Prevalence and risk factors for vaginal candidiasis among women seeking primary care for genital infections in Dar es Salaam, Tanzania.

OBJECTIVE: To determine the prevalence and risk factors for vaginal candidiasis (VC) among women seeking primary care for genital infections. DESIGN: Cross-sectional study. SETTING: Ilala Municipal Hospital in Dar es Salaam, Tanzania. SUBJECTS: Four hundred and sixty four women presenting with complaints of genital infections. RESULTS: Of the 464 women examined, 177 (38.1%) had abnormal vaginal discharge, 68(14.7%) had genital ulcers, 272 (58.6%) had genital pruritus, 18 (3.9%) had genital warts and 58 (12.5%) had chancre. The prevalencies of VC, bacterial vaginosis, HIV, T vaginalis, N. gonorrhoeae and syphilis were 45%, 48.4%, 22%, 93%, 1.5% and 4.3%, respectively. The occurrence of VC was positively associated with HIV, (OR = 1.81, 95% CI (1.0-2.67), bacterial vaginosis; (OR = 2.6, 95% CI (1.7-3.9), genital pruritus; (OR = 1.8 1, 95% CI (1.2-2.7) genital discharge; (OR = 1.867, 95% (1.28-2.73) and negatively with T. vaginalis (OR = 0.27, 95% CI (0.12 - 0.6), occupation (OR = 0.65, 95% CI (0.35-0.86)) and with education (OR = 0.43, 95% CI (0.11-0.73). There were increased but non-significant odds for VC in patients with syphilis (OR = 1.6 95% CI (0.6-4.3) and venereal warts (OR = 2.5 95% CI (0.92-6.8) VC was not associated with N. gonorrhoeae, genital ulcers, age at first intercourse, number of sexual partners, marital status or antibiotic usage. CONCLUSION: The high prevalence of vaginal candidiasis among women with genital infections should be taken into account when updating policies concerning syndromic management of sexually transmitted diseases. More gender specific approach to syndromic management of sexually transmitted infections in females should be considered.

Identification of Candida strains isolated from Tanzanian pregnant women with vaginal candidiasis.

OBJECTIVE: To identify Candida strains isolated from Tanzanian women (13 to 45 years) with vaginal candidiasis. DESIGN: A cross-sectional study. SETTING: Antenatal clinic in Ilala district hospital in Dar es Salaam, Tanzania from March 1998 to December 2000. RESULTS: The identities of the 272 isolates tested with API Candida were: Candida albicans 180(66.2%), Candida tropicalis 13(4.7%), Candida glabrata 20(7.35%), Candida famata 6(2.2%), Candida parapsilosis 6 (2.2%) and Candida lusitaniae one (0.37%). API Candida could not speciate 43 (15.8%) isolates of these; two (0.7%) fell between C. albicans and C. tropicalis, 17(6.25%) C. lusitaniael, C. guilliermondii/C. famata, 14(5.15%) C. krusei, C. inconspicua, and C. norvegensis and nine (3.3%) either C. parapsilosis, C. krusei, C. incospicua or Geotrichum spp. Four (1.5%) isolates had an assimilation pattern of Trichosporo spp, but were all germ tube positive and had morphological features on cornemeal agar that were consistent with C. albicans. API 20C AUX was used for testing 29 isolates and results showed: 11/29 (37.9%) C. albicans, 1/29 (3.4%) C. tropicalis, 4/29 (13.8%) C. glabrata, 1/29 (3.4%) C. parapsilosis, 1/29 (3.4%) C. famata, 1/29 (3.4%) C. lusitaniae, 1/29 (3.4%) C. colliculosa/C. magnoliae, 5/29(17.2%) C. albicans/ C. tropicals 2/29 (6.8%) C. norvegensis/C. parapsilosis, and 2/29(6.8%) C. kruseil/C. inconspicua. Results of 20 isolates identified by Randomly Amplified Polymorphic DNA (RAPID) technique showed a 95% agreement with API Candida and a 100% agreement with API 20C AUX. CONCLUSION: Although most (66.3%) of the species isolated from Dar es Salaam women with vaginal candidiasis were C. albicans, a considerable percentage (33.7%) were non-albicans, mainly C. glabrata, C. krusei and C. tropicalis. The high prevalence of non-albicans Candida spp observed in this population may have therapeutic implications.

