Improved microscopy diagnosis of pulmonary tuberculosis using sodium hypochlorite concentration technique in Tanga, Tanzania.

Pulmonary tuberculosis diagnosis commonly relies on the bacteriological examination of sputum. A cross-sectional hospital-based study was carried out to compare on "on the spot" sputum staining using sodium hypochlorite (bleach method) and routine Ziel-Neelsen (ZN) staining technique. Study candidates included individual patients presenting with cough <3 weeks (Group I) and > or =3 weeks (Group II). Sensitivity and specificity of the bleach method was calculated and compared at 100% using the ZN staining technique as the standard. A total of 171 patients (94 males, 77 females) with mean age 34.9 years (SD +/- 12.9) were recruited. Fifty-eight patients had coughed for <3 weeks while 113 had coughed for 23 weeks. Smear-positive TB in Group I was 13.8% (95% CI = 5-23) while in Group II was 25.7% (95% CI = 21-29). Using the bleach method, the prevalence of smear-positive TB in Group II was 28.3% (CI 95% = 20-36). This was an increase in smear-positivity rate of 15.6% as compared to the ZN technique. These results suggest that the use of bleach technique "on the spot" improve the sensitivity of tuberculosis diagnosis among patients with a history of coughing of over three weeks. However, further studies in different settings are recommended to validate the technique.

Implication of diethylcarbamazine induced morbidity and the role of cellular responses associated with bancroftian filariasis pathologies.

Pre and post-diethylcarbamazine treatment clinical expression, microfilaraemia prevalence and cellular responses were investigated in individuals in Tanga, Tanzania. Fifty-seven male individuals (aged = 15 years old) were identified for further studies on IL-4, IL-6, IL-8. IFN-gamma, IL-beta, TNF-alpha and nitric oxide in plasma and hydrocoele fluid. Microfilarial prevalence in the examined individuals was 12% with a geometric mean intensity (GMI) of 838 mff/ml in a community with a population of 1018 individuals. Microfilaraemic hydrocoele stage II and III were the most frequent pathologies observed with prevalence of 17.5% and 42. 1 %, respectively. All study individuals treated with diethylcarbamazine (DEC) standard dose of 6 mg/kg experienced post-treatment adverse events. There was no direct relationship between elevated IL-6 and the occurrence and severity of clinical adverse effects post-treatment. The findings from this study suggests that, blood elevated cytokine profile is not the main etiological factor in the inflammatory responses developing after treatment of bancroftian filariasis infections and pathology with DEC. Plasma levels of cellular (cytokines) responses during treatment revealed a proportion of symptomatic patients. Prior to treatment, patients with hydroecoele had high levels of IL-6 than those without the pathology. In conclusion these findings do not support the hypothesis that pro-inflammatory cytokines are directly responsible for adverse events to DEC chemotherapy in bancroftian filariasis infections and pathologies such as hydrocoele, lymphoedema and elephantiasis.

Hospital-based safety and tolerability study to assess efficacy of oral doxycycline in the treatment of Wuchereria bancrofti infection in north-eastern Tanzania.

A hospital based open-label clinical trial of 19 apparently healthy adult males with microfilaraemia was conducted to assess safety, tolerability and efficacy of doxycycline on Wuchereria bancrofti. Study individuals were assigned 8 weeks treatment with doxycycline 200 mg daily. The results of different selected tests showed that, the haematological, hepatic, renal and clinical parameters pre-and post-drug administrations were within the normal range for all treated individuals. Clinical adverse events were mild, transient, tolerable and reported in 7/19 (36.8%) of the study cohort. The mf clearance rate was 100% at 12 months post treatment for the 13 individuals who completed the follow up. These findings indicate that, although the drug was administered for a long period, there was no evidence of toxicity to the myocardium, hepatocytes, renal, bone marrow and blood cells, suggesting that an 8-week course of 200 mg/day doxycycline is a safe and tolerable regime for the treatment of Wuchereria bancrofti infections.