Single-dose metrifonate for the treatment of Schistosoma haematobium infection in an endemic area of Zimbabwe.

The excretion of Schistosoma haematobium eggs by school children in an endemic area of Zimbabwe was studied for 16 weeks following a single oral dose of 10 mg/kg body weight metrifonate. By 16 weeks, 40.7% of the children had ceased excreting eggs. The mean reduction in egg excretion was 75.1%, but over half the children showed a greater than 90% reduction. Of the treatment failures, the majority showed less marked or transient reductions in egg excretion, though evidence suggested that 17.5% of the failures may have been due to reinfection.

Eighteen-month follow-up on the treatment of urinary schistosomiasis with a single dose of metrifonate.

Egg excretion of school children with urinary schistosomiasis treated with a single 10 mg/kg dose of metrifonate was monitored over a period of 18 months. At 18 months 68.8% of infected children showed a greater than 90% reduction in egg excretion and 23.7% had ceased excreting eggs. During the study period 25% of children with no evidence of infection at the start of the trial had become infected, while 45.5% of children apparently cured by the metrifonate treatment had recommenced egg excretion. The evidence suggested that reinfection rather than recovery of adult worms was responsible. Children with scanty or light infections, in general, showed increasing egg excretion rates during the following period, while those with heavy or severe infections showed a sustained reduction. In view of this, single dose metrifonate may be a useful approach to mass treatment in a schistosomiasis control program, resulting in significant reduction in egg excretion in those most likely to be important sources of transmission.

Stillbirths and intrauterine infection, histologic chorioamnionitis and microbiological findings.

OBJECTIVE: To analyze whether placental inflammation is associated with stillbirth in Zimbabwe. METHOD: Placentas from 66 stillbirths (> 22 weeks' gestation; patients with congenital malformations, diabetes or preeclampsia were excluded) and 66 term live births were studied for the presence and severity of chorioamnionitis. The morphological results were compared with earlier presented microbiological findings in the same material. RESULTS: Chorioamnionitis was present in 79% of stillbirths and 30% of live births (O.R. 8.5, 95% C.I. 4.0-18). Nine percent of stillbirths but no live births presented vasculitis of the chorionic plate, which verified an inflammatory response from the infant (O.R. 14, 95% C.I. 2.8-72). The same types of microorganisms were isolated from stillbirths and liveborns, but Escherichia coli and group B streptococci were more frequent among stillbirths. CONCLUSIONS: Morphological chorioamnionitis occurred 2.6 times more often in women with stillbirths than in women with live births. In 9% of stillbirths the infant showed an inflammatory response. Thus the infant was alive when the infection occurred and it is therefore reasonable to assume that infection was the cause of death.

Intrauterine death and infections during pregnancy.

OBJECTIVE: To elucidate whether microbial infections are involved in the etiology of intrauterine death. METHODS: One hundred four cases of stillbirth of unknown etiology and 96 age- and parity-matched referents with live births were analyzed with respect to microbial infection by cultures from the placenta, endocervix and internal organs of the fetuses, external sites of the babies and fetuses, and by serology for bacteria, viruses and Toxoplasma gondii. RESULTS: In 17 cases in whom no other infectious agent was diagnosed, Escherichia coli was isolated from the placenta and one or more internal fetal organs. Tests for Treponema pallidum and Toxoplasma gondii were more frequently positive in cases than in referents (O.R. 8.3 and 3.9, respectively). There was no increased risk for intrauterine death in women with human immunodeficiency virus, cytomegalovirus, herpes simplex virus or rubella virus. CONCLUSIONS: Our findings indicate that infections remain an important cause of intrauterine death in Zimbabwe.

In-vitro activity of piperacillin and tazobactam combination against clinically significant bacteria.

