Bolanle O. P. Musa

Pattern of serum cytokine expression and T-cell subsets in sickle cell disease patients in vaso-occlusive crisis.

ABSTRACT The pathogenesis of sickle vaso-occlusive crisis (VOC) in sickle cell disease (SCD) patients involves the accumulation of rigid sickle cells and the stimulation of an ongoing inflammatory response, as well as the stress of infections. The immune response, via cytokine imbalances and deregulated T-cell subsets, also has been proposed to contribute to the development of VOC. In this study, a panel of high-sensitivity cytokine kits was used to investigate cytokines in the sera of SCD patients in VOC. The results were compared primarily with those for stable SCD patients and secondarily with those for normal healthy people who served as controls. The cytokines studied included interleukin-2 (IL-2), IL-4, and IL-10. Lymphocyte subsets of patients with VOC were also studied and were compared with those of both control groups (20 stable patients without crisis [SCD group] and 20 normal healthy controls [NHC]). The VOC group was notable for remarkably elevated levels of IL-4, among the three cytokines tested, compared with those for the SCD and NHC groups. Patients with VOC also differed from stable SCD patients and NHC by having notably lower IL-10 levels, as well as the lowest ratio of CD4+ to CD8+ T cells (0.7). The patterns of the proinflammatory cytokine IL-2 did not differ between VOC and stable SCD patients, but NHC had significantly lower IL-2 levels than both the VOC and SCD groups. Our results demonstrate coexisting levels, both high and low, of TH1- and TH2-type cytokines, as well as diminished levels of T-cell subsets in VOC. These results are discussed in an effort to better understand the importance of the immune system profile in the pathogenesis of sickle cell VOC. Since the possibility that a cytokine imbalance is implicated in the pathogenesis of sickle cell crisis has been raised, our results should prompt further investigation of the host immune response in terms of TH1 and TH2 balance in sickle cell crisis.

Seroprevalence of IgM and IgG Antibodies to Toxoplasma infection in healthy and HIV-positive adults from Northern Nigeria

INTRODUCTION We examined the seroprevalence of toxoplasma infection in HIV-negative and -positive adults from Zaria, Northern Nigeria, and assessed its relationship with demographic, clinical, and immunological findings. METHODOLOGY In a six-month cross-sectional study undertaken in 2008, sera of 219 adults, including 111 consecutive HIV-infected adults and 108 healthy HIV-negative adult volunteers from Zaria, Northern Nigeria, were examined for IgG and IgM antibodies to toxoplasma by ELISA. Clinical characteristics of the HIV-infected patients were documented. Differences in toxoplasma seropositivity between HIV-positive and negative adults were sought. The relationship between toxoplasma seropositivity and variables such as age, sex and antiretroviral (ART) status, as well as HIV clinical staging and CD4 cell counts were also determined. P < 0.05 was considered significant. RESULTS The seroprevalence of toxoplasma infection (IgG positive and or IgM positive) was 32.4% in HIV-negative healthy adults and 38.7% in HIV-infected adults (P > 0.05). The rate of IgM seropositivity was 4.6% in healthy adults and 1.8% in HIV-infected patients, while the rate of IgG seropositivity (without IgM seropositivity) was 28.7% in healthy adults and 37.8% in HIV-infected patients (p > 0.05). Toxoplasma seropositivity was not associated with age, sex, ART status, CD4 cell count or HIV clinical staging. Seventy-four percent of the toxoplasma seropositive HIV-infected patients were asymptomatic and no cases of toxoplasma encephalitis were identified. CONCLUSION Toxoplasmosis is equally prevalent in HIV-infected patients and healthy adults from similar environments in Northern Nigeria. It is imperative to develop public health policies to prevent toxoplasmosis in Nigeria, especially in HIV-infected patients.

Human papilloma virus (HPV) infection is associated with HIV-1 infection and AIDS in HIV-infected adult patients from Zaria, Northern Nigeria.

In order to provide preliminary information on the association between cumulative HPV-infection and HIV-1infection, we assayed serum IgG antibodies to HPV in 63 HIV-1 infected adults and 26 apparently healthy HIV-negative adults in Zaria, Northern Nigeria. One (3.8%) of the healthy adults and 26 (41.3%) of the HIV-patients were HPV IgG seropositive. On multivariate analyses, CD4-cell count<200cells/ul was the only independent predictor of HPV IgG seropositivity among HIV-infected patients. Our results suggest that in HIV-infected patients, HPV-infection is associated with significant immunosuppresion or AIDS.

