Modulation of the immune response to Mycobacterium tuberculosis during malaria/M. tuberculosis co-infection.

Tuberculosis (TB) causes significant morbidity and mortality on a global scale. The African region has 24% of the world's TB cases. TB overlaps with other infectious diseases such as malaria and HIV, which are also highly prevalent in the African region. TB is a leading cause of death among HIV-positive patients and co-infection with HIV and TB has been described as a syndemic. In view of the overlapping epidemiology of these diseases, it is important to understand the dynamics of the immune response to TB in the context of co-infection. We investigated the cytokine response to purified protein derivative (PPD) in peripheral blood mononuclear cells from TB patients co-infected with HIV or malaria and compared it to that of malaria- and HIV-free TB patients. A total of 231 subjects were recruited for this study and classified into six groups; untreated TB-positive, TB positive subjects on TB drugs, TB- and HIV-positive, TB- and malaria-positive, latent TB and apparently healthy control subjects. Our results demonstrate maintenance of interferon (IFN)-γ production in HIV and malaria co-infected TB patients in spite of lower CD4 counts in the HIV-infected cohort. Malaria co-infection caused an increase in the production of the T helper type 2 (Th2)-associated cytokine interleukin (IL)-4 and the anti-inflammatory cytokine IL-10 in PPD-stimulated cultures. These results suggest that malaria co-infection diverts immune response against M. tuberculosis towards a Th-2/anti-inflammatory response which might have important consequences for disease progression.

Evaluation of antioxidant status of female diabetic patients in Nnamdi Azikiwe University Teaching Hospital, Anambra State, Nigeria.

Diabetes mellitus has become an onerous disease to developing countries such as Nigeria. Rapid acceptance of urbanisation and sedentary life styles pose an encumbrance to its prevention and management. Increased oxidative stress in diabetes mellitus has been implicated as a culprit in perpetuating antioxidant depletion and diabetic complications in diabetes mellitus individuals. This study aims to evaluate the level of antioxidant status in type 2 diabetes mellitus (DM) female participants visiting the out-patient diabetic clinic of Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi, Anambra State, Nigeria. A total of 86 participants aged 51±10 years were recruited for this study. The test group consists of 43 already confirmed type 2 diabetes mellitus females, while the control group consists of 43 apparently healthy females. The test subjects were further subgrouped into good and poor glycaemic control groups, using a cut-off of <7% for HbA1c. Whole blood was collected from participants and aliquoted into specified sample containers for analysis of the following parameters: random blood glucose (RBG; mg/dL), glycosylated haemoglobin (HbA1c; %), glutathione reductase (GR; U/L) and total antioxidant status (TAS; mmol/L). Results from this study showed that the mean differences in RBG (197.74±49.29 mg/dL) and HbA1c (9.86±1.44%) were significantly higher in the test group compared to the control group RBG (104.79±11.33 mg/dL) and HbA1c (5.21±1.23%) (P<0.05). The mean differences of GR (45.81±20.45 U/L) and TAS (1.81±1.04 mmol/L) were significantly lower in the test group compared to the control group GR (61.21±14.34 U/L) and TAS (2.73±2.08 mmol/L) (P<0.05). The poor glycaemic test group was observed to have the highest RBG (200.34±50.4 mg/dL) and HbA1c (10.23±1.33%) compared both to good glycaemic test group RBG (186.38±45.39 mg/dL), HbA1c (6.54±0.45%) and non-diabetic group RBG (104.79±11.33 mg/dL) and HbA1c (5.21±1.23%) (P<0.05). Glutathione reductase (40.66±15.48 U/L) and TAS (1.80±1.08 mmol/L) were significantly more depleted in the poor glycaemic test group compared to the non-diabetic group GR (61.21±14.34 U/L), TAS (2.73±2.08 mmol/L) and good glycaemic test group GR (68.38±25.09 U/L), TAS (1.86±0.92 mmol/L) (P<0.05). Out of the 43 participants in the test group, only 18.6% had good glycaemic control and 81.4% had poor glycaemic control. There were significant negative correlations between RBG and TAS (r=-0.260; P=0.015); RBG and GR (r=-0.403; P=0.000) and HbA1c and GR (r=-0.471; P=0.000) (P<0.05). However, HbA1c and TAS showed no significant correlation (r=-0.170; P=0.119) (P>0.05). This study concludes that there is antioxidant depletion in females with type 2 diabetes.

