Leptospirosis in suspected cases of dengue in Jamaica, 2002-2007.

Due to overlapping clinical features with other febrile illnesses, the diagnosis of leptospirosis is often overlooked, resulting in delay in treatment and increased mortality. In this study the prevalence of leptospirosis was determined in 590 patients with dengue-like illnesses using the Leptospira IgM dipstick and dengue enzyme-linked immunosorbent assays. Leptospira IgM antibodies were found in 27 (5.0%) patients. Dengue IgM negative (6.9% versus 2.5%, P < 0.05) and dengue IgG positive patients (8.0% versus 3.5%, P < 0.01) were more likely to be leptospira IgM positive. Fever, skin rash, central nervous system and respiratory involvement were the most common presenting features. The presence of arthralgia (P = 0.016), hepatitis (P = 0.000), jaundice (P = 0.003), splenomegaly (P = 0.041) and haematuria (P = 0.029) were associated with leptospirosis. In countries with an endemicity of leptospirosis and dengue it is important that patients with dengue-like illnesses, especially those with no serological evidence of current primary dengue infection, be investigated for leptospirosis.

Seroprevalence of dengue virus antibodies in healthy Jamaicans.

Dengue fever, a mosquito borne viral infection, is endemic to Jamaica. The seroprevalence of dengue IgG and IgM antibodies were determined in 277 healthy Jamaicans by enzyme linked immunosorbent assay (ELISA). The seroprevalence of dengue IgG antibodies was 100% (277/277) while dengue IgM antibodies were found in 3.6% (10/277). A statistically significant association was found between the presence of dengue IgM antibodies and gender (males 10/105, 9.5% vs females 0/172, 0.0%); chi(2) = 17.0, p=0.000.The high seroprevalence rate of dengue IgG antibodies and the presence of dengue IgM in the healthy population are in keeping with the endemicity of the virus in Jamaica. Therefore tests for dengue IgG antibodies are of limited usefulness in Jamaica and can be safely excluded from diagnostic testing as a cost saving measure. Serological diagnosis of current dengue infection should be centred around the dengue IgM tests although the limitations in the predictive values of such tests should also be considered. The results also suggest that the risk of emergence of the more severe forms of dengue, dengue haemorrhagic fever (DHF) and dengue shock syndrome (DSS) in the Jamaican population, due to the presence of enhancing antibodies, is high.

Prevalence of human immunodeficiency virus infection in patients with pulmonary tuberculosis at the National Chest Hospital in Jamaica.

OBJECTIVE: This study was undertaken to determine the prevalence of human immunodeficiency virus-type 1 (HIV-1) infection in patients with pulmonary tuberculosis at the National Chest Hospital in Jamaica. METHODS: This retrospective study reviewed the hospital records of 537 patients admitted over a seven-year period from 1995 to 2001. We used a standardized data collection form to obtain data for sociodemographic characteristics, clinical features, signs and symptoms, laboratory diagnosis, treatment and outcome. RESULTS: We found that 11.6% (47/406) of the patients who met the inclusion criteria and were diagnosed as having pulmonary tuberculosis were HIV-1 seropositive. Most HIV-positive patients with tuberculosis were males, and prevalence of HIV coinfection among patients with tuberculosis was highest in patients aged 30-39 years. The mortality rate in patients with tuberculosis and HIV infection was 23.4% (11/47) compared to 3.9% (14/359; P = 0.001) in HIV-negative patients. Patients were treated with standard quadruple drug therapy. No multiple drug resistance was noted in the Mycobacterium tuberculosis isolates. CONCLUSIONS: The prevalence of HIV in patients with tuberculosis in Jamaica is similar to that in other developing countries, but the mortality rate is higher and this warrants prompt diagnosis of HIV infection and early institution of highly active antiretroviral therapy.