The in-vitro activity of piperacillin/tazobactum which is not among the routinely tested antibiotic at the Public Health Bacteriology Laboratory, Parirenyatwa Hospital, Harare, Zimbabwe was evaluated for its activity against bacterial pathogens using the Kirby-Bauer disk diffusion method. Piperacillin/tazobactum showed superior in-vitro activity against both gram positive and gram negative bacteria when compared with routinely tested antibiotics such as gentamicin, erythromycin, tetracycline, penicillin, chloramphenicol, fusidic acid and clindamycin and the difference was statistically significant (p < 0.05). Ciprofloxacin showed in-vitro activity comparable to that of tazobactam/piperacillin. Specifically, 96% of gram positive isolates (comprising Streptococcus pyogenes, Staphylococcus aureus, coagulase negative staphylococci and Streptococcus pneumoniae were sensitive to piperacillin/tazobactam. For gram negative organisms, 98% of Haemophilus influenzae Shigella spp, Klebsiella spp were also sensitive to the combination. The broad spectrum of activity of piperacillin/tazobactam shows that the potential of the drug combination for the treatment of infections caused by diverse microorganisms should not be underestimated. We recommend its inclusion in routine antibiotic sensitivity testing in our hospital.

In-vitro disk diffusion sensitivity of meropenem against bacterial pathogens in Harare.

OBJECTIVE: To compare the in-vitro sensitivity of meropenem with imipenem and other antibiotics against clinically significant bacteria. DESIGN: A longitudinal survey. SETTING: Department of Medical Microbiology, in a tertiary care university hospital. SUBJECTS: Specimens obtained from patients attending various clinics at tertiary care and teaching hospital in Harare. Those submitted to the Public Health Bacteriology Laboratory were analysed. MAIN OUTCOME MEASURES: Rates of resistance or susceptibility of the various bacteria to the antibiotics employed in the study. RESULTS: There was excellent in-vitro bacterial activity of meropenem against virtually all clinically significant Gram positive and Gram negative isolates when compared with other antibiotics such as imipenem, ciprofloxacin, gentamicin, penicillin, ampicillin, fusidic acid, tetracyclines, erythromycin and clindamycin (p < 0.5). All isolates of Streptococcus pyogenes, Pseudomonas aeruginosa, Enterobacteriaceae, Neisseria meningitidis were susceptible to meropenem. Meropenem showed 99% overall in-vitro sensitivity against Gram positive and Gram negative bacteria. About 80% of staphylococci were resistant to penicillin whereas at least 20-25% of S. aureus, coagulase negative staphylococci, S. pyogenes showed resistance to ampicillin, erythromycin, gentamicin, tetracycline and clindamycin. CONCLUSION: Meropenem is not included in the list of routinely tested antibiotics in our laboratory, a major tertiary laboratory in the country. As a result of the ultra-broad spectrum of activity, we recommend its inclusion in our routine antibiotic sensitivity testing and observe that there is a great potential for meropenem in the treatment of infections caused by several genera of bacteria in our environment.

Prevalence, capsular type distribution, anthropometric and obstetric factors of group B Streptococcus (Streptococcus agalactiae) colonization in pregnancy.

OBJECTIVE: To establish the prevalence, serotype distribution, anthropometry and obstetric factors of Group B Streptococcus (GBS) colonization in pregnant women. DESIGN: Cross sectional survey. SETTING: Chinhoyi General Hospital. SUBJECTS: 206 pregnant women attending the antenatal clinic at Chinhoyi General Hospital were systematically randomly sampled. MAIN OUTCOME MEASURES: All the isolates were serotyped on the basis of capsular polysaccharide (CHO) antigen designated, Ia, Ib, II, III, IV and V. RESULTS: 65 (31.6%) were carriers of GBS. The serotypes found were, type III (41.8%), type V (37.4%), type Ia (11.0%), type IV (3.3%), type Ib (3.3%) type II (1.0%) and 2.0% of the isolates were non-typable. All isolates were sensitive to penicillin and resistant to gentamycin. Colonization was more common in women with parity 0 to 2 (4.6%) and age group 20 to 24 years (43.1%). There was some evidence (p = 0.063) to suggest that GBS was more often isolated from the vagina (12.6%) than from the rectum (6.3%). CONCLUSION: There was a high prevalence of GBS colonization among pregnant women in Chinhoyi. Types III and V were the most common serotypes found.

Measles virus haemagglutination-inhibition antibodies among pregnant and non-pregnant women in the vaccine era in Harare, Zimbabwe.

