Prevalence and incidence rate of tuberculosis among HIV-infected patients enrolled in HIV care, treatment, and support program in mainland Tanzania.

BACKGROUND: Despite improvements in access to antiretroviral therapy (ART), mortality in people living with human immunodeficiency virus (PLHIV) is still high and primarily attributed to tuberculosis (TB) infection. In Sub-Saharan Africa, approximately 80% of HIV-related mortality cases are associated with TB. Relatively little is known about the incidence of TB among PLHIV in Tanzania and the determinant factors. We report the prevalence and incidence rate of confirmed TB and determine association with selected demographic and program-related factors based on data in the national HIV care and treatment program from 2011 to 2014. METHODS: We used the Tanzania National AIDS Control Programme database to obtain information on all HIV clients enrolled in the HIV care and treatment program between January 2011 and December 2014. We analyzed retrospective cohort data to assess the prevalence and TB incidence rate per 1000 person-years. A multivariable Cox proportional hazards regression model was used to estimate hazard ratios and 95% confidence intervals for putatively associated factors. RESULTS: Over 4 years, there were 22,071 confirmed cases of pulmonary TB in 1,323,600 person-years. The overall TB incidence was around 16.7 (95% CI 16.4-16.9) cases per 1000 person-years. The annual incidence rate decreased by 12.4 % from 17.0 (95% CI 16.5-17.4) in 2011 to 14.9 (95% CI 14.5-15.4) in 2014. The TB incidence rate was higher in persons not using ART and in males than in females. The incidence of TB was higher in patients with advanced HIV disease and decreased with increasing age. The overall prevalence of TB was 2.2%, with a peak prevalence of 2.5% in 2013 and was higher among children < 15 years (3.2%) in the same year. CONCLUSION: The study found an overall decrease in the incidence of TB in PLHIV. Our results emphasize the need for early initiation of ART and the provision of TB preventive therapy for those PLHIV without active TB after intensified TB case-finding.

Oral health status of handicapped primary school pupils in Dar es Salaam, Tanzania.

BACKGROUND: There is hardly any information regarding oral health status of handicapped primary school pupils in Tanzania. Determination of their oral health status could help in planning sustainable intervention programmes for this disadvantaged group. OBJECTIVES: To determine caries and periodontal status and treatment needs of handicapped primary school pupils in Dar es Salaam, Tanzania. DESIGN: A descriptive cross-sectional study. SETTING: Uhuru Mchanganyiko and Buguruni special schools, Dar es Salaam. RESULTS: The sample consisted of 179 (55.8%) males and 142 (44.2%) females aged between 7 and 22 years. Majority (71%) were deaf followed by blind (17.8%) and mentally retarded (8.7%). Six (1.9%) pupils were both deaf and blind, while one (0.3%) pupil was blind and mentally retarded. Forty one (12.8%) pupils had at least one decayed deciduous tooth, with the mean (dmfs) ranging from 0.25 to 3.24. The deaf had the highest mean decayed surfaces, followed by the mentally retarded and the blind. There was only one (0.3%) pupil who had a filled deciduous tooth. Thirty three (10.3%) pupils had decayed permanent teeth and 31 (9.7%) had missing permanent teeth. None of the decayed permanent teeth were restored. The blind had the lowest mean deciduous surfaces (DS) scores of between 0 and 1.0. In the mentally retarded group the mean DS ranged from 0.25 to 1.75. About 73.5% of the studied group had bleeding of the gums, with the blind having the highest mean bleeding index scores (p < 0.001) and about 82.8% of the pupils had calculus, with highest mean scores mainly among the blind (p = 0.008). CONCLUSION: The caries prevalence among handicapped primary school pupils was quite low. However, there was relatively high level of gingival bleeding and calculus. Regarding treatment needs, 23% required dental fillings mainly of one and two surface restorations and 82% required scaling and polishing. Despite these treatment needs these pupils had not received any dental attention.

Isolation and Potential for Transmission of Mycobacterium bovis at Human-livestock-wildlife Interface of the Serengeti Ecosystem, Northern Tanzania.

