Molecular surveillance of drug-resistance associated mutations of Plasmodium falciparumin south-west Tanzania

Background: In Tanzania; drug-resistant malaria parasites are an increasing public health concern. Because of widespread chloroquine (CQ) resistance Tanzania changed its first line treatment recommendations for uncomplicated malaria from CQ to sulfadoxine-pyrimethamine (SP) in 2001. Loss of SP sensitivity is progressing rapidly. SP resistance is associated with mutations in the dihydrofolate reductase (pfdhfr) and dihydropteroate synthase (pfdhps) genes. Methods: In samples from 86 patients with uncomplicated Plasmodium falciparum malaria from Mbeya and Matema; Mbeya region; south-western Tanzania; the occurrence of mutations was investigated in the pfcrt and pfmdr1 genes which are associated with CQ resistance and in pfdhfr and pfdhps; conferring SP resistance; as well in cytb which is linked to resistance to atovaquone. Reesults: Pfcrt T76 occurs in 50and pfmdr1 Y86 in 51.7. Pfdhfr triple mutations coexisting with pfdhps double mutations were detected in 64.3of the P. falciparum isolates. This quintuple mutation is seen as a possible predictive molecular marker for SP treatment failure. Mutations of the cytb gene were not detected.Conclusions: These findings of a high prevalence of mutations conferring SP resistance correspond to data of in vivo SP efficacy studies in other regions of Tanzania and underline the recommendation of changing first-line treatment to artemisinin-based combination therapy

Perinatal Risk Factors for Neonatal Bleedind at the Muhimbili National Hospital Dar-es-Salaam; Tanzania

This incident case-control study of bleeding neonates in a Baby Friendly Hospital was done to obtain the prevalence and risk factors associated with bleeding disorders in the neonatal unit. During a 4-month period from August to November 1998; 175 out of 1628 admitted infants were found to have some sort of bleeding. These were compared with 414 control infants. Prematurity; Low Birth Weight; Caesarian Section and anesthesia; and presence of asphyxia were significantly associated with bleeding. The Prothrombin and Activated Partial thromboplastin Test were not significantly altered in bleeding infants and had a poor correlation with clinical presence of a bleeding disorder.The low prevalence of bleeding disorder and coagulation defects is discussed and suggested that Breast Feeding may not be a risk factor for bleeding disorder in this unit. Further studies are needed in this regard

Aggressive Kaposi's sarcoma in a 6-month-old African infant: case report and review of the literature.

Kaposi's sarcoma (KS), known to exist in Africa for a century now, was rare in children and unknown in the newborn. With the onset of the HIV/AIDS epidemic, a more aggressive, disseminated type of KS (AKS) was recognized. Recently KS was diagnosed in a 6-month-old infant in Tanzania. Data support the notion that HHSV8 infectivity can be potentiated with HIV infection and thus produce multiple lesions in different anatomical sites early in life. Furthermore, the available evidence would suggest a nonsexual route of HHSV8 infection, possibly from mother to fetus.