HIV infection and associated risk factors among long-distance truck drivers travelling through Azerbaijan.

The aim of this study was to assess HIV prevalence and associated risk behaviours among international truck drivers (TDs) in Azerbaijan. The subjects signed consent and completed a questionnaire. Blood was tested using two rapid HIV tests: Determine and OraQuick. Genotyping was performed on 13 positives. Overall, 3763 TDs from 21 countries were enrolled. Fifty-eight (1.54%) were HIV-positive. Highest prevalence was among Russians (2.88%), Ukrainians (1.66%) and Azerbaijani (1.09%). On univariate analysis, highest prevalence (60%) was among injecting drug users (IDUs) compared with 0.4% among non-IDUs (P < 0.001). The prevalence in men who had sex with men (MSM) (42.9%) was high (P

A nascent HIV type 1 epidemic among injecting drug users in Kabul, Afghanistan is dominated by complex AD recombinant strain, CRF35_AD.

Injecting drug use (IDU), common in global centers of heroin production, confers significant risk for HIV-1 infection. Once introduced into IDU networks, an explosive rise in HIV-1 infection typically occurs, fueled principally by needle sharing. New HIV-1 epidemics in IDUs have occurred in Russia, China, Thailand, Spain, Iran, and in other countries, and some have spread into other risk groups in their respective countries. In Afghanistan, the introduction of HIV-1 into IDU networks has begun, but a recent report of 3% HIV-1 prevalence suggests that the epidemic is still at an early stage. Here we establish, by complete genome sequencing and phylogenetic analysis of four viral strains from Afghan IDUs, that all are the same complex recombinant strain, combining HIV-1 subtypes A and D and herein termed CRF35_AD. Published partial HIV-1 sequences from an HIV-1 epidemic among IDUs in Iran, already at 23.2% HIV-1 prevalence, are either CRF35_AD or a related recombinant. Voluntary HIV-1 screening and harm reduction programs in Afghanistan, applied now, could limit the spread of HIV-1, both in IDUs and in other social networks.

Sexually transmitted disease symptom management behaviours among female sex workers in Tashkent, Uzbekistan.

The objective of this cross-sectional study was to assess prevalence and correlates of self-treatment of sexually transmitted diseases (STD) among female sex workers (FSW) in Tashkent, Uzbekistan. Enrolled FSW completed a self-administered questionnaire, HIV serologic testing and optional pelvic examination. STD diagnosis was based on physical examination and/or microscopic findings. Of 448 women, 337 (75.0%) accepted examination; of these, 316 (93.8%) received at least one STD-related diagnosis. Nearly half (45.4%) reported prior STD self-treatment, which was associated with HIV infection (age-adjusted odds ratio [AOR] = 3.20, 95% confidence interval [CI] = 1.45-7.53) and condom knowledge (AOR = 2.10, 95% CI = 1.16-3.80). For those with history of STD, immediate resumption of sex work before completing treatment was common (87.0%). STD self-treatment is common among FSW in Tashkent, particularly women with HIV infection. Confidential venues for STD care and condom utilization programmes targeted to FSW and their clients are needed to prevent STD in this setting.

Serologic evidence of respiratory and rickettsial infections among Somali refugees.

Somali refugees living in a camp located in Djibouti were studied in October 1991 and May 1992. The refugees had been living at the camp for about two years. The median age of volunteers was 25 years, of whom 69% were female. Paired sera obtained seven months apart were evaluated by complement fixation, microimmunofluorescence, indirect fluorescent antibody, streptococcal antibody, and enzyme-linked immunosorbent assay techniques for evidence of pathogen infection. Fifty-two percent, 31.3%, 8.0%, 5.9%, and 25.4% of the volunteers had serologic evidence for pre-enrollment infection with Chlamydia pneumoniae, Mycoplasma pneumoniae, Rickettsia typhi, R. conorii, and Coxiella burnetti, respectively. Similarly, 43.5%, 5.2%, 6.1%, 10.7%, 15.8%, and 11.9% of the volunteers studied had serologic evidence for new infection with Streptococcus pyogenes, C. pneumoniae, M. pneumoniae, R. typhi, R. conorii, and Cox. burnetii, respectively. These data suggest that the studied pathogens may be endemic in displaced populations living in the Horn of Africa.

