Epidemiology of Histopathologically Diagnosed Mycoses: The Ibadan 37 Years Experience.

Background: Recent studies suggest that the occurrence of mycotic infections is increasing worldwide, due to predisposing factors such as immunosuppression from chemotherapy, surgery, HIV/AIDS and debilitating diseases, but there is paucity of information regarding fungal infections in our environment. Aim: This study aimed to characterise mycoses diagnosed histopathologically in the Department of Pathology, University College Hospital (UCH), Ibadan between 1970 and 2006. Methods: The surgical pathology and autopsy records of all mycoses diagnosed during the study period were retrieved and analysed. One hundred and eighty-six mycoses were recruited. Results: There was a progressive decline in the annual occurrence of mycoses from 19.7% to 1.1%. The cases comprised 121 males and 65 females, whose ages ranged from 6 weeks to 80 years, with 68.3% being less than 40 years of age. The mean age of the male patients (29.9±18.4 years) was not significantly different from that of the females (27.4±18.2 years), t = 0.867, df = 186, p = 0.387. The most common mycotic infections were African histoplasmosis (28%), aspergillosis (12.4%), mycetoma (9.7%), candidiasis (8.6%) and actinomycosis (7%). Systemic mycoses accounted for 62%, followed by subcutaneous mycoses (21%), cutaneous mycoses (11%) and superficial mycoses (6%). The most common sites involved were the skin (23.7%), upper and lower limbs (15.6%), nose (11.3%) and lungs (7%). Conclusion: The present study has demonstrated that fungal infections are common and account for significant morbidity and disease burden in our environment.

Genetic Determinants and Clinico-Pathological Outcomes of Helicobacter Pylori Infection

Helicobacter pylori is a spiral Gram-negative bacterium with a relatively small genome and is known to be the most common human bacterial infection worldwide; infecting about half of the world's population. The bacterium represents one of the most successful human pathogens; inducing severe clinical symptoms only in a small subset of individuals; thus signifying a highly balanced degree of co-evolution of H. pylori and humans. The prevalence of Helicobacter pylori infection varies greatly among countries and among population groups within the same country; but is falling in most developed countries. The clinical course of H. pylori infection is highly variable and is influenced by both microbial and host factors including genetic susceptibility while the pattern and distribution of inflammation correlate strongly with the risk of clinical sequelae; namely duodenal or gastric ulcers; mucosal atrophy; gastric carcinoma; or gastric lymphoma. Cytokine gene polymorphisms directly influence inter-individual variation in the magnitude of cytokine response; and this clearly contributes to an individual's ultimate clinical outcome. Polymorphisms in genes coding for innate immune factors have also been incriminated in the pathogenesis of H. pylori related disease; while promoter hypermethylation of tumor suppressor genes is considered an important factor in carcinogenesis and known to be present in H. pylori associated gastric tumors. Functional genomics may fill many of the gaps in our understanding of the pathogenesis of H. pylori infection and accelerate the development of novel therapies; including H. pylori specific antimicrobial agents

Histopathological Patterns of Thyroid Neoplasms in Ibadan Nigeria: A Twenty Year Retrospective Study.

Background: The thyroid gland is an endocrine organ which has an important function in regulation of physiological functions of normal body metabolism. Thyroid neoplasms are usually presented with palpable solitary or multiple nodules. This retrospective study aimed at describing the histopathological patterns of various thyroid neoplasms at the Pathology Department, University College Hospital (UCH), Ibadan between 1987 and 2006. Methods: We reviewed 174 cases with thyroidectomy and diagnosed thyroid neoplasm. We evaluated heamatoxilin and eosin stained slides retrieved from the records of the department and the population based cancer registry and where necessary the paraffin blocks were recut and stained. The World Health Organization Histological Classification of Thyroid tumour (2004) was used in this study. Results: A total 74,202 biopsies were received in the department over the study period. 1,207 cases were thyroidectomy specimens constituting 1.6% of all biopsies in the study period. 174 cases (14.4%) were thyroid gland neoplasms 122 (70.1%) of which were females and 52 of which (29.9%) were males. The ratio of female to male is 2.3:1. Seventy six (43.7%) cases were benign and 98 (56.3%) cases were malignant. Follicular adenoma accounted for 89.5% of benign thyroid neoplasms which makes a peak in the 5th decade. Papillary carcinoma was the most common malignant thyroid neoplasm in this study with a peak in the 3rd decade. Conclusion: This study showed that thyroid neoplasms were showing female predominance. The most common benign neoplasm was follicular adenoma and the malignant neoplasm was papillary carcinoma.

