoine University of Agriculture, Box 3019, Morogoro, Tanzania
| | - Janeth George
- College of Veterinary Medicine and Biomedical Sciences, Sokoine University of Agriculture, Box 3019, Morogoro, Tanzania.
| | - Calvin Sindato
- National Institute for Medical Research, Tabora, Tanzania
| | | | | | | | - Sharadhuli Kimera
- College of Veterinary Medicine and Biomedical Sciences, Sokoine University of Agriculture, Box 3019, Morogoro, Tanzania
| | - Moses Ole Nessele
- Food and Agriculture Organization of the United Nations (FAO), Country Office, Dodoma, United Republic of Tanzania
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Brucellosis: A Rare Cause of Febrile Neutropenia in a Child. Pediatr Infect Dis J 2022; 41:e430-e433. [PMID: 35830519 DOI: 10.1097/inf.0000000000003630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
We report a case of brucellosis-induced severe neutropenia in a 2-year-old girl who presented with a 2-week history of fever. On clinical examination, the patient was febrile with mild aphthous stomatitis. However, her general condition was stable, and systemic examination did not show involvement of any other organ. Laboratory test results revealed severe neutropenia, mild anemia, and an elevated serum C-reactive protein level. Flow cytometry of peripheral blood leukocytes revealed no malignancy, and blood film morphology was unremarkable except for mild microcytosis and hypochromia. Antineutrophil antibody and Coombs test results were negative. We administered intravenous cefuroxime; however, therapy was switched to meropenem plus clarithromycin because fever persisted for 5 days, despite treatment. On the 10th day after admission, Brucella serology tests showed positive results, and trimethoprim-sulfamethoxazole plus rifampicin therapy was prescribed for 8 weeks. The fever defervesced, and the child was discharged in a good state of health. Neutropenia persisted for several months but gradually resolved. Neutropenia, defined as an absolute neutrophil count (ANC) < 1.5 cells × 10 9 /L beyond the first year of life, is a benign transient condition associated with an intercurrent infection (usually viral illnesses or infections) in immunocompetent children. However, severe neutropenia (ANC < 0.5 × 10 9 /L) associated with fever necessitates hospitalization and administration of broad-spectrum antibiotics to avoid the high risk of sepsis, particularly in children. Brucellosis is rarely associated with hematologic abnormalities such as neutropenia. Early diagnosis of hematologic complications of brucellosis is essential for prompt initiation of specific and aggressive treatment.
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Thomas KM, Kibona T, Claxton JR, de Glanville WA, Lankester F, Amani N, Buza JJ, Carter RW, Chapman GE, Crump JA, Dagleish MP, Halliday JEB, Hamilton CM, Innes EA, Katzer F, Livingstone M, Longbottom D, Millins C, Mmbaga BT, Mosha V, Nyarobi J, Nyasebwa OM, Russell GC, Sanka PN, Semango G, Wheelhouse N, Willett BJ, Cleaveland S, Allan KJ. Prospective cohort study reveals unexpected aetiologies of livestock abortion in northern Tanzania. Sci Rep 2022; 12:11669. [PMID: 35803982 PMCID: PMC9270399 DOI: 10.1038/s41598-022-15517-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 06/24/2022] [Indexed: 11/15/2022] Open
Abstract
Livestock abortion is an important cause of productivity losses worldwide and many infectious causes of abortion are zoonotic pathogens that impact on human health. Little is known about the relative importance of infectious causes of livestock abortion in Africa, including in subsistence farming communities that are critically dependent on livestock for food, income, and wellbeing. We conducted a prospective cohort study of livestock abortion, supported by cross-sectional serosurveillance, to determine aetiologies of livestock abortions in livestock in Tanzania. This approach generated several important findings including detection of a Rift Valley fever virus outbreak in cattle; high prevalence of C. burnetii infection in livestock; and the first report of Neospora caninum, Toxoplasma gondii, and pestiviruses associated with livestock abortion in Tanzania. Our approach provides a model for abortion surveillance in resource-limited settings. Our findings add substantially to current knowledge in sub-Saharan Africa, providing important evidence from which to prioritise disease interventions.
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Affiliation(s)
- Kate M Thomas
- Centre for International Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
- Kilimanjaro Clinical Research Institute, Good Samaritan Foundation, Moshi, United Republic of Tanzania.
- Ministry for Primary Industries, New Zealand Food Safety, Wellington, New Zealand.
| | - Tito Kibona
- Nelson Mandela African Institution of Science and Technology (NM-AIST), Tengeru, United Republic of Tanzania
| | - John R Claxton
- Institute of Biodiversity, Animal Health and Comparative Medicine, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - William A de Glanville
- Institute of Biodiversity, Animal Health and Comparative Medicine, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Felix Lankester
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, WA, USA
- Global Animal Health Tanzania, Arusha, United Republic of Tanzania
| | - Nelson Amani
- Kilimanjaro Clinical Research Institute, Good Samaritan Foundation, Moshi, United Republic of Tanzania
| | - Joram J Buza
- Nelson Mandela African Institution of Science and Technology (NM-AIST), Tengeru, United Republic of Tanzania
| | - Ryan W Carter
- Institute of Biodiversity, Animal Health and Comparative Medicine, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Gail E Chapman
- School of Veterinary Medicine, University of Glasgow, Glasgow, UK
| | - John A Crump
- Centre for International Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
- Kilimanjaro Christian Medical University College, Moshi, United Republic of Tanzania
| | | | - Jo E B Halliday
- Institute of Biodiversity, Animal Health and Comparative Medicine, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | | | | | | | | | | | - Caroline Millins
- School of Veterinary Medicine, University of Glasgow, Glasgow, UK
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
| | - Blandina T Mmbaga
- Kilimanjaro Clinical Research Institute, Good Samaritan Foundation, Moshi, United Republic of Tanzania
- Kilimanjaro Christian Medical University College, Moshi, United Republic of Tanzania
| | - Victor Mosha
- Kilimanjaro Clinical Research Institute, Good Samaritan Foundation, Moshi, United Republic of Tanzania
| | - James Nyarobi
- Institute of Biodiversity, Animal Health and Comparative Medicine, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Obed M Nyasebwa
- Ministry of Livestock and Fisheries, Zonal Veterinary Centre-Arusha, Arusha, United Republic of Tanzania
| | | | - Paul N Sanka
- Tanzania Veterinary Laboratory Agency, Arusha, United Republic of Tanzania
| | - George Semango
- Nelson Mandela African Institution of Science and Technology (NM-AIST), Tengeru, United Republic of Tanzania
| | - Nick Wheelhouse
- School of Applied Sciences, Edinburgh Napier University, Edinburgh, UK
| | - Brian J Willett
- Medical Research Council, University of Glasgow Centre for Virus Research, Glasgow, UK
| | - Sarah Cleaveland
- Institute of Biodiversity, Animal Health and Comparative Medicine, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Kathryn J Allan
- Institute of Biodiversity, Animal Health and Comparative Medicine, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
- School of Veterinary Medicine, University of Glasgow, Glasgow, UK
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Lukambagire AS, Shirima GM, Shayo DD, Mathew C, Yapi RB, Kasanga CJ, Mmbaga BT, Kazwala RR, Halliday JEB. Brucellosis testing patterns at health facilities in Arusha region, northern Tanzania. PLoS One 2022; 17:e0265612. [PMID: 35320293 PMCID: PMC8942238 DOI: 10.1371/journal.pone.0265612] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 03/04/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Brucellosis is listed as one of six priority zoonoses in Tanzania's One Health strategic plan which highlights gaps in data needed for the surveillance and estimation of human brucellosis burdens. This study collected data on current testing practices and test results for human brucellosis in Arusha region, northern Tanzania. METHODS Retrospective data were extracted from records at 24 health facilities in Arusha region for the period January 2012 to May 2018. Data were captured on: the test reagents used for brucellosis, procurement and testing protocols, the monthly number of patients tested for brucellosis and the monthly number testing positive. Generalised linear mixed models were used to evaluate relationships between health facility characteristics and the probability that brucellosis testing was conducted in a given month, and the proportion of individuals testing positive. RESULTS Four febrile Brucella agglutination tests were used widely. The probability of testing for brucellosis in a given month was significantly associated with an interaction between year of testing and facility ownership. Test probability increased over time with more pronounced increases in privately owned as compared to government facilities. The proportion of individuals testing positive for brucellosis was significantly associated with facility type and district, with individuals tested in hospitals in Meru, Monduli and Ngorongoro districts more likely to test positive. CONCLUSIONS Febrile Brucella agglutination tests, known for their poor performance, were the mainstay of brucellosis testing at health facilities in northern Tanzania. The study indicates that historical data on human brucellosis in Arusha and other regions are likely to provide an inaccurate measure of true disease burden due to poor performance of the tests used and variation in testing practices. Measures to address these identified shortcomings could greatly improve quality of testing and surveillance data on brucellosis and ultimately inform prevention and control of this priority disease.
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Affiliation(s)
- AbdulHamid Settenda Lukambagire
- College of Veterinary Medicine and Biomedical Sciences, Sokoine University of Agriculture, Morogoro, Tanzania
- Kilimanjaro Christian Medical University College-Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | | | - Damas Davis Shayo
- Regional Health Management Team, Arusha Regional Medical Office, Arusha, Tanzania
| | - Coletha Mathew
- College of Veterinary Medicine and Biomedical Sciences, Sokoine University of Agriculture, Morogoro, Tanzania
| | - Richard B. Yapi
- Centre d’Entomologie Médicale et Vétérinaire Université Alassane Ouattara, Bouaké, Côte d’Ivoire
- Centre Suisse de Recherches Scientifiques en Côte d’Ivoire, Abidjan, Côte d’Ivoire
| | - Christopher Julius Kasanga
- College of Veterinary Medicine and Biomedical Sciences, Sokoine University of Agriculture, Morogoro, Tanzania
| | - Blandina Theophile Mmbaga
- Kilimanjaro Christian Medical University College-Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Duke Global Health Institute, Durham, North Carolina, United States of America
| | - Rudovick Reuben Kazwala
- College of Veterinary Medicine and Biomedical Sciences, Sokoine University of Agriculture, Morogoro, Tanzania
| | - Jo E. B. Halliday
- Institute of Biodiversity, Animal Health & Comparative Medicine, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
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Mligo BJ, Sindato C, Yapi RB, Mathew C, Mkupasi EM, Kazwala RR, Karimuribo ED. Knowledge, attitude and practices of frontline health workers in relation to detection of brucellosis in rural settings of Tanzania: a cross-sectional study. ONE HEALTH OUTLOOK 2022; 4:1. [PMID: 34983693 PMCID: PMC8725462 DOI: 10.1186/s42522-021-00056-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 10/21/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Brucellosis an important zoonotic disease worldwide, which frequently presents as an undifferentiated febrile illness with otherwise varied and non-specific clinical manifestations. Despite its importance, there are few reports on its awareness among frontline health workers. This study aimed at assessing the baseline knowledge, attitude and practice (KAP) related to detection and management of brucellosis among frontline health workers (FHWs) namely; healthcare workers (HWs) and community health workers (CHWs). METHODS A cross-sectional study was conducted from December 2019 to January 2020 in Kilosa and Chalinze districts of Tanzania. Data on demographic characteristics, knowledge, attitude and practices regarding brucellosis were collected from the study participants using a structured questionnaire. Interviews were conducted with 32 HWs and 32 CHWs who were systematically selected in study districts. Chi square/fisher Exact was used to assess the association between sociodemographic variables and those related to knowledge, attitude and practices. RESULTS Overall, a total of 30 (93.8%) HWs and nine (28.1%) CHWs from the study districts heard about brucellosis, with (34.4%) of HWs having knowledge about the causative organism. Overall, knowledge showed almost half (46.9%) HWs and (28.1%) CHWs were aware of the symptoms, clinical signs, diagnosis and control regarding brucellosis. Knowledge difference was statistically significant with HWs' age (p = 0.016). Almost half (46.9%) HWs and less than quarter (12.5%) CHWs had good practices regarding brucellosis control. Almost three quarters (71.9%) of HWs and (21.9%) CHWs had positive attitude regarding brucellosis control; overall attitude was statistically significant with CHWs age (p = 0.028) and education level (p = 0.024). Lack of awareness and unavailability of diagnostic tools were the main challenges faced by FHWs in the two districts. CONCLUSION The majority of participants were not aware of human brucellosis. Moreover, their overall knowledge was inadequate and the common practices were diagnostic tools, and adequate knowledge to manage brucellosis cases. These findings highlight the need to strengthen frontline health workers knowledge, practices and diagnostic capacities related to brucellosis.
