Surveillance of Bacterial Meningitis, Ethiopia, 2012-2013.

Among 139 patients with suspected bacterial meningitis in Ethiopia, 2012-2013, meningococci (19.4%) and pneumococci (12.9%) were the major disease-causing organisms. Meningococcal serogroups detected were A (n = 11), W (n = 7), C (n = 1), and X (n = 1). Affordable, multivalent meningitis vaccines for the African meningitis belt are urgently needed.

Performance of general health workers in leprosy control activities at public health facilities in Amhara and Oromia States, Ethiopia.

BACKGROUND: Leprosy is a chronic infectious disease of public health importance and one of the leading causes of permanent physical disability. Nevertheless, the drop in prevalence following multidrug therapy has resulted in the neglect of leprosy. The annual incidence of leprosy has remained the same in Ethiopia since decades with more than 76% of the reported new cases coming from Oromia and Amhara Regional States. This study was aimed to assess the knowledge, attitude and skill of general health workers in leprosy control activities at public health facilities in Oromia and Amhara Regional States. METHODS: A cross-sectional study was conducted from September 2011 to February 2012 at different public health facilities in selected eight zones in Oromia and Amhara Regional States. A multistage sampling method was used to obtain representative samples. High and low endemic zones for leprosy were included in the study in both regional states. Data were collected from general health workers through a structured self-administered questionnaire and at on-site assessment of their performance. Baseline socio-demographic data, health workers' attitude towards leprosy and their knowledge and skill in the management of leprosy were assessed. Bloom's cut off point was used to describe the knowledge and practical skills of the respondents while Likert's scale was used for attitude assessment. RESULT: A total of 601 general health workers responsible for leprosy control activities at public health facilities were included in knowledge and attitude assessment and 83 of them were subjected to practical evaluation, with on-site observation of how they handle leprosy patients. These included medical doctors (4%), health officers and nurses with Bachelor degree in Science (27%), clinical nurses with diploma (66%) and health assistants (2.8%). The median age of the respondents was 26.0 years and females made up of 45%. Generally the knowledge and skills of the respondents were found to be poor while attitude towards leprosy was positive for the majority of the respondents. The result showed that 519 (86.3%) had poor knowledge. Overall 155 (25.8%) of the respondents had positive attitude towards leprosy while 205 (34.1%) had intermediate (mixed) attitude and 241 (40.1%) had negative attitude to the disease. Among 83 respondents assessed for diagnosis of leprosy only 15(18.0%) diagnosed leprosy correctly. Variation in knowledge and attitude indicated a significant difference (p < 0.05) among different health institutions, professions, gender, in-service training and years of experience. CONCLUSION: The current finding underlines that although leprosy control activities are integrated to the general health services in the country, the knowledge and skills of leprosy diagnosis, treatment and management by health workers was unsatisfactory. Hence, attention should be given to develop training strategies that can improve health worker knowledge and promote better leprosy management at public health facilities. This could be achieved through pre-service and in-service training and giving adequate emphasis to leprosy related practical work and continuous follow- up.

Investigation of the high rates of extrapulmonary tuberculosis in Ethiopia reveals no single driving factor and minimal evidence for zoonotic transmission of Mycobacterium bovis infection.

BACKGROUND: Ethiopia, a high tuberculosis (TB) burden country, reports one of the highest incidence rates of extra-pulmonary TB dominated by cervical lymphadenitis (TBLN). Infection with Mycobacterium bovis has previously been excluded as the main reason for the high rate of extrapulmonary TB in Ethiopia. METHODS: Here we examined demographic and clinical characteristics of 953 pulmonary (PTB) and 1198 TBLN patients visiting 11 health facilities in distinct geographic areas of Ethiopia. Clinical characteristics were also correlated with genotypes of the causative agent, Mycobacterium tuberculosis. RESULTS: No major patient or bacterial strain factor could be identified as being responsible for the high rate of TBLN, and there was no association with HIV infection. However, analysis of the demographic data of involved patients showed that having regular and direct contact with live animals was more associated with TBLN than with PTB, although no M. bovis was isolated from patients with TBLN. Among PTB patients, those infected with Lineage 4 reported "contact with other TB patient" more often than patients infected with Lineage 3 did (OR = 1.6, CI 95% 1.0-2.7; p = 0.064). High fever, in contrast to low and moderate fever, was significantly associated with Lineage 4 (OR = 2.3; p = 0.024). On the other hand, TBLN cases infected with Lineage 4 tended to get milder symptoms overall for the constitutional symptoms than those infected with Lineage 3. CONCLUSIONS: The study suggests a complex role for multiple interacting factors in the epidemiology of extrapulmonary TB in Ethiopia, including factors that can only be derived from population-based studies, which may prove to be significant for TB control in Ethiopia.

