Public and private providers' quality of care for tuberculosis patients in Kampala; Uganda

Setting: The role of the private sector in tuberculosis treatment in developing countries in sub-Saharan Africa is largely unknown. In recent years; many fee-for-service clinics have opened up in Kampala; Uganda. Little is known about the tuberculosis caseload seen in private clinics or the standard of care provided to the patients. Objective: To compare the appropriateness of tuberculosis care in private and public clinics; and the extent of the tuberculosis burden handled in the private sector (...)

Impact of human immunodeficiency virus type-1 infection on the initial bacteriologic and radiographic manifestations of pulmonary tuberculosis in Uganda

Setting : TB Treatment Center; Kampala; Uganda. Objective : To evaluate the impact of Human immunodeficiency virus (HIV) co-infection on the bacteriologic radiographic presentation of pulmonary tuberculosis (TB) in Uganda; a nation with high rates of mycobacterium tuberculosis and HIV infection. Design : To compare baseline characteristics among HIV-infected and non-HIV-infected adults with initial newly-diagonised episodes of culture-confirmed pulmonary tuberculosis screened for participation in a randomised prospective TB treatment trial. Results : Negative and paucibacilliary (very scanty or scanty) sputum acid fast bacilli (AFB) smears were more frequent in HIV-infected patients presenting with pulmonary TB (p

Quantitative sputum bacillary load during rifampin-containing short course chemotherapy in human immunodeficiency virus-infected and non-infected adults with pulmonary tuberculosis

Setting: National Tuberculosis (TB) Treatment Centre; Mulago Hospital and Joint Clinical Research Centre; Kampala; Uganda. Objective: To compare the quantitative sputum bacillary load between TB patients infected with the human immunodeficiency virus (HIV) and those non-infected; during treatment with standard short course chemotherapy (SCC). Design: To comapre clinical characteristics and quantitative sputum bacillary load as measured by quantitative acid-fast bacilli (AFB) smears; colony forming unit (cfu) assay and time until positive culture in the BACTEC radiometric liquid system between 14 HIV-infected and 22 non-HIV-Infected adults with initial episodes of smear-positive polmunary TB at baseline and during treatment with standard four-drug SCC. Results: Other than cavitation (P=0.042) and adenopathy (P=0.03); which were more common among non-HIV-infected patients; respectively; there were no significant differences in baseline demographics; clinical; radiological and laboratory characteristics between the groups. Mean pretreatment sputum bacillary burden (6.5+/-0.51 log 10 AFB/ml; 5.91+/-0.91 log 10 cfu/ml and 1.8+/-1.7 days until positive BACTEC culture for HIV-infected patients and 6.32+/-0.85 log 10 AFB/ml; 5.58+/-0.68 log 10 cfu/ml and 1+/-1.2 days until positive BACTEC culture for non-HIV-infected patients) were comparable between HIV-infected and non-HIV-infected patients. Clinical bacteriological responses to standard SCC and treatment outcome did not differ between the groups. Conclusion: Quantitative sputum bacillary load at baseline and during SCC did not differ significantly between HIV-infected and non-HIV-Infected adults with initial episodes of smear - positive TB

Randomized controlled trial of Mycobacterium vaccae immunotherapy in non-human immunodeficiency virus-infected Ugandan adults with newly diagnosed pulmonary tuberculosis. The Uganda-Case Western Reserve University Research Collaboration

Adjunctive immunotherapy with heat-killed Mycobacterium vaccae was studied in a randomized; placebo-controlled trial of 120 non-human immunodeficiency virus-infected adults with newly diagnosed pulmonary tuberculosis. Patients were randomised to a single dose of M.vaccae or placebo 1 week after beginning chemtherapy and were followed up for 1 year. M.vaccae was safe and well tolerated. the rate of sputum culture conversion after 1 month of tuberculosis treatment was 35in the M.vaccae group and only 14in the placebo group (P=01) but was comparable at 2 months and thereafter. Patients receiving M.vaccae had greater improvement on chest radiography at 6 months (91) vs. 77for placebo recipients; P=04) and 12 months (94vs. 80; P=04) after initiation of tuberculosis treatment. These data provide evidence of an early increase in sputum culture conversion and greater radiographic improvement among patients who received M.vaccae. Further studies are warranted

Kaposi's Sarcoma in AIDS: High incidence of Kaposi's sarcoma-associated herpesvirus and Epstein-Barr virus in tumor lesions and peripheral blood mononuclear cells from patients with Kaposi's sarcoma in Uganda

With the advent of AIDS; Kaposi's sarcom (KS) has become one of the leading malignancies in sub-Saharan Africa. Recently; DNA sequences from a new human herpesvirus called KS-associated herpesvirus (KSHV) or human herpesvirus type 8 have been found in KS tumor lesions as revealed by polymerase chain reaction and Southern hybridization. In contrast; only 31(11/36) of the normal skin biopsies from the same patient population were positive. The frequency of KSHV DNA detection in peripheral blood mononuclear cells (PBMC) of KS patients was also high (84; 31/37). Similar analyses revealed the presence of cytomegalovirus (21in KS lesions) to be discordant with KS PBMC (70; 26/37) were; however; positive for Epstein-Barr virus sequences. In addition; KSHV DNA was not found in the PBMC of Ugandans without KS. (Source: J. Infect. Dis. 1997 April; 175(4):947-50)