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Bacterial isolates from cerebrospinal fluids and their antibiotic susceptibility patterns in Gondar University Teaching Hospital, Northwest Ethiopia
Andargachew Mulu, Afework Kassu, Belay Tassema
Ethiopian Journal of Health Development , 2005,
Immune restoration disease and changes in CD4+ T-cell count in HIV- infected patients during highly active antiretroviral therapy at Zewditu memorial hospital, Addis Ababa, Ethiopia
Kahsay Huruy, Afework Kassu, Andargachew Mulu, Yemataw Wondie
AIDS Research and Therapy , 2010, DOI: 10.1186/1742-6405-7-46
Abstract: A retrospective study of all HIV- infected patients starting HAART between September 1, 2005 and August 31, 2006 at Zewditu memorial hospital HIV clinic, Addis Ababa, Ethiopia was conducted. All laboratory and clinical data were extracted from computerized clinic records and patient charts.A total of 1166 HIV- infected patients with mean ± SD age of 36 ± 9.3 years were on HAART. IRD was identified in 170 (14.6%) patients. OIs diagnosed in the IRD patients were tuberculosis (66.5%, 113/170), toxoplasmosis (12.9%, 22/170), herpes zoster rash (12.9%, 22/170), Pneumocystis jirovecii pneumonia (4.1%, 7/170), and cryptococcosis (3.5%, 6/170). Of the 170 patients with IRD, 124 (72.9%) patients developed IRD within the first 3 months of HAART initiation. Low baseline CD4+ T-cell count (odds ratio [OR], 3.16, 95% confidence interval [CI], 2.19-4.58) and baseline extra pulmonary tuberculosis (OR, 7.7, 95% CI, 3.36-17.65) were associated with development of IRD. Twenty nine (17.1%) of the IRD patients needed to use systemic anti-inflammatory treatment where as 19(11.2%) patients required hospitalization associated to the IRD occurrence. There was a total of 8 (4.7%) deaths attributable to IRD.The proportion and risk factors of IRD and the pattern of OIs mirrored reports from other countries. Close monitoring of patients during the first three months of HAART initiation is important to minimize clinical deterioration related to IRD.Highly active antiretroviral therapy (HAART) improves the immune function and decreases morbidity, mortality and opportunistic infections (OIs) in HIV-infected patients [1,2]. However, the introduction of HAART presents new clinical problems, including adverse drug effects, and the event of diseases that are as the result of the restoration of the immune response. When clinical deterioration occurs during immune recovery and is associated with the host inflammatory response to pathogens, the clinical presentation has been described as immune restorat
Frequent detection of ‘azole’ resistant Candida species among late presenting AIDS patients in northwest Ethiopia
Mulu Andargachew,Kassu Afework,Anagaw Belay,Moges Beyene
BMC Infectious Diseases , 2013, DOI: 10.1186/1471-2334-13-82
Abstract: Background The chronic use of antifungal agents in the treatment of fungal infection in general and oropharyngeal candidiasis mainly in AIDS patient’s leads to the selection of strain resistant to these therapies and a shift in the spectrum of Candida species. This study determines the species diversity and in vitro susceptibility of Candida isolates from late presenting AIDS patients in northwest Ethiopia. Methods Two hundred and twenty one HIV/AIDS patients were assessed with a standardized evaluation form at enrolment. Oral rinses were cultured on CHROMagar plates at 37°C for 48 hours and Candida species identification were made following standard microbiological techniques. In vitro drug susceptibility tests were made using broth microdilution method. Results The colonization rate of Candida species was found to be 82.3% (177/215). C. albicans was the predominant species isolated from 139 (81%) patients but there was a diversity of other species. C. glabrata was the most frequent non-albicans species isolated in 22.5% (40/177) of the patients followed by C. tropicalis 14.1% (27/177), C. krusei 5.6% (10) and other unidentifiable Candida species 4% (7/177). Recurrent episodes of oropharyngeal candidiasis and previous exposure to antifungal drugs were found to be predisposing factors for colonization by non-albicans species. Irrespective of the Candida species identified 12.2% (11/90), 7.7% (7/90) and 4.7% (4) of the isolates were resistant to fluconazole, ketoconazole and itraconazole, respectively. In contrast, resistance to micafungin, amphotericin B and 5-Fluorocytosine was infrequent. Conclusion HIV/AIDS patients are orally colonized by single or multiple albicans and non- albicans Candida species that are frequently resistant to azoles and occasionally to amphotericin B, 5-Fluorocytosine and micafungin. These highlight the need for national surveillance for examining Candida epidemiology and resistance to antifungal drugs.