Mycobacterium bovis, the causative agent of bovine tuberculosis (bTB), is a multihost pathogen of public health and veterinary importance. We characterized the M. bovis isolated at the human-livestock-wildlife interface of the Serengeti ecosystem to determine the epidemiology and risk of cross-species transmission between interacting hosts species. DNA was extracted from mycobacterial cultures obtained from sputum samples of 472 tuberculosis (TB) suspected patients and tissue samples from 606 livestock and wild animal species. M. bovis isolates were characterized using spoligotyping and Mycobacterial Interspersed Repetitive Units-Variable Tandem Repeats (MIRU-VNTR) on 24 loci. Only 5 M. bovis were isolated from the cultured samples. Spoligotyping results revealed that three M. bovis isolates from two buffaloes (Syncerus caffer) and 1 African civet (Civettictis civetta) belonged to SB0133 spoligotype. The two novel strains (AR1 and AR2) assigned as spoligotype SB2290 and SB2289, respectively, were identified from indigenous cattle (Bos indicus). No M. bovis was detected from patients with clinical signs consistent with TB. Of the 606 animal tissue specimens and sputa of 472 TB-suspected patients 43 (7.09%) and 12 (2.9%), respectively, yielded non-tuberculous mycobacteria (NTM), of which 20 isolates were M. intracellulare. No M. avium was identified. M. bovis isolates from wildlife had 45.2% and 96.8% spoligotype pattern agreement with AR1 and AR2 strains, respectively. This finding indicates that bTB infections in wild animals and cattle were epidemiologically related. Of the 24 MIRU-VNTR loci, QUB 11b showed the highest discrimination among the M. bovis strains. The novel strains obtained in this study have not been previously reported in the area, but no clear evidence for recent cross-species transmission of M. bovis was found between human, livestock and wild animals.

Medicinal plants used by Tanzanian traditional healers in the management of Candida infections.

An ethnomedical survey in Coast, Dar es Salaam, Morogoro and Tanga regions of Tanzania has resulted in the identification of 36 plant species belonging to 21 plant families that are used traditionally for the treatment of Candida infections. Twenty-one plants constituting 58.3% of all collected plants are used to treat of oral candidiasis (Utando) one of the important signs of HIV/AIDS. The knowledge of traditional healers for the treatment of Candida infections has been highly supported by the literature in that 13 (36.1%) out of the 36 plants identified have been proven to be active against Candida albicans and/or other species of Candida. Also, some of the plants were reported to be active against other species of fungi including Cryptococcus neoformans, one of the important pathogenic fungi in HIV/AIDS. It can be seen that ethnomedical information from traditional healers provides a solid lead towards development of new drugs than random screening. The task that remains is to screen extracts prepared from these plants and perform a bioassay-guided fractionation of the active extracts so as to isolate the active compounds from these plants.

Atraumatic Restorative Treatment (ART): the Tanzanian experience.

OBJECTIVES: Atraumatic Restorative Treatment (ART), which involves the use of hand instruments, is a relatively inexpensive, non-sophisticated, tooth conservative technique that offers the opportunity for restorative work in remote areas without electricity. The objectives of this survey were to evaluate the experience of dental practitioners with ART and the impact of the technique on oral health care in Tanzania, where ART was pioneered. METHODS: Dental officers (DOs), assistant dental officers (ADOs) and dental therapists (DTs) from different parts of the Tanzania mainland participated in a cross-sectional study that gathered information using a self-administered structured questionnaire. RESULTS: Only 41 (35%) of the 117 respondents were practising ART with only 6.5% of them doing so either "most of the time" or "always". Practising ART was significantly associated with the cadre of the dental practitioner, being higher among ADOs (50%) than DOs (37%) and DTs (20%), and with ART training, but was not related to either working experience or material availability. CONCLUSIONS: To date, ART has made little impact on oral health care delivery in Tanzania, where dental extractions still account for over 90% of all forms of dental treatment, and restorative work for less than 5%. Several problems in providing ART were noted, such as limited practical training and practice in ART, scarce resources, and lack of advocacy. RECOMMENDATIONS: An increased involvement and support for ART from the Ministry of Health and professional organisations, and public education of ART is called for.

