Survival and predictors of mortality among human immunodeficiency virus patients on anti-retroviral treatment at Jinka Hospital, South Omo, Ethiopia: a six years retrospective cohort study / 한국역학회지

OBJECTIVES: The survival rate of human immunodeficiency virus (HIV)-infected patients receiving treatment in Ethiopia is poorly understood. This study aimed to determine the survival rate and predictors of mortality among HIV-infected adults on antiretroviral therapy (ART) at Jinka Hospital, South Omo, Ethiopia. METHODS: A 6-year retrospective cohort study was conducted using 350 patient records drawn from 1,899 patients on ART at Jinka Hospital from September 2010 to August 2015. The data were analyzed using Kaplan-Meier statistics and Cox regression models. RESULTS: Of the 350 study participants, 315 (90.0%) were censored and 35 (10.0%) died. Twenty-two (62.9%) of the deaths occurred during the first year of treatment. The total follow-up encompassed 1,995 person-years, with an incidence rate of 1.75 deaths per 100 person-years. The mean survival time of patients on highly active antiretroviral therapy (HAART) was 30.84±19.57 months. The overall survival of patients on HAART was 64.00% (95% confidence interval [CI], 61.85 to 66.21%) at 72 months of follow-up. The significant predictors of mortality included non-disclosure of HIV status (adjusted hazard ratio [aHR], 5.82; 95% CI, 1.91 to 17.72), a history of tuberculosis (aHR, 1.82; 95% CI, 1.41 to 3.51), and ambulatory (aHR, 2.97; 95% CI, 1.20 to 8.86) or bedridden (aHR, 4.67; 95% CI, 1.30 to 17.27) functional status, World Health Organization (WHO) clinical stage IV illness (aHR, 24.97; 95% CI, 2.75 to 26.45), and substance abusers (aHR, 3.72; 95% CI, 1.39 to 9.97). CONCLUSIONS: Patients with a history of tuberculosis treatment, ambulatory or bedridden functional status, or advanced WHO clinical stage disease, as well substance abusers, should be carefully monitored, particularly in the first few months after initiating antiretroviral therapy. Patients should also be encouraged to disclose their status to their relatives.

Evaluation of the GenoType MTBDRplus assay for detection of rifampicin- and isoniazid-resistant Mycobacterium tuberculosis isolates in central Ethiopia

Objective/Background: Multidrug-resistant tuberculosis [MDR-TB] is growing globally and becoming a major challenge for national TB control programs. Therefore, rapid identification of MDR strains of Mycobacterium tuberculosis and monitoring their transmission could contribute significantly to the control of TB. The GenoType MTBDRplus assay has been recommended by the World Health Organization to identify rifampicin [RIF] - and isoniazid [INH]-resistant M. tuberculosis isolates. This study was carried out to evaluate the performance of the GenoType MTBDRplus assay for the detection of RIF- and INH-resistant M. tuberculosis isolates in central Ethiopia

Methods: A total of 279 M. tuberculosis strains isolated from active TB cases in central Ethiopia were evaluated for their drug sensitivity by the conventional drug-susceptibility test [DST] and compared with data derived from the GenoType MTBDRplus assay. The DST served as the gold standard for evaluating the GenoType MTBDRplus assay

Results: The sensitivity and specificity of the GenoType MTBDRplus assay for the detection of RIF-resistant M. tuberculosis isolates were 80.0% and 99.6%, respectively. Its sensitivity and specificity for the detection of INH-resistant M. tuberculosis isolates were 82.7% and 99.6%, respectively, whereas they were 75.0% and 100%, respectively, for the detection of MDR M. tuberculosis strains. The concordances of the GenoType MTBDRplus assay and the conventional DST for the detection of RIF and INH susceptibility were 80% [8/10] and 86.2% [25/29], respectively. Furthermore, the concordance of the two tests for the detection of MDR M. tuberculosis strains was 75%. Specific mutations were detected in 55.6% [5/9] of the RIF-resistant isolates, with the highest mutation rate [33.3%] for the rpoB gene [Codon S531L]. For INH-resistant isolates, the highest mutation rate [88.8%] related to a katG mutation [Codon S315T1]

Conclusion: The findings of this study revealed that the GenoType MTBDRplus assay has high sensitivity and specificity for the detection of RIF and INH resistance. These preliminary data support the notion that the assay should be considered as an alternative to the DST for the characterization of MDR in M. tuberculosis isolates and the control of TB

Community-based prevalence of undiagnosed mycobacterial diseases in the Afar region, north-east Ethiopia