OBJECTIVES: To determine the prevalence of measles virus haemagglutination-inhibitive antibodies among pregnant and non-pregnant women born before 1963 (pre-vaccine era) and those born after 1963 (vaccine era) in Harare. DESIGN: Prospective study of serum samples collected from pregnant and non-pregnant women born during the pre-vaccine era and vaccine era in Harare. SETTING: A laboratory based study at the Virology Laboratory, Department of Medical Microbiology, University of Zimbabwe using serum samples of women from different communities in Harare. SUBJECTS: 546 pregnant and non-pregnant women. MAIN OUTCOME MEASURES: Age, pregnant or not pregnant and the use of measles virus haemagglutination-inhibition antibody tests to determine prevalence rates or levels of antibodies to the measles virus. RESULTS: The results showed that 158 (28.9pc) out of a total of 546 pregnant and non-pregnant women screened were positive for measles virus haemagglutination-inhibition antibodies (MVHIA) at titers ranging from 1:10 to 1:80.39.8pc and 18pc of pregnant women born before 1963 and after 1963 were respectively positive whereas 49pc and 27.3pc of non-pregnant women born before 1963 and after 1963 were also positive for MVHIA respectively. The mean age of women born before 1963 was 38 + 2 years (range 34 to 60 years, median 42 years) while those born after 1963 had a mean age of 22 + 2 years (range 10 to 28 years; median 23 years). Higher antibody titers (1:40 and 1:80) were most commonly observed in both pregnant and non-pregnant women born during the pre-vaccine era than those born during the vaccine era and the difference was of statistical significance (p < 0.01). CONCLUSION: Finally results suggest that immunity acquired by exposure to wild measles virus (pre-vaccine era or natural immunity) is higher than immunity acquired following immunisation (vaccine era) and this may affect the duration of maternally derived immunity by children of mothers born during the different eras. Consequently, while we expect that this finding will be of value in immunisation schedules, we suggest a titer of 1:40 and above as the likely screening titer for routine identification of protected women in Zimbabwe.

Detection of rotavirus in children under five years of age presenting with diarrhoea at Mapulaneng Hospital at Bushbuckeridge, Republic of South Africa.

OBJECTIVE: To determine the incidence of Rotavirus infection in children under five years of age presenting with diarrhoea. DESIGN: Cross sectional study. SETTING: Mapulaneng Hospital, Bushbuckridge, Republic of South Africa. SUBJECTS: 50 children under five years of age presenting with diarrhoea. MAIN OUTCOME MEASURES: Rotavirus seroprevalence. RESULTS: Out of 50, 24 (48%) had detectable Rotavirus particles in their stools. The highest incidence of infection was observed among the seven to 12 months age group. Out of the 245 positive subjects 22 (91.7%) were breast fed. CONCLUSION: This study shows that diarrhoea in children under five years of age is probably caused by Rotavirus in Bushbuckridge. We therefore recommend that all children presenting with diarrhoea should be screened for Rotavirus.

Comparison of four commercial enzyme-linked immunosorbent and one agglutination assays for the detection of HIV antibodies in sera from Zimbabwe.

Sera from 871 AIDS and AIDS related complex patients were used to evaluate four ELISA and one agglutination assays. Commercial tests compared were Abbot, Wellcoyzyme, Biotest, Du Pont and Serodia. Wellcozyme and Serodia had the highest sensitivity (96.8 pc and 98.8 pc respectively) but the lowest specificity (53.3 pc and 46.5 pc respectively). Du Pont was the least sensitive test (89.1pc). Biotest and Abbot were comparable--Biotest had a higher sensitivity (93.2pc as compared with 90.6pc) but Abbot had a higher specificity (94.1 pc as compared with 89.1 pc). Thus, Abbott and Biotest both had a satisfactory high sensitivity and specificity and could thereby be recommended for use in screening of HIV-1 antibodies in south east Africa.

A cross-sectional sero epidemiological prevalence of polio virus antibodies post-immunization with three doses of TOPV.