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Affiliation(s)
- Belinda Joseph Mligo
- College of Veterinary Medicine and Biomedical Sciences, Sokoine University of Agriculture, P.O. Box 3015, Morogoro, Tanzania.
| | - Calvin Sindato
- SACIDS Foundation for One Health, Sokoine University of Agriculture, P.O. Box 3297, Morogoro, Tanzania
- National Institute for Medical Research, Tabora Research Centre, Tabora, Tanzania
| | - Richard B Yapi
- Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, Abidjan, Côte d'Ivoire
- Centre d'Entomologie Médicale et Vétérinaire, Université Alassane Ouattara, Bouaké, Côte d'Ivoire
| | - Coletha Mathew
- College of Veterinary Medicine and Biomedical Sciences, Sokoine University of Agriculture, P.O. Box 3015, Morogoro, Tanzania
| | - Ernatus M Mkupasi
- College of Veterinary Medicine and Biomedical Sciences, Sokoine University of Agriculture, P.O. Box 3015, Morogoro, Tanzania
| | - Rudovick R Kazwala
- College of Veterinary Medicine and Biomedical Sciences, Sokoine University of Agriculture, P.O. Box 3015, Morogoro, Tanzania
| | - Esron D Karimuribo
- College of Veterinary Medicine and Biomedical Sciences, Sokoine University of Agriculture, P.O. Box 3015, Morogoro, Tanzania
- SACIDS Foundation for One Health, Sokoine University of Agriculture, P.O. Box 3297, Morogoro, Tanzania
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Knowledge of Brucellosis, Health-Seeking Behaviour, and Risk Factors for Brucella Infection amongst Workers on Cattle Farms in Gauteng, South Africa. Pathogens 2021; 10:pathogens10111484. [PMID: 34832639 PMCID: PMC8620615 DOI: 10.3390/pathogens10111484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 11/09/2021] [Accepted: 11/11/2021] [Indexed: 11/16/2022] Open
Abstract
Brucellosis in humans is under-detected and underreported in sub-Saharan Africa. Risk factors associated with Brucella infection and health seeking behaviour in response to brucellosis-like symptoms, amongst cattle farm workers and veterinary officials in South Africa, are unknown. Farm workers and veterinary officials (N = 230) were screened for brucellosis using commercial Rose Bengal Test (RBT®), IgM Enzyme-linked Immunoassay (ELISA)®, IgG ELISA® and the BrucellaCapt® test. Knowledge of brucellosis and risk factors for exposure to Brucella were also investigated. Seroprevalence varied according to test used: 10.1% (RBT®), 20.9% (IgG ELISA®) and 6.5% (BrucellaCapt®). Only 22.2% (6/27) of veterinary officials opt to visit a clinic, doctor, or hospital in response to self-experienced brucellosis-like symptoms, compared to 74.9% (152/203) of farm workers (p < 0.001). Of the BrucellaCapt® seropositive participants, 53% (7/15) did not visit a clinic in response to brucellosis-like symptoms. Weak evidence of an association between the handling of afterbirth or placenta and infection of a short evolution (RBT®, IgM ELISA® and IgG ELISA® seropositive) was found (OR = 8.9, 95% CI: 1.0–81.1, p = 0.052), and strong evidence of an association between this outcome and the slaughter of cattle (OR = 5.3, 95% CI: 1.4–19.6, p = 0.013). There was strong evidence of a positive association between inactive/resolved infection and veterinary officials vs. farm workers exposed to seropositive herds (OR = 7.0, 95% CI: 2.4–20.2, p < 0.001), with a simultaneous negative association with the handling of afterbirth or placenta (OR = 3.9, 95% CI: 1.3–11.3, p = 0.012). Findings suggest a proportion of undetected clinical cases of brucellosis amongst workers on cattle farms in Gauteng.
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Mehari S, Zerfu B, Desta K. Prevalence and risk factors of human brucellosis and malaria among patients with fever in malaria-endemic areas, attending health institutes in Awra and Gulina district, Afar Region, Ethiopia. BMC Infect Dis 2021; 21:942. [PMID: 34507538 PMCID: PMC8434724 DOI: 10.1186/s12879-021-06654-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 09/02/2021] [Indexed: 11/16/2022] Open
Abstract
Background Brucellosis is an important neglected bacterial zoonotic disease that has been affecting animals and humans for decades. Malaria has been considered major cause of illness in tropical areas, including Ethiopia. This study aimed to identify prevalence and risk factors of human brucellosis and malaria among patients with fever in malaria-endemic areas attending health institutes in Awra and Gulina district, Afar Region, Ethiopia. Methods A purposive cross-sectional study was conducted among febrile patients who attended health institutes in Awra and Gulina district of Afar region from February to May 2019. 3–5 ml blood samples were collected, thick and thin blood films were prepared and examined for malaria; serum was separated and tested for anti-Brucella using Rose Bengal Plate Test, and the seropositives were subjected to ELISA. Data were entered using EpiData3.1 and analyses were performed using Stata SE 14. Results A total of 444 febrile individuals (59.5% female) of age ranging from 2 to 83 years (mean = 26.1, SD = ± 11.8) were participated in this study. The overall seroprevalence of brucellosis was 31.5% (95% CI; 27.4–36.0%) by RBPT and 15.8% (95% CI; 12.7–19.7%) by ELISA, as well as the prevalence of malaria (P. falciparum) was 4.3% (95% CI; 2.7–6.6%) among febrile patients. Malaria was more common in males (7.2% 95% CI; 4.2–12.1%) than in female (2.3% 95% CI; 1.0–5.0%, p = 0.01) and in non-married than in married (7.6% 95% CI; 4.1–13.6% vs. 2.9% 95% CI; 1.5–5.4%, p = 0.02). Being male (AOR = 2.41, 95%CI: 1.36–4.26, p < 0.002), drinking raw milk (AOR = 26.68, 95%CI: 3.22- 221.13, p = 0.002) and boiled milk (AOR = 17.52, 95%CI: 2.06—149.04, p = 0.009) and touching aborted fetus/discharges without protective (AOR = 2.56, 95%CI: 1.01–6.528.50, p = 0.048) were independently associated with brucellosis among febrile patients. Conclusion The prevalence of brucellosis in fever patients in this study area is higher than malaria. Consumption of raw milk and contact with animal discharge can cause significant risk of Brucella infection. So, brucellosis disease must be sought in the differential diagnosis, like ELISA test that can be used to differentiate from other febrile diseases like malaria.
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Affiliation(s)
| | - Biruk Zerfu
- Department of Medical Laboratory Sciences, College of Health Sciences, Addis Ababa University, P.O. Box 1176, Addis Ababa, Ethiopia.
| | - Kassu Desta
- Department of Medical Laboratory Sciences, College of Health Sciences, Addis Ababa University, P.O. Box 1176, Addis Ababa, Ethiopia
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Mansoor T, Fomda BA, Koul AN, Bhat MA, Abdullah N, Bhattacharya S, Saleem SM. Rickettsial Infections among the Undifferentiated Febrile Patients Attending a Tertiary Care Teaching Hospital of Northern India: A Longitudinal Study. Infect Chemother 2021; 53:96-106. [PMID: 34409783 PMCID: PMC8032907 DOI: 10.3947/ic.2020.0147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 03/05/2021] [Indexed: 11/24/2022] Open
Abstract
Background Acute undifferentiated febrile illness (AUFI) is one of the most daunting challenges a physician faces in such settings. Among AUFI, rickettsial infections are most common and related infections (such as anaplasmosis, ehrlichiosis, and Q fever) which are caused by an unusual type of bacteria that can live only inside the cells of another organism. The present study was therefore planned with an objective to estimate the prevalence of rickettsial infection among patients of undifferentiated fever and to determine any association of socio-demographic characteristics with rickettsial disease. Materials and Methods Patients presenting with febrile illness and admitted or attending out-patient department of Sher-i-Kashmir Institute of Medical Sciences, Srinagar was approached and recruited in the study. Weil Felix Assay, enzyme-linked immunosorbent assay and indirect immunofluorescence assay were done to detect the anti-rickettsial antibodies. Serological evidence of a fourfold increase in IgG-specific antibody titer reactive with spotted fever group rickettsial antigen by indirect immunofluorescence antibody assays between paired serum specimens was considered a confirmatory diagnosis for the rickettsial disease. Results Most of the patients were males 61.6%, and most 46.2% were in the age group of 20 -39 years. Most of the patients, 80.8% belonged to rural areas, and 48% belonged to the upper middle (II) class of the socio-economic class according to modified Kuppuswamy scale. Of the studied participants, a majority, 47.0%, were determined undiagnosed, while 15.4% studied participants were diagnosed to have a rickettsial disease. In patients positive for typhus group, 67.8% were IgM positive, 28.5% were IgG positive, and only 3% were positive for IgM and IgG. In patients positive for Scrub Typhus Group, 32.7% were positive for IgM, and 62.0% were positive for IgG, and only 5.0% were positive for both IgM and IgG. In patients positive for spotted fever group, 36.1% were positive for IgM, and 58.5% were positive for IgG, and only 5.5% were positive for both IgM and IgG. The prevalence of rickettsial disease was found to be 11.3%. Conclusion Rickettsial diseases, typhoid and brucellosis, were the most prevalent diseased diagnosed among patients reporting to hospitals with undifferentiated febrile illness. Clinicians must consider rickettsial diseases as one of the differential diagnosis while treating patients with fever.
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Affiliation(s)
- Tabeen Mansoor
- Department of Microbiology, Government Medical College, Srinagar, India.
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Mburu CM, Bukachi SA, H. Tokpa K, Fokou G, Shilabukha K, Ezekiel M, Bonfoh B, Kazwala R, Kreppel K. Lay attitudes and misconceptions and their implications for the control of brucellosis in an agro-pastoral community in Kilombero district, Tanzania. PLoS Negl Trop Dis 2021; 15:e0009500. [PMID: 34111114 PMCID: PMC8219154 DOI: 10.1371/journal.pntd.0009500] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 06/22/2021] [Accepted: 05/21/2021] [Indexed: 12/26/2022] Open
Abstract
Brucellosis is a priority zoonotic disease in Tanzania that causes ill-health in people and affects livestock productivity. Inadequate awareness and behavior risking transmission can impede control efforts. We conducted a cross-sectional survey of 333 livestock owners in three villages in the Kilombero district, Tanzania, to understand their awareness, knowledge and behavior associated with brucellosis. Six Focus Group Discussions (FGDs), two in each village, were conducted, as well as an additional FGD with male herders from one of the villages. Factors associated with knowledge on brucellosis, food consumption and animal husbandry behavior risking transmission of this disease, were identified using generalized linear models. Predictors for knowledge of brucellosis were being male and having a higher educational level, while age was positively associated with a higher level of knowledge. Faith and ethnicity were associated with the performance of practices risking transmission. Following traditional religion and belonging to the Wamaasai ethnicity significantly increased the odds of carrying out these practices. Qualitative analysis gave insight into risk practices and reasoning. Of the 333 respondents, 29% reported that they had experienced abortions in their herds, 14% witnessed retained placentas, and 8% had seen still-births in their cattle within the previous year. However, survey results also showed that only 7.2% of participants had heard about brucellosis as a disease in livestock. Of those who had heard about brucellosis in livestock, 91% associated abortions with it and 71% knew that humans can get infected through raw milk consumption. People overwhelmingly attributed symptoms and transmission of brucellosis in livestock to infection with trypanosomiasis and to supernatural reasons instead. In the community, consumption of raw milk was valued and handling of aborted material was not considered a risk for infection. This agro-pastoralist community holds on to long-held beliefs and practices and lacks understanding of the biomedical concept of brucellosis. Transmission routes and symptoms of brucellosis in humans and livestock are completely unknown. The disparity between risk perception and actual transmission risk related to animal handling and consumption of animal products presents a challenge for disease awareness communication. This study recommends focused community engagement and sensitization to address the limited awareness and misconceptions among agro-pastoralists.
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Affiliation(s)
- Caroline M. Mburu
- Institute of Anthropology, Gender and African Studies, University of Nairobi, Nairobi, Kenya
| | - Salome A. Bukachi
- Institute of Anthropology, Gender and African Studies, University of Nairobi, Nairobi, Kenya
| | - Kathrin H. Tokpa
- Centre Suisse de Recherches Scientifiques en Côte d’Ivoire, Abidjan, Cote d’Ivoire
| | - Gilbert Fokou
- Centre Suisse de Recherches Scientifiques en Côte d’Ivoire, Abidjan, Cote d’Ivoire
| | - Khamati Shilabukha
- Institute of Anthropology, Gender and African Studies, University of Nairobi, Nairobi, Kenya
| | - Mangi Ezekiel
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Bassirou Bonfoh
- Centre Suisse de Recherches Scientifiques en Côte d’Ivoire, Abidjan, Cote d’Ivoire
| | | | - Katharina Kreppel
- Nelson Mandela African Institution for Science and Technology, Arusha, Tanzania
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Djangwani J, Ooko Abong’ G, Gicuku Njue L, Kaindi DWM. Brucellosis: Prevalence with reference to East African community countries - A rapid review. Vet Med Sci 2021; 7:851-867. [PMID: 33421354 PMCID: PMC8136958 DOI: 10.1002/vms3.425] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 11/22/2020] [Accepted: 12/09/2020] [Indexed: 12/11/2022] Open
Abstract
Brucellosis is a zoonotic disease which is endemic to certain regions of the world including Sub-Saharan Africa. The aim of this article is to provide a recent and rapid review on brucellosis prevalence in East African Community (EAC) countries. Literature was obtained using Google Scholar search engine and screened for relevancy and fulfilment of criteria to 1, 17, 4, 4, 30 and 29 articles retained for brucellosis prevalence in Burundi, Kenya, Rwanda, South Sudan, Tanzania and Uganda. Recent literature (published in the last decade 2010 to 2019) was considered for prevalence results in this review. In EAC, livestock had an animal-level prevalence of 0.2% to 43.8%, 0.0% to 20.0% and 0.0% to 13.8% for cattle, goats and sheep respectively. In humans, the prevalence varied mostly between 0.0% and 35.8%. In conclusion, brucellosis is quite prevalent in the region. The reported prevalence calls for plans or more efforts from individual member countries and from EAC, as a region, to control brucellosis.
