Evaluation of Some Cytokines, CD4, Hepcidin, Iron Profile and Some Haematological Parameters of Pulmonary Tuberculosis Patients Coinfected with HIV in Southeast of Nigeria

The study was done to determine the levels of interferon-gamma, interleukin 6, interleukin 10, iron status, hepcidin and haematologicalparameters of patients with pulmonary tuberculosis co-infected with human immunodeficiency virus in Southeast, Nigeria. This study was carried out at the directly observed treatment-short course Tuberculosis (TB DOTS) centre of Federal Medical Centre, Umuahia, located in South-Eastern Nigeria. Therefore, sample size of 240 was used to give room for attrition. A total of two hundred and forty (240) subjects aged 18-60 years were enlisted for this study. Seven milliliters (7ml) of venous blood was collected from each subject and 2.5ml was dispensed into bottles containing di-potassium salt of ethylenediamine tetra-acetic acid (K2-EDTA) and was used for full blood count, CD4 count and HIV screening. Also, 4.5ml was dispensed into plain tubes. Serum was obtained after clotting by spinning at 3000 RPM for 10 minutes and was used for interferon gamma, interleukin-6, and interleukin-10, iron and hepcidin determination. Data was analysed using statistical package for social science (SPSS) version 20. Student t-test, ANOVA (Analysis of Variance), Pearson Product Moment and Chi-Square were the tools employed. Results were expressed as mean ± standard deviation and are presented in table and significance level was set at P<0.05.The results showed difference that was statistically significant (P<0.05) in IFN-γ (P=0.000), IL-6 (P=0.000) IL-10 (P=0.000), CD4 (P=0.000), hepcidin (P=0.000), Iron (P=0.000), TIBC (P=0.000), %TSA (P=0.001) ,WBC (P=0.000), Neutrophils (P=0.000), Lymphocyes (P=0.000), Monocytes (P=0.000), Eosinophils (P=0.000), Basophils (P=0.018), RBC (P=0.000), haemoglobin (P=0.000), PCV (P=0.000), MCV (P=0.000), MCH (P=0.000), MCHC (P=0.000), Platelets (P=0.000), ESR (P=0.000) when compared among control, TB, HIV and TB-HIV subjects respectively. The co infection of HIV on pulmonary TB patients increases the levels of the cytokines. The cytokines and hepcidin can be used as adjunct to prognostic and diagnostic markers as their levels decreased with increased duration of treatment of the patients. The study hasshown wide variations in the haemtological indices studied

Seroprevalence of Herpes Simplex Virus Type 2 and Associated Risk Factors among Undergraduate Female Students of Babcock University Nigeria

Background: Herpes simplex virus type 2 (HSV-2) causes genital herpes, a chronic viral infection that is sexually transmitted and often results in genital ulcer disease (GUD) worldwide.Aim: The aim of this study was to determine the prevalence of herpes simplex virus type 2 (HSV-2) IgG and IgM antibodies and the associated risk factors among undergraduate female students of Babcock University.Methods: After ethical approval was obtained, serum samples of 150 consenting female participants (16-35 years) were collected randomly and screened using NADALR HSV-2 IgG/IgM Rapid Antibody Test Cassette (Bulgarian Company for Biotechnology, Sofia, Bulgaria). The demographic and clinical information of the participants were also collected using a structured questionnaire. The results were statistically analyzed using the SPSS version 18.0.Results: The outcome of the study shows that out of the 150 participants screened, 5 (3.3%) were positive for HSV-2 IgG antibody, 4 (2.7%) were positive for HSV-2 IgM; while 2 (1.3%) were positive for both HSV-2 IgG and IgM antibodies. There were no significant differences (P>0.05) in the seropositivity for HSV-2 IgG and IgM antibodies among the study participants on the basis of age distribution. With regards to clinical indication for genital herpes in relation to seropositivity of HSV-2 IgG and IgM antibodies among the study participants, none of the 7 (4.6%) who indicated vaginal itching was seropositive for either HSV-2 IgG or HSV-2 IgM or both. On the other hand, genital lesions were recorded in 0.7% HSV-2 IgG seropositive, 1.3% HSV-2 IgM seropositive and 0.7% HSV-2 both IgG and IgM seropositive. Genital ulcer was recorded among two participants who were either seropositive for HSV-2 IgG (0.7%) or HSV-2 IgM (0.7%). Only one (0.7%) participant indicated inguinal lymphadenopathy, however, the person was HSV-2 IgG/IgM seronegative. Identifiable risk factor significantly (P<0.05) associated with HSV-2 infection include: history of sexually transmitted infections, HIV positive status, and change of sex partners recently.Conclusion: The outcome of this study shows that HSV-2 infection exists among undergraduate female students of Babcock University, Nigeria and therefore appropriate public health measures must be taken to halt the cycle of infection within the University community. Early detection of genital herpes and prompt treatment will help prevent subsequent complications such as genital ulcer disease among young female adults.

Effectiveness of Tuberculosis Smear Microscopy in Laboratory Diagnosis of Mycobacterium tuberculosis in Resource Constrained Settings.