Correlation of Serum Anti-Helicobacter pylori Immunoglobulin A (IGA) with Histological Parameters of Chronic Gastritis in Ibadan; Nigeria

Background: The seroprevalence of anti-H. pylori IgA antibodies has been reported to vary among populations and in relation to strains of Helicobacter pylori bacterium. However; there has been conflicting reports on the association between IgA serological status and the histological variables of chronic gastritis. This study was therefore conducted to clarify this relationship. Method : Using an ELISA based commercial kit; anti-H. pylori IgA antibody tests were performed on 65 dyspeptic patients and 65 age- and ex-matched controls. The gastric biopsies of these patients were also examined histologically for the degrees of inflammation; activity; intestinal metaplasia and atrophy. The CagA status of the patients had been determined previously. Results: There was an anti-H. pylori IgA antibody prevalence of 67.7in dyspeptics and 56.9in non-dyspeptic individuals. No correlations were observed between serum H. pylori IgA antibody and the graded parameters of chronic gastritis in dyspeptic patients; although twice more patients with mild gastric inflammation were found among IgA positive than among IgA negative patients. However; a statistically significant relationship was established between serum IgA positivity and the CagA status of the patients (p = 0.028). Conclusion: The seroprevalence of anti-H. pylori IgA antibody is high in our environment. Serum IgA status may be associated with milder degrees of gastritis in our patients but a larger cohort of patients is needed to confirm this. There seems to be a good agreement between serum IgA and CagA statuses among dyspeptic patients

Enteric fever with suspected intestinal perforation and incidental renal cell carcinoma--a case report.

Enteric fever presents with protean manifestations, at times eluding the treating physician. We report the case of a 19-year-old woman whose clinical presentation suggested enteric fever, however, autopsy revealed occult renal cell carcinoma. We emphasise here, the need to investigate non-infective causes of pyrexia.

Infectious Agents and Cancer

The epidemiology of several types of cancers indicate the involvement of several transmissible agents in their development; and in most cases; these seem to be viruses. The classic examplesare Burkitt's lymphoma; nasopharyngeal carcinoma (EBV); hepatocellular carcinoma (HBV); and cervical carcinoma (HPV). Most of these cancers show substantial variations in their incidencein different parts of the world and in particular countries; they present significant health problems. Worldwide; infections account for up to 20of all cancers. Also; there is now ample evidence implicating infection with the Helicobacter pylori in the occurrence of gastric carcinoma and gastric lymphoma; and infection with Schistosoma haematobium in the occurrence of the squamous cell carcinoma of the urinary bladder.The impact of these infections on the burden of cancer worldwide is becoming increasingly evident because they are largely responsible for the cascade of opportunistic malignancies associated with AIDS. The burden is heaviest among populations in developing countries; reflecting the impact of very early infection with these agents on subsequent risk of cancer. There are currently no vaccines available to prevent these chronic infections; other than for HBV. As a result; changes in behaviour hold the most promise for prevention

Helicobacter pylori-associated gastritis and gastric cancer in Nigeria.

BACKGROUND: The etiology of gastric cancer has not been clearly delineated. There is some evidence of an association of gastric cancer with Helicobacter pylori-induced chronic gastritis, atrophic gastritis and intestinal metaplasia. Previous studies report a high rate of H. pylori infection and chronic gastritis among Nigerians. METHODS: We retrospectively reviewed 84 tissue specimens with gastric cancer seen in our department over an 18-year period for for the presence of H. pylori infection, chronic gastritis, atrophic gastritis, and intestinal metaplasia in the adjacent non-cancerous gastric mucosa. RESULTS: H. pylori infection was detected in 15 (17.9%) of 84 specimens. Moderate to severe gastritis was found in non-cancerous areas in 77 (91.7%) specimens, and was equally frequent in patients with 'intestinal' and 'diffuse' types of cancer. Atrophic gastritis and intestinal metaplasia were observed in 22 (26.2%) and 35 (41.7%) specimens, respectively, and were more common in 'intestinal' type of gastric cancer. CONCLUSION: Chronic gastritis was seen in the adjacent non-cancerous mucosa in most specimens with gastric cancer. However, its severity did not correlate with the histological subtype of gastric cancer.