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Life-threatening bacteraemia in HIV-1 seropositive adults admitted to hospital in Nairobi, Kenya

During 6 months, 506 consecutive adult emergency admissions to hospital in Nairobi were enrolled in a study of bacteraemia and HIV infection. 19% were HIV-1 antibody positive. Significantly more HIV-seropositive than seronegative patients had bacteraemia (26% vs 6%). The predominant organisms isolated from the seropositive patients were Salmonella typhimurium and Streptococcus pneumoniae. Mortality was higher in the seropositive than in the seronegative bacteraemic patients. The findings suggest that non-opportunistic bacteria are important causes of morbidity and mortality in HIV-infected individuals in Africa.

Extrapulmonary and disseminated tuberculosis in HIV-1-seropositive patients presenting to the acute medical services in Nairobi.

We studied 506 consecutive adult acute medical admissions to hospital in Nairobi; 95 (18.8%) were seropositive for HIV-1, and 43 new cases of active tuberculosis (TB) were identified. TB was clearly associated with HIV infection, occurring in 17.9% of seropositive patients compared with 6.3% of seronegatives [odds ratio (OR) 3.2; 95% confidence limits (CL) 1.6-6.5]. Extrapulmonary disease was more common in seropositive than seronegative TB patients (nine out of 17 versus five out of 26; OR 4.7; 95% CL 1.01-23.6); this accounted for most of the excess cases of TB seen in seropositive patients. Mycobacteraemia was demonstrated in two of eight seropositive TB patients but in none of 11 seronegative TB patients. No atypical mycobacteria were isolated. The World Health Organization (WHO) clinical case definition for African AIDS did not discriminate well between seropositive and seronegative TB cases. Five out of seven seropositive women with active tuberculosis had delivered children in the preceding 6 months and were lactating, compared with only one out of eight seronegative tuberculous women. An association between recent childbirth, HIV immunosuppression and the development of TB is suggested.

STD/HIV control in Malawi and the search for affordable and effective urethritis therapy: a first field evaluation.

OBJECTIVES--To evaluate gonococcal (GU) and nongonococcal urethritis (NGU), chlamydia antigen, and serostatus for syphilis and human immunodeficiency virus (HIV) among males attending a Malawian STD clinic with complaints of urethral discharge and/or dysuria. To collect demographic and behavioural data and to determine the effectiveness of five treatments for urethritis. METHODS--Urethritis was diagnosed using microscopy and culture for Neisseria gonorrhoeae. Sera were screened with rapid plasma reagin (RPR) and if reactive, with microhaemagglutination for Treponema pallidum (MHA-TP). HIV antibodies and chlamydia antigen were detected using enzyme immunoassay. Patients were randomised for treatment, cure was assessed 8-10 days later. RESULTS--At enrolment, GU was diagnosed in 415 (80.3%) and NGU in 59 (11.2%) of 517 males. Chlamydia antigen was found in 26 (5.2%) of 497 specimens tested. Syphilis seropositivity rate (RPR and MHA-TP reactive) was 10.7%. Overall HIV seroprevalence was 44.2%; 71.7% of men with reactive syphilis serology were HIV(+) compared with 40.9% of syphilis seronegatives (OR: 3.6, p < 0.001). Trimethoprim 320 mg/sulphamethoxazole 1600 mg by mouth for 2 days (TMPSMX), or the combination of amoxicillin 3 gm, probenicid 1 gm, and clavulanate 125 mg by mouth once (APC), failed to cure gonorrhoea effectively. Amoxicillin 3 gm, probenicid 1 gm, and clavulanate 125 mg, by mouth once with doxycycline 100 mg BID for 7 days (APC-D), gentamicin 240 mg IM once (GENT), ciprofloxacin 250 mg by mouth once (CIPRO) cured 92.9% to 95% of gonorrhoea. APC-D treatment did not generate less NGU at follow-up. HIV serostatus did not affect cure of urethritis. CONCLUSION--All patients presenting with urethritis should be treated syndromically using a simple algorithm and screened for syphilis seroreactivity for appropriate treatment and counselling.

HBV lamivudine resistance among hepatitis B and HIV coinfected patients starting lamivudine, stavudine and nevirapine in Kenya.

Summary.  Widespread use of lamivudine in antiretroviral therapy may lead to hepatitis B virus resistance in HIV–HBV coinfected patients from endemic settings where tenofovir is not readily available. We evaluated 389 Kenyan HIV‐infected adults before and for 18 months after starting highly active antiretroviral therapy with stavudine, lamivudine and nevirapine. Twenty‐seven (6.9%) were HBsAg positive and anti‐HBs negative, 24 were HBeAg negative, and 18 had HBV DNA levels ≤10 000 IU/mL. Sustained HBV suppression to <100 IU/mL occurred in 89% of 19 evaluable patients. Resistance occurred in only two subjects, both with high baseline HBV DNA levels. Lamivudine resistance can emerge in the setting of incomplete HBV suppression but was infrequently observed among HIV–HBV coinfected patients with low baseline HBV DNA levels.

