Genotyping of human immunodefiency virus isolates in Papua New Guinea.

BACKGROUND: There has been considerable escalation in the incidence of HIV infection in Papua New Guinea since the first cases have been reported in 1987. OBJECTIVES: The study was to identify the genetic subtype in HIV infected patients in Papua New Guinea. It is believed that the result will not only assist in tracing and tracking the sources of the infection, but will also help to evaluate the impact of the genotypes on the natural history of HIV in Papua New Guinea. METHODS: Plasma samples from eighty patients were definitively tested for HIV antibodies at PNG Central Public Health Laboratory using Welcome ELISA, Serodia, Immuno Comb and Hexagon. The samples were also tested for Hepatitis B (HBsAG and HBcAG) and Hepatitis C virus antibodies. The HIV positive samples were reconfirmed by the Western Blot analysis; RNA isolation and reverse transcription. DNA sequencing and phylogenetic analysis and determination of HIV subtypes were determined by using representative sequences A-H, J, N and 0 in the Los Alamos Database. RESULTS: The total number of HIV-1 positive patients' samples was 20 (5 females and 15 males) Out of this, 11 (all males) were successfully subtyped as c (91%) and b (9%) showing the predominant type to be subtype C. Nine isolates were designated not typable. This is attributable to either low viral load or new emerging strains that could not be detected by the database used in phylogenetic analysis. CONCLUSION: Data predicts that there is possible emergence of BC circulating recombinant form (CRF) because we also identified subtype B. We suggest that as subtype C remains a guide for tracking the sources of infection in PNG that both subtypes C and B (and any other subtypes that may be identified in future) be included in the future vaccine for use in Papua New Guinea since some potential vaccines work only against particular subtypes assuming that nearly all subtypes identified so far are responsive to ant-retroviral drugs.

A comparative clinical evaluation of econazole nitrate, miconazole, and nystatin in the treatment of vaginal candidiasis.

A controlled triple open clinical study on three vaginal tablets--Econazole nitrate, Miconazole and Nystatin, was carried out. Seventy-five patients, aged between 18 and 45 years, presenting with mycologically proven cases of vaginal candidiasis, met certain set criteria and were admitted into the study. Twenty-five patients were randomly assigned to each of the three treatment groups. Results of the study showed that at the 4th week after treatment, Econazole was comparable in antifungal action to Miconazole (x2 = 0.2128; p > 0.05) but significantly more antifungal than Nystatin (x2 = 8.8540; P < 0.05), although the overall clinicomycological assessment of the drugs showed no significant difference in their ratings (F = 21.34; P > 0.05).

Anti-retroviral treatment in Nigeria: a review.

Research studies in Nigeria have been done primarily in the areas of epidemiology, clinical practice, virology, and laboratory diagnosis. Therapy for infection with human immunodeficiency virus (HIV) types 1 and 2 has largely focussed on the treatment of the HIV disease (AIDS) rather than the infection. Therefore, opportunistic infections such as tuberculosis, diarrhea, Herpes zoster, and other skin conditions, and tumors (Kaposi's sarcoma) are essentially the targets for therapy. Two reasons are responsible for the dearth of data on anti-retroviral therapy in Nigeria: there was scepticism about zidovudine, the first anti-retroviral drug to be developed, because of its toxicity, and the subsequent reluctance of the Federal Government to allow it into the country. The other reason was the prohibitive cost, making it impossible for patients to afford. That notwithstanding, there have been several uncoordinated and unpublished clinical trials by hospitals in the private sector, as expected, without firm laboratory monitoring or back-up. This review discusses such attempts and the claims of traditional medicine practitioners, as well as pilot studies on private patients with the combination therapy of zidovudine and lamivudine, which agents were allowed into the country in the late 1990s. The patients showed appreciable rises in their CD4 counts, an indirect way of monitoring viral load. This finding was corroborated with results of clinical wellbeing, indicating that they benefitted from the administration of zidovudine and lamivudine.

Nasopharyngeal carriage of meningococcus and meningococcal meningitis in Sokoto, Nigeria.