In-Vitro Susceptibility Pattern of Candida isolated from Women with Vaginal Candidiasis to four Anti-fungal Agents in Dar es Salaam; Tanzania

Objective: To determine anti-fungal susceptibility pattern of Candida species (n = 272) isolated from women with vaginal candidiasis (VC) in Dar es Salaam; Tanzania against varying concentrations (0.05 to 12.8 g/ml) of miconazole; clotrimazole; ketoconazole and nystatin using agar dilution and broth macro-dilution methods. Test isolates and reference strains: Clinical isolates and reference strains; Candida albicans (ATCC 32354); Candida krusei (ATCC6258); Candida parapsilosis (ATCC22019) and Candida glabrata (ATCC2001).Methods: Determination of minimum inhibitory concentration ranges; and MIC50 and MIC90 (required to inhibit 50and 90of the isolates); respectively. MIC for nystatin was least concentration that prevented visible growth while for the azoles MIC was the concentration that caused 80growth inhibition compared with drug free control. Results: The MIC for Candida albicans; Candida famata; Candida krusei; Candida lusitaniae; Candida parapsilosis and Candida norvegensis were between 0.05 to 0.2 g/ml against all four anti-fungal drugs tested. Some Candida tropicalis and Candida glabrata isolates had moderately high (MIC =6.4) and high MICs (12.8 g/ml); especially with the azole anti-fungal drugs. The overall agreement between the results of the two methods were 88; and for individual antifungals the agreement was 90.8; 91.3; 80and 88for clotrimazole; ketoconazole; miconazole and nystatin; respectively. C. glabrata and C. parapsilosis gave low agreement (68- 75) for the azole antifungals. Conclusions: i) most of the clinical isolates had low MIC values to all the four anti-fungal drugs tested; indicating susceptibility; ii) some strains of C. tropicalis and C. glabrata had high MIC values; and; iii) there was a good overall agreement ( 88) between agar dilution and broth macro-dilution methods. There is a need for a follow-up in-vivo study to determine clinical response following treatment with the investigated anti-fungals

Influence of recirculation flow rate on the performance of anaerobic packed-bed bioreactors treating potato-waste leachate.

The performance of anaerobic, packed-bed bioreactors treating leachate from potato waste was evaluated in terms of organic loading rate (OLR) as well as the recirculation flow rate. Two 1 litre bioreactors, filled with porous glass beads as biofilm carriers and with continuous recirculation flow rates of 10 ml min(-1) and 20 ml min(-1) respectively, were used in the experiment. The OLR applied to each bioreactor was increased stepwise from 4 to 12 kg chemical oxygen demand (COD) m(-3)d(-1) by increasing feed flow rate. The methane yields decreased with increasing OLR in both bioreactors. The methane yield for the bioreactor with the lower recirculation flow rate ranged between 0.10 and 0.14 m3 CH4 kg COD(-1) removed, while for the other bioreactor it was 0.14-0.20 m3 CH4 kg COD(-1) removed. Both bioreactors demonstrated stable COD removal which was around 95% for the bioreactor with lower flow of recirculation while for the other it was 92%, over a range of OLRs of 4-8 kg COD m(-3)d(-1). The bioreactor with the lower recirculation flow rate showed operational stability when a high OLR, namely 12 kg COD m(-3)d(-1), was applied, while the other one became overloaded. There was an accumulation of volatile fatty acids which gave a corresponding drop in pH because the system had a low buffering capacity and this thus ultimately led to process failure. This study demonstrated the suitability of a packed bed bioreactor operated at lower recirculation flow rate for treating leachate from potato waste.

Conversion of cereal residues into biogas in a rumen-derived process.

A recently developed high-rate, two-phase process, which employs rumen microorganisms for efficient acidogenesis, was tested for anaerobic degradation of barley straw, rye straw, and maize stover. Under conditions similar to those of the rumen and loading rates varying between 9.8 and 26.0 g of organic matter/I/day in the first phase (acidogenic reactor), total fibre degradation efficiencies ranged between 42% and 57%, irrespective of the loading rate applied. Average specific production of volatile fatty acids and biogas/g volatile solid digested in the acidogenic reactor varied between 6.9 and 11.2 mmol and 0.10 and 0.25 l, respectively.The effect of varying solid retention times on the extent of degradation of barley straw was examined. Changing of retention times in the range of 60 to 156 h had no effect on degradation efficiency, but a decrease in efficiency was observed at retention times below 60 h.By connecting the acidogenic reactor in series to an Upflow Anaerobic Sludge Blanket (UASB) methanogenic reactor the volatile fatty acids were converted into biogas. Average methane contents of the gases produced in the acidogenic reactor and in the UASB reactor were 30±3% and 78±3%, respectively.