Success in controlling a major outbreak of malaria because of Plasmodium falciparum in Jamaica.

In 2006, after 44 years of eradication of malaria, Jamaica had an outbreak of Plasmodium falciparum: 406 confirmed cases between September 2006 and December 2009 with a peak of the epidemic in December 2006. In response to the outbreak, the Ministry of Health launched an emergency response through early detection and prompt treatment of cases, vector control, public education and intersectoral collaboration. Ninety percent (361) of cases were residents of Kingston, and 63.6% were identified through house to house surveillance visits. For 56% of the confirmed cases, treatment with chloroquine was initiated within a week of onset of symptoms. Only one (0.3%) of 358 cases who had a post-treatment smear on day 7 had a persistent asexual parasitaemia, while none of the 149 persons who had a follow-up smear on day 28 was positive. The outbreak highlighted the need for increased institutional capacity for surveillance, confirmation and treatment of malaria as well as effective prevention and control of outbreaks which can occur after elimination. Jamaica appears to have successfully eliminated malaria after its reintroduction.

Quality assurance in relation to mycobacterial sputum samples received and processed at the National Public Health Laboratory, Jamaica, 1st August 1997-31st January 1998, and the effects on patients' treatment

There has been a global increase in the incidence of mycobacterial cases since the advent of HIV and AIDS. This increase has not been seen in Jamaica. This study was done to determine the quality of samples received, at the National Public Health Laboratory, in terms of sputum/saliva and time submitted after collection, and to evaluate if this affected case treatment. Data was retrospectively extracted from bench records at the laboratory and analyzed. Cross checking of laboratory negative and positive cases was done using patients' records ar the National Chest Hospital, to validate laboratory results with clinical diagnosis. Evaluation of treatment of positive cases with respect to sensitivity results was done. Results showed that of the 925 sputum samples submitted 86.6 percent were true sputum samples, submitted mainly from the urban region. Sputum samples were five times more likely to yield positive TB culture results than saliva. There was no statistically significant difference in mycobacteria other than tuberculosis (MOTT)or contamination results between sputum and saliva. With respect to time of arrival, only 412 samples were analyzed due to lack of data. Of these, 56.1 percent of these arrival within one day. Positive TB cultures were no different among sputum (14.3 percent) and saliva (13.3 percent) sample with respect to time of arrival. Contamination rate was slightly higher in samples received >1 day (4.4 percent), to those received within one day (2.2 percent). The treatment of 22 TB positive cases evalusted, corresponded with the sensitivity results, but only one of the three MOTT cases corresponded. The quality of sputum samples received was generally good, and did not significantly affect culture results and patients' treatment. A further study however, needs to be done to evaluate quality assurance and quality control measures in the laboratory (AU)

Quality assurance in relation to mycobacterial sputum samples received and processed at the National Public Health laboratory, 1st August 1997 to 31st January, 1998 and the effect of patients' treatment

There has been a global increase in the incidence of mycobacterial cases since the advent of HIV and AIDS. This increase has not been seen in Jamaica. This study was done to determine the quality of sample received, at the National Public Laboratory, in terms of sputum/saliva and time submitted after collection, and to evaluate if this affected case treatment. Data was retrospectively extracted from bench records at the laboratory and analyzed. Cross checking of laboratory negative and positive cases was done using patients' record at the National Chest Hospital, to validate laboratory results with clinical diagnosis. Evaluation of treatment of positive cases with respect to sensitivity results was done. Results showed that of the 925 sputum submitted 86.6 percent were true sputum samples, submitted mainly from the urban region. Sputum samples were five times more likely to yield positive TB culture results than saliva. There was no statistically significant difference in mycobacteria other than tuberculosis (MOTT) or contamination results between sputum and saliva. With respect to time of arrival, only 412 samples were analyzed due to lack of data. Of these, 56.1 percent of these arrived within one day. Postive TB cultures were no different among sputum (14.3 percent) and saliva (13.3 percent) samples with respect to time of arrival. Contamination rate was slightly higher in samples received > 1 day (4.4 percent), to those received within one day (2.2 percent). The treatment of 22 TB positive cases evaluated, corresponded with the sensitivity results, but only one of the three MOTT cases corresponded. The quality of sputum samples received was generally good, and did not significantly affect culture results and patients' treatment. A further study however, needs to be done to evaluate quality control measures in the laboratory.(AU)

A case of disseminated phaeohyphomycosis caused by Cladosporium devriesii

In 1984, Gonzalez and co-workers reported a new fungus, Cladosporium devriesii. This was obtained from a young woman living in Grand Cayman, and was associated with deep organ involvement. Subsequently, this patient was treated at the University Hospital of the West Indies, Mona. There was no evidence of HIV infection. Following her demise, a full autopsy was performed, and fungal cultures were examined by electron microscopy. This is the first report of disseminated phaeohyphomycosis in the West Indies (AU)