A cross-sectional sero epidemiological study to detect the presence of antibodies to polio virus types 1, 2 and 3 was undertaken. A total of 437 infants with an average of 40 subjects per province was enrolled in this study. All the subjects had completed the three doses of TOPV. Blood samples were aseptically collected by heel pricking on calibrated filter papers and immediately transported to the laboratory for processing. In the laboratory, standardized techniques were used to detect neutralizing antibodies to polio virus. Antibodies with a titre of > 1:32 were detected in all studied subjects. Some infants developed titres as high as 1:1024. However, polio virus type 3 showed a higher antibody titre than the other two types. Differences in titres were observed from province to province.

HIV infection and HIV-1 clades among pregnant women in Harare, Zimbabwe.

OBJECTIVE: To determine HIV-1 seropositivity and HIV-1 clades/subtypes among pregnant women attending different clinics in Harare, Zimbabwe. DESIGN: A prospective study. SUBJECTS: 206 pregnant women attending Edith Opperman and Budiriro clinics in Harare. MAIN OUTCOME MEASURES: Frequency distribution of the various HIV-1 clades and rate of HIV-1 seropositivity. RESULTS: Results obtained showed that out of the 206 pregnant women screened, 60 (29.1%) were HIV-1 seropositive. The most predominant clade was HIV-1 clade C (66.6%) whereas HIV-1 clades A and B accounted for 48.3% and 33.3% of HIV-1 clades respectively. Results also revealed dual infections with clades A and C (45%), A and D (10%), B and C (30%) and multiple infections with A, B, C and D (6.6%) whereas two (3.3%) were non-reactive. CONCLUSION: Finally, the data on HIV-1 clades are of immense immunological, molecular and epidemiological importance in Harare, Zimbabwe and should serve as base line data for future investigations in the country.

PIP: Official figures indicate that at least 1 million of Zimbabwe's 11 million population are infected with HIV, while the most recent survey results indicate that about 24% of apparently healthy women in the country are HIV seropositive. 60 (29.1%) of 206 pregnant women attending Edith Opperman and Budiriro clinics in Harare who were screened for infection with HIV were found to be HIV-1 seropositive. 66.6% of the HIV-1-infected women were infected with subtype C, 48.3% with subtype A, and 33.3% with subtype B. 45% of the infected were infected with subtypes A and C, 10% with A and D, 30% with B and C, and 6.6% with subtypes A, B, C, and D. 2 samples (3.3%) were nonreactive. The high prevalence rate of HIV-1 infection in this study population points to the urgent need to implement more aggressive approaches to controlling HIV/AIDS among women in Zimbabwe.

Microbial pathogens associated with diarrhoea in children admitted to Harare Hospital for rehydration therapy.

PIP: Stool speciment from 236 children admitted to Harare Hospital with acute diarrhea were examined for bacterial, viral and parasitic pathogens. Results were compared with specimens from 192 control patients admitted to the same hospital for other reasons. C. jejuni (13,6% diarrhea, 2,1% controls) and E. coli (10,3% diarrhea, 2,6% controls) were the most common pathogens isolated, and were isolated only from children under 2 years of age. Other bacterial pathogens were isolated from older children as well as infants, while parasites were isolated mainly from children 2 years of age. Virus particles were detected by electron microscopy in only 2 patients, both with diarrhea. Of the E. coli strains isolated from children with diarrhea, the majority belonged to 5 serotypes and these serotypes were uncommon in controls. The significance of C. jejuni as a major cause of summer diarrhea in infants in Zimbabwe is demonstrated, but further studies are recommended to investigate microbial pathogens in older children and in winter months.^ieng

Tropical ulcers in a remote area in Zimbabwe.

There is a dearth of literature on tropical ulcers in the rural areas in the tropics and subtropics. Results of a study of 1680 tropical ulcer patients attending an out patient department of a clinic in a rural district in Zimbabwe over a 14 months period are presented. The ulcers were more common during the wet humid months with 63 percent of the ulcers falling in the 5-14 year age group. There was a male predominance over the female with a ratio of 1.4:1. Culture and sensitivity results of isolates from 8 patients are discussed and the need for further studies on the possible causative organism(s) stressed. Implications of such outbreaks on the already over-burdened health care system are stressed; and the need for the intensification of health education in the prevention of this disease highlighted.