Comparison of the Kato-Katz, Wet Mount, and Formol-Ether Concentration Diagnostic Techniques for Intestinal Helminth Infections in Ethiopia
Mengistu Endris,Zinaye Tekeste,Wossenseged Lemma,Afework Kassu
ISRN Parasitology , 2013, DOI: 10.5402/2013/180439
Abstract: Objective. The aim of this study was to evaluate the operational characteristics (sensitivity and negative predictive value (NPV)) of wet mount, formol-ether concentration (FEC), and Kato-Katz techniques for the determination of intestinal parasitic infections. Method. A total of 354 faecal specimens were collected from students in Northwest Ethiopia and screened with Kato-Katz, wet mount, and FEC for the presence of intestinal parasitic infection. Since a gold standard test is not available for detection of intestinal parasites, the combined results from the three methods were used as diagnostic gold standard. Result. The prevalences of intestinal parasites using the single wet mount, FEC, and Kato-Katz thick smear techniques were 38.4%, 57.1%, and 59%, respectively. Taking the combined results of three techniques as a standard test for intestinal parasitic infection, the sensitivity and negative predictive value of Kato-Katz is 81.0% (confidence interval (CI)?=?0.793–0.810) and 66.2% (CI?=?0.63–0.622), respectively. The FEC detected 56 negative samples that were positive by the gold standard, indicating 78.3% (CI?=?0.766–0.783) and 63.2% (CI?=?0.603–63) sensitivity and NPV, respectively. Furthermore, Kato-Katz detects 113 cases that were negative by a single wet mount. The agreement between the wet mount and Kato-Katz methods for the diagnosis of Ascaris lumbricoides and hookworm was substantial ( for Ascaris lumbricoides, for hookworm). 1. Background Intestinal parasitic infections are among the most common infections worldwide. It is estimated that 3.5 billion people are affected, and 450 million are ill as a result of these infections, the majority being children [1]. In Ethiopia, intestinal parasitic infection is the second most predominant cause of outpatient morbidity. However, there are difficulties in estimating the exact burden of parasitic infections in the country [2]. Although there are several factors that make estimating the number and burden of intestinal parasitic infections difficult, lack of accurate diagnostic tools is the major one [3–9]. Although several diagnostic methods such as Kato-Katz and Formol-Ether Concentration (FEC) techniques are available, direct wet mount is the commonly used as a reliable diagnosis method for the diagnosis of intestinal parasitic infections generally in Africa and particularly in Ethiopia [10–13]. However, low sensitivity of the direct wet mount technique has been reported in the detection of low-intensity infection elsewhere [14]. This shows that the use of direct wet mount as a confirmatory test
Sexually transmitted infections based on the syndromic approach in Gondar town, northwest Ethiopia: a retrospective cross-sectional study
Beyene Moges, Gizachew Yismaw, Afework Kassu, Berihun Megabiaw, Shitaye Alemu, Bemnet Amare, Dagnachew Muluye
BMC Public Health , 2013, DOI: 10.1186/1471-2458-13-143
Abstract: Medical records of patients who visited the clinic from January 2011 to December 2011 were reviewed. Sociodemographic and clinical data were extracted using data extraction form. The data were entered and analyzed using SPSS version 16 statistical package. Descriptive statistics and Chi-square tests were carried out.A total of 1071 clients visited the clinic during the study period. Among these, 383 (35.8%) had complained symptoms of sexually transmitted infections. The mean (SD) age of the patients was 26.8 +/- 7.4 years. The commonest chief complaints were vaginal discharge (38.4%) and urethral discharge (13.6%). Seventy seven percent of the cases did not bring their sexual partners for treatment.There was a high magnitude of STIs in the clinic according to the syndromic approach. However, the actual prevalence of STIs and the associated factors in the community need to be determined through further studies. The results of this study also urge the need for evaluation of the syndromic approach and test for antimicrobial resistance.