In an attempt to determine the epidemiology of meningococcal diseases in Sokoto, Nigeria, nasopharyngeal carriage of meningococcus was studied among the groups at the greatest risk of the disease, i.e. children and young adults. Of 726 subjects sampled, 45 (6.2%) carried meningococcus. Sixteen (35.6%) of the 45 isolates belonged to serogroup B. Others were as follows: group A, 8 (17.8%), C, 5 (11.1%), D, 1 (2.2%) and non-groupable 11 (24.4%). Clinical cases encountered during the period were caused by serogroups A (5, 62.5%) and C (3, 37.5%). A male:female carriage ratio of 1.2:1 was recorded for the potential epidemic serogroups, A and C (chi2 = 1.0091; p>0.05), while the clinical case ratio for the genders was 1.8:1 (chi = 16.1619; p<0.001). The 5-9-y-old age group carried meningococci more frequently (8.5%) than other age brackets, and also registered the highest incidence (46.5%) of the cases. Closeness of contact with a clinical case increased the carriage of the strain of the case (chi2 = 33.3940; p<0.001). Rural dwellers carried meningococcus more frequently than urban dwellers (chi2 = 9.5591; p<0.05). The season had no consistent influence on carriage rates, even though it significantly influenced the outbreaks of the disease. Mass vaccination with polysaccharide vaccine and improved living conditions appear to be the most practical ways to control meningococcal diseases in Africa.

Serum sCD23 in patients with lepromatous and tuberculoid leprosy.

Tuberculoid and lepromatous leprosy (TL and LL) manifest exaggerated Th1 and Th2 type immunity, respectively. Serum soluble CD23, which is regulated by the stimulatory action of IL4 and inhibitory action of IFNgamma, was significantly elevated in LL relative to TL and healthy controls. These results confirm the state of cellular and humoral immunity in TL and LL.

Prevalence and horizontal propagation of gonococcal infections among Nigerian children.

The prevalence and mode of spread of gonococcal infections was studied among prepubertal children in Nigeria. Of 16 children with symptoms suggestive of sexually transmissible diseases (STD), 9 (56%) had gonorrhoea, while no causative organism was found in 7. The majority (7; 78%) of the gonococcal isolates produced penicillinase. Three of the cases were by child-to-child transmission, with female peers as the initiators. Prepubertal children should no longer be ignored as propagators of STD.

Diagnostic potentials of the activities of lectins with whole cells of three bacterial diarrheagenic agents: Aeromonas, Plesiomonas, Campylobacter.

The reactiviteisofstrains ofPlesionmona shigeloides, Campylobater jejuni, Campylobacter coli and Aeromonas species with some lectins namely Soyabean agglutinin (SBA), Ricinus communis agglutinin (RCA), Peanut agllutinin (PNA), Cancanavalin-A (Con-A), Lima bean agglutinin (LMA) and Abrin were investigated using the microtitre plate method. The results obtained show that all stains of A. hydrophila, A. caviae, A. Sobria and P. shigelloides reacted very strongly with PNA and SBA. All strains of C. jejuni studied failed to react with SBA but reacted with PNA Whereas C. coli did not show any reaction towards PNA but reacted very strongly with SBA. All strains of the different organisms were strongly agglutinated by RCA and LMA except A. Hydrophilia and A. sobria which did not react with RCA and LMA respectively. C. jejuni was not agglutinated by Con-A unlike C. coli. Only C. jejuni, C. coli and P. shigelloides reacted with abrin. This study suggests that the reactivities of lectins with the diarrheogenic bacteria studied may be used for their presumptive identifications and for epidemiological purposes.

The antibacterial effect of honey on diarrhoea causing bacterial agents isolated in Lagos, Nigeria.

The antibacterial effect of local honey on local isolates of bacterial agents of diarrhoea was determined by an in vitro method involving the impregnation of filter paper discs in undiluted honey and different honey concentrations ranging from 10%-50%. The discs were later placed on plates that have been seeded with the different bacteria and zones of inhibition of growth were measured after a 48 hr. period of incubation. Results presented show that undiluted honey and honey at concentrations of 40% and above were inhibitory to all enteropathogens tested. Zones of inhibition of growth around the disc margin of the various enteropathogens tested ranged from 16-18mm in diameter for the local undiluted honey and 7-12mm in diameter for concentrations of honey at 40% and 50%. The possible mechanisms of this inhibitory effect of local honey are discussed.