Tuberculosis among Addis Ababa city bus drivers and cash collectors.

BACKGROUND: The risk of transmission of tuberculosis is high in crowded conditions. Addis Ababa has a relatively high burden of tuberculosis and its city buses are often filled with commuters. Tuberculosis is a potential occupational hazard for city bus drivers and cash collectors. OBJECTIVES: The objective of this study was to estimate the proportion of tuberculosis among city bus drivers and cash collectors. METHODS: We estimated the proportion of tuberculosis of all forms among city bus drivers and cash collectors of the Addis Ababa City Bus Organization, from January 2003 to December 2004. Study participants were screened with clinical, bacteriological and chest X-ray examination from January 2003 to December 2004. RESULTS: Sixteen cases of tuberculosis were identified among 903 study participants (466 city bus drivers and 437 cash collectors) examined, of whom 12 were already on anti-TB treatment and 4 were diagnosed during the study. The proportion of all forms of tuberculosis, smear-positive pulmonary tuberculosis and extra-pulmonary tuberculosis was 16/903 (1772/100,000), 4/903 (443/100,000) and 3/903(332/100,000), respectively. CONCLUSION AND RECOMMENDATIONS: The proportion of all forms of tuberculosis among the study population was higher than the notification case rates for Addis Ababa reported in 2003, which indicates the need for a routine screening of city bus drivers and cash collectors. Measures such as opening windows and reducing crowding in buses are recommended as a means of reducing the risk of exposure to bus drivers and cash collectors.

Human immunodeficiency virus infection among new smear positive pulmonary tuberculosis patients in Addis Ababa, Ethiopia.

BACKGROUND: It has been few years since the launching of provider-initiated HIV counselling and testing (PICT) for all tuberculosis (TB) suspected patients and patients presenting with signs and symptoms of TB. However, little is known about the prevalence of HIV in new smear positive confirmed TB cases in Addis Ababa. OBJECTIVE: To determine the proportion of HIV among newly diagnosed smear positive TB cases, who were screened between February 2007 and July 2010 in Addis Ababa. METHODS: A total of 418 pulmonary TB patients and 188 HIV positive non-TB cases were recruited from different health centres in Addis Ababa. All TB patients were tested for HIV. RESULTS: Of the total 418 new smear positive TB patients tested for HIV, 97 (23.2%) were HIV positive. The occurrence of HIV among TB patients was significantly higher in females, 50/182 (27.7%) compared to males, 47/236 (19.7%) (P < 0.05). The mean CD4 lymphocyte count among HIV positive active TB cases was significantly lower (P < 0.05) (210 +/- 23.9 cells/microL) compared to the counts among non-TB HIV positive cases (407.01 +/- 31.3 cells/microL). The proportion of HIV was significantly higher in the age group 31-40 (46.3%) and > 41 (42.2%) year (p < 0.001) compared to younger, 18-20 (3.75%) and 21-30 (17.8%) years of age groups. CONCLUSION: The occurrence of HIV in smear positive TB cases is high, with a higher proportion seen among females compared to males.

Characterization of the etiological agents of tuberculous lymphadenitis in Dera Woreda, North Showa, Ethiopia.

BACKGROUND: Tuberculous lymphadenitis (TBLN) is a common form of extra pulmonary tuberculosis where lymph nodes particularly from cervical, axillary and inguinal sites are mostly involved, however, its diagnosis poses a major challenge in resource limited settings. OBJECTIVE: To identify the etiological species of Mycobacteria responsible for TBLN in Derra area, a rural district in Ethiopia, where the status of TBLN is unknown. MATERIALS AND METHODS: A total of 153 patients who were clinically suspected for TBLN, between the periods of August 2004 and February 2005 were included in the study. Fine needle aspirates (FNA) were collected and processed from 145 participants and further analyzed using Ziehl Neelsen staining, culture, cytology and polymerase chain reaction (PCR) using sets of primers, targeting the IS6110 insertion sequence and the pncA gene allelic variation at position 169. RESULTS: Out of the 145 FNA samples, 66 (45.5%) demonstrated growth on Lowenstein-Jensen (LJ) medium and 115 (79.3%) cases were confirmed as TBLN by a combination of results from acid fast bacilli (AFB) smear examination, culture, cytology and PCR. From the 145 clinically suspected TBLN cases, 108 (75%) were identified by PCR at complex level of which 107/108 (99.1%) were positive for M. tuberculosis and 1/108 (0.9%) was positive for M. bovis using pncA primers. CONCLUSION: The study indicates that M. tuberculosis is the major cause of tuberculous lymphadenitis in Dera area.