Prevalence of human immunodeficiency virus infection in patients with pulmonary tuberculosis at the National Chest Hospital in Jamaica

OBJECTIVE: El presente estudio se efectuó para determinar la prevalencia del virus de la inmunodeficiencia humana tipo 1 (VIH-1) en pacientes con tuberculosis pulmonar del National Chest Hospital en Jamaica. MÉTODOS: En este estudio retrospectivo se revisaron los expedientes hospitalarios de 537 pacientes ingresados a lo largo de un período de siete años, de 1995 a 2001. Utili- zamos un formulario uniformado para obtener los datos relacionados con las características sociodemográficas; los rasgos, signos y síntomas clínicos; el diagnóstico de laboratorio; el tratamiento administrado, y los resultados observados. RESULTADOS: Encontramos que 11,6% (47/406) de los pacientes que satisfacían los criterios de inclusión y a quienes se les había diagnosticado tuberculosis pulmonar tenían seropositividad al VIH-1. La mayoría de los pacientes tuberculosos con positividad a VIH eran de sexo masculino, y la mayor prevalencia de infección simultánea con VIH en pacientes tuberculosos se observó en personas entre los 30 y 39 años de edad. La tasa de mortalidad en pacientes con tuberculosis e infección por VIH fue de 23,4% (11/47), en comparación con 3,9% (14/359; P = 0,001) en pacientes sin infección por VIH. A los pacientes se les administró el tratamiento estándar con cuatro medicamentos. No se observó ninguna resistencia en las cepas aisladas de Mycobacterium tuberculosis. CONCLUSIONES: En Jamaica la prevalencia de VIH en pacientes con tuberculosis es parecida a la observada en otros países en desarrollo, pero la tasa de mortalidad en estos pacientes es mayor. Por lo tanto, es imprescindible diagnosticar la infección por VIH en etapa temprana e iniciar de inmediato el tratamiento antirretrovírico de gran actividad.

Prevalence of human immunodeficiency virus infection in patients with pulmonary tuberculosis at the National Chest Hospital in Jamaica

OBJECTIVE: This study was undertaken to determine the prevalence of human immunodeficiency virus-type 1 (HIV-1) infection in patients with pulmonary tuberculosis at the National Chest Hospital in Jamaica. METHODS: This retrospective study reviewed the hospital records of 537 patients admitted over a seven-year period from 1995 to 2001. We used a standardized data collection form to obtain data for sociodemographic characteristics, clinical features, signs and symptoms, laboratory diagnosis, treatment and outcome. RESULTS: We found that 11.6 percent (47/406) of the patients who met the inclusion criteria and were diagnosed as having pulmonary tuberculosis were HIV-1 seropositive. Most HIV-positive patients with tuberculosis were males, and prevalence of HIV coinfection among patients with tuberculosis was highest in patients aged 30-39 years. The mortality rate in patients with tuberculosis and HIV infection was 23.4 percent (11/47) compared to 3.9 percent (14/359;P=0.001) in HIV-negative patients. Patients were treated with standard quadruple drug therapy. No multiple drug resistance was noted in Mycobacterium tuberculosis isolates. CONCLUSIONS: The prevalence of HIV in patients with tuberculosis in Jamaica is similar to that in other developing countries, but the mortality rate is higher and this warrants prompt diagnosis of HIV infection and early institution of highly active antiretroviral therapy (AU)

The effectiveness of the Gram stain of high vaginal swabs in the diagnosis of bacterial vaginosis at the University Hospital of the West Indies [abstract]

OBJECTIVE: To correlate the gram-stain of high vaginal swabs (HVS) with the diagnosis of bacterial vaginosis (BV) and to compare this with bacterial culture reports to determine whether any useful additional information is gained by culture. METHODS: HVS submitted to the microbiology laboratory (UWI) from patients diagnosed clinically with vaginal infection were used in this study. Specimens were submitted from the Family Planning, Gynaecology and Antenatal clinics at the University Hospital of the West Indies. Swabs were placed in Stuart's Transport Medium and taken to the microbiology laboratory within 24 hours. The specimens were subjected to standard bacteriological procedures of culture on blood and MacConkey agar and microscopic procedures of wet prepartion and gram stain. The gramstain was recorded on a specially designed data sheet for each patient with a standardized scoring method for the evaluation of gram-stained smears based on the recognition of both presence and amount of significant morphotypes. This result was then compared with the bacterial culture, available a few days later, to see the degree of correlation and to determine whether any relevant additional information was gained. Almost 60 percent of the specimens collected yielded no pathogens on culture. However, one-third of this 60 percent was diagnosed as BV by standardized scoring method. One-third of all specimens submitted yielded yeast (Candida albicans and yeast not-Candida albicans) on culture and by gram stain. Streptococcus group B was isolated in < 4 percent of all specimens and a miscellaneous group of organisms including Klebsiella sp, Pseudomonas sp and anaerobic Streptoccus made up the rest of bacterial isolates. CONCLUSIONS: The standardized scoring method of evaluating the HVS gram stains yielded a more accurate and rapid diagnosis of BV than the traditional culture method. This is worthy of further study, as implementation of this method would result in considerable cost and time saving. (AU)

