ABSTRACT
Bacteraemia is significantly associated with underlying Human Immunodeficiency Virus (HIV) infection and is often life-threatening. Streptococcus pneumoniae, non- typhoidal salmonella (NTS), Staphylococcus aureus and Escherichia coli have been shown in various studies to be common organisms that cause bacteraemia in HIV patients in other parts of Sub Saharan Africa (SSA). Methods: The study was a cross sectional analytical study carried out on febrile HIV infected adults who were admitted into the medical wards of the University of Abuja Teaching Hospital (UATH), North Central Nigeria. Blood cultures and other relevant laboratory investigations were carried out on admission. The patients were followed up for a period of one month and outcome thereafter was evaluated. Results: A total of 145 HIV positive patients with a mean age of 37.5 years (range 18-75 yrs.) were studied. The prevalence of bacteraemia was found to be 28.3%. The common causative pathogens were Streptococcus pneumoniae, Staphylococcus aureus and Klebsiella pneumonia, with Streptococcus pneumoniae being the most common isolate. Mortality was higher in the bacteremia group (51.2%) compared to the non bacteraemic group (32.7%) [P-value = 0.04] as well as among those with severe immunosuppression (96.4%) compared to those with CD4 cell counts above 200 cells /ml (3.6%)[p-value=0.004]. Conclusion: Bacteremia is common among febrile HIV patients presenting at the University of Abuja Teaching Hospital and it is associated with a high mortality rate. Streptococcus pneumoniae is the commonest causative organism.
ABSTRACT
Snakebite is a critical public health issue in tropical countries, particularly in Africa, where 20% of snakebites globally occur. In 2017, the WHO added snakebite envenoming to the category A of neglected tropical diseases. In 2019, thanks to broad institutional and international NGO support, including strong mobilization of African experts and governments, WHO launched a strategy for prevention and control of snakebite envenoming with more ambitious goals. In sub-Saharan Africa, accessibility of antivenoms and symptomatic, adjuvant or replacement therapy is a priority. Several antivenoms are available but their evaluation has not been properly carried out and they remain expensive. To date, there are no manufacturers of antivenom in sub-Saharan Africa (except in South Africa), which requires their importation from other continents. The lack of experience in antivenom choice and its use by health authorities, health personnel and population largely explains the shortage in sub-Saharan Africa. The deficiency of epidemiological data does not allow the implementation of appropriate and efficient care. It is crucial to strengthen the health system which does not have the necessary means for emergency management in general and envenoming in particular. Providing peripheral health centers with antivenoms would decrease complications and deaths. The motivation of communities at risk, identified through the epidemiological data, would be to reduce the delay in consultation that is detrimental to the efficiency of treatment. Partnerships need to be coordinated to optimize resources from international institutions, particularly African ones, and share the burden of treatment costs among all stakeholders. We propose here a project of progressive implementation of antivenom manufacturing in sub-Saharan Africa. The various steps, from the supply of...
Subject(s)
Humans , Animals , Antivenins/administration & dosage , Neglected Diseases , Snake Bites/prevention & control , Africa South of the SaharaABSTRACT
Snakebite envenoming is a major public health problem among rural communities of the Nigerian savanna. The saw-scaled or carpet viper (Echis ocellatus) and, to a lesser extent, the African cobras (Naja spp.) and puff adders (Bitis arietans) have proved to be the most important cause of mortality and morbidity. The main clinical features of E. ocellatus envenoming are systemic hemorrhage, incoagulable blood, shock, local swelling, bleeding and, occasionally, necrosis. Bites may be complicated by amputation, blindness, disability, disfigurement, mutilation, tissue destruction and psychological consequences. Antivenom remains the hallmark and mainstay of envenoming management while studies in Nigeria confirm its protection of over 80% against mortality from carpet-viper bites. However, the availability, distribution and utilization of antivenom remain challenging although two new antivenoms (monospecific EchiTab G and trispecific EchiTab ICP-Plus) derived from Nigerian snake venoms have proven very effective and safe in clinical trials. A hub-and-spoke strategy is suggested for broadening antivenom access to endemic rural areas together with instituting quality assurance, standardization and manpower training. With the advent of antivenomics, national health authorities must be aided in selecting and purchasing antivenoms appropriate to their national needs while manufacturers should be helped in practical ways to improve the safety, efficacy and potential coverage against snake venoms and pricing of their products.(AU)
Subject(s)
Animals , Snake Bites , Bites and Stings , Public HealthABSTRACT
Snakebite envenoming is a major public health problem among rural communities of the Nigerian savanna. The saw-scaled or carpet viper (Echis ocellatus) and, to a lesser extent, the African cobras (Naja spp.) and puff adders (Bitis arietans) have proved to be the most important cause of mortality and morbidity. The main clinical features of E. ocellatus envenoming are systemic hemorrhage, incoagulable blood, shock, local swelling, bleeding and, occasionally, necrosis. Bites may be complicated by amputation, blindness, disability, disfigurement, mutilation, tissue destruction and psychological consequences. Antivenom remains the hallmark and mainstay of envenoming management while studies in Nigeria confirm its protection of over 80% against mortality from carpet-viper bites. However, the availability, distribution and utilization of antivenom remain challenging although two new antivenoms (monospecific EchiTab G and trispecific EchiTab ICP-Plus) derived from Nigerian snake venoms have proven very effective and safe in clinical trials. A hub-and-spoke strategy is suggested for broadening antivenom access to endemic rural areas together with instituting quality assurance, standardization and manpower training. With the advent of antivenomics, national health authorities must be aided in selecting and purchasing antivenoms appropriate to their national needs while manufacturers should be helped in practical ways to improve the safety, efficacy and potential coverage against snake venoms and pricing of their products.
ABSTRACT
Background : Tuberculosis (TB) is an important cause of mortality and morbidity in human immunodeficiency virus (HIV) infection in Africa. The interaction between TB and HIV infections is reviewed. Methods : Literature on TB; HIV and their co-infection; especially in sub-Saharan Africa; including Nigeria; is reviewed. Results : Burden of TB is fueled by the HIV epidemic; and clinical presentation of TB may be atypical with co-infection. Recommendations on drugs and timing of antiretroviral therapy (ART) initiation are discussed. Use of cotrimoxazole prophylaxis (CPT) in co-infected patients reduces morbidity and mortality; while the principles of TB prevention in HIV infection can be summarized with the three I's: intensive TB case finding and surveillance; isoniazid preventive therapy (IPT) and infection-control measures; to these can be added a fourth 'I;' viz.; instituting ART. Clinical complications like drug resistance; toxicity and drug interactions; and immune reconstitution inflammatory syndrome (IRIS) with CPT; IPT and ART are highlighted. Emergence of drug-resistant- and nosocomial- TB in HIV infection poses serious challenges and potential consequences in Africa; and appropriate measures are recommended. Conclusions : Many barriers exist for optimizing the care of the two diseases; but the aim should be strengthening capacities; collaborations; linkages and eventually integrating the services. Interventions for TB prevention in HIV infection should be widely implemented