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Affiliation(s)
- Juvenal Djangwani
- College of Agriculture and Veterinary SciencesDepartment of Food Science, Nutrition and TechnologyUniversity of NairobiKangemiKenya
- College of Agriculture, Animal Sciences and Veterinary MedicineSchool of Agriculture and Food SciencesUniversity of RwandaMusanzeRwanda
| | - George Ooko Abong’
- College of Agriculture and Veterinary SciencesDepartment of Food Science, Nutrition and TechnologyUniversity of NairobiKangemiKenya
| | - Lucy Gicuku Njue
- College of Agriculture and Veterinary SciencesDepartment of Food Science, Nutrition and TechnologyUniversity of NairobiKangemiKenya
| | - Dasel W. M. Kaindi
- College of Agriculture and Veterinary SciencesDepartment of Food Science, Nutrition and TechnologyUniversity of NairobiKangemiKenya
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Lukambagire AS, Mendes ÂJ, Bodenham RF, McGiven JA, Mkenda NA, Mathew C, Rubach MP, Sakasaka P, Shayo DD, Maro VP, Shirima GM, Thomas KM, Kasanga CJ, Kazwala RR, Halliday JEB, Mmbaga BT. Performance characteristics and costs of serological tests for brucellosis in a pastoralist community of northern Tanzania. Sci Rep 2021; 11:5480. [PMID: 33750848 PMCID: PMC7943594 DOI: 10.1038/s41598-021-82906-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 01/21/2021] [Indexed: 01/31/2023] Open
Abstract
The control of brucellosis across sub-Saharan Africa is hampered by the lack of standardized testing and the use of tests with poor performance. This study evaluated the performance and costs of serological assays for human brucellosis in a pastoralist community in northern Tanzania. Serum collected from 218 febrile hospital patients was used to evaluate the performance of seven index tests, selected based on international recommendation or current use. We evaluated the Rose Bengal test (RBT) using two protocols, four commercial agglutination tests and a competitive enzyme-linked immunosorbent assay (cELISA). The sensitivity, specificity, positive predictive value, negative predictive value, Youden's index, diagnostic accuracy, and per-sample cost of each index test were estimated. The diagnostic accuracy estimates ranged from 95.9 to 97.7% for the RBT, 55.0 to 72.0% for the commercial plate tests, and 89.4% for the cELISA. The per-sample cost range was $0.69-$0.79 for the RBT, $1.03-$1.14 for the commercial plate tests, and $2.51 for the cELISA. The widely used commercial plate tests performed poorly and cost more than the RBT. These findings provide evidence for the public health value of discontinuing the use of commercial agglutination tests for human brucellosis in Tanzania.
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Affiliation(s)
- AbdulHamid S Lukambagire
- College of Veterinary Medicine and Biomedical Sciences, Sokoine University of Agriculture, Morogoro, Tanzania.
| | - Ângelo J Mendes
- Institute of Biodiversity, Animal Health and Comparative Medicine, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, G12 8QQ, UK
| | - Rebecca F Bodenham
- Institute of Biodiversity, Animal Health and Comparative Medicine, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, G12 8QQ, UK
| | - John A McGiven
- OIE/FAO Brucellosis Reference Laboratory, Department of Bacteriology, Animal and Plant Health Agency, Surrey, UK
| | | | - Coletha Mathew
- College of Veterinary Medicine and Biomedical Sciences, Sokoine University of Agriculture, Morogoro, Tanzania
| | - Matthew P Rubach
- Kilimanjaro Christian Medical Center, Moshi, Tanzania
- Duke Global Health Institute, Durham, NC, USA
| | - Philoteus Sakasaka
- Duke Global Health Institute, Durham, NC, USA
- Kilimanjaro Clinical Research Institute-Biotechnology Laboratory, Moshi, Tanzania
| | | | - Venance P Maro
- Kilimanjaro Christian Medical Center, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Gabriel M Shirima
- The Nelson Mandela African Institution for Science and Technology, Arusha, Tanzania
| | - Kate M Thomas
- Kilimanjaro Clinical Research Institute-Biotechnology Laboratory, Moshi, Tanzania
- Centre for International Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Christopher J Kasanga
- College of Veterinary Medicine and Biomedical Sciences, Sokoine University of Agriculture, Morogoro, Tanzania
| | - Rudovick R Kazwala
- College of Veterinary Medicine and Biomedical Sciences, Sokoine University of Agriculture, Morogoro, Tanzania
| | - Jo E B Halliday
- Institute of Biodiversity, Animal Health and Comparative Medicine, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, G12 8QQ, UK
| | - Blandina T Mmbaga
- Kilimanjaro Christian Medical Center, Moshi, Tanzania
- Duke Global Health Institute, Durham, NC, USA
- Kilimanjaro Clinical Research Institute-Biotechnology Laboratory, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
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Zeleke S, Anley M, Kefale D, Wassihun B. Factors Associated with Delayed Diagnosis of Cervical Cancer in Tikur Anbesa Specialized Hospital, Ethiopia, 2019: Cross-Sectional Study. Cancer Manag Res 2021; 13:579-585. [PMID: 33519237 PMCID: PMC7837583 DOI: 10.2147/cmar.s285621] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 01/09/2021] [Indexed: 01/03/2023] Open
Abstract
Background Cervical cancer is a preventable and curable disease if detected early enough. But several numbers of women in Ethiopia strive for treatment when the disease has extended to the last stage. Delay in diagnosis is the main reason for cervical cancer mortality in Ethiopia. The main objective of this study was to assess factors associated with delayed diagnoses of cervical cancer in Tikur Anbesa Specialized Hospital, Ethiopia. Methods An institution-based cross-sectional study was conducted. Randomly selected 422 cervical cancer patients were interviewed and their medical records were reviewed. Data were entered using EpiData version 3.1 and analyzed using SPSS version 22. Bivariate and multivariate analyses were conducted to examine the association between independent and outcome variables. Results A total of 410 women participated in the study with a response rate of 97.1%. The mean age of the women was 50 years (SD ±11.5). Half of the participants cannot read and write, and 66.3% of participants' income was <500 Ethiopian Birr (approximately 14 USD). Around 86.3% of the women had delayed diagnosis of cervical cancer. Women who have <500 Ethiopian Birr (14 USD) income (adjusted OR=3.79, CI: 1.48, 9.67), have no awareness of cervical cancer disease (adjusted OR=1.33, CI: 1.05, 2.71) and have no awareness about cervical cancer screening (adjusted OR=1.64, CI: 1.16, 4.07) were more likely for delayed diagnosis of cervical cancer. Conclusion Our study reports a high prevalence of delayed diagnosis of women with cervical cancer. A high level of illiteracy, low socioeconomic status, lack of awareness, traditional healers and absence of a routine screening program were accountable for delayed diagnosis of cervical cancer. Regular cervical cancer screening and expansion, raising awareness, increasing access and improving health services for cervical cancer patients should be promoted and advocated to decrease the usual delay in cervical cancer diagnosis.
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Affiliation(s)
- Shegaw Zeleke
- Department of Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Mesfine Anley
- Department of Oncology Nursing, Tikur Anbesa Specialized Hospital, Addis Ababa, Ethiopia
| | - Demewoz Kefale
- Department of Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Biresaw Wassihun
- Department of Midwifery, College of Health Sciences, Arba Minch University, Arba Minch, Ethiopia
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Utility of the Rose Bengal Test as a Point-of-Care Test for Human Brucellosis in Endemic African Settings: A Systematic Review. J Trop Med 2020; 2020:6586182. [PMID: 33014074 PMCID: PMC7519193 DOI: 10.1155/2020/6586182] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 04/26/2020] [Accepted: 08/10/2020] [Indexed: 02/01/2023] Open
Abstract
In endemic African areas, such as Tanzania, Brucella spp. cause human febrile illnesses, which often go unrecognized and misdiagnosed, resulting in delayed diagnosis, underdiagnosis, and underreporting. Although rapid and affordable point-of-care tests, such as the Rose Bengal test (RBT), are available, acceptance and adoption of these tests at the national level are hindered by a lack of local diagnostic performance data. To address this need, evidence on the diagnostic performance of RBT as a human brucellosis point-of-care test was reviewed. The review was initially focused on studies conducted in Tanzania but was later extended to worldwide because few relevant studies from Tanzania were identified. Databases including Web of Science, Embase, MEDLINE, and World Health Organization Global Index Medicus were searched for studies assessing the diagnostic performance of RBT (sensitivity and specificity) for detection of human brucellosis, in comparison to the reference standard culture. Sixteen eligible studies were identified and reviewed following screening. The diagnostic sensitivity (DSe) and specificity (DSp) of RBT compared to culture as the gold standard were 87.5% and 100%, respectively, in studies that used suitable "true positive" and "true negative" patient comparison groups and were considered to be of high scientific quality. Diagnostic DSe and DSp of RBT compared to culture in studies that also used suitable "true positive" and "true negative" patient comparison groups but were considered to be of moderate scientific quality varied from 92.5% to 100% and 94.3 to 99.9%, respectively. The good diagnostic performance of RBT combined with its simplicity, quickness, and affordability makes RBT an ideal (or close to) stand-alone point-of-care test for early clinical diagnosis and management of human brucellosis and nonmalarial fevers in small and understaffed health facilities and laboratories in endemic areas in Africa and elsewhere.
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Ntirandekura JB, Matemba LE, Kimera SI, Muma JB, Karimuribo ED. Association of brucellosis to abortions in humans and domestic ruminants in Kagera ecosystem, Tanzania. Transbound Emerg Dis 2020; 67:1879-1887. [PMID: 32065731 DOI: 10.1111/tbed.13516] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 01/15/2020] [Accepted: 02/11/2020] [Indexed: 11/27/2022]
Abstract
Brucellosis is a worldwide zoonotic disease of socio-economic importance. Understanding the association of this disease with pregnancy outcome has the potential of contributing to the reduction of its reproductive burden in humans and animals among pastoral communities in Tanzania. A prospective cohort study was conducted in Kagera Region on pregnant women (n = 76) and gravid ruminants (121 cattle, 125 goats and 111 sheep). Exposed and non-exposed groups to brucellosis were followed for 6 months (from 15 November 2017 to 15 April 2018). Sera were collected and analysed using Rose Bengal Test (RBT) and Fluorescence polarization assay (FPA) test. Measures of effect, univariable and multivariable logistic regression analyses were computed. Positivity to both RBT and FPA tests was 21% (95% CI: 12.5-32) in pregnant women and 5% (95% CI: 3.1-8) in gravid ruminants. Among aborted cases, four women (out of nine), two cows (out of seven), two goats (out of 26) and zero sheep (out of 11) were positive to brucellosis. The abortion rate in humans and ruminants was 11.8% and 12.3%, respectively. Seropositivity to brucellosis was similar in aborted and non-aborted cases in humans (p = .08) and in ruminants (p = .2). At the population level, brucellosis was associated with abortions (population attributable risk: PAR) at 3.5% in pregnant women and at 0.5% in gravid ruminants in the study area. Infections to brucellosis were increased in exposed pregnant women (OR = 19; 95% CI: 1.8-203, p = .01) and in cattle (OR = 11; 95% CI: 1.3-88, p = .02). There is an indication that brucellosis could be contributing to abortions in pregnant women and domestic ruminants Kagera Region. Molecular tools could support more the results from serological tests to avoid cross-reaction with other pathogen agents. Control of brucellosis in animals is likely to reduce the threat of abortions in humans.
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Affiliation(s)
- Jean-Bosco Ntirandekura
- Department of Veterinary Medicine and Public Health, College of Veterinary Medicine and Biomedical Sciences, Sokoine University of Agriculture, Morogoro, Tanzania
- Département de Santé et Productions Animales, Faculté d'Agronomie et de Bio-Ingénierie, Université du Burundi, Bujumbura, Burundi
| | | | - Sharadhuli Iddi Kimera
- Department of Veterinary Medicine and Public Health, College of Veterinary Medicine and Biomedical Sciences, Sokoine University of Agriculture, Morogoro, Tanzania
| | - John Bwalya Muma
- Department of Disease Control, School of Veterinary Medicine, University of Zambia, Lusaka, Zambia
| | - Esron Daniel Karimuribo
- Department of Veterinary Medicine and Public Health, College of Veterinary Medicine and Biomedical Sciences, Sokoine University of Agriculture, Morogoro, Tanzania
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Bodenham RF, Lukambagire AS, Ashford RT, Buza JJ, Cash-Goldwasser S, Crump JA, Kazwala RR, Maro VP, McGiven J, Mkenda N, Mmbaga BT, Rubach MP, Sakasaka P, Shirima GM, Swai ES, Thomas KM, Whatmore AM, Haydon DT, Halliday JEB. Prevalence and speciation of brucellosis in febrile patients from a pastoralist community of Tanzania. Sci Rep 2020; 10:7081. [PMID: 32341414 PMCID: PMC7184621 DOI: 10.1038/s41598-020-62849-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 03/11/2020] [Indexed: 01/18/2023] Open
Abstract
Brucellosis is an endemic zoonosis in sub-Saharan Africa. Pastoralists are at high risk of infection but data on brucellosis from these communities are scarce. The study objectives were to: estimate the prevalence of human brucellosis, identify the Brucella spp. causing illness, describe non-Brucella bloodstream infections, and identify risk factors for brucellosis in febrile patients from a pastoralist community of Tanzania. Fourteen (6.1%) of 230 participants enrolled between August 2016 and October 2017 met study criteria for confirmed (febrile illness and culture positivity or ≥four-fold rise in SAT titre) or probable (febrile illness and single SAT titre ≥160) brucellosis. Brucella spp. was the most common bloodstream infection, with B. melitensis isolated from seven participants and B. abortus from one. Enterococcus spp., Escherichia coli, Salmonella enterica, Staphylococcus aureus and Streptococcus pneumoniae were also isolated. Risk factors identified for brucellosis included age and herding, with a greater probability of brucellosis in individuals with lower age and who herded cattle, sheep or goats in the previous 12 months. Disease prevention activities targeting young herders have potential to reduce the impacts of human brucellosis in Tanzania. Livestock vaccination strategies for the region should include both B. melitensis and B. abortus.