Chronic meningitis in immunocompromised adult Ethiopians visiting Tikur Anbessa Teaching Hospital and Ye'huleshet Clinic from 2003-2004.

BACKGROUND: Chronic meningitis is inflammation of the meninges where signs and symptoms develop and last for at least four weeks without alleviation. Little is known about the current etiology and incidence of the disease in adults living in developing countries. OBJECTIVE: The objective of this study was to elucidate the most common etiologies of chronic meningitis in adult Ethiopian patients and give an aid in the empiric therapy. METHODOLOGY: A total of 53 adult patients (median age 32 years) having chronic meningitis and who were admitted at Tikur Anbessa Teaching Hospital and Ye'huleshet Clinic, Addis Ababa, Ethiopia were recruited between 2003 and 2004. Of the 53 patients, bacteriological, molecular and immunological investigations were done for 52 of the study participants to detect Cryptococcus neoformans, Mycobacterium tuberculosis, Toxoplasma gondii, Brucella and Neisseria meningitides infections. RESULTS: Forty eight of the participants were HIV positive and 15% (8/52) of the CSF were positive with Cryptococcal latex antigen detection test; in addition, M. tuberculosis DNA was detected using PCR from CSF ofpatients infew of the patients. Multiple infections were observed in studyparticipants with < 0.1 to 1 CD4 to CD8 ratio. CONCLUSION: Chronic meningitis mostly occurred in HIV infected patients, where most of the infections were attributed to Cryptococcus neoformans whereas M. tuberculosis appeared secondary.

A pilot study on detection and genotyping of humanpapilloma virus isolated from clinically diagnosed Ethiopian women having cervical intraepithelial neoplasia.

BACKGROUND: Human Papilloma virus associated cervical cancers are more prevalent in developing countries compared to developed countries. Cervical cancer is reported as the most frequent malignancy among women visiting hospitals in Ethiopia. This study is a pilot study designed to examine the prevalence and genotypes of HPV in twenty Ethiopian women, clinically diagnosed to have cervical neoplasia, while visiting gynecology unit of a tertiary level referral hospital in Addis Ababa. The objective of this study was to detect the presence of HPV L1 gene and respective genotypes among women clinically diagnosed with different grades of cervical neoplasia. METHODOLOGY: A total of 20 fresh biopsy samples were collected from clinically diagnosed cases, DNA extracted and further amplified using PCR for HPV L1 and beta globin genes. The PCR amplicons were denatured and allowed for hybridization onto a nitrocellulose strip containing the type-specific probes for 27 HPV genotypes representing both high and low risk groups as well as beta globin genes. Socio-demographic characteristics and clinical findings of the participants were recorded on structured questionnaires. RESULTS: Amplification of HPV L1 gene by PCR detected 17 cases out of 20. Based on reverse line blot hybridization assay, the most frequent genotype identified was HPV16 (13/20). Mixed infection of HPV 16 with HPV 33, HPV 35, HPV 45 and HPV 58 was detected from other four study participants. CONCLUSION: Human papilloma virus type 16 was the most prevalent genotype identified from the subjects screened. Further investigation with statistically sound sample size would help to clearly visualize the existing trend in Ethiopia regarding factors for high risk HPV positivity and multiple gravidity, young age at first coitus and cervical neoplasia.

Recent trends of cutaneous leishmaniasis in Alert Hospital, Addis Ababa.