Risky behaviour in Jamaican adolescent patients attending a sexually transmitted disease clinic

The prevalence of sexually transmitted diseases (STD) and risky behaviour patterns were studied in 165 adolescents attending a STD clinic in Jamaica. A standardised structured questionnaire, clinical algorithms for STD and serological tests for HIV and syphilitic infection were applied. High prevalences of risky behaviour including young age at onset of sexual activity, especially in boys, (mean age 12.5 ñ 2.5 years); unprotected sexual intercourse (only 4 percent used condoms consistently); multiple sexual partners (mean 3.8 ñ 2.4 and 1.8 ñ 1.2 for boys and girls, respectively were found. Marijuana, used by 60 percent of the boys, was an independent risk factor for dysuria (adjusted Odds Ratio (OR), 2.0; 95 prcent CI, 1.6 - 3.4). Repeated episodes of STD (33 percent), coinfection with HIV (1.2 percent), syphilis (1.2 percent) and teenage pregnancy (13 percent) were prominent findings. Educational strategies which promote behaviour intervention at an early age, frequent and consistent use of condoms, abstinence or delayed onset of sexual activity are essential to reducing the HIV/AIDS and STD risk in adolescents in Jamaica.(Au)

Blood-borne sexually transmitted infections among substance abuse patients in Jamaica

OBJECTIVE: The objective of this study was to determine the prevalence of blood-borne sexually transmitted infections (STI) including the human immunodeficiency virus (HIV), human T-cell lymphotropic virus type-1 (HTLV-1), hepetitis B virus (HBV) and syphillis in residents of a detoxification/rehabilitation unit in Jamaica. METHODS: The records of 301 patients presenting, over a 5-year period, for treatment of substance abuse were reviewed for demographic and laboratory data. The laboratory results were compared with those of 131 blood donors who were used as representative of the general population. The substances used were alcohol, cannabis and cocaine. None of the subjects was an intravenous (IV) drug user. Female substance abusers were at higher risk than males for STI. The prevalence of STI in substance abusers did not differ significantly from that in blood donors (12 percent v 10 percent). The prevalence of syphilis in substance abusers was significantly higher than in blood donors (6 percent v 3 percent; p < 0.05). The prevalence of syphilis was dramatically increased in female substance abusers and female blood donors (30 percent; p < 0.001 and 13 percent; p < 0.05, respectively) compared with males. An increased frequency of HTLV-1 was observed in female compared to male substance abusers. Unemployment was identified as a risk factor for sexually transmitted disease in substance abusers. CONCLUSION: These results support the policy of screening patients in detoxification units for STI and indicate a need for gender specific approaches in the control of substance abuse and STI in Jamaica.(Au)

Symptomatic and asymptomatic chlamydial non-gonococcal urethritis in Jamaica: the potential for HIV transmission