Evaluation of hormonal changes in menstrual cycle of women infected with pulmonary tuberculosis in Nnewi, south eastern Nigeria.

BACKGROUND & OBJECTIVE: The present study was designed to evaluate the hormonal changes in menstrual cycle of premenopausal women infected with pulmonary tuberculosis in Nnamdi Azikiwe University Teaching Hospital Nnewi. MATERIAL AND METHODS: A prospective study involving sixty-seven (67) female participants within the child-bearing age were randomly recruited and grouped based on their tuberculosis status as: Symptomatic TB infected females (n=20), Symptomatic TB infected females on ATT (n=20) and Control females (n=27). After due consent, a detailed medical history was obtained and routine investigations of pulmonary tuberculosis and confirmation using Ziehl Neelsen and sputum culture techniques for AFB and chest x-ray were done. Blood samples collected from the participants were used for hormonal assay using immunoenzymometric method. RESULTS: The results showed that the serum levels of FSH and LH (IU/ml) were significantly higher while progesterone and estradiol were significantly lower in Symptomatic TB females compared to Symptomatic TB females on ATT at follicular and luteal phases of menstrual cycle (P<0.05). The serum levels of FSH and LH were significantly reduced in Symptomatic TB females on ATT while progesterone and estradiol were significantly increased at follicular and luteal phases of menstrual cycle (P<0.05). FSH was significantly higher at follicular phase while estradiol was significantly higher at luteal phase of menstrual cycle in Symptomatic TB females on ATT. CONCLUSION: Tuberculosis induced hypogonadism in affected women which seemed to be reversed on treatment. Routine investigation for Tuberculosis should be done for women presenting with infertility, since early treatment can reverse the abnormality.

Relationship between serum levels of testosterone, zinc and selenium in infertile males attending fertility clinic in Nnewi, south east Nigeria.

In the recent years, male infertility and sub-fertility have increased, which is attributable to many factors. Some trace elements such as zinc and selenium have been shown to play a role in reproduction. The study was designed to determine the serum levels of zinc, selenium and testosterone in infertile males attending fertility clinic in Nnewi. We investigated fifty apparently infertile males (subjects) and twenty apparently healthy fertile males (controls) between the ages of twenty five and fifty five years. The serum levels of zinc and selenium were determined using Atomic Absorption Spectrophotometer while the serum level of testosterone was determined using Enzyme Immunoassay techniques. The results showed that there were significant differences in the mean serum zinc, selenium and testosterone when compared between the two groups. The results also showed a strong positive correlation between serum levels of zinc and selenium, a negative correlation between serum levels of testosterone and zinc, and a strong positive correlation between serum testosterone and selenium in the infertile males. We therefore conclude that there is a relationship between the serum levels of zinc, selenium and testosterone in infertile males and that these parameters be considered when investigating cases of infertility in males.

Possible biochemical impact of malaria infection in subjects with HIV co-infection in Anambra state, Nigeria.