BACKGROUND: Cutaneous leishmaniasis is endemic to many parts of the world and has re-emerged in a number of endemic countries in recent years. Environmental changes, immune status of the host and treatment failure are the three most important risk factors associated with the re-emerging and spread of Leishmaniasis. Cutaneous leishmaniasis (CL) ranges from localized, self-healing type to the disfiguring mucocutaneous and diffuse cutaneous type. OBJECTIVE: To access the trend of CL patient flow in ALERT Hospital, Addis Ababa, Ethiopia. METHODS: Patients' clinical and laboratory records were collected retrospectively for 1651 leishmaniasis suspected individuals from ALERT Hospital, from January 1, 2007 to December 30, 2010. RESULTS: From the suspected individuals, 234 cases were positive for Leishmania species with Giemsa stain and/or histopathology and confirmed for CL, of whom 30 (12.8%) were diagnosed in 2007, 29 (12.4%) in 2008, 75 (32.1%) in 2009, and 100 (42.7%) were in 2010. CONCLUSIONS AND RECOMMENDATIONS: The overall proportion of cases with leishmaniasis among the suspected cases was 234/1651 (14.2%). The distribution of CL reports was higher for patients coming from Addis Ababa surrounding areas and Oromia region, 96/234 (41.03%) and 71/234 (30.34%), respectively. In general, the trend of leishmaniasis in and around Addis Ababa seems to be increasing, which calls for further detailed epidemiological studies, including vector and reservoir host studies, to help in the prevention and control of the disease.

Mycobacterial lineages causing pulmonary and extrapulmonary tuberculosis, Ethiopia.

Molecular typing of 964 specimens from patients in Ethiopia with lymph node or pulmonary tuberculosis showed a similar distribution of Mycobacterium tuberculosis strains between the 2 disease manifestations and a minimal role for M. bovis. We report a novel phylogenetic lineage of M. tuberculosis strongly associated with the Horn of Africa.

Genotyping of human papillomavirus in paraffin embedded cervical tissue samples from women in Ethiopia and the Sudan.

Cervical cancer is the most frequent female malignancy in most developing countries. Previous studies have demonstrated a strong association of human papillomavirus (HPV) infection with dysplasia and carcinoma of the uterine cervix. The objective of this study was to identify the prevailing HPV genotypes responsible for the development of cervical cancer among women in Ethiopia and the Sudan. A molecular characterization of HPV was done on 245 paraffin embedded cervical biopsy samples collected from the two countries. Amplification of HPV and subsequent genotyping was done using SPF10 primers and Line probe assay. Of samples collected from Ethiopian patients, 93% (149/160) and 13% (21/160) had high risk and low risk HPV genotypes, respectively. Among samples collected from the Sudan, 94% (80/85) harbored high risk and 11.7% (10/85) low risk HPV genotypes. Human papillomavirus 16 was the most frequent genotype identified in samples from Ethiopia (91%, 136/149) and the Sudan (82.5%, 66/80). HPV 52, 58, and 18 were the second, third and fourth common genotypes identified in Ethiopia, whereas HPV 18, 45, and 52 were the second, third, and fourth genotypes identified in samples collected from the Sudan. Thus, individuals living in different geographical localities should receive vaccines based on the specific genotypes circulating in the area and a vaccine targeting HPV 16, 18, 45, 52, and 58 may be optimal for the control of cervical cancer in the two countries.

Parasitic infection may be associated with discordant responses to QuantiFERON and tuberculin skin test in apparently healthy children and adolescents in a tuberculosis endemic setting, Ethiopia.

BACKGROUND: M. tuberculosis remains one of the world's deadliest pathogens in part because of its ability to establish persistent, latent infections, which can later reactivate to cause disease. In regions of the globe where disease is endemic, as much as 50% of the population is thought to be latently infected, complicating diagnosis and tuberculosis control. The tools most commonly used for diagnosis of latent M. tuberculosis infection are the tuberculin skin test and the newer interferon-gamma release assays, both of which rely on an antigen-specific memory response as an indicator of infection. It is clear that the two tests, do not always give concordant results, but the factors leading to this are only partially understood. METHODS: In this study we examined 245 healthy school children aged from 12 to 20 years from Addis Ababa, a tuberculosis-endemic region, characterised them with regard to response in the tuberculin skin test and QuantIFERON™ test and assessed factors that might contribute to discordant responses. RESULTS: Although concordance between the tests was generally fair (90% concordance), there was a subset of children who had a positive QuantIFERON™ result but a negative tuberculin skin test. After analysis of multiple parameters the data suggest that discordance was most strongly associated with the presence of parasites in the stool. CONCLUSIONS: Parasitic gut infections are frequent in most regions where M. tuberculosis is endemic. This study, while preliminary, suggests that the tuberculin skin test should be interpreted with caution where this may be the case.