Bacterial profile and drug susceptibility pattern of urinary tract infection in pregnant women at University of Gondar Teaching Hospital, Northwest Ethiopia
Agersew Alemu, Feleke Moges, Yitayal Shiferaw, Ketema Tafess, Afework Kassu, Belay Anagaw, Abebe Agegn
BMC Research Notes , 2012, DOI: 10.1186/1756-0500-5-197
Abstract: A cross-sectional study was conducted at University of Gondar Teaching Hospital from March 22 to April 30, 2011. Mid stream urine samples were collected and inoculated into Cystine Lactose Electrolyte Deficient medium (CLED). Colony counts yielding bacterial growth of 105/ml of urine or more of pure isolates were regarded as significant bacteriuria for infection. Colony from CLED was sub cultured onto MacConkey agar and blood agar plates. Identification was done using cultural characteristics and a series of biochemical tests. A standard method of agar disc diffusion susceptibility testing method was used to determine susceptibility patterns of the isolates.The overall prevalence of UTI in pregnant women was 10.4?%. The predominant bacterial pathogens were Escherichia coli 47.5?% followed by coagulase-negative staphylococci 22.5?%, Staphylococcus aureus 10?%, and Klebsiella pneumoniae 10?%. Gram negative isolates were resulted low susceptibility to co-trimoxazole (51.9?%) and tetracycline (40.7?%) whereas Gram positive showed susceptibility to ceftriaxon (84.6?%) and amoxicillin–clavulanic acid (92.3?%). Multiple drug resistance (resistance to two or more drugs) was observed in 95?% of the isolates.Significant bacteriuria was observed in asymptomatic pregnant women. Periodic studies are recommended to check the outcome of asymptomatic bacteriuria and also monitor any changes in the susceptibility patterns of urinary tract pathogens in pregnant women.In the female human subject, the urinary tract has an important relationship with the reproductive organs because of its proximity. In the non-pregnant state, the uterus lies just behind and partly over the bladder while in the pregnant state the enlarging uterus affects all the tissues of the urinary tract at various times [1]. Urinary Tract Infection (UTI) has become the most common hospital-acquired infection, accounting for as many as 35?% of nosocomial infections, and it is the second most common cause of bacteraemi
Seroprevalence of HIV, HBV, HCV and syphilis infections among blood donors at Gondar University Teaching Hospital, Northwest Ethiopia: declining trends over a period of five years
Belay Tessema, Gizachew Yismaw, Afework Kassu, Anteneh Amsalu, Andargachew Mulu, Frank Emmrich, Ulrich Sack
BMC Infectious Diseases , 2010, DOI: 10.1186/1471-2334-10-111
Abstract: A retrospective analysis of consecutive blood donors' records covering the period between January 2003 and December 2007 was conducted. Logistic regression analysis was used to determine risk factors associated with HIV, HBV, HCV and syphilis infections.From the total of 6361 consecutive blood donors, 607 (9.5%) had serological evidence of infection with at least one pathogen and 50 (0.8%) had multiple infections. The overall seroprevalence of HIV, HBV, HCV and syphilis was 3.8%, 4.7%, 0.7%, and 1.3% respectively. Among those with multiple infections, the most common combinations were HIV - syphilis 19 (38%) and HIV - HBV 17 (34%). The seropositivity of HIV was significantly increased among female blood donors, first time donors, housewives, merchants, soldiers, drivers and construction workers. Significantly increased HBV seropositivity was observed among farmers, first time donors and age groups of 26 - 35 and 36 - 45 years. Similarly, the seroprevalence of syphilis was significantly increased among daily labourers and construction workers. Statistically significant association was observed between syphilis and HIV infections, and HCV and HIV infections. Moreover, significantly declining trends of HIV, HCV and syphilis seropositivity were observed over the study period.A substantial percentage of the blood donors harbour HIV, HBV, HCV and syphilis infections. Strict selection of blood donors and comprehensive screening of donors' blood using standard methods are highly recommended to ensure the safety of blood for recipient.The discovery of transfusion-transmissible infections (TTIs) has heralded a new era in blood transfusion practice worldwide with emphasis on two fundamental objectives, safety and protection of human life [1]. Blood safety remains an issue of major concern in transfusion medicine in Ethiopia where national blood transfusion services and policies, appropriate infrastructure, trained personnel and financial resources are inadequate.Human immunode
Humanized Rag1?/?γc?/? Mice Support Multilineage Hematopoiesis and Are Susceptible to HIV-1 Infection via Systemic and Vaginal Routes
Ramesh Akkina,Bradford K. Berges,Brent E. Palmer,Leila Remling,C. Preston Neff,Jes Kuruvilla,Elizabeth Connick,Joy Folkvord,Kathy Gagliardi,Afework Kassu,Sarah R. Akkina
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0020169
Abstract: Several new immunodeficient mouse models for human cell engraftment have recently been introduced that include the Rag2?/?γc?/?, NOD/SCID, NOD/SCIDγc?/? and NOD/SCIDβ2m?/? strains. Transplantation of these mice with CD34+ human hematopoietic stem cells leads to prolonged engraftment, multilineage hematopoiesis and the capacity to generate human immune responses against a variety of antigens. However, the various mouse strains used and different methods of engrafting human cells are beginning to illustrate strain specific variations in engraftment levels, duration and longevity of mouse life span. In these proof-of-concept studies we evaluated the Balb/c-Rag1?/?γ?/? strain for engraftment by human fetal liver derived CD34+ hematopoietic cells using the same protocol found to be effective for Balb/c-Rag2?/?γc?/? mice. We demonstrate that these mice can be efficiently engrafted and show multilineage human hematopoiesis with human cells populating different lymphoid organs. Generation of human cells continues beyond a year and production of human immunoglobulins is noted. Infection with HIV-1 leads to chronic viremia with a resultant CD4 T cell loss. To mimic the predominant sexual viral transmission, we challenged humanized Rag1?/?γc?/? mice with HIV-1 via vaginal route which also resulted in chronic viremia and helper T cell loss. Thus these mice can be further exploited for studying human pathogens that infect the human hematopoietic system in an in vivo setting.