BACKGROUND & OBJECTIVES: The present study was designed to determine possible contributory impact of malaria infection on some biochemical markers in subjects with HIV co-infection in order to know if they are adverse or protective. METHODS: Participants were recruited at the Voluntary Counseling and Testing Unit, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria and grouped into: (i) Malaria and HIV co-infection group (n = 45); and (ii) HIV infected group without concurrent malaria infection (n = 57). Standard laboratory methods were used for the HIV and Plasmodium falciparum antigen screening, malaria parasite density, CD4+ T-cell count, packed cell volume, white blood cell count, serum iron and albumin concentrations. RESULTS: The results showed that serum iron and albumin were significantly reduced and raised respectively in 'Malaria-HIV co-infection group' compared with 'HIV infection group' (p < 0.05 and p < 0.05). A positive association was observed between age and serum iron concentration in malaria and HIV co-infected group (r = 0.580; p < 0.05) while negative associations were observed between PCV and serum iron (r = - 0.388; p < 0.05) and between CD4+ T-cells and serum iron concentration (r = -0.362; p < 0.05) in malaria and HIV co-infected group. The CD4+ T-cell count, WBC count, PCV were not significantly different between the Malaria-HIV co-infection group and HIV infection group. INTERPRETATION & CONCLUSION: In the present study serum iron and albumin concentrations were the most sensitive indicators that showed the contributory impact of malaria infection on biochemical index in HIV co-infected subjects. The findings suggest that at the defined stage of HIV infection in the present study, malaria co-infection may moderate the impact of HIV infection on iron metabolism and hepatic synthesis of albumin.

Immunodiagnosis of bovine trypanosomiasis in Anambra and Imo states, Nigeria, using enzyme-linked immunosorbent assay: zoonotic implications to human health.

BACKGROUND & OBJECTIVES: The prevalence of trypanosomiasis was studied in cattle, being a major source of animal protein in Nigeria, thus, a very likely means of spread of Human African Trypanosomosis (HAT). METHODS: Enzyme-linked immunosorbent assay (ELISA) was used to diagnose bovine trypanosomiasis in 264 samples collected from adult cattle of mixed breeds, age and sex, in Anambra and Imo states, Nigeria. RESULTS: Out of 264 samples analysed, 21 (7.96%) were seropositive for Trypanosoma congolense while 20 (7.58%) were seropositive for T. vivax and 8 (3.03%) were seropositive for T. brucei infections in both the states. INTERPRETATION & CONCLUSION: The predominant species was found to be T. congolense. Mixed infection of three species, T. vivax, T. congolense and T. brucei was found to dominate other mixed infections in both the states. ELISA detected the infection of the three species of trypanosomes in the same group of animals. The usefulness of antigen capture ELISA in the diagnosis of human or animal trypanosomiasis was established, and the possibility of the spread of HAT caused by T. brucei gambiense and T.b. rhodesiense through cattle was expressed.

Prevalence of malaria as co-infection in HIV-infected individuals in a malaria endemic area of southeastern Nigeria.

BACKGROUND & OBJECTIVE: The present study was conducted on the prevalence of malaria as co-infection amongst 'asymptomatic HIV' and 'symptomatic HIV' subjects to see if such prevalence deviated from that commonly reported in apparently health individuals in same locality. METHODS: A prospective study that involved 196 participants grouped according to their HIV status as: 'asymptomatic HIV seropositive group' (n = 101); 'symptomatic HIV seropositive group' (n = 48) and 'control HIV-seronegative group (n = 47). Blood samples collected from the participants were used for double HIV screening by rapid immunoassay technique and immunochromatographic technique, and for the diagnosis of Plasmodium falciparum malaria using rapid P. falciparum antigen detection method. RESULTS: The result showed that the prevalence of P. falciparum malaria as a co-infection amongst the asymptomatic HIV seropositive group was 12 (11.8%) and amongst the symptomatic HIV seropositive group was 16 (33.3%). However, the prevalence rate of P. falciparum malaria amongst the control HIV seronegative group was 5 (10.6%) and the combined burden of P. falciparum malaria amongst both groups of HIV seropositives was 28 (18.9%). INTERPRETATION & CONCLUSION: The present study observed different prevalence rates of P. falciparum malaria amongst the three groups. The prevalence was tripled in symptomatic HIV seropositive group. This shows a clear departure from possible obtainable prevalence of malaria infection alone in this malaria endemic area. Due to the mortality rates associated with malaria infection in an endemic area, it may be necessary that routine malaria screening be adopted as part of the management policy to check the co-infection.