Quality assessment of sputum smear microscopy for detection of acid fast bacilli in peripheral health care facilities in Dar es Salaam, Tanzania.

BACKGROUND: There is no published information regarding the quality of sputum smear microscopy in Tanzania. OBJECTIVE: To evaluate technical quality and results of smear microscopy for acid-fast bacilli (AFB) in peripheral health care facilities in Kinondoni and Ilala Districts in Dar es Salaam, Tanzania. DESIGN: Cross-sectional study. SETTING: All tuberculosis diagnostic centres in Dar es Salaam, Tanzania. RESULTS: The proportion of well prepared smears was 86.2% and that of well stained smears was 81.2%. The overall average agreement in reading was (89.2%). The overall sensitivity was 88.5% and specificity was 100%. High false negatives (HFN) were the major errors found in this study and Low false negative (LFN) and quantification errors (QE) were the minor errors found. There were no false positive errors. Minor errors occurred more frequently in hospitals than dispensaries, while major errors occurred more frequently in dispensaries than in hospitals. CONCLUSIONS: The types of errors found in this survey, HFN, LFN and QE, suggest a systematic under-reading of smears in all the surveyed health facilities, probably due to a number of technical factors (quality of smears, poor stains, bad microscopes, or inadequate training) and other factors such as overwork and lack of motivation which need to be addressed. RECOMMENDATIONS: Regular supervision using the new WHO quality assurance guidelines should be conducted countrywide. We do recommend that blind re-checking as the most efficient means of making the first broad assessment of sputum smear microscopy in Tanzania.

Patients' satisfaction with dental care provided by public dental clinics in Dar es Salaam, Tanzania.

BACKGROUND: In Tanzania, patient satisfaction with dental services has received only minor attention. OBJECTIVE: To assess patients' satisfaction with public dental health services in Dar es Salaam. DESIGN: A cross-sectional study. SETTING: Five public dental clinics randomly selected from a list of all the nine public dental clinics in Dar es Salaam. SUBJECTS: Five hundred and sixteen consecutive patients, 193 males and 323 females aged between 12 and 77 years who, during the study period between July and November, 2002 were attending five dental clinics were randomly selected. RESULTS: No significant differences in patients' satisfaction level (overall or for the specific studied items) were found in all the five public dental clinics. The answers to the specific sub-items, apart from time spent with doctor, were around the average with very few responses with a high ranking. CONCLUSIONS: Findings indicate a moderate level of patient satisfaction with dental care offered in public dental clinics in Dar es Salaam. Areas identified as needing improvement included; technical quality of care, interpersonal aspects and communication.

Detection of Extended-Spectrum Beta-Lactamase-Producing Escherichia coli in Market-Ready Chickens in Zambia.

The frequent administering of antibiotics in the treatment of poultry diseases may contribute to emergence of antimicrobial-resistant strains. The objective of this study was to detect the presence of extended-spectrum ß-lactamase- (ESBL-) producing Escherichia coli in poultry in Zambia. A total of 384 poultry samples were collected and analyzed for ESBL-producing Escherichia coli. The cultured E. coli isolates were subjected to antimicrobial susceptibility tests and the polymerase chain reaction for detection of bla CTX-M, bla SHV, and bla TEM genes. Overall 20.1%, 77/384, (95% CI; 43.2-65.5%) of total samples analyzed contained ESBL-producing Escherichia coli. The antimicrobial sensitivity test revealed that 85.7% (66/77; CI: 75.7-92) of ESBL-producing E. coli isolates conferred resistance to beta-lactam and other antimicrobial agents. These results indicate that poultry is a potential reservoir for ESBL-producing Escherichia coli. The presence of ESBL-producing Escherichia coli in poultry destined for human consumption requires strengthening of the antibiotic administering policy. This is important as antibiotic administration in food animals is gaining momentum for improved animal productivity in developing countries such as Zambia.

Prevalence and risk factors for vaginal candidiasis among women seeking primary care for genital infections in Dar es Salaam, Tanzania.

