Performance of Xpert Ultra nasopharyngeal swab for identification of tuberculosis deaths in northern Tanzania.

OBJECTIVE: Numerous tuberculosis (TB) deaths remain undetected in low-resource endemic settings. With autopsy-confirmed tuberculosis as our standard, we assessed the diagnostic performance of Xpert MTB/RIF Ultra (Ultra; Cepheid) on nasopharyngeal specimens collected postmortem. METHODS: From October 2016 through May 2019, we enrolled pediatric and adult medical deaths to a prospective autopsy study at two referral hospitals in northern Tanzania with next-of-kin authorization. We swabbed the posterior nasopharynx prior to autopsy and tested the samples later by Ultra. At autopsy we collected lung, liver, and, when possible, cerebrospinal fluid for mycobacterial culture and histopathology. Confirmed tuberculosis was defined as Mycobacterium tuberculosis complex recovery by culture with consistent tissue histopathology findings; decedents with only histopathology findings, including acid-fast staining or immunohistochemistry, were defined as probable tuberculosis. RESULTS: Of 205 decedents, 78 (38.0%) were female and median (range) age was 45 (0,96) years. Twenty-seven (13.2%) were found to have tuberculosis at autopsy, 22 (81.5%) confirmed and 5 (18.5%) probable. Ultra detected M. tuberculosis complex from the nasopharynx in 21 (77.8%) of 27 TB cases (sensitivity 70.4% [95% confidence interval {CI} 49.8-86.2%], specificity 98.9% [95% CI 96.0-99.9%]). Among confirmed TB, the sensitivity increased to 81.8% (95% CI 59.7-94.8%). Tuberculosis was not included as a death certificate diagnosis in 14 (66.7%) of the 21 MTBc detections by Ultra. DISCUSSION: Nasopharyngeal Ultra was highly specific for identifying in-hospital tuberculosis deaths, including unsuspected tuberculosis deaths. This approach may improve tuberculosis death enumeration in high-burden countries.

Prevalence and histopathological characterization of Masai Giraffe (Giraffa camelopardalis tippelskirchi) skin disease in Tarangire-Manyara ecosystem, Northern Tanzania.

BACKGROUND: Masai Giraffes have declined dramatically in recent decades due to loss of habitat and illegal hunting. Hence, it is critically important that the epidemiology and etiology of so-called giraffe skin disease (GSD) is understood well. AIM: To assess the prevalence and histopathological characteristics of GSD in the Tarangire-Manyara Ecosystem (TME), northern Tanzania. METHODS: The study used road transects to gather field information on GSD. Eighty-four giraffes were sighted by systematic random sampling in the six study sites. Examination of giraffes involved body distribution of lesions, severity of the lesions and whether they were associated with age and sex of the affected giraffes. Five giraffes with GSD were immobilized for tissue collection and histopathological analysis. RESULTS: Prevalence among adults was 79%. Affected animals typically had 1-5 lesions which were mostly moderate and were predominantly observed on the forelegs. GSD positivity rate was higher among females versus males, whereas males had a higher rate of severe lesions and generally had more lesions than females. Calves showed no lesions. All tissue sections from five affected giraffes showed the presence of large quantities of fungal elements (hyphae and spores) that involved hair shafts and sub-cutaneous tissue after staining with Grocott Methenamine Silver as special fungal staining technique. CONCLUSIONS: Our findings suggest the involvement of fungal infection in GSD pathogenesis. CLINICAL RELEVANCE: We recommend further characterization of the lesions using modern molecular techniques and culture to identify primary and secondary or opportunistic etiologies, and the order in which the pathogens occur in the lesions.

Missed opportunity of deworming a Maasai boy from nomadic family leading to life threatening intestinal obstruction.

Mass deworming against soil-transmitted helminthiasis, including Ascaris lumbricoides (AL), is one of the largest public health interventions in low- and middle-income countries. The prevalence of A. lumbricoides in Tanzania is 6.8%. We present a 3-year-old male of a known Tanzanian nomadic tribe (Masaai tribe) with history of missed deworming, who was brought to the emergency department with a 3-day history of constipation, nonprojectile, bilious vomiting, generalized abdominal distension and pain.He was diagnosed with intestinal obstruction by the use of a plain abdominal X-ray, which revealed marked gaseous distension of the stomach and bowels without significant air-fluid levels. He was initially treated with intravenous ceftriaxone 50 mg/kg, metronidazole 15 mg/kg and acetaminophen 15 mg/kg. An explorative laparotomy was then performed. Intraoperative findings demonstrated a dense collection of A. lumbricoides worms in the gangrenous proximal jejunum and duodenum. Thorough abdominal lavage was carried out and abdomen was closed.