To determine the contribution of Chlamydia trachomatis to non-gonococcal urethritis (NGU) in men attending sexually transmitted (STD) clinics in Jamaica, we studied men with NGU (n=339), and control groups including asymptomatic men who were STD contacts (n=61), asymptomatic men who were not STD contacts (n=32) and men with gonococcal urethritis (GU) (n=61). Urethral specimens were examined for C. trachomatis and Neisseria gonorrhoeae. Serological tests for syphillis (STS) and HIV-1 infection were also performed. C. trachomatis accounted for 63 percent of cases of NGU but high prevalence of C. trachomatis in men with GU differed significantly from that in men with NGU and asymptomatic STD non-contacts (P<0.05). C. trachomatis infection in men with NGU was associated with multiple sex partners (71 percent vs 58 percent; x2=4.78; odds ratio OR=1.76; P<0.05) and previous history of gonococcal infection (83 percent vs 42 percent; x2=59.8; OR=6.8; P<0.0001). Concomitant infection with HIV-1 occured in 5.2 percent of cases of NGU and 50 percent and 90 percent, respectively, of the HIV-positive men had chlamydia or reactive STS. As a cost effective strategy in the control of STD and HIV we recommend presumptive treatment for C. trachomatis in men seeking STD treatment in Jamaica.(Au)

The prophylaxis of acute rheumatic fever in a pair of monozygotic twins: the public health implications

Recurrent acute rheumatic fever and rheumatic heart disease can be prevented by antibiotic intervention. We report the case of genetically identical twins, one of whom had overt rheumatic fever, received penicillin prophylaxis and did not have rheumatic heart disease. The other must have had inapparent rheumatic fever, received no chemotherapy prophylaxis and proceeded to develop rheumatic heart disease. A greater clinical and laboratory vigilance is required for the diagnosis of acute rheumatic fever in the asymptomatic identical twin of a patient with rheumatic fever. This case provides further evidence of a genetic predisposition of rheumatic fever and demonstrates the continued value of penicillin in the prophylaxis of acute rhuematic fever. It emphasises the need to maintain the integrity of preventive programmes against rheumatic fever worldwide. Studies which explores the HLA and other genetic linkages with rheumatic fever should be encouraged.(AU)

High prevalence of genital Chlamydia trachomatis infection in women presenting in different clinical settings in Jamaica: implications for control strategies

OBJECTIVE: To determine the prevalence of genital Chlamydia trachomatis infection and risk factors in women attending family planning, gynaecology, and sexually transmitted disease (STD) clinics in Jamaica. METHODS: Endocervical specimens from 645 women including 238 family planning, 170 gynaecology, and 237 STD clinic attendees were examined for C trachomatis using a direct fluorescence assay (DFA) and culture. Investigations were carried out for the presence of other STD pathogens and demographic, behavioural, historical, and clinical data recorded for each participant. RESULTS: The prevalence of C trachomatis infection was 35 percent, 47 percent, and 55 percent in family planning, gynaecology, and STD clinic clients, respectively. The performance of the DFA was comparable to that of culture in screening for C trachomatis. Logistic regression analysis revealed that the independent risk factors for C trachomatis were non-barrier contraceptive methods in family planning clients (OR = 2.1; 95 percent confidence interval (CI) = 1.2 - 3.9; p= 0.0110), cervical ectopy in gynaecology clients (OR = 3.9; 95 percent CI = 1.4 - 10.6; p= 0.0076) and concomitant Trichomonas vaginalis infection in STD clients (OR = 3.5; 95 percent CI = 1.8 - 6.8; p = 0.003). Age, number of sex partners, and reason for visit were not identified as risk factors for C trachomatis infection. CONCLUSIONS: Consistently high prevalence if C trachomatis infection occurs in Jamaican women. Universal screening or presumptive treatment should be evaluated as prevention and control measures for C trachomatis infection in this population where all women appear to be at risk. (AU)