OBJECTIVE: To determine the prevalence and risk factors for vaginal candidiasis (VC) among women seeking primary care for genital infections. DESIGN: Cross-sectional study. SETTING: Ilala Municipal Hospital in Dar es Salaam, Tanzania. SUBJECTS: Four hundred and sixty four women presenting with complaints of genital infections. RESULTS: Of the 464 women examined, 177 (38.1%) had abnormal vaginal discharge, 68(14.7%) had genital ulcers, 272 (58.6%) had genital pruritus, 18 (3.9%) had genital warts and 58 (12.5%) had chancre. The prevalencies of VC, bacterial vaginosis, HIV, T vaginalis, N. gonorrhoeae and syphilis were 45%, 48.4%, 22%, 93%, 1.5% and 4.3%, respectively. The occurrence of VC was positively associated with HIV, (OR = 1.81, 95% CI (1.0-2.67), bacterial vaginosis; (OR = 2.6, 95% CI (1.7-3.9), genital pruritus; (OR = 1.8 1, 95% CI (1.2-2.7) genital discharge; (OR = 1.867, 95% (1.28-2.73) and negatively with T. vaginalis (OR = 0.27, 95% CI (0.12 - 0.6), occupation (OR = 0.65, 95% CI (0.35-0.86)) and with education (OR = 0.43, 95% CI (0.11-0.73). There were increased but non-significant odds for VC in patients with syphilis (OR = 1.6 95% CI (0.6-4.3) and venereal warts (OR = 2.5 95% CI (0.92-6.8) VC was not associated with N. gonorrhoeae, genital ulcers, age at first intercourse, number of sexual partners, marital status or antibiotic usage. CONCLUSION: The high prevalence of vaginal candidiasis among women with genital infections should be taken into account when updating policies concerning syndromic management of sexually transmitted diseases. More gender specific approach to syndromic management of sexually transmitted infections in females should be considered.

Identification of Candida strains isolated from Tanzanian pregnant women with vaginal candidiasis.

OBJECTIVE: To identify Candida strains isolated from Tanzanian women (13 to 45 years) with vaginal candidiasis. DESIGN: A cross-sectional study. SETTING: Antenatal clinic in Ilala district hospital in Dar es Salaam, Tanzania from March 1998 to December 2000. RESULTS: The identities of the 272 isolates tested with API Candida were: Candida albicans 180(66.2%), Candida tropicalis 13(4.7%), Candida glabrata 20(7.35%), Candida famata 6(2.2%), Candida parapsilosis 6 (2.2%) and Candida lusitaniae one (0.37%). API Candida could not speciate 43 (15.8%) isolates of these; two (0.7%) fell between C. albicans and C. tropicalis, 17(6.25%) C. lusitaniael, C. guilliermondii/C. famata, 14(5.15%) C. krusei, C. inconspicua, and C. norvegensis and nine (3.3%) either C. parapsilosis, C. krusei, C. incospicua or Geotrichum spp. Four (1.5%) isolates had an assimilation pattern of Trichosporo spp, but were all germ tube positive and had morphological features on cornemeal agar that were consistent with C. albicans. API 20C AUX was used for testing 29 isolates and results showed: 11/29 (37.9%) C. albicans, 1/29 (3.4%) C. tropicalis, 4/29 (13.8%) C. glabrata, 1/29 (3.4%) C. parapsilosis, 1/29 (3.4%) C. famata, 1/29 (3.4%) C. lusitaniae, 1/29 (3.4%) C. colliculosa/C. magnoliae, 5/29(17.2%) C. albicans/ C. tropicals 2/29 (6.8%) C. norvegensis/C. parapsilosis, and 2/29(6.8%) C. kruseil/C. inconspicua. Results of 20 isolates identified by Randomly Amplified Polymorphic DNA (RAPID) technique showed a 95% agreement with API Candida and a 100% agreement with API 20C AUX. CONCLUSION: Although most (66.3%) of the species isolated from Dar es Salaam women with vaginal candidiasis were C. albicans, a considerable percentage (33.7%) were non-albicans, mainly C. glabrata, C. krusei and C. tropicalis. The high prevalence of non-albicans Candida spp observed in this population may have therapeutic implications.