Prevalence of human immunodeficiency virus (HIV) antibodies in tuberculosis patients in Lagos, Nigeria.

To establish the prevalence of HIV antibodies in patients with pulmonary tuberculosis, 536 new cases presenting with symptoms of bronchopulmonary disorders were randomly selected from the six referral chest clinics in Lagos and screened for tuberculosis and HIV infections. Sputum and serum samples were obtained from all the patients. The sputum samples were examined for acid-fast bacilli (AFB) by both microscopy and culture. The sera were screened for HIV-1 and HIV-2 antibodies by ELISA and confirmed by Western blot (WB). Of the 536 cases studied, 188 (35%) were positive for AFB while 13 (2.4%) were seropositive for HIV. Correlation between the AFB and HIV results revealed that 10 (5.3%) of the 188 AFB positives were also seropositive for HIV as compared to 3 (0.9%) in the 348 AFB negative cases. The difference in the HIV seroprevalence rates in the two groups was statistically significant (P < 0.001). The recorded higher frequency of HIV infections in the AFB positives strongly suggested some level of interaction between TB and HIV infections in Lagos. Infections with HIV-2 were more prevalent than HIV-1 in the patients with HIV and TB. No case of dual infection with HIV-1 and HIV-2 was recorded in this group of patients. However, in the 3 HIV-seropositive patients within the control group (non-tuberculosis patients), 2 (67%) were positive for both HIV-1 and HIV-2 while 1 (33%) was positive for HIV-2 only. Mycobacterium tuberculosis (70%), M. avium (20%) and M. kansasii (10%) were the mycobacteria strains isolated from the HIV/TB infected patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Prevalence of human immunodeficiency virus (HIV) antibody among apparently healthy pregnant women in Nigeria.

OBJECTIVE: To determine the prevalence of human immunodeficiency virus (HIV) in pregnancy in our community. METHOD: A prospective study on 250 pregnant women currently attending the antenatal clinic at the Lagos University Teaching Hospital was carried out in 1991. RESULT: Results obtained showed that of the 250 pregnant women screened only two (0.8%) were seropositive for HIV. This indicates the risk of vertical or materno-fetal HIV transmission in our community and underscores the need for urgency for prospective monitoring of infants born to HIV seropositive women. CONCLUSION: Although the prevalence rate of HIV seropositivity amongst the otherwise healthy Nigerian pregnant women is only 0.8%, we advocate universal screening of HIV during pregnancy.

A comparison of human immunodeficiency virus (HIV) seropositivity and hepatitis B surface antigenemia (HBs Ag) among the same group of apparently healthy pregnant women in Lagos, Nigeria: a preliminary report.

Two hundred and fifty apparently healthy pregnant women attending the Obstetrics and Gynecology Clinic of the Lagos University Teaching Hospital (LUTH), Lagos, Nigeria were screened for a comparison of the prevalence of HIV seropositivity and hepatitis B surface antigenemia (HBs Ag) amongst them. The Karpas AIDS cell test for HIV seropositivity and Bioman Hepatitis test kits were used as described by the manufacturers. HIV seropositive cases were confirmed using the Western blot test. Results revealed that out of the 250 pregnant women screened, 2 (0.8%) and 11 (4.4%) were HIV-1 and HBs Ag seropositive, respectively. However, the same 2 pregnant women now constituting 2 (18.2%) of the 11 HBs Ag positive pregnant women were simultaneously HIV-1 seropositive. Antibody to HIV-2 was not recorded in all HIV seropositive cases. This is the first report on the simultaneous prevalence of HBs Ag and HIV seropositivity among apparently healthy pregnant women in Lagos, Nigeria.

PIP: 250 sperm from apparently healthy pregnant patients at the Obstetrics and Gynecology Clinic at Lagos University Teaching Hospital, Lagos, Nigeria, were tested for HIV-1 and HIV-2 and hepatitis B surface antigen (HBsAg). Sera were screened for HIV with the Karpas AIDS cell test using HIV-1 and HIV-2 isolated in Great Britain, and confirmed with the Karpas confirming test and the Western blot. Bioman Hepatek kits were used for hepatitis screening. 2 pregnant women (0.8%) tested positive for HIV-1 and none for HIV-2. 11 women (4.4%) had HBsAg in their serum, and among these, 2 were positive for both HBsAg and HIV-1. This is the first report of pregnant women with both HIV and hepatitis virus screens in Lagos.