Vitamin A deficiency during pregnancy of HIV infected and non-infected women in tropical settings of Northwest Ethiopia
Andargachew Mulu, Afework Kassu, Kahsay Huruy, Birhanemeskel Tegene, Gashaw Yitayaw, Masayo Nakamori, Nguyen Van Nhien, Assegedech Bekele, Yared Wondimhun, Shigeru Yamamoto, Fusao Ota
BMC Public Health , 2011, DOI: 10.1186/1471-2458-11-569
Abstract: In this cross-sectional study, blood samples were collected from 423 pregnant women and from 55 healthy volunteers who visited the University of Gondar Hospital. Serum concentration of vitamin A was measured by high performance liquid chromatography.After controlling for total serum protein, albumin and demographic variables, the mean ± SD serum vitamin A in HIV seropositive pregnant women (0.96 ± 0.42 μmol/L) was significantly lower than that in pregnant women without HIV infection (1.10 ± 0.45 μmol/L, P < 0.05). Likewise, the level of serum vitamin A in HIV seropositive non-pregnant women (0.74 ± 0.39) was significantly lower than that in HIV negative non-pregnant women (1.18 ± 0.59 μmol/L, P < 0.004). VAD (serum retinol < 0.7 μmol/L) was observed in 18.4% and 17.7% of HIV infected and uninfected pregnant women, respectively. Forty six percent of non-pregnant women with HIV infection had VAD while only 28% controls were deficient for vitamin A (P = 0.002).The present study shows that VAD is a major public health problem among pregnant women in the tropical settings of Northwest Ethiopia. Considering the possible implications of VAD during pregnancy, we recommend multivitamin (which has a lower level of vitamin A) supplementation in the care and management of pregnant women with or without HIV infection.Vitamin A deficiency (VAD) is known to be a significant public health problem around the world and it is particularly serious among women of reproductive age in South-East Asia and Africa [1-4]. It has now become evident that VAD in women has negative consequences on their health status as well as on their infants [3,4]. The link between VAD morbidity and mortality from infectious diseases [5] and non-infectious diseases [6-8] has been known for several years.VAD in pregnant women is associated with night blindness, severe anaemia, wasting, malnutrition, and reproductive and infectious morbidity [9], and increased risk of mortality 1-2 years following delivery [4].
Nutritional status, intestinal parasite infection and allergy among school children in Northwest Ethiopia
Bemnet Amare, Jemal Ali, Beyene Moges, Gizachew Yismaw, Yeshambel Belyhun, Simon Gebretsadik, Desalegn Woldeyohannes, Ketema Tafess, Ebba Abate, Mengistu Endris, Desalegn Tegabu, Andargachew Mulu, Fusao Ota, Bereket Fantahun, Afework Kassu
BMC Pediatrics , 2013, DOI: 10.1186/1471-2431-13-7
Abstract: A cross sectional study was performed involving school children in two elementary schools in Gondar, Ethiopia. Nutritional status of these children was determined using anthropometric parameters (weight-for-age, height-for-age and BMI-for-age). Epi-Info software was used to calculate z-scores. Stool samples were examined using standard parasitological procedures. The serum IgE levels were quantified by total IgE ELISA kit following the manufacturer’s instruction.A total of 405 children (with mean age of 12.09.1?±?2.54 years) completed a self-administered allergy questionnaire and provided stool samples for analysis. Overall prevalence of underweight, stunting and thinness/wasting was 15.1%, 25.2%, 8.9%, respectively. Of the total, 22.7% were found to be positive for intestinal parasites. The most prevalent intestinal parasite detected was Ascaris lumbricoides (31/405, 7.6%). There was no statistically significant association between prevalence of malnutrition and the prevalence of parasitic infections. Median total serum IgE level was 344 IU/ml (IQR 117–2076, n?=?80) and 610 IU/ml (143–1833, n?=?20), respectively, in children without and with intestinal parasite infection (Z?=??0.198, P?>?0.8). The prevalence of self reported allergy among the subset was 8%. IgE concentration was not associated either with the presence of parasitic infection or history of allergy.The prevalence of malnutrition, intestinal parasitism and allergy was not negligible in this population. In addition, there was no significant association between the prevalence of allergy and their nutritional status, and parasite infection. Further research prospective observational and intervention studies are required to address the question of causality between nutritional factors, parasites, and allergy.According to the World Health Organization (WHO), approximately 2 billion people are affected by helminthic infection worldwide [1]. These infections are responsible for high levels of morbidity and mo
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