The pattern of bacterial isolates and drug sensitivities of infected ulcers in patients with leprosy in ALERT, Kuyera and Gambo hospitals, Ethiopia.

INTRODUCTION: Leprosy remains a public health problem, mainly in Africa, Asia and Latin America. Leprosy has many complications that include leprosy reactions, development of plantar and hand ulcerations, lagophthalomus and corneal anesthesia. OBJECTIVES: In Ethiopia there is scarce information on the pattern of bacterial isolates and drug sensitivities of infected ulcers in patients with leprosy. This study was undertaken to identify the bacteriology of infected ulcers and to determine their antimicrobial susceptibility pattern. STUDY DESIGN: A descriptive cross-sectional study was conducted in 245 informed and consented leprosy patients with infected ulcers visiting ALERT, Kuyera and Gambo hospitals during the period August 2006 to May 2007. MATERIAL AND METHODS: Wound aspirate specimens were collected from ulcers of each patient aseptically and inoculated into standard bacteriological media. Antimicrobial susceptibility testing was performed for all isolates according to the criteria of the National Committee for Clinical Laboratory Standards (NCCLS) by disk diffusion method. RESULTS: Of the 245 patients investigated, 64.1% were males and 35.9% females (P < 0.05). The average age of the patients was 50 years (age range 13 to 92 years). According to Ridley-Jopling classifications, patients presented with TT (3.7%), BT, (31.4%), BL (44.5%) and LL (15.9%) types of leprosy. Plantar and hand ulcers were observed in 92.2% and 7.8% of patients, respectively. According the patients, the commonest cause of their ulcers was 'spontaneous' (56.7%). There were 44% Gram-positive and 56% Gram negative bacteria (P > 0.05). Proteus spp. accounted for 29.5% of the total isolates followed by Staphylococcus spp. (28.8%), beta-hemolytic streptococci (15.1%) and different types of Gram-negative bacteria (26.2%). Multiple organisms (two or three) were isolated from 19.6% patients. Of the 212 wound samples cultured anaerobically, 5.2% were positive for anaerobic culture. In this study both Gram-positive and Gram negative bacteria showed decreased sensitivity to most antimicrobial agents tested. CONCLUSION: Proteus spp. was the most common isolate from infected ulcers. Ciprofloxacin, norfloxacin and gentamicin were the most effective drugs against the tested bacteria mainly for Gram-negative bacteria. This refers to the in vitro-sensitivity during the study period. The results of this study may help inform clinicians about the selection of an antibiotic in situations where use of an antibiotic may be indicated.

Low prevalence of bovine tuberculosis in Somali pastoral livestock, southeast Ethiopia.

A cross-sectional study of bovine tuberculosis (BTB) detected by the comparative intradermal tuberculin test (CIDT) was conducted in livestock of the Somali region in southeast Ethiopia--in four pastoral associations from January to August 2009. In 94 herds, each of 15 cattle, camels, and goats was tested per herd leading to a total of 1,418 CIDT tested animals, with 421 cattle, 479 camels, and 518 goats. A herd was considered positive if it had at least one reactor. Prevalence per animal species was calculated using a xtgee model for each species. The individual animal prevalence was 2.0% [95% confidence interval (CI), 0.5-8.4], 0.4% (95% CI, 0.1-3%), and 0.2% (95% CI, 0.03-1.3) in cattle, camels, and goats, respectively. Prevalence of avian mycobacterium purified protein derivative (PPD) reactors in cattle, camels, and goats was 0.7% (95% CI, 0.2-2.0%), 10.0% (95% CI, 7.0-14.0%), and 1.9 (95% CI, 0.9-4.0%), respectively, whereby camels had an odds ratio of 16.5 (95% CI, 5.0-55.0) when compared to cattle. There was no significant difference between livestock species in BTB positivity. In the present study, the prevalence of bovine tuberculosis was low in Somali pastoral livestock in general and in camels and goats in particular. The high proportion of camel reactors to avian PPD needs further investigation of its impact on camel production.

Expression of apoptosis-related genes in an Ethiopian cohort study correlates with tuberculosis clinical status.

