SCHISTOSOMA MANSONI INFECTION AND THE ASSOCIATED ANTIBODY IMMUNE RESPONSE AMONGST RESIDENTS OF KIGUNGU ENTEBBE, UGANDA.

UNLABELLED: BACNKGROUND: There are many foci endemic for Schistosoma (S.) mansoni in Uganda. The immune responses to infection with the parasites in these areas have been found to vary with host sex, age and infection intensity. OBJECTIVE: To determine the profile of antibody isotypes responses against S. mansoni crude soluble egg antigens (SEA) and soluble adult worm protein (SWAP) antigens that determine the host resistance or susceptibility to reinfection. DESIGN: Cross Sectional, cohort study. SETTING: Kigugu fishing village in Entebbe, Uganda. SUBJECTS: Nine hundred and forty five (945) Kigungu residents reported forpre-treatment screening and enrolment and 626 cohorts report for post-treatment screening and enrolment 18 months later. RESULTS: Pearson's Chi-sq2 showed thatincrease in titres of anti (SWAP IgE, SEA IgE, and SEA IgG2) was not significant, but increase in anti SEA IgG3 was significant. Decrease in titres of anti (SWAP IgG1, SEA IgG1, and SEA IgG4) was not significant but decrease of anti (SWAP IgG2, SWAP IgG3 and SWAP IgG4) was significant. Positive correlation existed between age and anti SWAP IgE in before and after treatment sera. On the contrary, age was positively correlated with anti SWAP IgG4 in pre-treatment sera but was negatively correlated with anti SWAP IgG4 in the post-treatment sera. In addition there were positive correlation between higher egg counts and the immunoglobulin levels of anti SWAP IgG4 and anti SEA IgG4 but negative correlations were observed between anti SWAP IgE and anti SEA IgE. Conversely low egg counts were associated with high levels of anti SWAP IgE. Furthermore, IgG1-4, IgE antibody to SEA and SWAP antigens did not differ significantly according to sex. CONCLUSION: We concluded that praziquantel treatment of S. mansoni infected persons alter the immune responses that are influenced by age and intensity. A phenomenon that is useful in the effort to produce vaccine against schistosome.

Evidence of Long Term Benefit of Praziquantel Treatment Against Schistosoma mansoni in Kigungu Fishing Village of Entebbe, Uganda

Praziquantel (PZQ) is efficacious against all species of schistosome: Schistosoma mansoni; Schistosoma haematobium; Schistosoma japonicum and other parasites like the Taenia species. This cross-sectional cohorts study was carried out in Kigungu fishing village along Lake Victoria shore in Entebbe Uganda. Our analysis was based on examining microscopically three slides from a single stool specimen from each of base line cohorts 945.These included children and adults; participants from both sexes in Kigungu fishing village in Entebbe Uganda. Nine hundred and one (901) of the cohorts were re-examined after six months and 625 of the same cohorts who were examined at the baseline and after six months were re-examined 18 months later. The slides were prepared using modified Kato/Katz (Odongo-Aginya) method. The infection proportion with Schistosoma mansoni at baseline was 448 (47.5) but this was reduced to 244 (25.8) 18 months after treatment with a single oral dose of praziquantel at 40mg/kg. However 495 (52.5) were negative at the baseline study. The cure proportion after six was significant ///{(P=0.00); (OR4.63) CI at 95(3.53-6.06)///}. Similarly the cure proportion after 18 months was significant ///{(P=0.00); (OR2.2) CI at 95(1.87-3.34)///}. The force of re-infection after six months was significant ///{(P=0.0001); (OR 0.47) CI at 95(0.31-0.71)///}. Nevertheless the force of re-infection was not significant after 18 months ///{(P=0.766); (OR 0.95) CI at 95(0.68-1.34)///} eggs excretion did not reach the level of the pre-treatment intensity. The egg reduction was 69.3. This was associated with age and pre-treatment intensity 400 eggs per gram (epg) of faeces and age groups ? 30 years. The egg reduction also resulted in marked decrease in clinical symptoms in the participants. Our study suggests evidence of long-term benefit of praziquantel in Kigungu and that the re-infection occurred more commonly in younger age group than in the older patients

Eligibility for HIV/AIDS Treatment among Adults in a Medical Emergency Setting at an Urban Hospital in Uganda

Background: Despite global effort to scale up access to antiretroviral therapy (ART); many people in need of HIV/AIDS care in Uganda have not been reached. HIV testing and ART are not widely offered as routine medical services and data on HIV/AIDS in emergency settings in Sub-Saharan Africa is limited.We determined the HIV prevalence and eligibility for ART in a medical emergency unit at Mulago hospital. Methods: In a cross-sectional study; we interviewed 223 patients who were systematically selected from the patients'register from October through December 2004. HIV testing was offered routinely and results were delivered within 30 minutes.We evaluated HIV infected patients for WHO clinical stage of disease and referred them for HIV/AIDS care. Results: Out of 223 patients; 111 (50) had HIV infection of whom 78 (70) had WHO clinical stage 3 and 4 of disease thereby requiring ART. Overall; 84 out of 111 (76) HIV positive patients had not received any specific HIV/AIDS care. Conclusion: The burden of HIV infection in the medical emergency unit is high and majority of the patients who required ART had no prior HIV/AIDS care.We recommend scale up of HIV/AIDS care in acute care settings in order to increase access to ART