Application of an immunoperoxidase monolayer assay for the detection of arboviral antibodies.

An immunoperoxidase monolayer assay (IPMA) was adapted for the detection of antibodies to six arboviruses: three viruses within the flavivirus group (dengue 2, West Nile (WN) and yellow fever) and three in the phlebovirus group (Rift Valley fever (RVF), sandfly fever Naples and sandfly fever Sicilian). Antibody titers of homologous hyper-immune mouse ascitic fluid (HMAF) measured by IPMA were two to eight-fold less than those determined by ELISA. In tests with heterologous HMAF, cross-reactions frequently observed in ELISA, particularly in the flavivirus group, were absent in all IPMA titrations. With human serum samples tested for antibodies to RVF (n = 52) and WN (n = 90), the sensitivity of IPMA as compared with ELISA was 96 and 91%, respectively, specificity of IPMA was 100%. In addition, the IPMA format has several advantages that make it a useful alternative to ELISA for diagnosing arboviral infections under field conditions.

Antibody responses to Fermi antirabies vaccine in 21 patients bitten by a rabid jackal.

In a village in Upper Egypt, 21 persons were bitten by a rabid jackal. All received antirabies vaccine of the Fermi type within a few hours after the exposure. Antirabies hyperimmune serum was not administered. Three of the 21 victims died on days 16, 17 and 27 after exposure. Blood samples were obtained from 19 of the 21 bitten persons 5 days after completion of a series of 20 vaccine doses. Sera were tested for rabies antibodies by the indirect fluorescent antibody test (IFAT) and enzyme-linked immunosorbent assay (ELISA) test. All 19 persons developed rabies antibodies detectable by these techniques. IFAT titres ranged from 128 to greater than or equal to 1024. ELISA antiglycoprotein titres were generally low, ranging from 0.7 to 18 iu/ml of serum.

Arboviral causes of non-specific fever and myalgia in a fever hospital patient population in Cairo, Egypt.

Fever and myalgia are non-specific clinical manifestations of illness which commonly occur in patients with arboviral disease. In Egypt, such illness is often mis-diagnosed as "influenza". To determine arboviral aetiology in patients admitted with fever and myalgia, acute and convalescent sera samples were obtained from 55 patients admitted with these clinical manifestations to the Imbaba Fever Hospital, Giza, Egypt, during October and November 1984. Based on viral isolation, and a comparison of acute and convalescent sera, 4 patients (7%) had acute arboviral infections. Haemagglutination inhibition and indirect immunofluorescence tests showed that one had West Nile virus (WNV) infection, 2 had sandfly fever virus-Naples (SFN), and 1 had sandfly fever virus-Sicilian (SFS) infection. SFN was isolated from the acute serum sample of 1 of the 2 patients with SFN infection.

Prevalence of hantavirus antibody in patients with chronic renal disease in Egypt.

In Egypt, the etiology of chronic renal failure (CRF) is not well defined. A hospital-based case-control study was initiated in February 1998, to determine whether hantavirus infection is involved in chronic renal disease (CRD) in Egypt. The study enrolled 350 study patients with a history of CRF and 695 matched controls with CRD due to renal calculus or renal cancer, but with normal renal functions. Sera from cases and controls were tested for anti-hantavirus IgG using ELISA with a cell-lysate antigen from Hantaan virus prototype strain 76-118. A demographic questionnaire was completed for each study participant. Five of the 350 cases (1.4%), and seven of the 695 controls (1.0%) were antibody-positive to hantavirus, with a titer > or =1:400. The difference in antibody prevalence between the study cases and the control cases was not statistically significant (P = 0.48). All antibody-positive study cases and controls had been exposed to rodents. Data indicated that in Egypt, hantavirus seroprevalence in CRD patients is low, and hantavirus infections do not appear to be a significant cause of CRF.