Clinical presentation and outcome of toxoplasma encephalitis in HIV-infected patients from Zaria, Northern Nigeria: a case series of 9 patients.

Toxoplasma encephalitis (TE) is the most common cause of focal deficits in patients living with HIV/AIDS. Among 257 HIV-infected adult patients seen between January 2006 and December 2010 in a tertiary hospital in Zaria, northern Nigeria, 9 (3.5%) patients had clinical, serological, and brain imaging evidence of TE. All 9 patients had CD4 count of less than 50 cells/mm3. Of the 9 patients, 7 were antiretroviral therapy (ART)-naive, while 2 were cases of ART-induced TE-immune reconstitution inflammatory syndrome. After administering intravenous dexamethasone for cerebral decompression and specific antitoxoplasma therapy, symptoms and signs resolved in 8 patients within 4 to 14 days, but 1 patient died. Our data suggest that even in the ART era in Nigeria, TE remains a fairly common cause of morbidity among HIV-infected patients due to late HIV diagnosis and significant immunosuppression at diagnosis. Early HIV diagnosis, early initiation of highly active ART, and routine prophylaxis against TE are imperative in combating the challenge of HIV/AIDS-related TE in Nigeria.

Anemia and iron deficiency in pregnant women in Zaria, Nigeria

Introduction: Anemia is common in pregnancy and iron deficiency is a major cause of anemia in pregnant women in Africa. This is due to increased demands of the fetus, growing uterus, placenta, and poor nutritional habits. Objectives: To determine the prevalence of anemia and the role of iron deficiency in causation of anemia in pregnant women attending the antenatal clinic of the Ahmadu Bello University teaching hospital (ABUTH) in Zaria, Nigeria. Materials and Methods: Ninety (90) consenting pregnant women were entered for this study with an equal number of controls. A structured questionnaire was administered to participants. Full blood count, serum ferritin, urine and stool microscopy for parasites were carried out. Results: The mean hematocrit in the pregnant and non-pregnant subjects was 35% (SD ± 3.8; 95 CI = 34.2-35.8) and 39% L/L (SD ± 3.2; 95% CI = 37.3-38.7) with P < 0.001. In the pregnant subjects 11(12.2%) had anemia while none of the controls was anemic. Mean serum ferritin among the pregnant and non-pregnant subjects was 26.0 μg/L (SD ± 35.2; 95% CI = 18.6-33.4) and 70.3 μg/L (SD ± 106.1; 95% CI 48.1-92.5), respectively, with P-value of <0.001. Even though iron deficiency was observed in 68/90 (75.6%) of pregnant women, it was latent in 61/68(89.7%) of the women while it was frank in 7/68 (10.3%). In the non-pregnant subjects, 23/90 (25.6%) had iron deficiency despite a normal hematocrit. Of the 11/90 (12.2%) of pregnant subjects that had anemia 7/11(63.6%) had frank iron deficiency anemia while 4/11 (36.4) had anemia due to other causes. 2/90 (2.2%) of the pregnant subjects had ova of hookworm in their stool samples and both had iron deficiency anemia. Conclusion: Iron deficiency underlies many cases of anemia in pregnancy, thus justifying the use of iron supplementation in pregnancy as is currently practiced. Latent iron deficiency among non-pregnant controls suggests that iron supplementation may benefit non-pregnant women within the reproductive age group could help to improve their iron stores before the contemplation of pregnancy, thereby, reducing the prevalence of pregnancy related anemia in this environment.

Seroepidemiology of cytomegalovirus antibodies in Hiv-positive and Hiv-negative adults in Nigeria