Nosocomial and community acquired infections in malnourished Jamaican children - abstract

Infection is a contributing or initiating factor in children with inadequate food intake who develop malnutrition, and malnutrition by virtue of immunosuppression leads to further episodes of infection. In this prospective study, 206 community acquired and 73 nosocomial infections occurring in 50 hospitalised severely malnourished children were investigated. This represented an average of 5.6 episodes of infection per child. Predominant community acquired infections in the 50 children included gastroenteritis (68 percent), otitis media (60 percent), rhinopharyngitis (60 percent), oral candidiasis (46 percent), skin infections (40 percent), pneumonia (28 percent), bacteraemia (24 percent), and bacteriuria (18 percent). The most frequent nosocomial infections were rhinopharyngitis (34 percent), lower respiratory tract infections (24 percent) and septicaemia (18 percent). In those infections where an aetiological agent was identified, Giardia lamblia was the commonest enteric pathogen and Klebsiella sp. were recovered from the majority of urines. Coagulase Negative Staphylococcus was the most frequent aetiological agent of bacteraemia, 12 of the 13 episodes were associated with fever +/- leucocytosis and in six episodes this organism was recovered from two or more blood culture sets. The lack of clinical signs and symptoms, and the atypical presentation in some of the infected malnourished children were attributed to impairment of the acute inflammatory response. Nasal, throat and axillary swabs taken on admission revealed significant colonisation with coliforms and pneumococcus; however, these swabs were not useful as indicators of potentially infective organisms. Two of the four deaths were attributed to infection. The role of Cryptosporidium, an enteric pathogen which is prevalent in immunocompromised hosts, was further investigated. Cryptosporidium was isolated from the stools of 19.5 percent (15/77) malnourished children compared to 2.4 percent (10/436) well-nourished children, who were more likely to present with fever, vomiting, prolonged diarrhoea and dehydration. Community acquired non-bacterial respiratory tract infections were further investigated from paired sera in 83 moderately malnourished children. In 60 percent of the children with a history of respiratory tract disease and 25 percent of those without reported disease, a specific non-bacterial infection was diagnosed. Multiple aetiological agents were identified in 6 of the 42 chidren with respiratory disease. The most common micro-organisms observed were: Para-influenza 1,2 or 3 (in 15 children), Influenza H1N1, H2N3 or "B" in 12, Adenovirus in 10, Respiratory Syncitial Virus in 7 and Mycoplasma Pneumoniae in 6 children. These three studies report a high prevalence of common and unusual infections, especially Cryptosporidium enteritis and Coagulase Negative Staphylococcus bacteraemia, occurring in these immunocompromised children. Diagnosis of infection requires a high index of suspicion and a comprehensive screening system (AU)

Cryptosporidiosos in well-nourished and malnourished children

During a 5-month period, 513 stool samples submitted to the enteric laboratory at the University Hospital of the West Indies were examined for Cryptosporidium. Oocysts were detected in 4.9 percent of all stools, 7.3 percent of diarrhoeal stools, 19.5 percent of stools from malnourished children and 23.7 percent of stools from malnourished children with diarrhoea. Cryptosporidium was the sole pathogen detected in all 25 positive stools, and was the second most frequent enteric isolate. All cases of cryptosporidiosis occurred in children less than 2.5 years of age. All 15 malnourished children were admitted to hospital where they presented with dehydration (87 percent), vomiting (93 percent), fever (100 percent) and diarrhoea which lasted an average of 15.3 days. Two of these children died. In contrast, dehydration (20 percent), vomiting (40 percent) and fever (50 percent) were less common and diarrhoea less protracted in well-nourished children, four of whom were admitted to hospital. This preliminary report suggests that cryptosporidial gastroenteritis presents with increased frequency and severity in malnourished compared with well-nourished Jamaican children.(AU)

Cryptosporidiosis in well-nourished and malnourished Jamaican children - abstract

During a 5-month period, 513 stool samples submitted to the enteric laboratory of the University Hospital of the West Indies were examined for Cryptosporidium. Oocysts were detected in 4.9 percent of all stools, 7.9 percent of diarrhoeal stools, 19.4 percent of stools from malnourished children and 25.4 percent of stools from malnourished children with diarrhoea. Cryptosporidium was the sole pathogen detected in all 25 positive stools, and was the second most enteric isolate. All cases of cryptosporidiosis occurred in children less than 2.5 years of age. The fifteen malnourished children excreting cryptosporidium presented with dehydration (87 percent), vomiting (93 percent), fever (100 percent) and diarrhoea which lasted for an average of 15.7 days. Two of these children died. In contrast, dehydration (20 percent), vomiting (40 percent) and fever (50 percent) were less common and diarrhoea less protracted in well-nourished children, 4 of whom were hospitalised for an average of 3 days. This preliminary report suggests that cryptosporidial gastroenteritis presents with increased frequency and severity in malnourished compared with well-nourished children.(AU)