The significance of immune disorder in tropical spastic paraparesis

The reports of the occurrence of HTLV-1 infection and/or HTLV-1 associated myelopathy (HAM)/tropical spastic paraparesis (TSP) in patients with certain organ-specific and nonorgan-specific autoimmune diseases prompted us to assess the relationship between TSP and humoral autoimmunity. Blood samples from 76 TSP patients, 60 asymptomatic HTLV-1 carriers and 100 HTLV-1 seronegative blood donors were examined for the presence of organ-specific and nonorgan-specific autoantibodies, reactive serological tests for syphilis, immunoglobulin and complement concentrations as well as immunecomplexes. High prevalences of autoantibodies (39/76, 51 percent), reactive serological tests for syphilis (23/76; 30 percent), hypergammaglobulinaemia (69/76, 90 percent) and the complement fixing immune complexes (44/76, 58 percent) were found in the TSP patients. These indicators of immunological disorder were found in statistically significantly lower prevalences in asymptomatic HTLV-1 carriers (12/60, 20 percent; p < 0.001; 6/60, 10 percent; p < 0.05; 32/60, 53 percent; p < 0.001 and 8/60, 13 percent; p < 0.001, respectively) and HTLV-1 seronegative blood donors (8/100, 8 percent; p < 0.001; 3/100, 3 percent; p < 0.001; 15/100, 15 percent p < 0.001 and 5/100, 5 percent; p < 0.001, respectively). The profiles of autoimmune phenomena observed in the patient and control groups revealed that they were associated with TSP rather than mere HTLV-1 infection and consequently pathogenic significance. The array of immunological features present in TSP was suggestive of autoimmune disease resulting from immune dysfunction. Studies which explore the possible existence of HTLV-1 induced autoantibodies with specificity for antigens of the spinal cord in TSP might be useful in elucidating its pathogenesis.(Au)

Epidemiology of non-ulcerative sexually transmitted diseases in a high risk population in Jamaica

The role of ulcerative STDs such as syphilis in facilitating the transmission and acquisition of HIV is well established. Non-ulcerative STDs such as gonorrhoea and Chlamydia infection are considered facilitators of HIV transmission. This study was designed to determine the types of non-ulcerative sexually transmitted diseases and associated risk factors among high-risk Jamaican men and women. A cross-sectional survey was conducted including 510 clients attending an STD clinic in Kingston. A standardised questionnaire was administered and microbiological investigations performed on urethral or cervical swab specimens obtained from each participant. All the subjects were symptomatic; 377 (74 percent) had genital discharge and 197 (39 percent) had dysuria with or without discharge. There were 309 cases of NGU; 115 cases of Candidiasis, 275 confirmed gonococcal infections and 226 cases of Trichomoniasis. Men were two times more likely to have gonococcal infection than women (69 percent vs. 50 percent; p<0.01). History of smoking marijuana was significantly associated with a positive test for gonorrhoea (69 percent vs. 52 percent; p<0.01). Forty one percent of women reported that their partners never used condoms (41 percent vs. 19 percent; p<0.01). Only nine men acknowledged consistent condom use. Those who were first time attendees at the STD clinic (n=263) were more likely to report never using condoms (38 percent vs. 27 percent; p<0.01). These data highlight the need for priority targetting in this high-risk group for counselling and health education in controlling, STD and HIV infection in Jamaica.(AU)

Clinical usefulness of thyroid autoantibodies in patients with Graves' disease

The prevalence of thyroid antibodies varies with the population studied. It has been suggested that the presence of anti-thyroid microsomal (TMAb)/thyroid peroxidase (TPO) antibodies and anti-thyroglobulin antibodies (TgAB) may predict clinical parameters including anti-thyroid drug therapy outcome in Graves' disease. Commercially available kits were used to measure anti-TPO and Tgab titres. Antibody titres were compared in the following clinical groups: newly diagnosed (n=21), treated with radioactive iodine (n=2), remission (n=22), relapse (n=27), chronic (n=44). Anti-thyroglobulin antibodies were present in 10.3 percent (10/97) of the patients with titres ranging from 40 to 320 with a geometric mean titre of 80. Ant-TPO antibodies were found in 49.4 percent (48/97) with titres ranging from 100 to 102, 400 and a geometric mean titre of 1,800. The presence and titres of thyroid antibodies did not correlate with age at diagnosis, duration of disease, cardiac complications, other concommitant autoimmune diseases, antithyroid drug therapy or the relapse or remission rate. The results of this study did not indicate any clinical usefulness of thyroglobulin and thyroid peroxidase beyond diagnosis in Graves' disease.(AU)

Limited usefulness of antithyroperoxidase and antithyroglobulin assays in Jamaicans with Graves' disease

