Body composition of HIV-positive patients with pulmonary tuberculosis: a cross-sectional study in Mwanza, Tanzania.

To estimate the weight deficit and body composition of cases of pulmonary TB (PTB), and assess the roles of HIV and the acute-phase response, a cross-sectional study was carried out in Tanzania. Weight, body mass index (BMI), arm muscle area (AMA), arm fat area (AFA) and the serum concentration of the acute-phase protein alpha(1)-antichymotrypsin (serum ACT) were evaluated for each of 532 cases of PTB and 150 'non-TB' controls. On average, the female cases of PTB not only weighed 7.8 kg less but also had BMI that were 3.1-kg/m(2) lower, AMA that were 14.8-cm(2) lower, and AFA that were 7.6-cm(2) lower than those seen in the female subjects without TB. Similarly, on average, the male cases of PTB weighed 7.1 kg less and had BMI that were 2.5-kg/m(2) lower, AMA that were 18.8-cm(2) lower and AFA that were 1.6-cm(2) lower than those seen in the male subjects without TB. Although HIV infection was associated with a 1.7-kg lower weight and a 0.6-kg/m(2) lower BMI (with deficits in both AMA and AFA) among males, it was not associated with any such deficits among the female subjects. Elevated serum ACT was found to be a negative predictor of BMI, AMA and AFA, partially explaining the effects of the PTB but not those of the HIV. There is need for a better understanding of the determinants and effects of loss of fat and lean body mass in HIV-positive tuberculosis.

HIV and parasitic co-infections in tuberculosis patients: a cross-sectional study in Mwanza, Tanzania.

A cross-sectional study was conducted in Mwanza, Tanzania, to determine the burden of HIV and parasitic co-infections among patients who were confirmed or suspected cases of pulmonary tuberculosis (PTB). Of the 655 patients investigated, 532 (81.2%) had been confirmed as PTB cases, by microscopy and/or culture (PTB+), whereas the other 123 (18.8%) were only suspected cases, on the basis of other clinical criteria (PTB-). Hookworm and Schistosoma mansoni infections were common in the patients, with prevalences of 18% and 34%, respectively. Malarial, Ascaris lumbricoides, Trichuris trichiura and Strongyloides stercoralis infections were less common, each recorded at a prevalence of <5%. The PTB+ patients were less likely to be HIV-positive than the PTB- patients (43.6% v. 62.6%; P<0.0001). Among the PTB+ patients, the HIV-positive had a significantly lower prevalence (12.1% v. 25%; P<0.0001) and mean intensity (49 v. 123 eggs/g; P=0.003) of hookworm infection than the HIV-negative. The PTB patients in the study area were, however, still frequently co-infected with HIV and with parasitic infections that may increase morbidity and accelerate the progression of HIV disease.

Historical review of mosquito control as a component of malaria eradication program in the Ryukyu Archipelago.

In the Ryukyu Archipelago, where malaria used to be endemic, eradication of the disease was achieved by the year 1962, as a consequential effect of a planned malaria eradication program in the area. This achievement was facilitated by concerted efforts in controlling vector mosquitos and treatment of all detected and presumptive cases of malaria infections. Anopheles minimus Theobald and An. sinensis Wiedemann were common in all areas endemic for malaria. Knowledge of the biology and bionomics of the mosquitos in malaria endemic areas formed the basis for formulating strategies for the control of vectors and subsequent surveillance activities. Insecticide residual spray, larvivorous fishes and environmental management were the basic strategies for vector control. The whole program was augmented by an active community participation in all eradication activities.