Clinical and Imaging Features of Adults with Recurrent Pulmonary Tuberculosis - A Prospective Case-Controlled Study.

BACKGROUND: Recurrent pulmonary tuberculosis (RPTB) is a growing, important and neglected problem affecting treated TB patients and TB health services across the world, particularly in sub-Saharan Africa. Analyses and identification of differences in clinical features between recurrent PTB and newly diagnosed PTB may lead to improved management recommendations. METHODS: Between September 1st 2019 and January 31st 2020, we performed a prospective case controlled study of clinical and imaging features of patients with recurrent pulmonary tuberculosis and compared them with those of newly diagnosed PTB cases. Recurrent PTB was defined as a patient with bacteriologically confirmed active PTB who was previously successfully treated for PTB and was cured. A control was defined as a patient who presents for the first time with bacteriologically confirmed PTB. Clinical and radiological features were assessed and documented. Chi-square and t-test were used to test the difference between proportion and continuous data, respectively. Logistic regression analysis was done to determine factors associated with RPTB using SPSS version 23 software. RESULTS: A total of 312 patients with PTB were enrolled (104 RPTB cases and 208 newly diagnosed controls). Clinically hemoptysis was more common in RPTB compared to controls 28/104 (26.9%) vs 35/208 (16.8%), P = 0.036. Chest pain was significantly less common among patients with RPTB compared to controls 33 (31.7%) vs 92 (44.2%), P = 0.034. A higher proportion of RPTB presented with cavitation 34/104 (32.7%) compared to control 44/208 (21.2%) P = 0.027. The median score for lung pathology was higher among patients with RPTB (50) compared to controls (30); P = 0.001. Lung function of patients with RPTB at diagnosis of index TB were more likely to show mixed restrictive and obstructive pattern 36/104 (34.6%) compared to controls 31/208 (14.9%). p<0.001. Multivariate analysis showed that patients older than 45 years of age (adjusted odds ratio [aOR]: 3.59, 95% CI: 1.38 - 9.32), those with hemoptysis (aOR 1.96, 95% CI: 1.04 - 3.69) p=0.04) and fibrosis on chest x rays (aOR 2.18, 95% CI: 1.16 - 4.10) were significantly associated with recurrent PTB. CONCLUSIONS: Hemoptysis, lung parenchymal damage, and patients being older than 45 years of age are significant features of RPTB. Management should focus on risk factors for recurrence, and a more holistic model of care to prevent long term lung injury.

The spectrum of dermatological disorders among primary school children in Dar es Salaam.

BACKGROUND: Dermatologic disorders are common in many countries but the spectrum varies greatly. Many studies have reported a significant burden of skin diseases in school children. The objective of this study was to determine the current spectrum of dermatological disorders in primary school children in Dar es Salaam city. METHODS: Primary school children were recruited by multistage sampling. Detailed interview, dermatological examination and appropriate laboratory investigations were performed. Data was analyzed using the 'Statistical Package for Social Sciences' (SPSS) program version 10.0 and EPI6. A p-value of < 0.5 was significant. RESULTS: A total of 420 children were recruited (51% males; mean age 11.4 ± 2.8 years; range 6-19 years). The overall point prevalence of any skin disorder was 57.3% and it was 61.9% and 52.6% in males and females respectively (p = 0.05). Infectious dermatoses accounted for 30.4% with superficial fungal infections (dermatophytoses and pityriasis versicolor) being the commonest (20%). Dermatophytoses were diagnosed in 11.4% (48/420); the prevalence in males and females being 12.6% and 10.1% respectively (p = 0.41) and higher (21.8%) in the age-group 6-10 years (p = 0.045). Fungal cultures were positive in 42/48 children (88%). All three dermatophyte genera were isolated. Tinea capitis was the commonest disease among culture-positive dermatophytoses (30/42; 71.4%) with an overall prevalence of 7.1% (30/420) followed by tinea pedis (11/42; 26.1%) whose overall prevalence was 2.6%. Microsporum canis was common in tinea capitis (14/30; 46.7%) followed by Trichophyton violaceum (6/30; 20%). Trichophyton rubrum was common in tinea pedis (5/11; 45.5%). Thirty six children (8.6%) had pityriasis versicolor which was more prevalent (6/27; 22.l2%) in the age group 16-19 years (p = 0.0004). The other common infectious dermatoses were pyodermas (4%) and pediculosis capitis (3.6%). Common non-infectious dermatoses were: acne vulgaris (36.4%), non-specific dermatoses (10.7%), non-specific ulcers (5%) and atopic eczema (2.6%). Rare conditions (prevalence < 1%) included: vitiligo, alopecia areata and intertrigo. The majority of the affected children (67.2%) did not seek any medical assistance. CONCLUSIONS: Skin disorders are common in primary school children; infectious dermatoses are still rampant and many children do not seek medical assistance.

Sanitary practices and occurrence of zoonotic conditions in cattle at slaughter in Morogoro Municipality, Tanzania: implications for public health.

As meat consumption is increasing worldwide to cover for protein demands, also raise concerns and challenges regarding meat hygiene and safety. The current one year follow up study aimed at investigating on sanitary practices and occurrence of zoonotic conditions, during post-mortem examination, in cattle at slaughter in Morogoro Municipality abattoir. Sanitary practices were assessed through direct observation where as routine post-mortem inspection procedures were employed to detect zoonotic conditions in cattle at slaughter. During the study period a total of 30,713 cattle were slaughtered and inspected at the abattoir. Results revealed poor hygienic practices at the level of abattoir surrounding, the slaughter operation area, personnel as well as meat vans. Whole carcasses, lungs, livers, hearts and heads were condemned due to zoonotic conditions at rates of 0.026%, 1.96%, 1.61%, 0.02% and 0.21% respectively. Bovine tuberculosis, Cysticercus bovis cysts, fasciolosis and hydatidosis were the responsible zoonotic conditions for the condemnations. Bovine tuberculosis was a leading zoonotic cause of condemnations accounting for 95.7% of lungs and 100% of all head and carcass condemnations. Cysticercus bovis cysts were ranking the second in serving as causes of condemnations closely followed by fasciolosis and lastly hydatidosis. Occurrence of disease conditions with zoonotic implication in cattle at slaughter, meant for human consumption, may pose significant economic and public health risks to especially disaster-prone marginalized communities. Thus, there is a need to introduce appropriate control measures of livestock diseases to minimize the rate of infection; and eventually reduce economic losses and safeguard public health.