The relationship between malaria and HIV.

OBJECTIVE: To determine if there is an association between HIV and malaria infection. DESIGN: A cross sectional survey. SETTING: Sanyati Rural District, a malarious endemic area of Zimbabwe. SUBJECTS: 338 volunteers aged 15 months to 76 years. MAIN OUTCOME MEASURES: Prevalence of Malaria and HIV. RESULTS: The prevalence of malaria and HIV was 26.6% and 26.3% respectively. There was no association between prevalence of HIV and malaria. CONCLUSION: There is no association between malaria and HIV.

The incidence of rotavirus infection in children from two selected study areas in Zimbabwe.

Five hundred and twenty faecal samples or rectal swabs, collected over one year from children mainly under 24 months, were tested for the presence of human rotavirus (HRV) in enzyme linked immunosorbent assays (ELISA). Fifty-three (23.6 pc) of 225 diarrhoea samples and 25 (8.5 pc) of 295 control samples were HRV positive. The association between diarrhoea and detection of HRV in stools was statistically significant with an overall odds ratio of diarrhoea patients of 3.32 (0.001 greater than p). No significant difference in the incidence of HRV infection between populations at a communal farming location and a high density suburb community was proved. The highest HRV incidence was found during the dry cool season in diarrhoea patients between four and 24 months of age. Overall proportions of 16.7 pc and 28.6 pc HRV positive in groups of 0-3 and 4-6 months old diarrhoea patients respectively was remarkably high, suggesting influence of close human contact, crowding in residences and insufficient sanitary facilities on the transmission of the HRV. Approximately 10 pc of 4-18 months old control patients were HRV positive.

The detection of rotavirus antigen in faeces of asymptomatic children from two different communities in Zimbabwe.

A study of the existence in Zimbabwe of Rotavirus asymptomatic infection was conducted. Rectal swabs were collected from children aged between one month and two years, who were attending health clinics at Chiweshe Hospital (rural area) and Rujeko (a Harare high density suburb) in Zimbabwe. These infants were tested for the presence of Rotavirus antigen, using the ELISA test. Out of 292 specimens collected during a period of one year, 6.9 pc were found positive for Rotavirus antigen although none of the infants had symptoms of Rotavirus infection. Our results show no significant difference (x2 = .357, P = .55) between the prevalence of Rotavirus in children, 1-12 months old from Rujeko and Chiweshe. Likewise, there was no significant difference (x2 = 1.52, P = .281) in the 13-14 months children. It was however shown that a significant difference (x2 = 9.28, P = 0.0096) appeared between winter months versus dry or wet months. We, therefore, conclude that Rotavirus antigen is prevalent in asymptomatic children, and that it is more frequent during winter months.

Subtypes of HIV-1 and the impact of dual infections of HIV-1 and measles virus on micronutrient levels of pregnant women in Harare, Zimbabwe.

OBJECTIVE: To determine subtypes of HIV-1, simultaneous prevalence of HIV-1 and measles virus antibodies and their impact on micronutrient levels of pregnant women in Harare, Zimbabwe. DESIGN: Cross sectional. SETTING: Budiriro and Edith Opperman Antenatal Clinics Harare; Departments of Medical Microbiology, Medical Laboratory Technology and Institute of Food, Nutrition and Family Sciences, University of Zimbabwe. SUBJECTS: Pregnant women attending antenatal clinics in Harare, Zimbabwe. MAIN OUTCOME MEASURES: HIV-1 subtypes, measles virus seropositivities and levels of micronutrients among the pregnant women. RESULTS: Results showed that 101 (22.7%) out of a total of 444 pregnant women screened were HIV-1 positive. A separate group of 238 (inclusive of the 444) were screened for measles antibody and 118 (49.5%) were positive, whereas 41 (17.2%) were HIV-1 positive. Thirty five (29.7%) were seropositive for both HIV-1 and measles virus (simultaneous infection). HIV-1 subtypes revealed subtype C (70.4%) as the predominant subtype. HIV-1 subtypes B, A and D accounted for 40.8%, 39.8% and 22.4% respectively whereas HIV-1 subtypes E and F were not detected. Dual infections showed that 37.7%, 36.7%, 7.1% and 4.4% harboured subtypes A and C; B and C; A and D and B and D respectively. Multiple infections with subtypes A, B, C and D (5.1%) were also recorded whereas 9.2% were non-reactive. Results on micronutrients portrayed that HIV-1 positive pregnant women had significantly lower zinc than the control but co-infection with measles virus did not cause further decrease. Infection by either HIV-1 or measles virus increased serum copper (p < 0.05) but co-infection by the two viruses reduced the copper level significantly (p < 0.05). HIV-1 seropositivity did not affect serum magnesium level but was lower (p < 0.05) in women positive for both HIV-1 and measles virus. CONCLUSION: This is a single report on HIV-1 infection, HIV-1 subtypes, simultaneous prevalence of HIV-1 and measles virus antibodies and their impact on micronutrient levels of pregnant women in Harare, Zimbabwe. The study is of nutritional, clinico-epidemiologic importance.