The clinical usefulness of commercially prepared haemagglutination kits for thryro peroxidase (TPO) antibody and thyroglobulin (TG) antibody was evaluated in 145 consecutive Jamaicans with Graves' disease. Sixty two (43 percent) of the patients were newly diagnosed, 12 (8 percent) were in remission and 71 (49 percent) had relapsed. Sera from 65 (45 percent) patients were positive for thyroid antibodies. The TPO antibodies were found in 43 percent (63/145), thyroglobulin antibodies in 12 percent (17/145) fifteen (10 percent) patients had both anti-TPO and TG antibodies. Similar prevalences of TPO antibody were found in newly diagnosed patients and those who had relapsed (44 percent v. 41 percent) but the prevalence in the patients in remission was significantly higher (75 percent; X2 = 4.8, P <0.05). The prevalence of TPO antibody increased significantly with age at onset before age 35 years compared to later onset (56 percent v. 32 percent; X2 = 8.09, P <0.005). The presence of both TPO antibody (64 percent v. 31 percent; X2 = 13.1, P <0.001) and TG antibody (22 percent v. 6 percent; X2 = 8.8, P <0.005) correlated positively with Graves' opthalmopathy. Neither of the tests was adequately sensitive in detecting GD in Jamaicans. (AU)

Prevalence of viral and bacterial sexually transmitted pathogens in Jamaican pregnant women

In this study we investigated the prevalence of Chlamydia trachomatis, Neisseria gonorrhoeae, Treponema pallidum, human immunodeficiency virus type I (HIV-I), human T cell lymphotropic virus type 1 (HTLV-1) and hepatitis B virus (HBV) infections in 200 pregnant women attending antenatal clinics at the University Hospital of the West Indies. 19 percent of the women had at least one pathogen: C. trachomatis was found in 16 percent, HTLV-1 in 2 percent, HIV-1, HBV and N. gonorrhoeae each in 0.5 percent C. trachomatis infection was more prevalent in women less than 20 years of age (31 percent) than in those 20 years and older (16 percent, OR = 0.43; chi 2 = 5.66; p < 0.05). The study demonstrates the need for identification of sexually transmitted pathogens in antenatal women for syndromic management of genital infections as part of the strategy for prevention and control of HIV/AIDS (acquired immunodeficiency syndrome) in Jamaica(AU)

Photosensitivity and antinuclear antibodies in black patients with systemic lupus erythematosus

Black patients with systemic lupus erythematosus (SLE) have a lower prevalence of photosensitivity rashes than white patients. The reasons for this are unkown, but some studies suggest a correlation between the presence of antinuclear antibodies and protection from phosensitivity. In our study, we determined serum antinuclear-antibody profiles, including anti-dsDNA, anti-Sm, anti-RNP, anti-Ro/SS-A, anti-La/SS-B antibodies, in 91 black Jamaican patients with SLE. All 91 serum samples from SLE patients (100 percent) were positive in the fluorescent antinuclear-antibody test. Using the crithidia luciliae immunofluorescence test, anti-dsDNA was found in 27.5 percent of the samples. By a double immunodiffusion method, anti-Sm antibodies were found in 15.4 percent, and anti-RNP in 18.7 percent, anti-Ro/SS-A in 9.9 percent and anti-La/SS-B in 11.0 percent. However, no statistically significant differences were observed in the seroprevalence of these antinuclear antibodies when sera from patients of the following groups were compared: only photosensitivity rashes (n = 17), photosensitivity and other rashes (n = 23), other rashes without photosensitivity (n = 27), and patients with no skin rash of any type (n = 24). These results suggest that photosensitivity in black Jamaican patients with SLE is not associated with antinuclear-antibody specificity(AU)

IGA antiphospholipid antibodies in HLTV-1-associated tropical spastic paraparesis

A retrovirus human T cell lymphotropic virus type I (HTLV-I), is an essential but not a sufficient aetiological factor for tropical spastic paraparesis (TSP). Because some TSP patients have biological false positive tests for trepomemal infections (BFP-STS), we used EISA to study BFP-STS and anticardiolipin antibodies in 42 Jamaican TSP patients. The data indicate that in TSP anticardiolipin antibodies accur in about 26 percent of patients, are associated with biological false positive treponemal serology, are relatively restricted to the IgA isotype and may be induced by HTLV-I or other non-treponemal infections. (Au)