Biotypes of oral Candida albicans isolates in a Tanzanian child population.

Although biotypes of Candida albicans from adult populations, especially in the West, have been described, there are no data either from a child population, or from the African continent. Hence a total of 200 oral C. albicans isolates from Tanzanian children aged 6-24 months were biotyped using two commercially available API micromethod kit systems and a boric acid resistance test. The predominant biotypes, which comprised two thirds of the organisms isolated, were J1S (19.5%), A1S (16.0%), J1R (14.5%), A1R (9.5%) and P1R (7.5%). In total, 16 new biotypes comprising 44 (22%) isolates which have not hitherto been described were found in this Tanzanian population and, of these, the P1R biotype predominated with 15 (7.5%) isolates. There was no significant association between predominant biotypes (with clusters > or = 15 isolates) and age, gender, breast feeding and malnutrition. These data indicate that the biotype profile of C. albicans isolates may differ in paediatric and adult populations, and/or global distribution of various subtypes of this common opportunistic pathogen.

Cariogenicity depends more on diet than the prevailing mutans streptococcal species.

This review aims to compare the occurrence and distribution of mutans streptococci in Africa, Europe, and North America and in addition will try to offer explanations for existing relationships among salivary mutans streptococci counts, dietary patterns, and dental caries. The literature reveals that salivary mutans streptococci counts in child populations of the three continents are comparable. The distribution of mutans streptococci species, with a predominance of S. mutans followed by S. sobrinus, and the virtual absence of other mutans streptococci species are also comparable. Although it is widely believed that diet has an important effect on mutans streptococci counts, this review provides evidence that this does not hold true when variations in dietary patterns are moderate, as they normally are in real-life situations. Since the diets of the child populations in the three continents vary moderately, a strong dietary-induced effect on salivary mutans streptococci counts cannot be expected. The observed analogous salivary mutans streptococci counts in these child populations are thus 'not surprising' but are in accordance with the conceptual expectation. The differences in caries experience in children of the three continents cannot be explained by the prevailing mutans streptococci species but instead should be attributed to differences in the cariogenicity of the various diets. The fact that the cariogenicity of the diet determines the development of dental caries while hardly affecting the mutans streptococci counts explains the limited value of the latter as an indicator of dental caries. The reviewed literature shows that mutans streptococci are ubiquitous in children aged 7 years and older in Africa, Europe, and North America. Mutans streptococci should therefore be considered as belonging to the indigenous microflora of the human mouth.

Fermentation of carbohydrates in different flours by Streptococcus mutans.

The ability of Streptococcus mutans to ferment carbohydrates and to produce acid was investigated in different flours in vitro. The amounts of acid produced suggest a possible ecological role of the tested flours in the occurrence of Strep. mutans in dental plaque.

Association between carriage of oral yeasts, malnutrition and HIV-1 infection among Tanzanian children aged 18 months to 5 years.

The objective was to determine whether there is an association between carriage of oral yeasts, malnutrition and HIV-1 infection among Tanzanian children. A case-control study design within a cross-sectional study was used, and the outcome was carriage of oral yeasts. The exposure variables were malnutrition and HIV-1 antibody, and confounders to be adjusted for were age, sex, and breastfeeding. The study was carried out in Dar-es-Salaam, Tanzania, in two maternal and child health (MCH) clinics that offer routine medical checkups to all expectant mothers and children aged between 0 and 5 years in the catchment area. A total of 882 children aged between 18 months and 5 years participated. Smears from the tongue and buccal mucosa were examined for oral yeasts. Malnutrition was categorized according to standards on the MCH chart and World Health Organization/Centers for Disease Control (WHO/CDC) standards as weight-for-height (wasted), weight-for-age (underweight), and height-for-age (stunted). HIV-1 infection was determined by an enzyme-linked immunosorbent assay. Reactive sera were confirmed by Western Blot. About 27% of the children were slightly or severely malnourished according to standards on the MCH chart. According to WHO/CDC standards, 2.6% were wasted, 16.3% were underweight, and 29.6% were stunted. Fourteen (1.6%) were seropositive for HIV-1 antibody. Hyphal forms and blastospores were much more frequent among children infected with HIV-1 with odds ratios ranging from 3.8 (95% CI: 1.3;11.2) to 6.2 (95% CI: 2.1;18.4) depending on categorization of malnutrition. Malnutrition was a risk factor, too, albeit to a much lesser and insignificant degree. The study supports our previous findings that malnutrition may predispose to carriage of oral yeasts and subsequent infection. However, in this study population HIV infection was clearly the predominant risk factor.