Investigating the association between African spontaneously fermented dairy products, faecal carriage of Streptococcus infantarius subsp. infantarius and colorectal adenocarcinoma in Kenya.

Graphical abstract

Esophageal Cytology Sponge Diagnostic Test Results in Kenyatta National Referral Hospital, Kenya

Objective: To describe the cytological findings of the esophagus using sponge cytology as a triage test in patients referred for esophageal endoscopy at Kenyatta National Hospital. Study Design: A cross-sectional descriptive study was undertaken to obtain specimens from the esophagus for cytological evaluation using a sponge. The cellular yield and pattern of esophageal cytological findings was described by cytopathologists using the Bethesda system. The cytological findings were compared with endoscopy findings and whenever possible with biopsy results. Results: All the participants (100%) swallowed the encapsulated sponge successfully and had smears with satisfactory material for evaluation. Negative smears for intraepithelial lesion or malignancy were the most common (86.6%), with intestinal metaplasia reported in 10% of all patients, high-grade squamous intraepithelial lesions in 1.7% and squamous cell carcinoma in 1.7%. There was good agreement between endoscopic and cytological findings. Conclusion: Sponge cytology is a simple and inexpensive technique which seems to have promising results as a primary test as well as a triage test whenever there is any suspicion of an esophageal lesion, especially in clinical settings where endoscopic facilities and medical professionals are not available. Hence, further evaluation using a larger sample size is recommended.

Colorectal cancer-associated Streptococcus infantarius subsp. infantarius differ from a major dairy lineage providing evidence for pathogenic, pathobiont and food-grade lineages

Streptococcus infantarius subsp. infantarius (Sii), a member of the Streptococcus bovis/Streptococcus equinus complex (SBSEC), predominates as dairy-adapted and non-adapted variants in fermented dairy products (FDP) in East and West Africa. Epidemiologic data suggest an association with colorectal cancer for most SBSEC members, including Sii from Kenyan patients. Phylogenetic relationships of East African human (EAH) isolates to those of dairy and pathogenic origin were analysed to better estimate potential health implications via FDP consumption. The MLST-derived population structure was also evaluated to provide host, disease, geography and dairy adaptation associations for 157 SBSEC isolates, including 83 novel Sii/SBSEC isolates of which 40 originated from Kenyan colonoscopy patients. Clonal complex (CC) 90 was delineated as potential pathogenic CC for Sii. Single EAH, West African dairy (WAD), food and animal Sii isolates clustered within CC-90, suggesting a potential link to pathogenic traits for CC-90. The majority of EAH and WAD Sii were clustered in a shared clade distinct from CC-90 and East African dairy (EAD) isolates. This indicates shared ancestry for the EAH and WAD clade and limitations to translate disease associations of EAH and CC-90 to EAD Sii, which could support the separation of pathogenic, pathobiont/commensal and food lineages.

In Memoriam - A Tribute to Alexander Meisels (1926-2014)

awards, among them the Goldblatt Award of the IAC (1975), the Papanicolaou Award of the ASC (1982) and the membership in the Order of Canada (2000). All members of the Executive Council and the entire membership of the IAC pay tribute to this great man and express their feelings of loss and sadness. Alex will be sadly missed. Volker Schneider, Freiburg i.B. Dr. Alexander Meisels died peacefully in September 2014 at the age of 88 years. His service to the International Academy of Cytology is legendary as he was a member of the Executive Council of the IAC for 39 years. He served as Secretary-Treasurer from 1971 to 1986 and continued subsequently as President, Treasurer and Member until 2010. He was responsible as Secretary or President for six International Congresses of Cytology organized by the IAC (Miami 1974, Tokyo 1977, Munich 1980, Montreal 1983, Brussels 1986 and Buenos Aires 1989). His contributions to the field of cytopathology were decisive and manifold. He considered his discovery of the relationship between the infection by human papillomavirus and the development of cervical carcinoma to be his most significant contribution, of which he was understandably proud. In 1976, he postulated that the koilocytotic changes in cervical epithelial cells represent an expression of viral infection and the initial step of carcinogenesis [1] , a hypothesis which was then controversially debated and is now common knowledge. Born in Berlin, he had to flee Germany with his parents and received his early schooling in Paris, France. He later attended the National University of Mexico, where he obtained his BSc and MD in 1951. In 1960 he moved to Quebec, Canada, where he worked until his retirement at the St. Sacrement Hospital and Laval University as Director of the Department of Pathology and the School of Cytotechnology. He educated numerous cytotechnologists, residents of pathology and foreign guests, who subsequently spread around the world. He was fluent in four languages, was an eloquent and gifted speaker, and travelled widely. He was particularly interested in the Spanish-speaking world and spread the cytologic gospel throughout Latin America. He received numerous Published online: October 29, 2014