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Affiliation(s)
- Rebecca F Bodenham
- Institute of Biodiversity, Animal Health & Comparative Medicine, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | | | - Roland T Ashford
- OIE/FAO Brucellosis Reference Laboratory, Department of Bacteriology, Animal & Plant Health Agency, Surrey, UK
| | - Joram J Buza
- Nelson Mandela African Institution for Science and Technology, Arusha, Tanzania
| | - Shama Cash-Goldwasser
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA.,Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - John A Crump
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA.,Kilimanjaro Christian Medical Centre, Moshi, Tanzania.,Kilimanjaro Clinical Research Institute, Moshi, Tanzania.,Centre for International Health, University of Otago, Dunedin, New Zealand.,Kilimanjaro Christian Medical University College, Moshi, Tanzania.,Division of Infectious Diseases and International Health, Duke University Medical Center, North Carolina, USA
| | | | - Venance P Maro
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania.,Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - John McGiven
- OIE/FAO Brucellosis Reference Laboratory, Department of Bacteriology, Animal & Plant Health Agency, Surrey, UK
| | - Nestory Mkenda
- Endulen Hospital, Ngorongoro Conservation Area, Arusha, Tanzania
| | - Blandina T Mmbaga
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA.,Kilimanjaro Christian Medical Centre, Moshi, Tanzania.,Kilimanjaro Clinical Research Institute, Moshi, Tanzania.,Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Matthew P Rubach
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA.,Kilimanjaro Christian Medical Centre, Moshi, Tanzania.,Division of Infectious Diseases and International Health, Duke University Medical Center, North Carolina, USA.,Programme in Emerging Infectious Diseases, Duke-NUS Medical School, Singapore, Singapore
| | | | - Gabriel M Shirima
- Nelson Mandela African Institution for Science and Technology, Arusha, Tanzania
| | - Emanuel S Swai
- Directorate of Veterinary Services, Ministry of Livestock and Fisheries, Dodoma, Tanzania
| | - Kate M Thomas
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania.,Centre for International Health, University of Otago, Dunedin, New Zealand
| | - Adrian M Whatmore
- OIE/FAO Brucellosis Reference Laboratory, Department of Bacteriology, Animal & Plant Health Agency, Surrey, UK
| | - Daniel T Haydon
- Institute of Biodiversity, Animal Health & Comparative Medicine, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Jo E B Halliday
- Institute of Biodiversity, Animal Health & Comparative Medicine, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, UK.
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17
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Hercik C, Cosmas L, Mogeni OD, Kohi W, Mfinanga S, Loffredo C, Montgomery JM. Health Beliefs and Patient Perspectives of Febrile Illness in Kilombero, Tanzania. Am J Trop Med Hyg 2020; 101:263-270. [PMID: 31115309 DOI: 10.4269/ajtmh.17-0862] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
This qualitative study assessed the knowledge and beliefs surrounding fever syndrome among adult febrile patients seeking health care in Kilombero, Tanzania. From June 11 to July 13, 2014, 10% of all adult (≥ 15 years) febrile patients enrolled in the larger syndromic study, who presented with an axillary temperature ≥ 37.5°C and symptom onset ≤ 5 days prior, were randomly selected to participate in an in-depth physician-patient interview, informed by Health Belief Model constructs. Interviews were audio recorded, translated, and transcribed. Transcripts were coded using NVivo Version 11.1, and the thematic content was analyzed by two separate researchers. Blood and nasopharyngeal/oralpharyngeal specimens were collected and analyzed using both acute febrile illness and respiratory TaqMan Array Cards for multipathogen detection of 56 potential causative agents. A total of 18 participants provided 188 discrete comments. When asked to speculate the causative agent of febrile illness, 33.3% cited malaria and the other 66.6% offered nonbiomedical responses, such as "mosquitoes" and "weather." Major themes emerging related to severity and susceptibility to health hazards included lack of bed net use, misconceptions about bed nets, and mosquito infestation. Certain barriers to treatment were cited, including dependence on traditional healers, high cost of drugs, and poor dispensary services. Overall, we demonstrate low concurrence in speculations of fever etiology according to patients, clinicians, and laboratory testing. Our findings contribute to the important, yet limited, base of knowledge surrounding patient risk perceptions of febrile illness and underscore the potential utility of community-based participatory research to inform disease control programs.
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Affiliation(s)
| | - Leonard Cosmas
- Division of Global Health Protection, Center for Global Health, US Centers for Disease Control and Prevention (US CDC), Nairobi, Kenya
| | - Ondari D Mogeni
- Centre for Global Health Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Wanze Kohi
- Muhimbili Research Centre, National Institute of Medical Research, Dar es Salaam, Tanzania
| | - Sayoki Mfinanga
- Muhimbili University of Health and Allied Science, Dar es Salaam, Tanzania.,Muhimbili Research Centre, National Institute of Medical Research, Dar es Salaam, Tanzania
| | - Christopher Loffredo
- Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, Washington, District of Columbia
| | - Joel M Montgomery
- Division of Global Health Protection, Center for Global Health, US Centers for Disease Control and Prevention (US CDC), Nairobi, Kenya
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18
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Althaus T, Lubell Y, Maro VP, Mmbaga BT, Lwezaula B, Halleux C, Biggs HM, Galloway RL, Stoddard RA, Perniciaro JL, Nicholson WL, Doyle K, Olliaro P, Crump JA, Rubach MP. Sensitivity of C-reactive protein for the identification of patients with laboratory-confirmed bacterial infections in northern Tanzania. Trop Med Int Health 2020; 25:291-300. [PMID: 31808588 DOI: 10.1111/tmi.13358] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Identifying febrile patients requiring antibacterial treatment is challenging, particularly in low-resource settings. In South-East Asia, C-reactive protein (CRP) has been demonstrated to be highly sensitive and moderately specific in detecting bacterial infections and to safely reduce unnecessary antibacterial prescriptions in primary care. As evidence is scant in sub-Saharan Africa, we assessed the sensitivity of CRP in identifying serious bacterial infections in Tanzania. METHODS Samples were obtained from inpatients and outpatients in a prospective febrile illness study at two hospitals in Moshi, Tanzania, 2011-2014. Bacterial bloodstream infections (BSI) were established by blood culture, and bacterial zoonotic infections were defined by ≥4 fold rise in antibody titre between acute and convalescent sera. The sensitivity of CRP in identifying bacterial infections was estimated using thresholds of 10, 20 and 40 mg/l. Specificity was not assessed because determining false-positive CRP results was limited by the lack of diagnostic testing to confirm non-bacterial aetiologies and because ascertaining true-negative cases was limited by the imperfect sensitivity of the diagnostic tests used to identify bacterial infections. RESULTS Among 235 febrile outpatients and 569 febrile inpatients evaluated, 31 (3.9%) had a bacterial BSI and 61 (7.6%) had a bacterial zoonosis. Median (interquartile range) CRP values were 173 (80-315) mg/l in bacterial BSI, and 108 (31-208) mg/l in bacterial zoonoses. The sensitivity (95% confidence intervals) of CRP was 97% (83%-99%), 94% (79%-98%) and 90% (74%-97%) for identifying bacterial BSI, and 87% (76%-93%), 82% (71%-90%) and 72% (60%-82%) for bacterial zoonoses, using thresholds of 10, 20 and 40 mg/l, respectively. CONCLUSION C-reactive protein was moderately sensitive for bacterial zoonoses and highly sensitive for identifying BSIs. Based on these results, operational studies are warranted to assess the safety and clinical utility of CRP for the management of non-malaria febrile illness at first-level health facilities in sub-Saharan Africa.
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Affiliation(s)
- Thomas Althaus
- Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Yoel Lubell
- Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Venance P Maro
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania.,Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Blandina T Mmbaga
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania.,Kilimanjaro Christian Medical University College, Moshi, Tanzania.,Duke Global Health Institute, Durham, NC, USA
| | | | - Christine Halleux
- Special Programme for Research and Training in Tropical Diseases, WHO, Geneva, Switzerland
| | - Holly M Biggs
- Division of Infectious Diseases, Department of Medicine, Duke University, Durham, NC, USA
| | - Renee L Galloway
- Bacterial Special Pathogens Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Robyn A Stoddard
- Bacterial Special Pathogens Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jamie L Perniciaro
- Rickettsial Zoonoses Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - William L Nicholson
- Rickettsial Zoonoses Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kelly Doyle
- Intermountain Central Laboratory, Intermountain Healthcare, Murray, UT, USA
| | - Piero Olliaro
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK.,Special Programme for Research and Training in Tropical Diseases, WHO, Geneva, Switzerland
| | - John A Crump
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania.,Kilimanjaro Christian Medical University College, Moshi, Tanzania.,Duke Global Health Institute, Durham, NC, USA.,Division of Infectious Diseases, Department of Medicine, Duke University, Durham, NC, USA.,Centre for International Health, University of Otago, Dunedin, New Zealand
| | - Matthew P Rubach
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania.,Duke Global Health Institute, Durham, NC, USA.,Division of Infectious Diseases, Department of Medicine, Duke University, Durham, NC, USA.,Programme in Emerging Infectious Diseases, Duke-National University of Singapore Medical School, Singapore, Singapore
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19
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Saddique A, Ali S, Akhter S, Khan I, Neubauer H, Melzer F, Khan AU, Azam A, El-Adawy H. Acute Febrile Illness Caused by Brucella abortus Infection in Humans in Pakistan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16214071. [PMID: 31652718 PMCID: PMC6862605 DOI: 10.3390/ijerph16214071] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 10/14/2019] [Accepted: 10/16/2019] [Indexed: 01/04/2023]
Abstract
Brucellosis is a zoonosis of great and worldwide public health concern that can cause a severe febrile illness in humans. In Pakistan, brucellosis is a critical problem in both animals and humans. This study aimed to gain insight into its prevalence and to analyze the potential risk factors of patients with acute febrile illness (AFI) of an unknown cause, at the hospitals of Rawalpindi and Islamabad in Pakistan. In total, 446 blood samples were collected from patients and screened for brucellosis using the Rose Bengal Plat Test (RBPT). All the serum samples were investigated for Brucella DNA using specific real-time PCR. Age, sex, occupation, urbanicity, socioeconomic status and history of animal contact were recorded and assessed as potential risk factors. The proportion of acute febrile illness patients for whom brucellosis could be suspected was 10.1% by the RBPT. Brucella DNA was detected in 26 (5.8%) cases and identified as B. abortus. Contact with infected animals, consumption of raw milk and socioeconomic status showed a highly significant (p < 0.05) correlation with seropositivity. Elderly patients (19.7% RBPT and 12.1% PCR) and females (13% RBPT and 9.3% PCR) were of high risk of brucellosis. Patients suffering from brucellosis-related manifestations should be screened for brucellosis, especially those in contact with animals or those consuming their unprocessed products, given the increased risk. The results of this study, which highlight that Brucella abortus as an important cause of acute febrile illnesses in humans, aid the development of effective control strategies for human brucellosis in Pakistan.
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Affiliation(s)
- Arbab Saddique
- Animal Physiology Laboratory, Department of Zoology, Pir Mehr Ali Shah Arid Agriculture University 46000 Rawalpindi, Pakistan.
| | - Shahzad Ali
- Wildlife Epidemiology and Molecular Microbiology Laboratory (One Health Research Group), Discipline of Zoology, Department of Wildlife and Ecology, University of Veterinary and Animal Sciences, Lahore, Ravi Campus, 55300, Pattoki, Pakistan.
| | - Shamim Akhter
- Animal Physiology Laboratory, Department of Zoology, Pir Mehr Ali Shah Arid Agriculture University 46000 Rawalpindi, Pakistan.
| | - Iahtasham Khan
- Section of Epidemiology and Public Health, University of Veterinary and Animal Sciences, Lahore Sub- campus Jhang, 35200, Pakistan.
| | - Heinrich Neubauer
- Friedrich-Loeffler-Institut, Institute of Bacterial Infections and Zoonoses, Naumburger Str. 10 96a, D-07743 Jena, Germany.
| | - Falk Melzer
- Friedrich-Loeffler-Institut, Institute of Bacterial Infections and Zoonoses, Naumburger Str. 10 96a, D-07743 Jena, Germany.
| | - Aman Ullah Khan
- Friedrich-Loeffler-Institut, Institute of Bacterial Infections and Zoonoses, Naumburger Str. 10 96a, D-07743 Jena, Germany.
- Department of Pathobiology, College of Veterinary and Animal Sciences, 35200, Jhang, Pakistan.
| | - Asima Azam
- Department of Zoology, Shaheed Benazir Bhutto Women University, 25000, Peshawar, Pakistan.
| | - Hosny El-Adawy
- Friedrich-Loeffler-Institut, Institute of Bacterial Infections and Zoonoses, Naumburger Str. 10 96a, D-07743 Jena, Germany.
- Faculty Medicine of Veterinary, Kafrelsheikh University, 33516, Kafr El-Sheikh, Egypt.