PIP: The association between carriage of oral yeasts, malnutrition, and HIV-1 infection was investigated in a case-control study involving 403 girls and 479 boys 18 months-5 years of age attending 2 maternal-child health clinics in Dar-es-Salaam, Tanzania, in a 4-month period in 1994. The children designated as cases had Candida-like microorganisms on smears from the tongue and buccal mucosa. 14 children (1.6%) were HIV-positive; 11 of these children were under 3 years of age. 241 (27%) were moderately or severely malnourished. 20.0% had hyphal forms and 17.5% had blastospores. Presence of HIV infection was the most significant risk factor for hyphal forms or blastospores consistent with Candida-like microorganisms (unadjusted odds ratios, 5.5 and 3.8, respectively). Although malnutrition was also a risk factor for oral yeasts, the association was not significant. The study findings suggest that malnutrition may predispose to carriage of oral yeasts and subsequent infection. The rates of oral yeasts detected among these children were lower than expected and may reflect a reduced secretion of stimulated whole saliva associated with malnutrition and HIV infection.

The effect of choosing different units of analysis when estimating risk of presence of dental caries in the primary dentition.

BACKGROUND: Data on caries are usually collected with the tooth surface or the tooth as the unit, but subsequently analysed by aggregating the data at the level of the individual. AIMS: To evaluate how different units of analysis may affect the result of the statistical analyses in a study of the association between deciduous dental caries and a set of risk factors. METHOD: 293 children (mean age: 7.5 yrs) from two primary schools in Dar es Salaam, Tanzania were examined. Thus the study design was cross-sectional. Logistic regression analysis was used to determine the association between caries experience and nutritional status, socioeconomic background, and microbiological and salivary characteristics using the subject, the tooth, and the tooth surface as unit of analysis, allowing for the fact that teeth and surfaces within the same individual must be considered non-independent. RESULTS: When aggregated data were used, point estimates were larger in some instances. The precision of the estimates increased considerably when the tooth as compared to the individual was used as the unit of analysis. No or limited gain in precision was obtained when the tooth surface as compared to the tooth was used as unit of analysis. CONCLUSIONS: The choice of unit of analysis may strongly influence the result of the statistical analyses and thus the conclusion of an investigation.

Reasons for taking radiographs in general dental practice in Dar-es-Salaam, Tanzania.

This study investigated the reasons why dental practitioners at the Muhimbili Dental OPD clinic in Dar-es-Salaam take radiographs. Information was obtained from medical records at the Department of Dental Radiology for an eighteen month period, during which 28,171 patients were seen at the hospital, and of which 2,672 (9.48 per cent) were radiographed. The main reasons for taking radiographs (percentages) was to detect fractures (17.2), tumours (14.1), caries (12.5), impacted teeth (12.2), periodontal disease (11.3), and non-specific dental pain (10.4). Radiographs were also taken for orthodontic (7.0 per cent) and endodontic (6.8 per cent) reasons. Some of the reasons for taking radiographs such as hypersensitive teeth, apicectomy, neuralgia and xerostomia were previously unheard of, indicating an increasing diversity of dental services. In conclusion, there is a need to increase the utilisation of dental radiographs from the present modest level in order to meet the growing need of the increasingly informed dental population in Dar-es-Salaam.

Oral tumours in Tanzanian children based on biopsy materials examined over a 15-year period from 1982 to 1997.