Waning significance of anti-streptolysin O (ASO) titres in diagnosing streptococcal infections in Lagos, Nigeria.

A total of 200 serum specimens comprising 100 specimens from patients with streptococcal disease conditions, 50 from patients with other diseases and another 50 specimens from apparently healthy individuals were collected from Lagos University Teaching Hospital and from various areas of Lagos metropolis and screened for the presence of anti-streptolysin O (ASO). For streptococcal disease conditions, other diseases and for apparently healthy persons, anti-streptolysin O titres above 250 iu/ml recorded for each category of clinical conditions in terms of the number examined were 34%, 36% and 28% respectively. It is therefore suggested that high anti-streptolysin O (ASO) titres occur in apparently healthy individuals with no history of streptococcal infection and individuals with disease conditions other than those of streptococcal origin. Consequently the diagnosis of streptococcal diseases based on high titres of ASO in Lagos, is not pathognomonic, should be interpreted with caution and must not be definitive since healthy individuals and others without streptococcal infections develop high ASO titres.

Human pulmonary infections with bovine and atypical mycobacteria in Lagos, Nigeria.

A total of 2784 cases with persistent symptoms of lower respiratory tract infections were seen in four of the chest clinics in Lagos between January and June of 1983. Of these, 668 were randomly selected and screened for pulmonary tuberculosis. Repeated sputum samples from the 668 patients were cultured on Lowenstein-Jenseen slopes and 102 pure mycobacterial isolates were obtained. The isolates were differentiated into tubercle bacilli, bovine or atypical mycobacteria on the basis of results obtained from nine identification tests. Of the 102 mycobacterial isolates obtained, 87 (85%) were identified as Mycobacterium tuberculosis, four (4%) as M. bovis and 11 (11%) as atypical mycobacteria. Among this atypical group, six were classified as M. avium, four as M. kansasii and one as M. fortuitum. The study showed the involvement of bovine and atypical mycobacteria in pulmonary infections in Lagos. Tuberculosis-like diseases produced by some of the atypical group are resistant to most of the conventionally used anti-tuberculosis drugs. The need for adequate bacteriological analysis in current-day diagnosis and treatment of pulmonary tuberculosis is therefore highlighted since the 11 atypical cases seen in this study would otherwise have been diagnosed and treated as cases of classical tuberculosis.

Anti-rabies treatment of dog-bite victims in Lagos, Nigeria: trial of suckling mouse brain and fetal bovine kidney cell rabies vaccines.

Human rabies is common in Nigeria, a country known for rabies endemicity. Yet the supply of anti-rabies vaccines for human use (adult sheep brain origin, produced locally, and duck embryo and human diploid cell vaccines, imported) is grossly inadequate. This study involved controlled treatment of dog-bite victims with suckling mouse brain (SMBV) or fetal bovine kidney (FBKV) rabies vaccines in an effort to determine which type to recommend for production and use in Nigeria. Dog-bite victims treated were aged three to 74 years, with about equal numbers of males and females. Of the 136 patients, 116 (85.3%) completed at least the primo-series of vaccinations, and all have survived without any evidence of clinical rabies. Recipients of the SMBV showed local and generalized reactions in 11.1% and 2.5% of the cases, respectively. Recipients of the FBKV administered subcutaneously showed local and generalized reactions, in 12.5% and 9.4% of cases, respectively. There were no side effects attributable to the vaccine among patients who received the FBKV intramuscularly. By day 7, 26.7% of SMBV recipients and 28.6% of FBKV recipients showed antibody response, with titres of at least one Equivalent Unit ml-1. These percentages increased to 95.1 and 81.1, respectively, by day 14, and by day 20 (for SMBV recipients) or day 30 (FBKV recipients) the response was 100%. Titres dropped by day 90, but in no case to below 1 EU ml-1. We have concluded that both vaccines are equally efficacious and well tolerated. In view of the simple technology required, and the resultant lower cost, the SMBV is being recommended for production and use in Nigeria.