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20
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Carugati M, Biggs HM, Maze MJ, Stoddard RA, Cash-Goldwasser S, Hertz JT, Halliday JEB, Saganda W, Lwezaula BF, Kazwala RR, Cleaveland S, Maro VP, Rubach MP, Crump JA. Incidence of human brucellosis in the Kilimanjaro Region of Tanzania in the periods 2007-2008 and 2012-2014. Trans R Soc Trop Med Hyg 2019; 112:136-143. [PMID: 29697848 PMCID: PMC5961162 DOI: 10.1093/trstmh/try033] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 03/23/2018] [Indexed: 11/23/2022] Open
Abstract
Background Brucellosis causes substantial morbidity among humans and their livestock. There are few robust estimates of the incidence of brucellosis in sub-Saharan Africa. Using cases identified through sentinel hospital surveillance and health care utilization data, we estimated the incidence of brucellosis in Moshi Urban and Moshi Rural Districts, Kilimanjaro Region, Tanzania, for the periods 2007–2008 and 2012–2014. Methods Cases were identified among febrile patients at two sentinel hospitals and were defined as having either a 4-fold increase in Brucella microscopic agglutination test titres between acute and convalescent serum or a blood culture positive for Brucella spp. Findings from a health care utilization survey were used to estimate multipliers to account for cases not seen at sentinel hospitals. Results Of 585 patients enrolled in the period 2007–2008, 13 (2.2%) had brucellosis. Among 1095 patients enrolled in the period 2012–2014, 32 (2.9%) had brucellosis. We estimated an incidence (range based on sensitivity analysis) of brucellosis of 35 (range 32–93) cases per 100 000 persons annually in the period 2007–2008 and 33 (range 30–89) cases per 100 000 persons annually in the period 2012–2014. Conclusions We found a moderate incidence of brucellosis in northern Tanzania, suggesting that the disease is endemic and an important human health problem in this area.
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Affiliation(s)
- Manuela Carugati
- Division of Infectious Diseases, Duke University Medical Center, Durham, NC, USA.,Kilimanjaro Christian Medical Centre, Moshi, Tanzania.,Division of Infectious Diseases, San Gerardo Hospital, Monza, Italy
| | - Holly M Biggs
- Division of Infectious Diseases, Duke University Medical Center, Durham, NC, USA
| | - Michael J Maze
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania.,Centre for International Health, University of Otago, Dunedin, New Zealand
| | - Robyn A Stoddard
- Centers for Disease Control and Prevention, Bacterial Special Pathogens Branch, Atlanta, GA, USA
| | - Shama Cash-Goldwasser
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania.,Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Julian T Hertz
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Jo E B Halliday
- Boyd Orr Centre for Population and Ecosystem Health, Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, UK
| | | | | | | | - Sarah Cleaveland
- Boyd Orr Centre for Population and Ecosystem Health, Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, UK
| | - Venance P Maro
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania.,Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Matthew P Rubach
- Division of Infectious Diseases, Duke University Medical Center, Durham, NC, USA.,Kilimanjaro Christian Medical Centre, Moshi, Tanzania.,Duke Global Health Institute, Duke University, Durham, NC, USA
| | - John A Crump
- Division of Infectious Diseases, Duke University Medical Center, Durham, NC, USA.,Centre for International Health, University of Otago, Dunedin, New Zealand.,Duke Global Health Institute, Duke University, Durham, NC, USA.,Kilimanjaro Christian Medical University College, Moshi, Tanzania
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21
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Systematic Review of Important Bacterial Zoonoses in Africa in the Last Decade in Light of the 'One Health' Concept. Pathogens 2019; 8:pathogens8020050. [PMID: 30995815 PMCID: PMC6631375 DOI: 10.3390/pathogens8020050] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 04/10/2019] [Accepted: 04/11/2019] [Indexed: 02/07/2023] Open
Abstract
Zoonoses present a major public health threat and are estimated to account for a substantial part of the infectious disease burden in low-income countries. The severity of zoonotic diseases is compounded by factors such as poverty, living in close contact with livestock and wildlife, immunosuppression as well as coinfection with other diseases. The interconnections between humans, animals and the environment are essential to understand the spread and subsequent containment of zoonoses. We searched three scientific databases for articles relevant to the epidemiology of bacterial zoonoses/zoonotic bacterial pathogens, including disease prevalence and control measures in humans and multiple animal species, in various African countries within the period from 2008 to 2018. The review identified 1966 articles, of which 58 studies in 29 countries met the quality criteria for data extraction. The prevalence of brucellosis, leptospirosis, Q fever ranged from 0–40%, 1.1–24% and 0.9–28.2%, respectively, depending on geographical location and even higher in suspected outbreak cases. Risk factors for human zoonotic infection included exposure to livestock and animal slaughters. Dietary factors linked with seropositivity were found to include consumption of raw milk and locally fermented milk products. It was found that zoonoses such as leptospirosis, brucellosis, Q fever and rickettsiosis among others are frequently under/misdiagnosed in febrile patients seeking treatment at healthcare centres, leading to overdiagnoses of more familiar febrile conditions such as malaria and typhoid fever. The interactions at the human–animal interface contribute substantially to zoonotic infections. Seroprevalence of the various zoonoses varies by geographic location and species. There is a need to build laboratory capacity and effective surveillance processes for timely and effective detection and control of zoonoses in Africa. A multifaceted ‘One Health’ approach to tackle zoonoses is critical in the fight against zoonotic diseases. The impacts of zoonoses include: (1) Humans are always in contact with animals including livestock and zoonoses are causing serious life-threatening infections in humans. Almost 75% of the recent major global disease outbreaks have a zoonotic origin. (2) Zoonoses are a global health challenge represented either by well-known or newly emerging zoonotic diseases. (3) Zoonoses are caused by all-known cellular (bacteria, fungi and parasites) and noncellular (viruses or prions) pathogens. (4) There are limited data on zoonotic diseases from Africa. The fact that human health and animal health are inextricably linked, global coordinated and well-established interdisciplinary research efforts are essential to successfully fight and reduce the health burden due to zoonoses. This critically requires integrated data from both humans and animals on zoonotic diseases.
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22
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Migisha R, Dan Nyehangane, Boum Y, Page AL, Zúñiga-Ripa A, Conde-Álvarez R, Bagenda F, Bonnet M. Prevalence and risk factors of brucellosis among febrile patients attending a community hospital in south western Uganda. Sci Rep 2018; 8:15465. [PMID: 30337685 PMCID: PMC6194062 DOI: 10.1038/s41598-018-33915-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 10/07/2018] [Indexed: 11/08/2022] Open
Abstract
Human brucellosis, a chronic disease contracted through contact with animals and consuption of unpasteurized dairy products is underreported in limited-resource countries. This cross-sectional study aimed to determine the prevalence and risk factors of brucellosis among febrile patients attending a community hospital in South western Uganda. A questionnaire that captured socio-demographic, occupational and clinical data was administered. Blood samples were tested for Brucella antibodies using Rose Bengal Plate Test (RBPT) and blood culture with standard aerobic BACTEC bottle was done. Of 235 patients enrolled, prevalence of brucellosis (RBPT or culture confirmed) was 14.9% (95% CI 10.6-20.1) with a culture confrmation in 4.3% of the participants. The factors independently associated with brucellosis were consumption of raw milk (aOR 406.15, 95% CI 47.67-3461.69); history of brucellosis in the family (aOR 9.19, 95% CI 1.98-42.54); and selling hides and skins (aOR 162.56, 95% CI 2.86-9256.31). Hepatomegaly (p < 0.001), splenomegaly (p = 0.018) and low body mass index (p = 0.032) were more common in patients with brucellosis compared to others. Our findings reveal a high prevalence of brucellosis among febrile patients and highlight a need for implementing appropiate tests, public awareness activities and vaccination of animals to control and eliminate the disease.
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Affiliation(s)
- Richard Migisha
- Mbarara University of Science and Technology (MUST), Mbarara, Uganda.
| | | | - Yap Boum
- Mbarara University of Science and Technology (MUST), Mbarara, Uganda
- Epicentre, Paris, France
| | | | - Amaia Zúñiga-Ripa
- Institute for Tropical Health, University of Navarra (ISTUN), Pamplona, Spain
| | | | - Fred Bagenda
- Mbarara University of Science and Technology (MUST), Mbarara, Uganda
| | - Maryline Bonnet
- Epicentre, Paris, France
- IRD UMI233/, INSERM U1175, Montpellier, France
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23
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Maze MJ, Bassat Q, Feasey NA, Mandomando I, Musicha P, Crump JA. The epidemiology of febrile illness in sub-Saharan Africa: implications for diagnosis and management. Clin Microbiol Infect 2018; 24:808-814. [PMID: 29454844 PMCID: PMC6057815 DOI: 10.1016/j.cmi.2018.02.011] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 02/08/2018] [Accepted: 02/10/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND Fever is among the most common symptoms of people living in Africa, and clinicians are challenged by the similar clinical features of a wide spectrum of potential aetiologies. AIM To summarize recent studies of fever aetiology in sub-Saharan Africa focusing on causes other than malaria. SOURCES A narrative literature review by searching the MEDLINE database, and recent conference abstracts. CONTENT Studies of multiple potential causes of fever are scarce, and for many participants the infecting organism remains unidentified, or multiple co-infecting microorganisms are identified, and establishing causation is challenging. Among ambulatory patients, self-limiting arboviral infections and viral upper respiratory infections are common, occurring in up to 60% of children attending health centres. Among hospitalized patients there is a high prevalence of potentially fatal infections requiring specific treatment. Bacterial bloodstream infection and bacterial zoonoses are major causes of fever. In recent years, the prevalence of antimicrobial resistance among bacterial isolates has increased, notably with spread of extended spectrum β-lactamase-producing Enterobacteriaceae and fluoroquinolone-resistant Salmonella enterica. Among those with human immunodeficiency virus (HIV) infection, Mycobacterium tuberculosis bacteraemia has been confirmed in up to 34.8% of patients with sepsis, and fungal infections such as cryptococcosis and histoplasmosis remain important. IMPLICATIONS Understanding the local epidemiology of fever aetiology, and the use of diagnostics including malaria and HIV rapid-diagnostic tests, guides healthcare workers in the management of patients with fever. Current challenges for clinicians include assessing which ambulatory patients require antibacterial drugs, and identifying hospitalized patients infected with organisms that are not susceptible to empiric antibacterial regimens.
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Affiliation(s)
- M J Maze
- Centre for International Health, University of Otago, New Zealand; Kilimanjaro Christian Medical Centre, Moshi, Tanzania.
| | - Q Bassat
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique; ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain; ICREA, Pg. Lluís Companys 23, Barcelona, Spain; Paediatric Infectious Diseases Unit, Paediatrics Department, Hospital Sant Joan de Déu (University of Barcelona), Barcelona, Spain
| | - N A Feasey
- Liverpool School of Tropical Medicine, Liverpool, UK; Malawi Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - I Mandomando
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique; Instituto Nacional de Saúde, Ministério da Saúde, Maputo, Mozambique
| | - P Musicha
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - J A Crump
- Centre for International Health, University of Otago, New Zealand; Kilimanjaro Christian Medical Centre, Moshi, Tanzania; Kilimanjaro Christian Medical University College, Tumaini University, Moshi, Tanzania
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24
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Cash-Goldwasser S, Maze MJ, Rubach MP, Biggs HM, Stoddard RA, Sharples KJ, Halliday JEB, Cleaveland S, Shand MC, Mmbaga BT, Muiruri C, Saganda W, Lwezaula BF, Kazwala RR, Maro VP, Crump JA. Risk Factors for Human Brucellosis in Northern Tanzania. Am J Trop Med Hyg 2018; 98:598-606. [PMID: 29231152 PMCID: PMC5929176 DOI: 10.4269/ajtmh.17-0125] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 10/08/2017] [Indexed: 11/27/2022] Open
Abstract
Little is known about the epidemiology of human brucellosis in sub-Saharan Africa. This hampers prevention and control efforts at the individual and population levels. To evaluate risk factors for brucellosis in northern Tanzania, we conducted a study of patients presenting with fever to two hospitals in Moshi, Tanzania. Serum taken at enrollment and at 4-6 week follow-up was tested by Brucella microagglutination test. Among participants with a clinically compatible illness, confirmed brucellosis cases were defined as having a ≥ 4-fold rise in agglutination titer between paired sera or a blood culture positive for Brucella spp., and probable brucellosis cases were defined as having a single reciprocal titer ≥ 160. Controls had reciprocal titers < 20 in paired sera. We collected demographic and clinical information and administered a risk factor questionnaire. Of 562 participants in the analysis, 50 (8.9%) had confirmed or probable brucellosis. Multivariable analysis showed that risk factors for brucellosis included assisting goat or sheep births (Odds ratio [OR] 5.9, 95% confidence interval [CI] 1.4, 24.6) and having contact with cattle (OR 1.2, 95% CI 1.0, 1.4). Consuming boiled or pasteurized dairy products was protective against brucellosis (OR 0.12, 95% CI 0.02, 0.93). No participants received a clinical diagnosis of brucellosis from their healthcare providers. The under-recognition of brucellosis by healthcare workers could be addressed with clinician education and better access to brucellosis diagnostic tests. Interventions focused on protecting livestock keepers, especially those who assist goat or sheep births, are needed.
