Resurgence In Incidence Research Articles

PERITONITE TUBERCULEUSE : CIRCONSTANCES DE DECOUVERTE, PRISE EN CHARGE ET FACTEURS PRONOSTIQUES AU SERVICE DE CHIRURGIE GENERALE DU CHU IGNACE DEEN.

Summary The aim of this study was to report our experience in the management of tuberculous peritonitis in the general surgery department of the Ignace Deen National Hospital, Conakry University Hospital. Material and method:Ten-year retrospective descriptive study (January 2013 to December 2022) carried out in the general surgery department of the Hôpital national Ignace Deen/CHU de Conakry. All complete records of patients admitted for tuberculous peritonitis and confirmed by bacteriology and anatomical pathology were included in the study. Sociodemographic, clinical, therapeutic and prognostic variables were studied. Results:In the course of this study, we collated 41 cases of tuberculous peritonitis out of 4366 hospitalizations in the general surgery department of the Ignace Deen national hospital/CHU in Conakry, representing 0.94% of the department's total activity. Mean age was 58.97 years, with extremes of 12 and 77 years. HIV was associated with TBP in 56.1% of cases. Symptoms were dominated by fever (100%), abdominal pain (100%), weight loss (97.6%) and ascites (97.6%). The diagnosis was suspected preoperatively in all cases and confirmed by bacteriology and pathological anatomy. Treatment was based on two months' RHZE and four months' RH, on a short six-month regimen in 95.1% of cases. L’évolution a été majoritairement favorable dans 97,56%. Nous avons enregistré 3 décès. The majority of cases progressed favorably (97.56%). We recorded 3 deaths. Conclusions: Tuberculous peritonitis, reputed to be rare, has seen a resurgence in incidence with the advent of HIV. Careful questioning can help avoid unnecessary laparotomies. Key words: Tuberculous peritonitis, circumstances of discovery, treatment, prognosis, Ignace Deen.

Whole genome sequence analysis of Neisseria meningitidis strains circulating in Kazakhstan, 2017-2018.

Neisseria meningitidis (meningococcus) is a cosmopolitan bacterium that is often found in the upper respiratory tract of asymptomatic humans. However, N. meningitidis also causes meningeal inflammation and/or sepsis in humans with a periodic resurgence in incidence and high mortality rates. The pathogen is highly diverse genetically and antigenically, so that genotyping is considered important for vaccine matching to circulating strains. Annual incidence of meningococcal disease in Kazakhstan ranges between 0.2 and 2.5 cases per 100 thousand population. In total, 78 strains of N. meningitidis were isolated from clinical patients and contact persons during the years 2017-2018 in Kazakhstan. Of these, 41 strains including four from the patients and 37 from contacts, were sequenced using Illumina MiSeq. In silico typing was completed using the Neisseria pipeline 1.2 on the Galaxy Workflow Management System and PubMLST. Whole genome SNP (single nucleotide polymorphisms) trees were built using BioNumerics 8. Seven-gene multilocus sequence typing (MLST) identified ten sequence types (ST), two of which have not been previously described (ST-16025; ST-16027). ST-16025 was detected in two patients with invasive meningococcal disease in 2017 and 2018 in Akmola region and 16 contacts in 2017 in Turkistan region. This prevalent type ST-16025 demonstrates considerable intertypic diversity as it consists of three subcomplexes with a distance of more than 2000 SNPs. Invasive and carrier strains belong to different serogroups (MenB and MenC), PorA and FetA_VR. Two invasive strains were MenB, one MenC and one MenW (Hajj lineage). The strains from the contact persons were: MenC (n = 18), cnl (n = 9), MenY (n = 7), MenW (n = 1), MenB (n = 1) and one unidentifiable. Different numbers of alleles were present: 12, 11, 7, and 7 alleles for PorA, FetA, fHbp, and NHBA, respectively. This study is the first report of the genetic diversity of N. meningitidis strains in Kazakhstan. Despite limitations with the studied sample size, important conclusions can be drawn based on data produced. This study provides evidence for regulatory authorities with regard to changing routine diagnostic protocols to increase the collecting of samples for WGS.

Persistence of traditional and emergence of new structural drivers and factors for the HIV epidemic in rural Uganda; A qualitative study

BackgroundIn Uganda, the HIV epidemic is now mature and generalized. Recently, there have been reports of resurgence in the incidence of HIV after several years of successful control. The causes for this resurgence are not clear but suspected to be driven by structural factors that influence large groups of people rather than individuals. The aim of this study was to describe the structural drivers of the HIV epidemic in high prevalence regions and inform the next generation of interventions.MethodologyWe conducted a total of 35 focus group discussions in 11 districts in Uganda. Due to their high HIV prevalence, the districts had been selected to implement a donor supported program to scale up HIV prevention, care and treatment. Focus groups consisted of men and women including opinion leaders, civil servants including teachers, police officers, religious, political leaders, shop keepers, local residents and other ordinary persons from all walks of life. The qualitative data were transcribed and analyzed manually. Texts were coded using a coding scheme which was prepared ahead of time but emerging themes and codes were also allowed.ResultsOur data indicated there is persistence of several structural drivers and factors for HIV in rural Uganda. The structural drivers of HIV were divided into three categories: Gender issues, socio-cultural, and economic drivers. The specific drivers included several gender issues, stigma surrounding illness, traditional medical practices, urbanization, alcohol and substance abuse and poverty. New drivers arising from urbanization, easy access to mobile phone, internet and technological advancement have emerged. These drivers are intertwined within an existing culture, lifestyle and the mixture is influenced by modernization.ConclusionThe traditional structural drivers of HIV have persisted since the emergence of the HIV epidemic in Uganda and new ones have emerged. All these drivers may require combined structural interventions that are culturally and locally adapted in order to tackle the resurgence in incidence of HIV in Uganda.