Mycobacterium tuberculosis remains one of the world's deadliest pathogens in part because of its ability to persist in the face of an active immune response. It has been suggested that apoptosis of infected macrophages is one way in which the host deals with intracellular pathogens and that M. tuberculosis can inhibit this process. To assess the relevance of this process for human disease, we compared the expression of multiple genes involved in the activation of the extrinsic ("death receptor initiated") pathway of apoptosis in 29 tuberculosis patients, 70 tuberculosis contacts and 27 community controls from Ethiopia. We found that there is a strong upregulation of genes for factors that promote apoptosis in PBMC from individuals with active disease, including TNF-alpha and its receptors, Fas and FasL and pro-Caspase 8. The anti-apoptotic factor FLIP, however, was also upregulated. A possible explanation for this dichotomy was given by fractionation of PBMC using CD14, which suggests that macrophage/monocytes may regulate several key molecules differently from non-monocytic cells (especially TNF-alpha and its receptors, a finding confirmed by protein ELISA) potentially reducing the sensitivity to apoptotic death of monocyte/macrophages--the primary host cell for M. tuberculosis. This may represent an important survival strategy for the pathogen.

Throat carriage rate and antimicrobial susceptibility pattern of group A Streptococci (GAS) in healthy Ethiopian school children.

BACKGROUND: Group A Streptococci (GAS) or Streptococcus pyogenes are the most frequent cause of pharyngitis and skin infection in children and lead to post infection complications including acute rheumatic fever and glomerulonephritis. Pharyngeal carriage rates of GAS among healthy school children vary with geographical location and seasons. There is not much information on the screening of children for carriage of GAS in Ethiopia. OBJECTIVES: The study aimed at assessing the carriage rate of Group A Streptococci and antimicrobial susceptibility of the isolates in healthy Ethiopian school children. METHODS: A total of 937 children residing in Addis Ababa (n=491), Gondar (n=265) and Dire-Dawa (n=181) were investigated during a period between November 2004 and January 2005. Throat specimens were collected and cultured using standard procedure. Beta haemolytic streptococci were serogrouped by agglutination tests using specific antisera. Antimicrobial susceptibility testing of the isolates was performed by diffusion method. RESULTS: The median and the mean ages of the study participants were 11 (range 6-14) years. Girls constituted 52% (486/937) of the study participants. A total of 167 (17.8%) beta haemolytic streptococci were recovered from 937 children investigated GAS accounted for 91/167 (54.5%) of beta hemolytic streptococcal isolates. The carrier rate for GAS was 9.7% (91/937) of the screened children followed by group G with 3.2% (30/937) and group C streptococci with 2.2% (21/937). All GAS isolates were sensitive to oxacillin, penicillin, erythromycin, clindamycin and trimethoprim-sulphamethoxazole. Lower frequency of resistance was observed against tetracycline and vanocmycin. CONCLUSION: The present study revealed that GAS was the most predominant beta-haemolytic streptococcus among healthy Ethiopian school children. Our results showed that pharyngeal carriage of GAS in school children should not be underestimated. Therefore it is recommended to conduct regular screening and GAS surveillance in schools, and maintain rational use of antibiotics to minimize GAS resistance.

Prevalence of bovine tuberculosis in pastoral cattle herds in the Oromia region, southern Ethiopia.

A cross-sectional study of bovine tuberculosis (BTB) was conducted in pastoral cattle herds in southern Ethiopia, from February to August 2008 using the comparative intradermal tuberculin test. The prevalence of BTB and the risk factors for having positive reactor herds were assessed in four pastoral associations in two districts of southern Ethiopia, namely Goro-Dola with 242 cattle in 16 herds and Liben with 231 cattle in 15 herds. A herd was considered positive if there was at least one reactor animal in a herd. The test results were interpreted based on the Office Internationale des Epizooties recommended 4-mm and a recently suggested 2-mm cut-off. The apparent individual animal prevalence of tuberculin reactors was 5.5% (95% confidence interval (CI), 4.0-8.0%) and 7.0% (95% CI, 5.0-10.0%), whereas the true prevalence estimate was 4.4% (95% CI, 0.8-8.0%) and 6.1% (95% CI, 2.6-9.5%), when using the 4-mm and the 2-mm cut-offs, respectively. The overall herd apparent prevalence of tuberculin reactor animals was 41.9% (95% CI, 24.9-60.9%) and 48.4% (95% CI, 30.2-66.9%) with the 4-mm and 2-mm cut-offs, respectively. A positive tuberculin test was associated with the age of animals and the main drinking water sources during dry seasons. In order to investigate the public health risks and the epidemiological importance of BTB in the area, we recommend to include other livestock species (camels and goats) as well as humans in future studies.