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Affiliation(s)
- Shama Cash-Goldwasser
- Duke Global Health Institute, Duke University, Durham, North Carolina
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Michael J. Maze
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Centre for International Health, University of Otago, Dunedin, New Zealand
| | - Matthew P. Rubach
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina
| | - Holly M. Biggs
- Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina
| | - Robyn A. Stoddard
- Centers for Disease Control and Prevention, Bacterial Special Pathogens Branch, Atlanta, Georgia
| | - Katrina J. Sharples
- Department of Mathematics and Statistics, University of Otago, Dunedin, New Zealand
- Department of Medicine, University of Otago, Dunedin, New Zealand
| | - Jo E. B. Halliday
- Boyd Orr Centre for Population and Ecosystem Health, Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, United Kingdom
| | - Sarah Cleaveland
- Boyd Orr Centre for Population and Ecosystem Health, Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, United Kingdom
| | - Michael C. Shand
- Boyd Orr Centre for Population and Ecosystem Health, Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, United Kingdom
| | - Blandina T. Mmbaga
- Duke Global Health Institute, Duke University, Durham, North Carolina
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Charles Muiruri
- Duke Global Health Institute, Duke University, Durham, North Carolina
| | | | | | - Rudovick R. Kazwala
- Department of Veterinary Medicine and Public Health, Sokoine University of Agriculture, Morogoro, Tanzania
| | - Venance P. Maro
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - John A. Crump
- Duke Global Health Institute, Duke University, Durham, North Carolina
- Centre for International Health, University of Otago, Dunedin, New Zealand
- Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
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Hercik C, Cosmas L, Mogeni OD, Wamola N, Kohi W, Houpt E, Liu J, Ochieng C, Onyango C, Fields B, Mfinanga S, Montgomery JM. A Combined Syndromic Approach to Examine Viral, Bacterial, and Parasitic Agents among Febrile Patients: A Pilot Study in Kilombero, Tanzania. Am J Trop Med Hyg 2017; 98:625-632. [PMID: 29280432 PMCID: PMC5929188 DOI: 10.4269/ajtmh.17-0421] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
The use of fever syndromic surveillance in sub-Saharan Africa is an effective approach to determine the prevalence of both malarial and nonmalarial infectious agents. We collected both blood and naso/oro-pharyngeal (NP/OP) swabs from consecutive consenting patients ≥ 1 year of age, with an axillary temperature ≥ 37.5°C, and symptom onset of ≤ 5 days. Specimens were analyzed using both acute febrile illness (AFI) and respiratory TaqMan array cards (Resp TAC) for multiagent detection of 56 different bloodstream and respiratory agents. In addition, we collected epidemiologic data to further characterize our patient population. We enrolled 205 febrile patients, including 70 children (1 < 15 years of age; 34%) and 135 adults (≥ 15 years of age; 66%). AFI TAC and Resp TAC were performed on 191 whole blood specimens and 115 NP/OP specimens, respectively. We detected nucleic acid for Plasmodium (57%), Leptospira (2%), and dengue virus (1%) among blood specimens. In addition, we detected 17 different respiratory agents, most notably, Haemophilus influenzae (64%), Streptococcus pneumonia (56%), Moraxella catarrhalis (39%), and respiratory syncytial virus (11%) among NP/OP specimens. Overall median cycle threshold was measured at 26.5. This study provides a proof-of-concept for the use of a multiagent diagnostic approach for exploratory research on febrile illness and underscores the utility of quantitative molecular diagnostics in complex epidemiologic settings of sub-Saharan Africa.
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Affiliation(s)
| | - Leonard Cosmas
- Global Disease Detection Branch, Division of Global Health Protection, Center for Global Health, US Centers for Disease Control and Prevention (CDC), Nairobi, Kenya
| | - Ondari D Mogeni
- Kenya Medical Research Institute-Centre for Global Health Research (KEMRI-CGHR), Nairobi, Kenya
| | - Newton Wamola
- Kenya Medical Research Institute-Centre for Global Health Research (KEMRI-CGHR), Nairobi, Kenya
| | - Wanze Kohi
- National Institute of Medical Research (NIMR), Muhimbili Research Centre, Salaam, Tanzania
| | - Eric Houpt
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia
| | - Jie Liu
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia
| | - Caroline Ochieng
- Kenya Medical Research Institute-Centre for Global Health Research (KEMRI-CGHR), Nairobi, Kenya
| | - Clayton Onyango
- Global Disease Detection Branch, Division of Global Health Protection, Center for Global Health, US Centers for Disease Control and Prevention (CDC), Nairobi, Kenya
| | - Barry Fields
- Global Disease Detection Branch, Division of Global Health Protection, Center for Global Health, US Centers for Disease Control and Prevention (CDC), Nairobi, Kenya
| | - Sayoki Mfinanga
- National Institute of Medical Research (NIMR), Muhimbili Research Centre, Salaam, Tanzania
| | - Joel M Montgomery
- Global Disease Detection Branch, Division of Global Health Protection, Center for Global Health, US Centers for Disease Control and Prevention (CDC), Nairobi, Kenya
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Are brucellosis, Q fever and melioidosis potential causes of febrile illness in Madagascar? Acta Trop 2017; 172:255-262. [PMID: 28502643 DOI: 10.1016/j.actatropica.2017.05.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 05/09/2017] [Accepted: 05/10/2017] [Indexed: 12/18/2022]
Abstract
Brucellosis, Q fever and melioidosis are zoonoses, which can lead to pyrexia. These diseases are often under-ascertained and underreported because of their unspecific clinical signs and symptoms, insufficient awareness by physicians and public health officers and limited diagnostic capabilities, especially in low-resource countries. Therefore, the presence of Brucella spp., Coxiella burnetii and Burkholderia pseudomallei was investigated in Malagasy patients exhibiting febrile illness. In addition, we analyzed zebu cattle and their ticks as potential reservoirs for Brucella and C. burnetii, respectively. Specific quantitative real-time PCR assays (qPCRs) were performed on 1020 blood samples drawn from febrile patients. In total, 15 samples (1.5%) were Brucella-positive, mainly originating from patients without travel history, while DNA from C. burnetii and Bu. pseudomallei was not detected. Anti-C. burnetii antibodies were found in four out of 201 zebu serum samples (2%), whereas anti-Brucella antibodies could not be detected. Brucella DNA was detected in a single zebu sample. Three out of 330 ticks analyzed (1%) were positively tested for C. burnetii DNA but with high Ct values in the qPCR assay. Our data suggest that zebus as well as Amblyomma and Boophilus ticks have to be considered as a natural reservoir or vector for C. burnetii, but the risk of cattle-to-human transmission is low. Since bovine brucellosis does not seem to contribute to human infections in Madagascar, other transmission routes have to be assumed.
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Gafirita J, Kiiza G, Murekatete A, Ndahayo LL, Tuyisenge J, Mashengesho V, Ruhirwa R, Nyandwi T, Asiimwe-Kateera B, Ndahindwa V, Njunwa KJ. Seroprevalence of Brucellosis among Patients Attending a District Hospital in Rwanda. Am J Trop Med Hyg 2017; 97:831-835. [PMID: 28749771 DOI: 10.4269/ajtmh.16-0632] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Studies on human brucellosis in Rwanda are scarce, and the incidence is likely to be higher than official estimates. In a recent study using Rose Bengal Test (RBT) on women who had aborted or had still births in Huye district, 25% were Brucella seroprevalent. Thus, purpose of the present study was to investigate the Brucella seroprevalence in patients presenting with the key signs and symptoms of brucellosis. Cross-sectional study was done in Nyagatare District in the Eastern Province of Rwanda. A total of 198 patients were recruited from Nyagatare District Hospital, blood samples were collected, and sera analyzed with RBT. A questionnaire was used to explore the risk factors. A total of 12 patients (6.1%; 95% confidence interval [CI] = 0.662-7.820) were Brucella seropositive. Infection was significantly associated with drinking unboiled milk (odds ratio [OR] = 8.3; 95% CI = 2.4-29.2) and having had recurrent fever (OR = 5.6; 95% CI = 1.5-21.3). Drinking unboiled milk is a risk factor for Brucella infection. Provision of adequate resources and trainings to staff in brucellosis diagnosis is needed to reduce recurrence of fevers probably because of misdiagnosis. Public awareness creation on transmission routes of brucellosis is to be intensified.
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Affiliation(s)
- James Gafirita
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - George Kiiza
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | | | - Leonard L Ndahayo
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - John Tuyisenge
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | | | | | - Theogene Nyandwi
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | | | - Vedaste Ndahindwa
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Kato J Njunwa
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
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Papadatos SS, Bazoukis G, Deligiannis G, Mylonas S, Zissis C. Respiratory Symptoms as Prominent Manifestation of Brucellosis: A Case Series. J Clin Diagn Res 2017; 11:OR01-OR03. [PMID: 28658841 DOI: 10.7860/jcdr/2017/26117.9848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Accepted: 03/09/2017] [Indexed: 11/24/2022]
Abstract
Brucellosis is a zoonotic infection primarily affecting the reticuoendothelial system: spleen, liver and bone marrow. Despite the fact that multisystem infection in brucellosis is usually reported, pulmonary involvement is considered to be very rare. We report four cases (three male and one female, farm workers) of pulmonary brucellosis who presented with signs and symptoms of lower respiratory infection. All of them underwent thorough clinical examination and laboratory tests before the diagnosis of pulmonary brucellosis was confirmed. All patients were hospitalized for at least eight days and given appropriate antibiotic therapy. Follow up after 12-24 months showed no lasting effects from the infection and laboratory tests were found within the normal limits.
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Affiliation(s)
- Stamatis S Papadatos
- Faculty, Department of Internal Medicine, Athens School of Medicine, National and Kapodistrian University of Athens, Sotiria General Hospital, Athens, Greece
| | - George Bazoukis
- Faculty, Department of Internal Medicine, Elpis General Hospital, Athens, Attica, Greece
| | - Georgios Deligiannis
- Faculty, Department of Cardiology, General Hospital of Karditsa, Karditsa, Thessaly, Greece
| | - Stefanos Mylonas
- Faculty, Department of Internal Medicine, General Hospital of Trikala, Trikala, Thessaly, Greece
| | - Christos Zissis
- Faculty, Department of Internal Medicine, General Hospital of Trikala, Trikala, Thessaly, Greece
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Ducrotoy M, Bertu W, Matope G, Cadmus S, Conde-Álvarez R, Gusi A, Welburn S, Ocholi R, Blasco J, Moriyón I. Brucellosis in Sub-Saharan Africa: Current challenges for management, diagnosis and control. Acta Trop 2017; 165:179-193. [PMID: 26551794 DOI: 10.1016/j.actatropica.2015.10.023] [Citation(s) in RCA: 126] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2015] [Revised: 09/14/2015] [Accepted: 10/29/2015] [Indexed: 02/04/2023]
Abstract
Brucellosis is a highly contagious zoonosis caused by bacteria of the genus Brucella and affecting domestic and wild mammals. In this paper, the bacteriological and serological evidence of brucellosis in Sub-Saharan Africa (SSA) and its epidemiological characteristics are discussed. The tools available for the diagnosis and treatment of human brucellosis and for the diagnosis and control of animal brucellosis and their applicability in the context of SSA are presented and gaps identified. These gaps concern mostly the need for simpler and more affordable antimicrobial treatments against human brucellosis, the development of a B. melitensis vaccine that could circumvent the drawbacks of the currently available Rev 1 vaccine, and the investigation of serological diagnostic tests for camel brucellosis and wildlife. Strategies for the implementation of animal vaccination are also discussed.
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Njeru J, Wareth G, Melzer F, Henning K, Pletz MW, Heller R, Neubauer H. Systematic review of brucellosis in Kenya: disease frequency in humans and animals and risk factors for human infection. BMC Public Health 2016; 16:853. [PMID: 27549329 PMCID: PMC4994226 DOI: 10.1186/s12889-016-3532-9] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 08/17/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Brucellosis is a debilitating zoonotic disease affecting humans and animals. A comprehensive, evidence-based assessment of literature and officially available data on animal and human brucellosis for Kenya are missing. The aim of the current review is to provide frequency estimates of brucellosis in humans, animals and risk factors for human infection, and help to understand the current situation in Kenya. METHODS A total of accessible 36 national and international publications on brucellosis from 1916 to 2016 were reviewed to estimate the frequency of brucellosis in humans and animals, and strength of associations between potential risk factors and seropositivity in humans in Kenya. RESULTS The conducted studies revealed only few and fragmented evidence of the disease spatial and temporal distribution in an epidemiological context. Bacteriological evidence revealed the presence of Brucella (B.) abortus and B. melitensis in cattle and human patients, whilst B. suis was isolated from wild rodents only. Similar evidence for Brucella spp infection in small ruminants and other animal species is unavailable. The early and most recent serological studies revealed that animal brucellosis is widespread in all animal production systems. The animal infection pressure in these systems has remained strong due to mixing of large numbers of animals from different geographical regions, movement of livestock in search of pasture, communal sharing of grazing land, and the concentration of animals around water points. Human cases are more likely seen in groups occupationally or domestically exposed to livestock or practicing risky social-cultural activities such as consumption of raw blood and dairy products, and slaughtering of animals within the homesteads. Many brucellosis patients are misdiagnosed and probably mistreated due to lack of reliable laboratory diagnostic support resulting to adverse health outcomes of the patients and routine disease underreporting. We found no studies of disease incidence estimates or disease control efforts. CONCLUSION The risk for re-emergence and transmission of brucellosis is evident as a result of the co-existence of animal husbandry activities and social-cultural activities that promote brucellosis transmission. Well-designed countrywide, evidence-based, and multidisciplinary studies of brucellosis at the human/livestock/wildlife interface are needed. These could help to generate reliable frequency and potential impact estimates, to identify Brucella reservoirs, and to propose control strategies of proven efficacy.