Bias in Pertussis Incidence Data and Its Implications for Public Health Epidemiology

A fter a decline of more than 99% from 1934 to 1976, pertussis incidence in the United States has increased dramatically over the last 3 decades. Although the initial decrease was attributed to the introduction of vaccination programs, the muchpublicized recent resurgence has occurred despite continued high-vaccination uptake estimates.4 Unfortunately, an incomplete understanding both of the underlying factors causing this resurgence in incidence and of the key drivers of pertussis transmission in general confounds creation of effective vaccination strategies and public health responses. A powerful approach to dissecting and elucidating the relative contributions of these drivers is the development of disease transmission models and their confrontation—via statistical inference methodology—with highly resolved incidence data. Despite the existence of highly resolved data collected through the Supplementary Pertussis Surveillance System (SPSS), and generous stated policy guidelines regarding data sharing/release, these data are not publicly accessible for researchers. Here, we discuss the lack of resolution and important biases in the incidence reports that are publicly available and argue in favor of more transparency in data sharing policies and broader dissemination of incidence data such as those collated through the SPSS. In addition to mortality and morbidity, the public health consequences of pertussis include an economic burden from lost productivity, as well as financial expenditures in areas such as associated medical costs, public awareness campaigns, and increased vaccinations. The most significant increase in pertussis in the United States (and other developed countries with vaccine programs) has occurred among adolescents and adults, with smaller increases observed for infants and older children. Nonetheless, infants make up the plurality of reported cases and nearly all of the fatalities,

Biochemical evaluation of aestivation and starvation in two snail species

There is resurgence in incidence of schistosomiasis in Nigeria with attendant socio-economic and health impact. The agents transmitting this disease are theBulinus snails which employ aestivation to survive conditions of unfavourable weather such as lack of food and water. The mechanism of aestivation under aridity and drought is not clear. This study therefore investigated the effects of aestivation and starvation on endogenous metabolic reserves in haemolymph of two snail species namely: Bulinus globosus (Morelet) and Bulinus rohlfsi (Clessin). Aestivation, starvation and control experiments were set up for 30 days in the laboratory by placing three groups of snails collected from Oyan dam, Abeokuta in standard aestivation slope (30 B. globosus and 19 B. rohlfsi), aquarium (30 B. globosus and 23 B. rohlfsi) and control slope which had 20 B. globosus and 15 B. rohlfsi. Aestivation and control slopes contained water and mixture of sand and clay (3:1), while aquarium contained water only for starvation. All the snails were fed on lettuce ad libitum for 28 days during which water was completely drained out in the aestivation slope. The aestivation slope and aquarium were left for another 30 days without lettuce. Snails were thereafter sacrificed and haemolymph biochemical parameters were assayed. In aestivating and starving B. globosus, haemolymph creatinine, urea, total protein, glucose, alanine transferases (ALT) and aspartate transferases (AST) were significantly decreased, while haemolymph total cholesterol, triglyceride and a-amylase concentrations and activity increased significantly (p < 0.05). In B. rohlfsi, creatinine, urea, ALT and AST were significantly decreased when compared with controls (p < 0.05). B. globosus and B. rohlfsipossess ability to survive unfavourable conditions by economical utilization of stored metabolites, thus enabling them to carry infection from one season to the next. Our findings suggest that B. globosus is a better aestivator than B. rohlfsi. Key words: Aestivation, enzymes, Bulinus globosus, Bulinus rohlfsi, schistosomiasis.

Necrotic enteritis in chickens: A paradigm of enteric infection by Clostridium perfringens type A

Withdrawal of antimicrobial growth promoters and ionophore coccidiostats has been accompanied by a resurgence in incidence of necrotic enteritis (NE), a severe Clostridium perfringens-induced disease which some consider the most clinically dramatic bacterial enteric disease of poultry. Lesions, in jejunum and ileum, are focal-to-confluent, often with a tightly adhered pseudomembrane, and hemorrhage is uncommon. The key risk factor for development of NE is an intestinal environment that favors growth of the organism. Birds on high energy, protein-rich, wheat- or barley-based diets experience NE at a rate up to ten times greater than do birds on maize-based diets. Specific strains of type A cause NE, although only a few specific virulence attributes are known. The role of alpha toxin (CPA) has been called into question by the finding that an engineered CPA mutant retained full virulence in vivo, although the counterpoint to this is the finding that immunization with CPA toxoids provides substantial protection against NE. A recently described toxin, NetB, seems likely to be involved in pathogenesis of infection by most NE strains. Immunization with CPA, NetB, or other proteins, delivered by conventional means or vectored by recombinant attenuated Salmonella vectors may help the industry deal with NE. Future progress may be based in large part on genomic and proteomic analyses.