Isolation of Campylobacter species from Zambian patients with acute diarrhoea.

Four hundred and one consecutive diarrhoea patients and 101 adult patients without diarrhoea were enrolled for this study from a health centre in Lusaka. Campylobacter was isolated from 6% of patients with acute diarrhoea. However, non of these were seen in control group. Further studies are being carried out to determine the importance of Campylobacter species with other bacterial pathogens. It will also be interesting to see its impact and association with human immuno deficiency virus in this region.

Antimicrobial-resistant epidemic Shigella dysenteriae type 1 in Zambia: modes of transmission.

To determine the modes of transmission of an epidemic caused by Shigella dysenteriae type I (Sd1) in Zambia, a case-control study was conducted. Case-patients were more likely to have recent contact with a person with dysentery (P = .03) and to have a family member with preceding dysentery (P = .01). Case households were more likely to share their latrine (P = .06). Stored drinking water was obtained by hand-dipping a cup into wide-mouthed vessels or by pouring from narrow-mouthed vessels; case households were more likely to obtain drinking water only by hand-dipping (P = .03). Case-patients were more likely to have eaten relish (a cooked meat or vegetable dish; P = .03) purchased from a vendor. Evidence from this study suggests that Sd1 was transmitted by person-to-person spread, by water stored in vessels that permitted hand-dipping, and by prepared foods sold by vendors. Preventive measures should be directed at these risk factors.

HIV-related enteropathy in Zambia: a clinical, microbiological, and histological study.

To investigate the etiology of chronic diarrhea associated with human immunodeficiency virus (HIV) infection in Lusaka, we studied 63 HIV-positive patients and 36 seronegative controls clinically and endoscopically. Stools were studied for morphology and for opportunist infections. Fifty-five percent of patients seropositive for HIV who presented with a history of chronic diarrhea had parasites; the most common were Cryptosporidium (32%), Isospora belli (16%), and Strongyloides stercoralis (6%). As indicated by villous blunting and inflammation on duodenal histology, those with diarrhea and parasites showed the most severe damage. We could not implicate mycobacteria or bacterial overgrowth as causes for the enteropathy associated with HIV.

Faecal mycobacteria and their relationship to HIV-related enteritis in Lusaka, Zambia.

The prevalence of infection with mycobacteria, both typical and atypical, is increasing along with prevalence of infection with HIV. Patients with pulmonary tuberculosis (PTB) and patients with chronic diarrhoea are forming a growing proportion of the patient population in hospitals in central Africa. To investigate the possibility that mycobacteria may be responsible for some of the HIV-related enteropathy seen in Lusaka, we studied 89 patients in four different diagnostic groups, clinically, by Mantoux test and by microscopy and culture of stool specimens for mycobacteria. In the HIV-positive group with chronic diarrhoea (n = 31), two patients were found to have mycobacteria on faecal smear and three were culture positive while of the 15 HIV-negative controls, three were smear positive and three were culture positive. Of the 15 patients with proven PTB, three had positive faecal smears but none were culture positive. In the fourth group of 24 patients with suspected PTB, seven were smear positive and five, culture positive. Only in this last group was there some correlation between smear results and culture results. Although this last finding is difficult to explain, it appears that there is no correlation between the symptom of chronic diarrhoea and the presence of mycobacteria in the stool. We conclude that mycobacteria do not play a significant role in the pathogenesis of HIV-related enteropathy in Lusaka.