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Affiliation(s)
- J. Njeru
- Institute of Bacterial Infections and Zoonoses, Friedrich-Loeffler-Institut (FLI), Naumburger str. 96a, 07743 Jena, Germany
- Center for Infectious Diseases and Infection Control, Jena University Hospital, 07740 Jena, Germany
- Centre for Microbiology Research (CMR), Kenya Medical Research Institute, P. O. Box 19464-00202, Nairobi, Kenya
| | - G. Wareth
- Institute of Bacterial Infections and Zoonoses, Friedrich-Loeffler-Institut (FLI), Naumburger str. 96a, 07743 Jena, Germany
- Faculty of Veterinary Medicine, Benha University, Moshtohor, Egypt
| | - F. Melzer
- Institute of Bacterial Infections and Zoonoses, Friedrich-Loeffler-Institut (FLI), Naumburger str. 96a, 07743 Jena, Germany
| | - K. Henning
- Institute of Bacterial Infections and Zoonoses, Friedrich-Loeffler-Institut (FLI), Naumburger str. 96a, 07743 Jena, Germany
| | - M. W. Pletz
- Center for Infectious Diseases and Infection Control, Jena University Hospital, 07740 Jena, Germany
| | - R. Heller
- Institute for Molecular Cell Biology, Center for Molecular Biomedicine, Jena University Hospital, 07745 Jena, Germany
| | - H. Neubauer
- Institute of Bacterial Infections and Zoonoses, Friedrich-Loeffler-Institut (FLI), Naumburger str. 96a, 07743 Jena, Germany
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Integrating serological and genetic data to quantify cross-species transmission: brucellosis as a case study. Parasitology 2016; 143:821-834. [PMID: 26935267 PMCID: PMC4873909 DOI: 10.1017/s0031182016000044] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Epidemiological data are often fragmented, partial, and/or ambiguous and unable to yield the desired level of understanding of infectious disease dynamics to adequately inform control measures. Here, we show how the information contained in widely available serology data can be enhanced by integration with less common type-specific data, to improve the understanding of the transmission dynamics of complex multi-species pathogens and host communities. Using brucellosis in northern Tanzania as a case study, we developed a latent process model based on serology data obtained from the field, to reconstruct Brucella transmission dynamics. We were able to identify sheep and goats as a more likely source of human and animal infection than cattle; however, the highly cross-reactive nature of Brucella spp. meant that it was not possible to determine which Brucella species (B. abortus or B. melitensis) is responsible for human infection. We extended our model to integrate simulated serology and typing data, and show that although serology alone can identify the host source of human infection under certain restrictive conditions, the integration of even small amounts (5%) of typing data can improve understanding of complex epidemiological dynamics. We show that data integration will often be essential when more than one pathogen is present and when the distinction between exposed and infectious individuals is not clear from serology data. With increasing epidemiological complexity, serology data become less informative. However, we show how this weakness can be mitigated by integrating such data with typing data, thereby enhancing the inference from these data and improving understanding of the underlying dynamics.
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Halliday JEB, Allan KJ, Ekwem D, Cleaveland S, Kazwala RR, Crump JA. Endemic zoonoses in the tropics: a public health problem hiding in plain sight. Vet Rec 2015; 176:220-5. [PMID: 25722334 PMCID: PMC4350138 DOI: 10.1136/vr.h798] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Zoonotic diseases are a significant burden on animal and human health, particularly in developing countries. Despite recognition of this fact, endemic zoonoses often remain undiagnosed in people, instead being mistaken for febrile diseases such as malaria. Here, as part of Veterinary Record's ongoing series of articles on One Health, a multidisciplinary team of researchers from Scotland, Tanzania and New Zealand argues that a One Health approach is needed to effectively combat these diseases
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Affiliation(s)
- Jo E B Halliday
- College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow G12 8QQ, UK
| | - Kathryn J Allan
- College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow G12 8QQ, UK
| | - Divine Ekwem
- College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow G12 8QQ, UK
| | - Sarah Cleaveland
- College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow G12 8QQ, UK
| | - Rudovick R Kazwala
- Faculty of Veterinary Medicine, Sokoine University of Agriculture, P. O. Box 3015, Chuo Kikuu, Morogoro, Tanzania
| | - John A Crump
- Centre for International Health, Dunedin School of Medicine, University of Otago, PO Box 56, Dunedin 9054, New Zealand
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Chipwaza B, Mhamphi GG, Ngatunga SD, Selemani M, Amuri M, Mugasa JP, Gwakisa PS. Prevalence of bacterial febrile illnesses in children in Kilosa district, Tanzania. PLoS Negl Trop Dis 2015; 9:e0003750. [PMID: 25955522 PMCID: PMC4425467 DOI: 10.1371/journal.pntd.0003750] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2014] [Accepted: 04/10/2015] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Bacterial etiologies of non-malaria febrile illnesses have significantly become important due to high mortality and morbidity, particularly in children. Despite their importance, there are few reports on the epidemiology of these diseases in Tanzania, and the true burden of such illnesses remains unknown. This study aimed to identify the prevalence of leptospirosis, brucellosis, typhoid fever and urinary tract infections and their rate of co-infections with malaria. METHODS A cross-sectional study was conducted at Kilosa district hospital in Tanzania for 6 months. Febrile children aged from 2-13 years were recruited from the outpatient department. Patients were screened by serological tests such as IgM and IgG ELISA, and microscopic agglutination test. RESULTS A total of 370 patients were enrolled; of these 85 (23.0%) had malaria parasites, 43 (11.6%) had presumptive acute leptospirosis and 26/200 (13%) had confirmed leptospirosis. Presumptive acute brucellosis due to B. abortus was identified among 26 (7.0%) of patients while B. melitensis was detected in 57 (15.4%) of the enrolled patients. Presumptive typhoid fever due to S. Typhi was identified in thirty eight (10.3%) of the participants and 69 (18.6%) had urinary tract infections. Patients presented with similar symptoms; therefore, the identification of these diseases could not be done based on clinical ground alone. Co-infections between malaria and bacterial febrile illnesses were observed in 146 patients (39.5%). Although antibacterials and/or anti-malarials were prescribed in most patients, some patients did not receive the appropriate treatment. CONCLUSION The study has underscored the importance of febrile bacterial diseases including zoonoses such as leptospirosis and brucellosis in febrile children, and thus such illnesses should be considered by clinicians in the differential diagnoses of febrile diseases. However, access to diagnostic tests for discrimination of febrile illnesses is needed. This would allow febrile patients to receive the correct diagnoses and facilitation of accurate and prompt treatment.
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Affiliation(s)
- Beatrice Chipwaza
- Nelson Mandela African Institution of Science and Technology, Arusha, Tanzania
- Ifakara Health Institute, Ifakara, Tanzania
| | - Ginethon G. Mhamphi
- Sokoine University of Agriculture, Pest Management Center, Chuo Kikuu, Morogoro, Tanzania
| | | | | | | | - Joseph P. Mugasa
- National Institute for Medical Research, Amani Medical Research Centre, Tanga, Tanzania
| | - Paul S. Gwakisa
- Nelson Mandela African Institution of Science and Technology, Arusha, Tanzania
- Genome Science Centre and Department of Veterinary Microbiology and Parasitology, Sokoine University of Agriculture, Morogoro, Tanzania
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Shirima GM, Masola SN, Malangu ON, Schumaker BA. Outbreak investigation and control case report of brucellosis: experience from livestock research centre, Mpwapwa, Tanzania. ACTA ACUST UNITED AC 2014; 81:818. [PMID: 25685904 DOI: 10.4102/ojvr.v81i1.818] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Revised: 10/05/2014] [Accepted: 08/25/2014] [Indexed: 11/01/2022]
Abstract
Brucellosis screening was conducted between 2005 and 2010 at the National Livestock Research Institute headquarters, Mpwapwa, Tanzania, following an abortion storm in cattle. The initial screening targeted breeding herds; 483 cattle were screened using the Rose Bengal Plate Test (RBPT) followed by the Competitive Enzyme-linked Immunosorbent Assay (c-ELISA) as a confirmatory test. The seropositivity on c-ELISA was 28.95% in 2005; it subsequently declined to 6.72%, 1.17%, 0.16% and 0.00% in 2006, 2007, 2009 and 2010, respectively. Brucella seropositivity was not detected in goats. Seropositivity declined following institution of stringent control measures that included: gradual culling of seropositive animals through slaughter; isolation and confinement of pregnant cows close to calving; proper disposal of placentas and aborted foetuses; the use of the S19 vaccine; and restricted introduction of new animals. It was thought that the source of this outbreak was likely to have been from the introduction of infected animals from another farm. Furthermore, humans were found with brucellosis antibodies. Out of 120 people screened, 12 (10%) were confirmed seropositive to brucella antigen exposure by c-ELISA analysis. The majority of the seropositive individuals (80%) were milkers and animal handlers from the farm. Nine individuals had clinical signs suggestive of brucellosis. All cases received medical attention from the district hospital. This achievement in livestock and human health showed that it is possible to control brucellosis in dairy farms, compared to pastoral and agro-pastoral farms, thus providing evidence to adopt these strategies in dairy farms thought to be at risk.
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Rubach MP, Maro VP, Bartlett JA, Crump JA. Etiologies of illness among patients meeting integrated management of adolescent and adult illness district clinician manual criteria for severe infections in northern Tanzania: implications for empiric antimicrobial therapy. Am J Trop Med Hyg 2014; 92:454-62. [PMID: 25385866 DOI: 10.4269/ajtmh.14-0496] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
We describe the laboratory-confirmed etiologies of illness among participants in a hospital-based febrile illness cohort study in northern Tanzania who retrospectively met Integrated Management of Adolescent and Adult Illness District Clinician Manual (IMAI) criteria for septic shock, severe respiratory distress without shock, and severe pneumonia, and compare these etiologies against commonly used antimicrobials, including IMAI recommendations for emergency antibacterials (ceftriaxone or ampicillin plus gentamicin) and IMAI first-line recommendations for severe pneumonia (ceftriaxone and a macrolide). Among 423 participants hospitalized with febrile illness, there were 25 septic shock, 37 severe respiratory distress without shock, and 109 severe pneumonia cases. Ceftriaxone had the highest potential utility of all antimicrobials assessed, with responsive etiologies in 12 (48%) septic shock, 5 (14%) severe respiratory distress without shock, and 19 (17%) severe pneumonia illnesses. For each syndrome 17-27% of participants had etiologic diagnoses that would be non-responsive to ceftriaxone, but responsive to other available antimicrobial regimens including amphotericin for cryptococcosis and histoplasmosis; anti-tuberculosis therapy for bacteremic disseminated tuberculosis; or tetracycline therapy for rickettsioses and Q fever. We conclude that although empiric ceftriaxone is appropriate in our setting, etiologies not explicitly addressed in IMAI guidance for these syndromes, such as cryptococcosis, histoplasmosis, and tetracycline-responsive bacterial infections, were common.
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Affiliation(s)
- Matthew P Rubach
- Division of Infectious Diseases and International Health, Department of Medicine, Duke University, Durham, North Carolina; Department of Medicine, Kilimanjaro Christian Medical Centre, Moshi, Tanzania; Kilimanjaro Christian Medical University College, Tumaini University, Moshi, Tanzania; Duke Global Health Institute, Duke University, Durham, North Carolina; Centre for International Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Venance P Maro
- Division of Infectious Diseases and International Health, Department of Medicine, Duke University, Durham, North Carolina; Department of Medicine, Kilimanjaro Christian Medical Centre, Moshi, Tanzania; Kilimanjaro Christian Medical University College, Tumaini University, Moshi, Tanzania; Duke Global Health Institute, Duke University, Durham, North Carolina; Centre for International Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - John A Bartlett
- Division of Infectious Diseases and International Health, Department of Medicine, Duke University, Durham, North Carolina; Department of Medicine, Kilimanjaro Christian Medical Centre, Moshi, Tanzania; Kilimanjaro Christian Medical University College, Tumaini University, Moshi, Tanzania; Duke Global Health Institute, Duke University, Durham, North Carolina; Centre for International Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - John A Crump
- Division of Infectious Diseases and International Health, Department of Medicine, Duke University, Durham, North Carolina; Department of Medicine, Kilimanjaro Christian Medical Centre, Moshi, Tanzania; Kilimanjaro Christian Medical University College, Tumaini University, Moshi, Tanzania; Duke Global Health Institute, Duke University, Durham, North Carolina; Centre for International Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
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Noden BH, Tshavuka FI, van der Colf BE, Chipare I, Wilkinson R. Exposure and risk factors to coxiella burnetii, spotted fever group and typhus group Rickettsiae, and Bartonella henselae among volunteer blood donors in Namibia. PLoS One 2014; 9:e108674. [PMID: 25259959 PMCID: PMC4178180 DOI: 10.1371/journal.pone.0108674] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Accepted: 09/03/2014] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The role of pathogen-mediated febrile illness in sub-Saharan Africa is receiving more attention, especially in Southern Africa where four countries (including Namibia) are actively working to eliminate malaria. With a high concentration of livestock and high rates of companion animal ownership, the influence of zoonotic bacterial diseases as causes of febrile illness in Namibia remains unknown. METHODOLOGY/PRINCIPAL FINDINGS The aim of the study was to evaluate exposure to Coxiella burnetii, spotted fever and typhus group rickettsiae, and Bartonella henselae using IFA and ELISA (IgG) in serum collected from 319 volunteer blood donors identified by the Blood Transfusion Service of Namibia (NAMBTS). Serum samples were linked to a basic questionnaire to identify possible risk factors. The majority of the participants (64.8%) had extensive exposure to rural areas or farms. Results indicated a C. burnetii prevalence of 26.1% (screening titre 1∶16), and prevalence rates of 11.9% and 14.9% (screening titre 1∶100) for spotted fever group and typhus group rickettsiae, respectively. There was a significant spatial association between C. burnetii exposure and place of residence in southern Namibia (P<0.021). Donors with occupations involving animals (P>0.012), especially cattle (P>0.006), were also significantly associated with C. burnetii exposure. Males were significantly more likely than females to have been exposed to spotted fever (P<0.013) and typhus (P<0.011) group rickettsiae. Three (2.9%) samples were positive for B. henselae possibly indicating low levels of exposure to a pathogen never reported in Namibia. CONCLUSIONS/SIGNIFICANCE These results indicate that Namibians are exposed to pathogenic fever-causing bacteria, most of which have flea or tick vectors/reservoirs. The epidemiology of febrile illnesses in Namibia needs further evaluation in order to develop comprehensive local diagnostic and treatment algorithms.