Introduction: Cytomegalovirus (CMV) is the most common viral opportunistic infection in HIV/AIDS reported in the Western literature. There is a paucity of reports on the seroprevalence of CMV antibodies in Nigeria despite the high HIV burden. Few studies were carried out in pregnant women and healthy blood donors. This analytical cross-sectional study was conducted to describe the seroepidemiology of CMV antibodies in HIV-positive and healthy adults in Nigeria. Materials and Methods: Between August 2012 and March 2013, a structured questionnaire was administered to 250 HIV-positive patients attending the HIV clinic and 250 HIV-negative controls matched for age and gender. Participants were screened for quantitative CMV immunoglobulin G (IgG) and qualitative CMV immunoglobulin M (IgM) antibodies by enzyme-linked immunosorbent assay. Information was collected on sociodemographic characteristics, risk for HIV infection, and anthropometric measurements. Data were analyzed with SPSS Version 17. Results: A total of 500 participants were recruited. Females comprised 54%. Median age for males was 39 years (range 17-65 years), whereas for females, it was 35 years (range 16-62 years) (P = 0.002). In HIV-positive patients, CMV IgG and IgM antibodies were detected in 215 (86%) and 33 (13.2%), respectively, but in HIV-negative controls, it was 182 (72.8%) and 7 (2.8%), respectively (P = 0.001). In HIV-positive patients, CMV IgG age-specific seroprevalence was highest in the 16-25 years age group (93.5%), whereas CMV IgM, it was highest in the 26-35 years age group (16.1%). Mean quantitative CMV IgG antibody titer was higher in HIV-positive patients (P = 0.001). There was no gender difference between groups. Conclusion: Seroprevalence of CMV antibodies is high in Nigeria. HIV preventive strategies and routine screening of HIV patients and blood donors for CMV antibodies before blood transfusion are recommended to minimize the potential risk of transfusion transmitted CMV infection.

Antiphospholipid antibodies among pregnant women with recurrent fetal wastage in a tertiary hospital in Northern Nigeria.

Context: The association between antiphospholipid antibodies (APAs) and pregnancy loss has been established and now considered as a treatable cause of pregnancy loss. Data on the prevalence of APA in patients with recurrent pregnancy loss are scarce in our environment. Aims: To determine the prevalence of APA in pregnant women with and without recurrent fetal wastage. Settings and Design: Antenatal clinic of Ahmadu Bello University Teaching Hospital, Zaria, Nigeria. A cross-section analytical study. Subjects and Methods: Eighty-five antenatal patients with recurrent fetal loss (cases) and an equal number of antenatal patients without recurrent fetal loss (control) matched for age were studied. Their sociodemographic data obtained and blood samples analyzed for lupus anticoagulant (LA) using activated partial thromboplastin time, direct Russels viper venom time, hexagonal phospholipids, and IgG anticardiolipin antibody (ACA) using enzyme-linked immunosorbent assay. Statistical Analysis Used: Data were analyzed with Statistical Package for Social Sciences (version 17) by univariate analysis and Chi-square test. Results: The age range of the patients was 18–42 years with a median of 30 years. The prevalence of APA was 14.1% and 4.7% among the cases and controls, respectively. The prevalence of LA was 7.1% and 1.2% among the cases and controls, respectively, whereas ACA was 8.2% and 3.5%, respectively. However, one of the cases was positive for both APA and ACA, giving a prevalence of 1.2%. Conclusions: The prevalence of APA among antenatal patients with recurrent pregnancy loss was, at least, 3 times higher than that of normal antenatal clients. APA should be included in the investigation protocol of women with recurrent fetal wastages in our setting.

Human Herpesvirus 8 Infections and AIDS-Associated Kaposi Sarcoma in Zaria, Northern Nigeria

Background/Objectives: Studies on human herpesvirus 8 (HHV8) infection in patients with AIDS-associated Kaposi sarcoma (AIDS-KS), from Nigeria are lacking. We examined the seroprevalence of HHV8 infection in patients with AIDS-KS presenting to Ahmadu Bello University Teaching Hospital (ABUTH), Zaria, Nigeria, and also described their clinical presentation. Methods: A total of 20 (11 males and 9 females) histologically confirmed adults with AIDS-KS were recruited consecutively in 2007. The clinical types of lesions, associated diseases, and the AIDS clinical trial group staging of AIDS-KS were noted. Anti-lytic HHV8 antibodies were determined by enzyme-linked immunosorbent assay (ELISA). Results: Kaposi sarcoma skin lesions were diverse but mostly nodules (19 cases) and papules (16). Majority (18 cases) had poor risk AIDS-KS, with 10 (50%) patients having concomitant opportunistic infections and 3 (15%) patients having generalized skin lesions. Females had a more severe disease. Seventeen patients (85%) were HHV8-seropositive. Conclusion: AIDS-KS is associated with high HHV8 infection and presents with a variety of skin manifestations that are often aggressive, advanced, and worse in females.