Aim: To determine the correlation of accuracy of direct smear microscopy compared with BACTEC MGIT 960. Design: The study prospectively compare direct smear microscopy with BACTEC MGIT 960 using the reference standard, Lowenstein Jensen culture. Place and Duration: The study was conducted in Zankli Medical Centre, Abuja, between November 2004 and July 2005. Methodology: 340 suspected patients for Mycobacterium tuberculosis referred from direct observation therapy clinics located in six different government owned health facilities were referred to our facility. These patients; male (192) and female (148) were between the age of 10 and 64 years old. Three sputa samples were collected over two consecutive days and direct smear microscopy and culture were performed on these samples. Results: When compared with the reference standard, BACTEC MGIT 960 has a sensitivity and specificity of 100.0% and 56.4% respectively, and a negative predictive value of 100.0%; indicating the proportion of AFB negative participants were actually not infected with M. tuberculosis when tested with BACTEC MGIT 960. The sensitivity of direct microscopy was significantly lower than BACTEC MGIT 960 (84.9% versus 100%, p<0.001) and the specificity was significantly higher (96.6% versus 56.4%, p<0.001). Conclusions: For the purpose of effectiveness of tuberculosis program in developing countries, direct smear microscopy may still be relevant in the diagnosis of Mycobacterium tuberculosis.

Improved sensitivity, safety and laboratory turn around time in the diagnosis of pulmonary tuberculosis by use of bleach sedimentation

Background: Inadequate diagnostic processes and human resources in laboratories contribute to a high burden of tuberculosis (TB) in low- and middle-income countries. Direct smear microscopy is relied on for TB diagnosis; however; sensitivity rates vary. To improve sensitivity of direct microscopy; the researchers employed several approaches; including sputum digestion and concentration of acid-fast bacilli (AFB); a technique which uses commercial bleach. Objectives: This study compared methods used to diagnose active Mycobacterium tuberculosis infections. Methods: Three sputum specimens were collected from each of 340 participants in Abuja; Nigeria; over two consecutive days. Direct microscopy was performed on all specimens; following microscopy; one specimen from each patient was selected randomly for bleach sedimentation and one for Lowenstein-Jensen culture.Results: Direct microscopy produced 28.8% AFB-positive results; whilst bleach sedimentation resulted in 30.3%. When compared with the cultures; 26.5% were AFB true positive using direct microscopy and 27.1% using bleach sedimentation. Whilst the specificity rate between these two methods was not statistically significant (P = 0.548); the sensitivity rate was significant (P = 0.004).Conclusion: Based on these results; bleach increases the sensitivity of microscopy compared with direct smear and has similar specificity. When diagnosing new cases of pulmonary TB; one bleach-digested smear is as sensitive as three direct smears; reducing waiting times for patients and ensuring the safety of laboratory technicians

Evaluation of Commercial Rapid Diagnostic Test Kit for Tuberculosis: Further Evidence Supporting Negative Policy on the Use of Serological Tests for Pulmonary Tuberculosis Diagnosis in Developing Countries.

Aim: To know whether one of the commercially available immunochromatographic tuberculosis tests is comparable with the widely available method, direct sputum microscopy. Design: The study prospectively validated the pulmonary tuberculosis rapid test kit using the reference standard, Lowenstein Jensen culture and compared the outcome with the direct sputum microscopy. Place and Duration: The study was conducted in Zankli Medical Centre, Abuja, between November 2004 and July 2005. Methodology: 340 patients from direct observation therapy clinics located in six different government owned health facilities were referred to our facility. These patients; male (192) and female (148) were between the age of 10 and 64 years old. Three sputa samples were collected over two consecutive days and direct microscopy and culture were performed on these samples. Also, 4ml of blood were collected from the same patients for antibody detection using immunochromatographic technique. Results: The evaluated rapid diagnostic kit when compared with the reference standard has a sensitivity of 59.3% and 81.1% specificity. Sensitivity and specificity of direct microscopy, when compared with the rapid test is statistically significant (P=0.001); indicating diagnostic accuracy of the conventional method of pulmonary tuberculosis testing over the immunochromatographic test. Conclusions: The conventional test indicated high performance in this report and it is suggestive of the relevance and diagnostic accuracy of the widely available method in the diagnosis of pulmonary tuberculosis in developing countries. This assertion is also, supported by the 2008 WHO/TDR report on evaluation of nineteen tuberculosis rapid diagnostic kits.

Treatment Outcomes in Patients Receiving Combination Antiretroviral Therapy in Central Hospital; Benin City; Nigeria

Purpose: This study investigated mortality rate; early CD4 responses; pattern of ARVs substitutions and medication adherence of HIV-infected patients on first-line triple combination antiretroviral therapy (ART) in Central Hospital; Benin City; Nigeria. Methods: A retrospective assessment of 196 HIV-infected patients on first-line combination ART regimens was performed following 18 months of therapy. Medication adherence assessment of a 69-patient follow-up target group was based on a study-specific questionnaire. Paired sample t-test and simple linear correlation were used to test the association of the CD4-cell counts at different time intervals. Kaplan-Meier model was used to assess survival functions while log-rank test was applied to assess statistical difference at 95confidence interval (CI). Mean age of participants was 33.6 years (95CI; 32.1 - 35.2; 67.9were females. Results: At ART initiation; 27.0were at WHO clinical stage II; 47.0at stage III. Mortality rate (N = 196) was 20.3 deaths per 100 patient-months; 31.6occurred in 30 days while 52.6occurred post-120 days of treatment. The mean CD4-cell count (cells/mm3) at ART initiation was 179.2 which increased to 328.5 at 3 months; 325.6 at 6 months; 357.4 at 12 months; and 366.7 at 18 months; (p 0.01). Patients started on stavudine-based or efavirenz-based regimens were considerably more likely to have that drug substituted; compared to patients started on zidovudine-based or nevirapine-based regimens. The level of adherence reported after 18 months on ART was 73.8. Conclusion: In this setting; patients receiving ART showed significant improvements in CD4-cell status but adherence level was relatively poor. Patients were more stable on zidovudine-based or nevirapine-based regimens than on stavudine-based or efavirenz-based regimens. Early mortality rate was high; indicating a need for early interventions