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Affiliation(s)
- Bruce H. Noden
- Department of Biomedical Science, Polytechnic of Namibia, Windhoek, Namibia
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- Blood Transfusion Service of Namibia, Windhoek, Namibia
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Rubach MP, Halliday JEB, Cleaveland S, Crump JA. Brucellosis in low-income and middle-income countries. Curr Opin Infect Dis 2014; 26:404-12. [PMID: 23963260 DOI: 10.1097/qco.0b013e3283638104] [Citation(s) in RCA: 131] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE OF REVIEW Human brucellosis is a neglected, underrecognized infection of widespread geographic distribution. It causes acute febrile illness and a potentially debilitating chronic infection in humans, and livestock infection has substantial socioeconomic impact. This review describes new information regarding the epidemiology of brucellosis in the developing world and advances in diagnosis and treatment. RECENT FINDINGS The highest recorded incidence of human brucellosis occurs in the Middle East and Central Asia. Fever etiology studies demonstrate brucellosis as a cause of undifferentiated febrile illness in the developing world. Brucellosis is a rare cause of fever among returning travelers, but is more common among travelers returning from the Middle East and North Africa. Sensitive and specific rapid diagnostic tests appropriate for resource-limited settings have been validated. Randomized controlled trials demonstrate that optimal treatment for human brucellosis consists of doxycycline and an aminoglycoside. Decreasing the burden of human brucellosis requires control of animal brucellosis, but evidence to inform the design of control programs in the developing world is needed. SUMMARY Brucellosis causes substantial morbidity in human and animal populations. While improvements in diagnostic options for resource-limited settings and stronger evidence for optimal therapy should enhance identification and treatment of human brucellosis, prevention of human disease through control in animals remains paramount.
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Affiliation(s)
- Matthew P Rubach
- Division of Infectious Diseases and International Health, Department of Medicine, Duke University, Durham, North Carolina, USA
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Evaluation of in-hospital management for febrile illness in Northern Tanzania before and after 2010 World Health Organization Guidelines for the treatment of malaria. PLoS One 2014; 9:e89814. [PMID: 24587056 PMCID: PMC3933647 DOI: 10.1371/journal.pone.0089814] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Accepted: 01/25/2014] [Indexed: 12/01/2022] Open
Abstract
Objective In 2010, the World Health Organization (WHO) published updated guidelines emphasizing and expanding recommendations for a parasitological confirmation of malaria before treating with antimalarials. This study aimed to assess differences in historic (2007–2008) (cohort 1) and recent (2011–2012) (cohort 2) hospital cohorts in the diagnosis and treatment of febrile illness in a low malaria prevalence area of northern Tanzania. Materials and Methods We analyzed data from two prospective cohort studies that enrolled febrile adolescents and adults aged ≥13 years. All patients received quality-controlled aerobic blood cultures and malaria smears. We compared patients' discharge diagnoses, treatments, and outcomes to assess changes in the treatment of malaria and bacterial infections. Results In total, 595 febrile inpatients were enrolled from two referral hospitals in Moshi, Tanzania. Laboratory-confirmed malaria was detected in 13 (3.2%) of 402 patients in cohort 1 and 1 (0.5%) of 193 patients in cohort 2 (p = 0.041). Antimalarials were prescribed to 201 (51.7%) of 389 smear-negative patients in cohort 1 and 97 (50.5%) of 192 smear-negative patients in cohort 2 (p = 0.794). Bacteremia was diagnosed from standard blood culture in 58 (14.5%) of 401 patients in cohort 1 compared to 18 (9.5%) of 190 patients in cohort 2 (p = 0.091). In cohort 1, 40 (69.0%) of 58 patients with a positive blood culture received antibacterials compared to 16 (88.9%) of 18 patients in cohort 2 (p = 0.094). In cohort 1, 43 (10.8%) of the 399 patients with known outcomes died during hospitalization compared with 12 (6.2%) deaths among 193 patients in cohort 2 (p = 0.073). Discussion In a setting of low malaria transmission, a high proportion of smear-negative patients were diagnosed with malaria and treated with antimalarials despite updated WHO guidelines on malaria treatment. Improved laboratory diagnostics for non-malaria febrile illness might help to curb this practice.
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Hertz JT, Munishi OM, Sharp JP, Reddy EA, Crump JA. Comparing actual and perceived causes of fever among community members in a low malaria transmission setting in northern Tanzania. Trop Med Int Health 2013; 18:1406-15. [PMID: 24103083 DOI: 10.1111/tmi.12191] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To compare actual and perceived causes of fever in northern Tanzania. METHODS In a standardised survey, heads of households in 30 wards in Moshi, Tanzania, were asked to identify the most common cause of fever for children and for adults. Responses were compared to data from a local hospital-based fever aetiology study that used standard diagnostic techniques. RESULTS Of 810 interviewees, the median (range) age was 48 (16, 102) years and 509 (62.8%) were women. Malaria was the most frequently identified cause of fever, cited by 353 (43.6%) and 459 (56.7%) as the most common cause of fever for children and adults, respectively. In contrast, malaria accounted for 8 (2.0%) of adult and 6 (1.3%) of paediatric febrile admissions in the fever aetiology study. Weather was the second most frequently cited cause of fever. Participants who identified a non-biomedical explanation such as weather as the most common cause of fever were more likely to prefer a traditional healer for treatment of febrile adults (OR 2.7, P < 0.001). Bacterial zoonoses were the most common cause of fever among inpatients, but no interviewees identified infections from animal contact as the most common cause of fever for adults; two (0.2%) identified these infections as the most common cause of fever for children. CONCLUSIONS Malaria is perceived to be a much more common cause of fever than hospital studies indicate, whereas other important diseases are under-appreciated in northern Tanzania. Belief in non-biomedical explanations of fever is common locally and has important public health consequences.
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Affiliation(s)
- Julian T Hertz
- Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, NC, USA
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Crump JA, Morrissey AB, Nicholson WL, Massung RF, Stoddard RA, Galloway RL, Ooi EE, Maro VP, Saganda W, Kinabo GD, Muiruri C, Bartlett JA. Etiology of severe non-malaria febrile illness in Northern Tanzania: a prospective cohort study. PLoS Negl Trop Dis 2013; 7:e2324. [PMID: 23875053 PMCID: PMC3715424 DOI: 10.1371/journal.pntd.0002324] [Citation(s) in RCA: 277] [Impact Index Per Article: 25.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Accepted: 06/09/2013] [Indexed: 12/13/2022] Open
Abstract
Introduction The syndrome of fever is a commonly presenting complaint among persons seeking healthcare in low-resource areas, yet the public health community has not approached fever in a comprehensive manner. In many areas, malaria is over-diagnosed, and patients without malaria have poor outcomes. Methods and Findings We prospectively studied a cohort of 870 pediatric and adult febrile admissions to two hospitals in northern Tanzania over the period of one year using conventional standard diagnostic tests to establish fever etiology. Malaria was the clinical diagnosis for 528 (60.7%), but was the actual cause of fever in only 14 (1.6%). By contrast, bacterial, mycobacterial, and fungal bloodstream infections accounted for 85 (9.8%), 14 (1.6%), and 25 (2.9%) febrile admissions, respectively. Acute bacterial zoonoses were identified among 118 (26.2%) of febrile admissions; 16 (13.6%) had brucellosis, 40 (33.9%) leptospirosis, 24 (20.3%) had Q fever, 36 (30.5%) had spotted fever group rickettsioses, and 2 (1.8%) had typhus group rickettsioses. In addition, 55 (7.9%) participants had a confirmed acute arbovirus infection, all due to chikungunya. No patient had a bacterial zoonosis or an arbovirus infection included in the admission differential diagnosis. Conclusions Malaria was uncommon and over-diagnosed, whereas invasive infections were underappreciated. Bacterial zoonoses and arbovirus infections were highly prevalent yet overlooked. An integrated approach to the syndrome of fever in resource-limited areas is needed to improve patient outcomes and to rationally target disease control efforts. The syndrome of fever is caused by a large number of infectious diseases. Malaria is thought to have been declining in the tropics since 2004. Increasing use of malaria diagnostic tests reveal a growing proportion of patients with fever who do not have malaria. While malaria diagnostic tests may be available, healthcare workers have few tools to diagnose causes of fever other than malaria. In order to identify major causes of fever other than malaria in northern Tanzania, we studied 870 patients with fever who were sufficiently ill to require admission to hospital. Malaria was uncommon and over-diagnosed, whereas invasive infections, including bloodstream infections, were underappreciated. Infections associated with animals such as brucellosis, leptospirosis, Q fever, and spotted fever group rickettsioses as well as viral infections transmitted by mosquitoes were common yet overlooked. We recommend that research on the syndrome of fever in resource-limited areas should focus on a wide range of potential causes. Animal-associated infections should be prioritized in patient management and disease control.
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Affiliation(s)
- John A Crump
- Division of Infectious Diseases and International Health, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA.
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Fiorillo SP, Diefenthal HC, Goodman PC, Ramadhani HO, Njau BN, Morrissey AB, Maro VP, Saganda W, Kinabo GD, Mwako MS, Bartlett JA, Crump JA. Chest radiography for predicting the cause of febrile illness among inpatients in Moshi, Tanzania. Clin Radiol 2013; 68:1039-46. [PMID: 23809268 DOI: 10.1016/j.crad.2013.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2012] [Revised: 04/02/2013] [Accepted: 05/01/2013] [Indexed: 11/26/2022]
Abstract
AIM To describe chest radiographic abnormalities and assess their usefulness for predicting causes of fever in a resource-limited setting. MATERIALS AND METHODS Febrile patients were enrolled in Moshi, Tanzania, and chest radiographs were evaluated by radiologists in Tanzania and the United States. Radiologists were blinded to the results of extensive laboratory evaluations to determine the cause of fever. RESULTS Of 870 febrile patients, 515 (59.2%) had a chest radiograph available; including 268 (66.5%) of the adolescents and adults, the remainder were infants and children. One hundred and nineteen (44.4%) adults and 51 (20.6%) children were human immunodeficiency virus (HIV)-infected. Among adults, radiographic abnormalities were present in 139 (51.9%), including 77 (28.7%) with homogeneous and heterogeneous lung opacities, 26 (9.7%) with lung nodules, 25 (9.3%) with pleural effusion, 23 (8.6%) with cardiomegaly, and 13 (4.9%) with lymphadenopathy. Among children, radiographic abnormalities were present in 87 (35.2%), including 76 (30.8%) with homogeneous and heterogeneous lung opacities and six (2.4%) with lymphadenopathy. Among adolescents and adults, the presence of opacities was predictive of Streptococcus pneumoniae and Coxiella burnetii, whereas the presence of pulmonary nodules was predictive of Histoplasma capsulatum and Cryptococcus neoformans. CONCLUSIONS Chest radiograph abnormalities among febrile inpatients are common in northern Tanzania. Chest radiography is a useful adjunct for establishing an aetiologic diagnosis of febrile illness and may provide useful information for patient management, in particular for pneumococcal disease, Q fever, and fungal infections.
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Affiliation(s)
- S P Fiorillo
- Division of Infectious Diseases and International Health, Department of Medicine, Duke University Medical Center, Durham, NC, USA
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Auma MA, Siedner MJ, Nyehangane D, Nalusaji A, Nakaye M, Mwanga-Amumpaire J, Muhindo R, Wilson LA, Boum Y, Moore CC. Malaria is an uncommon cause of adult sepsis in south-western Uganda. Malar J 2013; 12:146. [PMID: 23634654 PMCID: PMC3654878 DOI: 10.1186/1475-2875-12-146] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Accepted: 04/29/2013] [Indexed: 12/21/2022] Open
Abstract
Background Malaria is often considered a cause of adult sepsis in malaria endemic areas. However, diagnostic limitations can make distinction between malaria and other infections challenging. Therefore, the objective of this study was to determine the relative contribution of malaria to adult sepsis in south-western Uganda. Methods Adult patients with sepsis were enrolled at the Mbarara Regional Referral Hospital between February and May 2012. Sepsis was defined as infection plus ≥2 of the following: axillary temperature >37.5°C or <35.5°C, heart rate >90 or respiratory rate >20. Severe sepsis was defined as sepsis plus organ dysfunction (blood lactate >4 mmol/L, confusion, or a systolic blood pressure <90 mmHg). Sociodemographic, clinical and laboratory data, including malaria PCR and rapid diagnostic tests, as well as acid fast bacteria sputum smears and blood cultures were collected. Patients were followed until in-patient death or discharge. The primary outcome of interest was the cause of sepsis. Multivariable logistic regression was performed to assess predictors of mortality. Results Enrollment included 216 participants who were 51% female with a median age of 32 years (IQR 27–43 years). Of these, 122 (56%) subjects were HIV-seropositive of whom 75 (66%) had a CD4+ T cell count <100 cells/μL. The prevalence of malaria was 4% (six with Plasmodium falciparum, two with Plasmodium vivax). Bacteraemia was identified in 41 (19%) patients. In-hospital mortality was 19% (n = 42). In multivariable regression analysis, Glasgow Coma Score <9 (IRR 4.81, 95% CI 1.80-12.8) and severe sepsis (IRR, 2.07, 95% CI 1.03-4.14), but no specific diagnoses were statistically associated with in-hospital mortality. Conclusion Malaria was an uncommon cause of adult sepsis in a regional referral hospital in south-western Uganda. In this setting, a thorough evaluation for alternate causes of disease in patients presenting with sepsis is recommended.
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Affiliation(s)
- Mary A Auma
- Department of Medicine, Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, USA
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