AIM: To provide information on the types and distribution of oral tumours and tumour-like lesions occurring in a Tanzanian child population aged 0-16 years. DESIGN: Retrospective study of biopsy results from hospital records from 1982-1997. SETTING: Department of Histopathology, the Muhimbili Medical Centre (MMC) in Dar es Salaam. INTERVENTION/ METHODS: A total of 158 biopsy results, from 75 girls and 83 boys, were retrieved and studied. RESULTS: Malignant tumours were the most frequent (43.0%) followed by benign tumours (30.4%) and tumour-like lesions (26.6%). Burkitt's lymphoma was the most frequent malignant tumour accounting for 88.2% of all malignancies followed by squamous cell carcinoma (4.4%) and oral Kaposi's sarcoma (2.9%). Fibroma, papilloma and haemangioma were the most frequent benign tumours constituting 27.1%, 14.6% and 12.5%, respectively. Odontogenic cysts were the most frequent tumour-like lesions (28.6%) followed by fibrous dysplasia (19%) and giant cell granuloma (16.7%). CONCLUSION: The six most common oral lesions were Burkitt's lymphoma, fibroma, odontogenic cysts, fibrous dysplasia, papilloma and giant cell granuloma.

Pathogenic isolates in meningitis patients in Dar Es Salaam, Tanzania.

OBJECTIVES: To determine, from laboratory records, the spectrum of bacterial and fungal pathogens isolated from cerebrospinal fluids (CSF) of in-patients with meningitis at Muhimbili Medical Centre (MMC) in Dar es Salaam and to ascertain the laboratory results (based on microscopy and culture) using the latex agglutination technique. DESIGN: A retrospective study based on laboratory records of CSF samples investigated between November 1999 and June 2000 and a cross-sectional study involving investigation of 60 freshly collected CSF samples by conventional (microscopy and culture) and antigen detection by latex agglutination technique (LAT). SETTING: Muhimbili Medical Centre in Dar es Salaam, Tanzania. INVESTIGATIONS: Information from laboratory records, bacteriological examination of CSF by microscopy, culture and agglutination techniques. RESULTS: According to records, a total of 1144 CSF samples were investigated between November 1999 and June 2000, of which two hundred and twenty two specimens (19.4%) had a positive bacterial or fungal culture. Fifty five of the isolates were from children (aged less than 15 years) and were; 20 (36.4%) were Streptococcus pneumoniae, 12(21.8%) were Cryptococcus neoformans, and nine (16.4%) were Haemophilus influenzae type b. The remaining 14 (25%) isolates included three group B streptococci, three Klebsiella spp, two E. coli, two Staphylococcus aureus, two Pseudomonas spp, one Moraxella and one Salmonella group B. For adults a total of 167 positive cultures were reported and 163 (97.6%) of the isolates were Cryptococcus neoformans, two (1.2%) were Pseudomonas spp. and two were S. aureus. There was good agreement between conventional microscopy and culture with the latex agglutination technique in the identification of CSF pathogens. CONCLUSION: In children, S. pneumonia, and bacteria in general constituted the majority of isolates. Adult cases of meningitis were almost exclusively due to C. neoformans. Overall, C. neoformans appears to be the most common isolate among meningitis cases. Based on LAT results, our routine diagnostic methods seem to be adequate in the identification of the common CSF pathogens.

Cervico-facial necrotising fasciitis occurring with facial paralysis: case report.

Necrotising fasciitis is a soft tissue infection, usually polymicrobial, characterised by necrosis of fascia and subcutaneous tissue. It frequently involves the groin, abdomen and extremities, but rarely involves the cervico-facial region. A case is presented of a 70-year old man who, following a futile attempt to extract a lower left first molar, developed a cervico-facial necrotising faciitis with facial nerve paralysis. Bacteriological investigations revealed the presence of Klebsiella spp and viridans streptococci. It is emphasized that early detection of this disease followed by aggressive surgical debridement and antibiotic therapy are most important.

Oro-facial lesions occurring in HIV-infected individuals in Dar es Salaam.

This study demonstrates a strong association between the occurrence of oro-facial lesions and HIV-1 seropositivity in a group of patients in Dar es Salaam. Among the different oro-facial lesions Kaposi's sarcoma seems to be the most frequent and the most important pathognomonic feature. Since some of the lesions occur fairly early in HIV infection, a through and systematic examination of the oro-facial region may provide an early clue for HIV infection.