ABSTRACT
SETTING: Estimates of the tuberculosis (TB) burden in the Philippines are largely dependent on prevalence surveys. OBJECTIVE: To conduct a prospective community-based survey to generate epidemiological data on TB among patients seeking care in public health centres in a rural municipality in the Philippines. DESIGN: Prospective surveillance and follow-up of presumptive TB cases from May 2013 to July 2015. RESULTS: Of 1622 participants with presumptive TB, 468 (28.8%) (95%CI 26.6-31.1) were diagnosed with TB. The annual TB case notification rate in San Juan was 212 (95%CI 184-242) per 100 000 population. There were nine TB-attributable deaths during the study period. Only 8.8% (95%CI 6.2-11.32) of the cases were children aged <15 years; 274 (58.5%) cases were bacteriologically confirmed. Of 210 isolates tested for antimicrobial resistance, 49 (23.3%, 95%CI 17.58-29.02) were resistant. Resistance to isoniazid (INH) was common (n = 33, 15.7%); multidrug-resistant TB was 1.9%. CONCLUSION: TB remains an important health problem in the Philippines. We identified low case detection of TB in children and high INH resistance rates in this rural community.
Subject(s)
Population Surveillance , Rural Population , Tuberculosis, Multidrug-Resistant/epidemiology , Tuberculosis/epidemiology , Adolescent , Adult , Aged , Antitubercular Agents/therapeutic use , Child , Child, Preschool , Female , Follow-Up Studies , Humans , Infant , Infant, Newborn , Isoniazid/therapeutic use , Kanamycin/therapeutic use , Male , Middle Aged , Philippines/epidemiology , Prevalence , Prospective Studies , Public Health , Rifampin/therapeutic use , Streptomycin/therapeutic use , Treatment Outcome , Tuberculosis/diagnosis , Tuberculosis/drug therapy , Tuberculosis, Multidrug-Resistant/diagnosis , Tuberculosis, Multidrug-Resistant/drug therapy , Young AdultABSTRACT
BACKGROUND: Subacute sclerosing panencephalitis (SSPE) is a chronic and debilitating disease of the central nervous system caused by a latent measles virus infection. Three candidate genes, MxA, IL-4, and IRF-1 genes were shown to be associated with SSPE in Japanese patients. These genes have been suggested to play a role in the establishment of persistent viral infection in the central nervous system. SUBJECTS AND METHODS: Sixty Filipino SSPE patients and 120 healthy control subjects were included in the study. Single nucleotide polymorphisms at promoter regions ( IL-4-590C/T and MXA-88G/T) were screened using PCR-RFLP method. Genotyping was done for GT repeat polymorphism within intron 7 of IRF-1. RESULTS: The TT genotype of MXA, as well as the CT genotype of IL-4, were seen a little more frequently among the SSPE patients as compared to the control subjects. The values though, did not reach statistical significance. IRF-1 analysis did not differ between the two groups. CONCLUSION: Our study failed to demonstrate a significant association between IL-4, MXA, or IRF-1, and SSPE in the Filipino population. Our results might be explained by a greater contribution of environmental factors such as the socio-economic and nutritional factors in the susceptibility of Filipinos to SSPE other than genetic factors.
Subject(s)
GTP-Binding Proteins/genetics , Interferon Regulatory Factor-1/genetics , Interleukin-4/genetics , Subacute Sclerosing Panencephalitis/genetics , Adolescent , Adult , Case-Control Studies , Child , Child, Preschool , DNA Mutational Analysis/methods , Female , Gene Frequency , Genotype , Humans , Male , Measles virus/pathogenicity , Myxovirus Resistance Proteins , Philippines/epidemiology , Polymorphism, Restriction Fragment Length , RNA, Messenger/metabolism , Retrospective Studies , Reverse Transcriptase Polymerase Chain Reaction/methods , Subacute Sclerosing Panencephalitis/bloodABSTRACT
AIM: To provide information on the current status of West syndrome (WS) in the Philippines. METHODS: This is a retrospective review of WS cases from January 1997 to December 1999 from two largest referral government institutions. A questionnaire interview survey on anticonvulsant usage was also conducted among practicing child neurologists. RESULTS: Twelve patients diagnosed to have infantile spasms at 2-15 months were included, with a male:female ratio of 1:1. The proportion of WS cases among epileptic children under age 3 was 3.18%. The etiologies were idiopathic/cryptogenic in four (33%) and symptomatic in eight (66%). Symptomatic cases include hypoxic-ischemic encephalopathy, neonatal sepsis, bacterial meningitis, inborn error of metabolism, congenital brain anomaly and intracranial hemorrhage. Phenobarbital was the first line drug in 75% of cases. Other drugs used were valproic acid, clonazepam and pyridoxine. With a follow-up duration of 1-40 months, only three patients became seizure free and most had poor neurodevelopmental outcome. Among practicing child neurologists, the preferred ideal drug was adrenocorticotrophic hormone (ACTH) and valproic acid for idiopathic and symptomatic cases, respectively. However, in actual clinical practice valproic acid or prednisone was the initial drug used. Pyridoxine was usually added on. CONCLUSIONS: The proportion of WS in our patient population may not reflect the true prevalence in our country since our data came from a biased population, i.e. referral centers. A national statistics is currently not available. ACTH, which was perceived by most child neurologists as the ideal first line drug was not used primarily because it is unavailable and unaffordable. The poor seizure control and developmental outcome may be due to the treatment given or directly related to the etiology of WS.