Information on the community-based prevalence of tuberculosis [TB] in different settings is vital for planning, execution and evaluation of strategies to control the disease. To assess community-based prevalence of undetected active pulmonary TB [PTB] in pastoralists of the Amibara District. Between March and April 2010, a community-based cross-sectional survey of undiagnosed active PTB was conducted in the pastoralists of the Amibara District of the Afar Region, north-east Ethiopia. The study participants were interviewed for symptoms suggestive of PTB using a structured questionnaire. Sputum samples were collected and processed for smear microscopy and culture. Mycobacterium genus typing was performed using a multiplex polymerase chain reaction [PCR]. Out of 222 individuals who had symptoms suggestive of PTB, 4 [1.8%] were found positive by smear microscopy, while mycobacterial growth was observed on 62 [27.9%] samples. Mycobacterium genus typing was carried out for 42 of these 62 samples; 39 [92.9%] gave a positive signal for the genus Mycobacterium. Of these, 23 [59%] isolates proved to be members of the Mycobacterium tuberculosis [Mtb] complex, while the remaining 16 [41.0%] were found to be members of non-tuberculous Mycobacteria [NTM] species. Sputum culture is highly sensitive, and it is the gold standard for the bacteriological diagnosis of PTB, while smear microscopy is less sensitive to detect acid fast bacilli [AFB] in stained sputum smears. The findings of the present study warrant the strengthening of culture facility services in the study area. The study also provides important preliminary information on the status of NTM infection in the pastoral setting. Nevertheless, further investigations into the species identification of the NTM infections would be useful in the study area

Evaluation of berries of Phytolacca dodecandra for growth inhibition of Histoplasma capsulatum var. farciminosum and treatment of cases of epizootic lymphangitis in Ethiopia

Objective:To evaluate the berries of Phytolacca dodecandra (P. dodecandra) for its effect on Histoplasma capsulatum var. farciminosum (HCF) and for the treatment of cases of epizootic lymphangitis (EL). Methods:Samples were collected from un-ruptured nodules of cases of EL at Debre Zeit and Akaki (central Ethiopia). Mycological culture and isolation of HCF were performed at the Aklilu Lemma Institute of Pathobiology. Phytochemical screening was done for n-butanol extract of P. dodecandra to detect alkaloids, saponins, phenolic compounds and flavonoids. The minimum inhibitory concentrations (MICs) and minimum fungicidal concentrations (MFCs) of aqueous and n-butanol extracts of P. dodecandra against HCF were determined by agar dilution assay. For the in vivo trial, 5%simple ointment was prepared from n-butanol extract and applied topically to 24 (twelve early and twelve moderate) cases of EL. Results:Phytochemical screening showed that n-butanol extract of P. dodecandra was positive for alkaloids, saponins and phenolic compounds but negative for flavonoids. The MICs of n-butanol and aqueous extracts of P. dodecandra were (0.039%-0.078%) and (0.625%-1.250%), respectively. The MFCs of n-butanol and aqueous extracts of P. dodecandra were (0.078%-0.156%) and (1.250%-2.500%), respectively. The MIC and MFC of ketoconazole (positive control) was (1.200×10-5%-2.500×10-5%) and (5.000×10-5%-1.000×10-4%), respectively while growth was observed on free medium (negative control). From the total of 24 treated cases of EL, 14 (58.3%) responded to treatment;however, 10 (41.7%) did not respond to treatment. There was no significant difference in the degree of response to treatment between early and moderate cases (χ2=0.686;P=0.408). Conclusions:It can be concluded that n-butanol extract of P. dodecandra demonstrates antifungal effects while the aqueous extract shows no antifungal activity.

Study on Histoplasmosis (Epizootic Lymphangitis) in Cart-Horses in Ethiopia

A cross-sectional study was conducted to determine the prevalence of Histoplasma farciminosum in 2907 carthorses using clinical and microbiological examinations at three towns (Debre Zeit, Mojo and Nazareth), Central Ethiopia, between December 1999 and January 2001. An overall prevalence of 26.2% (762/2907) was recorded; the highest prevalence (39.1%) being recorded at Mojo whereas the lowest (21.1%) was recorded at Nazareth. The difference in prevalence among the three towns was highly significant (chi2 = 76.92, P<0.0001). Carthorses found at Mojo [OR =2.4, CI=(1.9-3.0), P<0.0001] and Debre Zeit [OR=1.9, CI=(1.5-2.3), P<0.0001] were at higher risk of infection than those found at Nazareth. The mycelial and yeast forms of the Histoplasma capsulatum variety farciminosum were isolated on the Sabouraud's dextrose agar. The results of the present study showed the rampant occurrence of histoplasmosis farciminosi at the three towns and indicates the need for further nationwide investigation into the disease to design sound control strategy.