Presence of Schistomiasis in Genital Biopsies from Patients at the University Teaching Hospital in Lusaka; Zambia

Background: Ectopic localizations of the adult Schistosomes and ova in the genital tract of individuals living in schistosoma endemic areas are common. The infection can affect both male and female reproductive organs; and although it is predominant in adult women; case reports in girls younger than 15 years of age have been documented. Objective: The objective of this review was to determine and document the presence of genital schistosomiasis from biopsy specimens. Methods: Patients' laboratory records at the University Teaching Hospital histopathology laboratory for the period 2001 to 2007 were retrieved and reviewed for reports on the presence of schistosomiasis. Data were analysed by age; sex and biopsy site. Results: Thirty eight (65.5) of the 58 specimens with schistosomiasis were from the genital organs. Female genital tract schistosomiasis was more prevalent (84.2) than male genital schistosomiasis (15.8); p0.001. Schistosomiasis was high in biopsy specimens collected from the cervix

Nitazoxanide for persistent diarrhoea in Zambian acquired immune deficiency syndrome patients: a randomized-controlled trial.

BACKGROUND: Adults with acquired immune deficiency syndrome and persistent diarrhoea in Zambia have intestinal infection, predominantly protozoa. AIM: To search for treatment which can be offered with minimal investigation, we carried out a double-blind, randomized-controlled trial of nitazoxanide (a drug with a range of activity against parasites and bacteria). METHODS: Patients with diarrhoea of 1 month duration or longer were randomized to receive nitazoxanide (1000 mg twice daily) or placebo for 2 weeks. End-points were clinical response, parasitological clearance and mortality. RESULTS: Two hundred and seven adults were randomized; 42 died during the study. The primary assessment of efficacy was made after 17 days. Clinical response was observed in 56 (75%) of 75 patients receiving nitazoxanide and 45 (58%) of 77 patients receiving placebo (P = 0.03). The rate of improvement was markedly higher in patients with CD4 counts under 50 cells/microL receiving nitazoxanide (P = 0.007). The benefit was largely restricted to the period when the drug was being administered. No difference was seen in parasitological clearance between the two groups. Mortality was 19% by 4 weeks of follow-up and did not differ with treatment allocation. CONCLUSIONS: Nitazoxanide given orally for 14 days was associated with clinical improvement in Zambian acquired immune deficiency syndrome patients with diarrhoea, especially those with very low CD4 counts.

Host pathogen interaction and the development of oral lesions.

The aetiologies of oral ulceration, disseminated interstitial lymphocytosis syndrome and oral lymphomas have been reviewed, with emphasis on the role of HIV infection in the primary causation or modification of the presentation of these entities. There is a paucity of evidence to explain why oral ulceration is so severe in HIV infection, and why major ulceration affects the oropharynx. A number of mechanisms have been proposed to account for the development of lymphomas in patients with HIV infection, including a genetic predisposition, decreased immunosurveillance due to HIV infection, alteration of endothelial cell function and dysregulation of cytokine networks. From this review, it was concluded that there is a need for a prospective multicentre study, to elucidate the aetiological mechanisms involved in lymphomas of the oral regions in this patient group. It was concluded that, although there is anecdotal evidence implicating tobacco use in the aetiology of the lesions reviewed, this is insufficient to allow definitive statements to be made and further systematic evaluation is indicated.