PIP: HIV and measles virus seropositivities among pregnant women in Harare, Zimbabwe, are 30.4% and 28.9%, respectively. Measles and HIV/AIDS are both associated with persistent diarrhea, opportunistic infections, nutritional status, and neurological problems. Both viruses also have an affinity for lymphocytes. Findings are presented from an investigation of HIV-1 infections, HIV-1 genotypes/subtypes, measles virus seropositivities, and micronutrient status among pregnant women screened in Harare. 101 (22.7%) of the 444 pregnant women screened were HIV-1 seropositive. 118 (49.5%) of the 238 women screened for measles antibody were seropositive only for measles virus, while 41 (17.2%) of the 238 were seropositive for HIV-1 only. 35 (29.7%) of the 118 pregnant women seropositive for antibody to the measles virus were also seropositive for HIV-1. HIV-1 clades of 98 HIV-1 positive samples were determined. 69 (70.4%) HIV-1-infected women were infected with HIV-1 subtype C. HIV-1 subtypes B, A, and both types of D accounted for 40.8%, 39.8%, and 22.4% of infections, respectively. Subtypes E and F were not detected. 37.7% of the HIV-1 positive women were infected with both subtypes A and C, 36.7% with B and C, 7.1% with A and D, and 4.4% with B and D. 5.1% of the women were infected with subtypes A, B, C, and D. Micronutrient examination found that HIV-1-positive pregnant women had significantly lower serum zinc than did control subjects; co-infection with measles virus caused no additional decrease. Infection with either HIV-1 or measles virus increased serum copper, but co-infection with the 2 viruses significantly reduced the copper level. HIV-1 seropositivity did not affect serum magnesium level, but was lower in women positive for both HIV-1 and measles virus.

Low risk and high risk human papillomaviruses (HPVs) and cervical cancer in Zimbabwe: epidemiological evidence.

OBJECTIVE: To establish the prevalence of detectable low-risk and high-risk, oncogenic HPV types in cervical swabs of women with histologically proven cancer of the cervix. DESIGN: Cross sectional study. SETTING: Harare Central and Parirenyatwa Hospitals. SUBJECTS: 119 women with histologically proven cervical cancer of whom 63 had the degree of differentiation of the tumour reported. MAIN OUTCOME MEASURES: Frequency of infection with high and low-risk human papillomaviruses. RESULTS: The presence of HPV DNA was demonstrated in 63% (75/119) of cases. Low risk HPVs were present in 26% (31/119) and high-risk HPVs were demonstrated in 51% (61/119) of samples tested. Co-infection with both low-risk and high-risk HPVs was observed in 14% (17/119) of the specimens. High-risk HPVs were detected in 55% (21/38) of poorly differentiated tumours while 60% (15/25) of moderately and well-differentiated tumours showed the presence of high-risk HPVs. CONCLUSION: High-risk human papillomaviruses are associated with cervical cancer. There was no significant difference in the frequency of high-risk HPV types in women with moderately to well-differentiated tumours and those with poorly-differentiated tumours.