Identification of drug susceptibility pattern and mycobacterial species in sputum smear positive pulmonary tuberculosis patients with and without HIV co-infection in north west Ethiopia.

BACKGROUND: Ethiopia is among the high-burden countries of tuberculosis (TB) in the world Since mycobacterial culture and susceptibility testing are not routinely performed in Ethiopia, recent data on susceptibility patterns and the mycobacterial species cultured from sputum smear positive patients are limited. OBJECTIVES: The aim was to determine first line anti-TB drug susceptibility of Mycobacterium tuberculosis isolates obtained from consecutive newly diagnosed smear positive pulmonary TB patients in north west Ethiopia. METHODOLOGY: A retrospective cross sectional study was conducted using previously collected sputum samples (n=180) kept at the referral hospital of the University of Gondar at -20 degrees C. Sputum samples were cultured on Lowenstein Jensen (LJ) medium. Conventional Polymerase Chain Reaction (PCR) using RD4 primers to identify the M. tuberculosis complex was performed on cultured isolates. Ninety eight (84.4%) of the 116 isolates identified as M. tuberculosis were tested for their drug susceptibility pattern using the proportion method Clinical baseline data including body mass index, body temperature, clinical symptoms and erythrocyte sedimentation rate were obtained. RESULTS: The culture retrieval rate of previously frozen sputum samples was 64.4% (116/180). All the isolated mycobacterial species (n=116) were confirmed as belonging to the M. tuberculosis complex by PCR. Of 98 isolates for which the drug susceptibility test was done, 15.3% (15/98) were found to be resistant to one or more antimycobacterial drugs, and resistance to isoniazid and streptomycin was most common with 8.2% (8/98) and 6.1% (6/98) respectively. TB patients co infected with HIV had increased erythrocyte sedimentation rate, higher age and lower sputum smear grade than HIV negative TB patients. CONCLUSIONS: No mycobacteria other than M. tuberculosis were detected in sputum smear positive TB-patients. Although no multi drug resistant strain was observed, relatively high rates of INH resistance were found in this region. Culture facilities are urgently needed in regional centers to increase diagnostic sensitivity and monitor developing trends of drug resistance in Ethiopia.

Performance of OptiMAL-IT compared to microscopy, for malaria detection in Burkina Faso.

OBJECTIVE: To compare the performance of OptiMAL-IT, a rapid diagnostic test for malaria, with that of microscopy in Burkina Faso. METHOD: Finger-prick blood samples of 464 children attending hospital for suspected malaria were tested for malaria by microscopy and OptiMAL-IT. RESULTS: The sensitivity and specificity of OptiMAL-IT were 98.7% (CI 95% = 97.6-99.8) and 96.2% (CI 95% = 94.3-98.1) respectively, with a high positive likelihood ratio (25.97). CONCLUSION: OptiMAL-IT can be considered a good method to diagnose malaria in Burkina Faso, particularly in remote areas with little or no access to microscopy services.

Is tuberculous lymphadenitis over-diagnosed in Ethiopia? Comparative performance of diagnostic tests for mycobacterial lymphadenitis in a high-burden country.

Ethiopia reports the third highest number of extrapulmonary TB cases globally, most of which are lymph node TB (TBLN). We investigated the performance of the available diagnostic tests for TBLN. Fine needle aspirate (FNA) and excision biopsy samples from affected lymph nodes were collected from 150 consenting patients with suspected TBLN visiting regional hospitals in Ethiopia. The sensitivity, specificity, positive (PPV) and negative predictive value (NPV) of histopathology against culture as reference was 92%, 88%, 97% and 77% and of FNA cytology (FNAC) 76%, 88%, 100% and 55%, respectively. Naked eye examination of FNA had 67% sensitivity and 64% specificity. HIV coinfection did not diminish the performance of macroscopic examination, Ziehl-Neelsen stain, histology or cytology examinations. When any positive result in ZN, histopathology or culture was considered confirmatory, clinical diagnosis could be confirmed in 85% of the patients, suggesting that TBLN is over-diagnosed in up to 15% of cases. With combined criteria as reference standard, the sensitivity, specificity, PPV and NPV of FNAC was 72%, 100%, 100% and 55%, respectively. FNAC is a practical tool that can improve the diagnosis of TBLN in high-burden settings. Over-diagnosis alone cannot explain the high burden of LNTB in Ethiopia.