Malaria specific-IgG, inter-pregnancy intervals, birth weights and body mass index in cases of asymptomatic malaria parasitaemia.

BACKGROUND & OBJECTIVES: Considerations of both inter-pregnancy intervals and malaria parasitaemia may help in understanding some aspects of susceptibility and pregnancy outcomes in malaria endemic areas. METHODS: Pregnant women with asymptomatic malaria parasitaemia were recruited and divided into groups based on their inter-pregnancy intervals and malaria specific-IgG, body mass index, and birth weights were studied in the groups. RESULTS: The results showed that the P. falciparum specific-IgG concentration (f=3.52, p<0.02), malaria parasites density (f=6.44, p<0.001) and birth weights (f=7.36, p<0.001) were significantly different amongst the groups with varying inter-pregnancy intervals. In addition, different levels of associations between variables such as 'inter-pregnancy intervals vs P. falciparum specific-IgG concentration' (r = 0.23, p<0.05); 'malaria parasites density vs birth weight' (r = -0.84, p < 0.01) was observed. INTERPRETATIONS & CONCLUSION: This study suggests that inter-pregnancy intervals could be one of the factors influencing dynamic serum concentrations of P. falciparum specific-IgG while malaria parasitaemia could be one of the factors affecting birth weights. Hence, observance of inter-pregnancy intervals has its own implications in malaria endemic areas.

Prevalence of asymptomatic malaria parasitaemia amongst pregnant women.

Two hundred and forty-six apparently healthy pregnant women aged 19-40 years, without symptoms were recruited (147 recruited during the dry season and 99 recruited during the rainy season) for the present study. Blood examinations for malaria parasites, Plasmodium falciparum specific-IgG concentration and serological reactivity with P. falciparum-histidine rich protein-2 (HRP-2) antigens were conducted on all the pregnant women during the dry and rainy seasons of the year. During the dry season, 109 (74%) of the recruited pregnant women without symptoms had P. falciparum parasitaemia, while 79 (80%) of the recruited pregnant women without symptoms had P. falciparum parasitaemia during the rainy season. However, the P. falciparum malaria parasites density was significantly raised during the dry season compared with that of in the rainy season (p < 0.05). Serological analysis with P. falciparum histidine rich protein-2 antigen (HRP-2) showed 108 (73%) and 71 (77%) of the pregnant women without symptoms as seropositive during the dry and rainy seasons respectively. The P. falciparum specific-IgG concentration was similar during both seasons in the HRP-2 seropositive pregnant women without symptoms (p > 0.05). The results showed no seasonal tide in the incidences of asymptomatic P. falciparum parasitaemia; however, the significantly raised parasitaemia during the dry season may suggest possible increased parasites tolerance. The P. falciparum specific-IgG concentration during both seasons may not be the primary effector mechanism offering tolerance in asymptomatic parasitaemia in pregnant women.

Prevalence of rubella-IgG antibody in women of childbearing age in Lagos, Nigeria.

The prevalence of Rubella-IgG antibody was assessed in 152 Nigerian women consisting of 62 pregnant women. 82 non-pregnant women of childbearing age and 7 women who had suffered miscarriage. Rubella-IgG antibody was detected in sera of the female subjects by Immunocomb II Rubella IgG test kit (Orgenics, Israel) which is an indirect solid face Immunoassay (EIA). Rubella-IgG antibody was detected in 76% of pregnant women, 77% of non-pregnant women of childbearing age and 86% of women who had miscarriage. Similarly, the Rubella-IgG antibody titres of between 15 iu/ml and 120 iu/ml was encountered among the female subjects. Thus in general 77% of all the female subjects were positive for Rubella-IgG antibody while 23% had no detectable Rubella IgG antibody. There is need to protect this set of people considering the potential dangers of congenital anomalies associated with Rubella infection during pregnancy. The implications of the presence or absence of Rubella IgG antibody and titres are discussed.