Rapid response to meningococcal disease cluster in Foya district, Lofa County, Liberia January to February 2018

Introduction: early detection of disease outbreaks is paramount to averting associated morbidity and mortality. In January 2018, nine cases including four deaths associated with meningococcal disease were reported in three communities of Foya district, Lofa County, Liberia. Due to the porous borders between Lofa County and communities in neighboring Sierra Leone and Guinea, the possibility of epidemic spread of meningococcal disease could not be underestimated. Methods: the county incidence management system (IMS) was activated that coordinated the response activities. Daily meetings were conducted to review response activities progress and challenges. The district rapid response team (DRRT) was the frontline responders. The case based investigation form; case line list and contacts list were used for data collection. A data base was established and analysed daily for action. Tablets Ciprofloxacin were given for chemoprophylaxis.Results: sixty-seven percent (67%) of the cases were males and also 67% of the affected age range was 3 to 14 years and attending primary school. The attack rate was 7/1,000 population and case fatality rate was 44.4 % with majority of the deaths occurring within 24-48 hours of symptoms onset. Three of the cases tested positive for Neisseria Meningitidis sero-type W while six cases were Epi-linked. None of the cases had recent meningococcal vaccination and no health-worker infections were registered.Conclusion: this cluster of cases of meningococcal disease during the meningitis season in a country that is not traditionally part of the meningitis belt emphasized the need for strengthening surveillance, preparedness and response capacity to meningitis

Antibacterial effect of crude methanol Carica papaya L. (papaya) extract and amoxicillin combination

Background: the emergence of multi-drug resistant bacteria and the diseases caused by them are a serious threat to global health necessitating an urgent need for new approaches to combat them. Synergy studies of conventional antimicrobial drugs and medicinal plants with antibacterial effects are important to establish whether it is prudent to recommend their concurrent administration to get successful treatments. Objective: evaluate the antibacterial effect resulting from the combination of Carica papaya (papaya) and amoxicillin. Methods: the papaya methanol extract was obtained from seeds and phytochemical screening was done. Checkerboard assay was used to determine the Minimum Inhibitory Concentration. Combined effect of both Carica papaya methanol extract and amoxicillin was determined by calculating the Fractional Inhibitory Concentration index. Strains of Staphylococcus aureus ATCC 25923 and Escherichia coli ATCC 25922 were used in the tests. Results: phenols and tannins were found in the Carica papaya seed methanol extract. The minimum inhibitory concentration of Carica papaya extract was 100 µg/mL for both microorganisms studied which was higher than the Minimum Inhibitory Concentration of amoxicillin being 3.12 µg/mL for Escherichia coli and 0.2 µg/mL for Staphylococcus aureus. The Fractional Inhibitory Concentration of the combination of drugs was 0.99 for Escherichia coli and 2.51 for Staphylococcus aureus. Conclusions: the antibacterial effect of Carica papaya extract may be attributed to the presence of phenolic compounds. There was no interaction between amoxicillin and Carica papaya extract on Staphylococcus aureus, but the antimicrobial activity against Escherichia coli of both drugs can be potentiated by their additive interaction(AU)

Introducción: la creciente multi-resistencia bacteriana y emergencia de enfermedades causadas por estas bacterias, constituyen un serio problema global, por lo que es importante y urgente el desarrollo de nuevas propuestas terapéuticas para combatirlas. Estudios sinérgicos sobre la combinación de antimicrobianos convencionales y plantas con efectos antibacterianos son importantes para determinar si es aconsejable la administración concomitante de los mismos. Objetivo: evaluar el efecto antibacteriano de la combinación de Carica papaya (papaya) y amoxicilina. Método: fueron usadas semillas de papaya para obtener el extracto alcohólico de papaya y realizado el estudio fitoquímico. La Concentración Mínima Inhibitoria fue determinada por el método del tablero de ajedrez. La Concentración Inhibitoria Fraccionada se calculó para medir el posible efecto sinérgico de la combinación entre el extracto alcohólico de Carica papaya y la amoxicilina. Cepas de Staphylococcus aureus ATCC 25923 y Escherichia coli ATCC 25922 fueron usadas. Resultados: en el extracto alcohólico de papaya fueron encontrados fenoles y taninos. La Concentración Mínima Inhibitoria del extracto de papaya coincidió para ambos microorganismos (100 µg/mL), la cual fue mayor que la Concentración Mínima Inhibitoria de la amoxicilina, siendo 3.125 µg/mL para Escherichia coli y 0.2 µg/mL para Staphylococcus aureus. La Concentración Inhibitoria Fraccionada de la combinación de drogas, fue 0.99 para Escherichia coli y 2.51 para Staphylococcus aureus. Conclusiones: los compuestos fenólicos presentes en el extracto de papaya pueden ser responsables de su efecto antimicrobiano. No existe interacción entre la amoxicilina y el extracto metanólico de papaya contra Staphylococcus aureus. Sin embargo, la actividad antomicrobiana contra Escherichia coli puede ser potenciada por su interacción aditiva(AU)

Microscopy Negative Malaria during a Peak Transmission Season in a Malaria Endemic Setting: Diagnostic Accuracy of RDTs, Expert Microscopy and the Value of Presumptive Treatment.

Aim: We investigated all malaria symptomatic patients with microscopy-negative results during a peak malaria transmission season to ascertain the need for presumptive treatment of malaria among these patients. Justification: Due to improved malaria control measures, the administration of anti-malarial drugs to symptomatic patients with negative microscopy results is uncalled for. However, in malaria endemic low resource settings, this practice is upheld especially during peak transmission seasons. There is paucity of data to either support or discourage this practice in these settings. Study Design: It was a cross-sectional study. Place and design of study: This study was conducted at Gulu regional referral hospital, Uganda, between October and November 2012. Methodology: A routine blood smear (BS) was examined for all the 542 malaria symptomatic participants. A rapid diagnostic test (RDT) was performed on all patients with negative BS results. All smears were later read by expert microscopists. Results: Of the 542 patients seen, 503 (92.8%) had negative routine BS results. Eighty nine (7.2%) were excluded due to history of treated fever in the previous two months. Of the 414 qualifying participants, 14 (3.4%) were positive by RDT and 6 (1.4%) were positive by expert microscopy. Nearly all participants (12/14) with microscopy-negative but RDT-positive results were children less than 5 years. Conclusion: At a rate of 3.4% true malaria cases, presumptive treatment of all malaria symptomatic cases offers a marginal benefit to children less than five years and is an uncalled-for expense among adults. Prescription practices consistent with these findings could greatly improve rational anti-malarial use and minimize costs, especially in sub-Saharan Africa.