Some observations on experimentally induced infection of dogs with Babesia gibsoni.

Splenectomized andnonsplenectomized dogs were experimentally infected with Babesia gibsoni. Infectivity of parasites was retained for 1 month in samples of blood kept at 4 C in a mixture with Alsever's, acid-citrate-dextrose (ACD), or ammonium-potassium oxalate solutions. When samples were slowly frozen to -70 C in a mixture with citrate solution, the parasites remained infective for 4 months. The average prepatent period was 3.3 days in splenectomized dogs and 4 days in nonsplenectomized dogs. Clinical signs were mild fever and anemia in nonsplenectomized dogs and fever, anemia, icterus, and rarely, hemoglobinuria in splenectomized dogs. Blood packed cell volume (PCV) decreased to as little as 11%, and total bilirubin increased to as great as 0.85 mg/dl. Latent parasitemia was still detectable in some dogs 135 days after the initial parasitemia. Gross pathologic changes mainly involved liver and spleen. Hepatic degeneration was always present.

Canine ehrlichiosis in Egypt: sero-epidemiological survey.

A total of 374 dogs, 252 from five military kennels and 122 privately owned, were tested for Ehrlichia canis antibody. Sera were tested at a 1:20 dilution by indirect fluorescent antibody with the use of E. canis cell-culture antigen slides. The overall prevalence of E. canis antibody was 33%. Antibody prevalence among military dogs (29%) was significantly lower than among privately owned dogs (41%; P < 0.05). The E. canis seroprevalence among dogs infested with ticks (Rhipicephalus sanguineus) was higher (44%) than that among uninfested dogs (31%; P = 0.08). The seroprevalence among military dogs varied from 21-46% at the five kennels; lower prevalences were observed in kennels with higher sanitary and hygienic conditions. Age- and sex-related E. canis antibody prevalences were not significantly different among military and privately owned dogs, although adult and male privately owned dogs had the highest seroprevalences (45% and 44%, respectively). Three dogs with epistaxis had E. canis antibody titres > 1:320. These data demonstrate the first laboratory evidence of E. canis infection among dogs in Egypt.

Technique for liver biopsy in the dromedary camel.

A technique for needle liver biopsy in camels was developed. Xylazine, 15 mg/100 kg intravenously, was used for sedation and analgesia. A 1.2 mm X 7 cm Menghini needle was introduced anteroventrally through the ninth right intercostal space, 1 cm caudal to the ninth rib and 2 cm dorsal to the costal cartilage. The needle was directed toward the contralateral olecranon with the camel in sternal recumbency. A core of liver tissue between 1 and 2 cm long was obtained from 99 of 120 attempts in 23 animals. There were no adverse effects from the procedure and histological preservation of the tissue was excellent.

Remote village survey for agents causing hepatosplenic disease in the Republic of Yemen.

The objective of this study was to epidemiologically describe potential infectious agents among rural people in the Republic of Yemen. This would aid clinicians in designing empirical therapy and public health officials in planning disease prevention. We sought to examine evidence for the geographical distribution of pathogens causing human hepatic and splenic disease among villagers and domestic animals living in three remote areas with differing altitudes. In June 1992, a cross-sectional survey was conducted at three survey sites of differing altitudes: 3080, 1440 and 250 m above sea level. Questionnaires, parasitic and serological tests were administered to 627 human volunteers. Additionally 317 domestic animals were studied. Malaria, schistosomiasis, and hepatitis B and C infections were found to be likely causes of human hepatic or splenic disease. Additionally, evidence of human and animal infections with the agents of brucellosis and Q fever was found: IgG antibodies against hepatitis E virus were discovered in two (2.0%) of the 100 volunteers. The prevalence of markers for human and animal disease was often lowest at the village of highest elevation, suggesting that increasing altitude, as a surrogate or a true independent risk factor, was protective against infection with the agents studied.