Epidemiological investigation of severe leptospirosis in the parish of St. Andrew, Barbados

The parish of St. Andrew has been shown to have the highest incidence of leptospirosis in Barbados (40/100 000 for the period 1979-1991 inclusive, compared with the mean incidence for the whole island over the same period of 13.3/100 000). A survey was conducted to try to identify which of the known risk-factors for leptospirosis were common in St. Andrew. Thirty-six cases of laboratory-confirmed leptospirosis occurring in the parish were identified during the 14 years from January 1980 to December 1993 inclusive. The incidence of leptospirosis in St. Andrew over this period showed a close association with mean monthly rainfall. However, there was no relationship between individual cases and rainfall in the preceding months. A questionnaire was administered to 71 percent of the thirty-one available subjects. The most common occupations were students (23 percent) agricultural workers (20 percent) while the unemployed were 17 percent. Gardening was practised by 40 percent of the respondents; 63 percent kept livestock animals and 86 percent kept dogs. Exposure to ponds or other water was common (41 percent) and 23 percent of respondents admitted walking barefoot some or all of the time. Mongooses were seen near the home or workplace by eight (36 percent) respondents, rats by 16 (73 percent), mice by 13 (59 percent) and frogs or toads by 14 (64 percent). The patients who responded to this questionnaire were exposed to multiple risk factors. Few indicated a change in lifestyle since recovering from leptospirosis. The importance of education for preventing exposure must be emphasized (AU)

Seroepidemiology of helicobacter pylori infection in Barbados - abstract

Helicobacter pylori is now recognised as the cause of chronic (type B) gastritis. We have previously reported on the detection of H.pylori in biopsies obtained by endoscopy of patients with upper gastrointestinal symptoms. An ELISA method was used to study the seroepidemiology of H.pylori infection in Barbadian patients and controls. Using an IgG concentration of 10 U/ml as a threshold, antibodies were detected in 78 percent of 100 patients undergoing endoscopy, 72 percent of 230 blood donors and 22 percent of 50 children. The mean antibody concentration was significantly higher in patients (91.9 U/ml) than in blood donors (48.56 U/ml) or in children (9.5 U/ml). Similarly, culture-positive patients (120 U/ml) had significantly higher IgG concentrations than in culture-negative patients (63.88 U/ml). Using isolation of H.pylori or a positive biopsy urease test as a measure of true prevalence of infection, the sensitivity of serology was 96 percent the specificity 42 percent, its positive predictive value was 67 percent and the negative predictive value was 90 percent. Seroprevalence increased with age, to a peak of more thatn 90 percent in blood donors aged 50-59 years and in patients aged over 60 years. The epidemiology of H.pylori in Barbados is similar to that in developed countries, in that few children are infected, but resembles other developing countries in the high seroprevalence observed in middle-aged adults. Our results confirm the utlitiy of serology for detecting H.pylori by a non-invasive technique (AU)

Helicobacter pylori in Barbadian patients undergoing endoscopy - abstract

The prevalence of Helicobacter pylori infection in Barbados was studied in 100 patients undergoing routine endoscopy. Biopsies were taken from within 3 cm of the gastric pylorus for culture, histology and rapid detection of urease in a buffered medium. Fifty-four patients gave a positive urease test, 50 were culture positive and 55 had histological appearance consistent with H. pylori. When compared to culture, the rapid urease test gave a sensitivity of 96 percent and a specificity of 92 percent; the positive predictive value was 92 percent and the negative predicitive value was 96 percent. The prevalence of H. pylori infection in the population studied increased with age, reaching a peak of 70 percent in the 60-79 age group. H. pylori was detected in 95 percent of patients with duodenal ulcers, 83 percent of those with type B. chronic gastritis, 57 percent of those with gastric ulcers and 66 percent of those with carcinoma of the stomach. We conclude that H. pylori infection is common in patients with chronic gastritis and duodenal ulcers in Barbados. We have demonstrated the value of a cheap, rapid direct urease test for the detection of H. pylori in gastric biopsies (AU)

Antimicrobial resistance in Helicobacter pylori in Barbados

OBJECTIVE: Helicobacter pylori eradication is essential in patients with peptic ulcer who are infected with the organism. The rate of eradication is related to the level of antimicrobial resistance to metronidazole, clarithromycin, amoxycillin and tetracycline in H pylori in this community. DESIGN AND METHODS: Gastric biopsies from all patients undergoing upper gastrointestinal endoscopy were cultured. Isolation was done on Thayer-Martin medium under microaerophilic conditions and isolates were sub-cultured on chocolate agar. MICs were determined using the E-test. RESULTS: 64 isolates were available for testing. Metronidazole resistance (MIC > 8mg/l) was observed in 39 percent (25/64), clarithromycin resistance (MIC > 2mg/l) in 4.7 percent (3/64), amoxycillin resistance (MIC > 8mg/l) in 4.7 percent (3/64) and tetracycline resistance (MIC > 4mg/l) in 3.1 percent (2/64). CONCLUSIONS: The high level of metronidazole resistance precludes the use of this antibiotic as first line therapy for H pylori in Barbados. It is recommended that a proton pump inhibitor, amoxycillin and clarithromycin be the combination of choice for eradication of H pylori in patients in Barbados.(Au)

Epidemiology of Helicobacter pylori infection in Barbados

The epidemiology of Helicobacter pylori infection in Barbadian patients and controls was studied. H. pylori was isolated from biopsies from 50/100 (50 percent) adult patients undergoing endoscopy for investigation of upper gastrointestinal tract symptoms. Urease was detected in biopsies from 54 patients and gastritis was detected by histology in 71 patients. Serology was performed using a commercial ELISA method. Using an IgG concentration of 10 U/ml as a threshold, antibodies were detected in 78 percent of 100 patients undergoing endoscopy, 72 percent of 230 blood donors and 22 percent of 50 children. The mean antibody concentration was significantly higher in patients (92 U/ml) than in blood donors (49 U/ml) or in children (9.5 U/ml). Culture-positive patients (120 U/ml) had higher IgG concentration than culture-negative patients (64 U/ml). Using isolation of H. pylori or a positive biopsy urease test as a measure of true prevalence of infection, the sensitivity of serology was 96 percent, the specificity 42 percent positive predictive value 67 percent and negative predictive value 90 percent. Seroprevalence increased with age, to a peak of more than 90 percent in blood donors aged 50 - 59 years and in patients aged over 60 years. The epidemiology of H. pylori in Barbados is similar to that in developed countries, where few children was infected, but resembles other developing countries in the high seroprevalence observed in middle-aged adults. (AU)