An outbreak of liver disease in Tahtay Koraro Woreda, Tigray region of Ethiopia: a case-control study for the identification of the etiologic agent.

BACKGROUND: An outbreak of fatal liver disease of unidentified origin in Tahtay Koraro Woreda, Tigray Region was reported at the end of 2005. In response to this report, a team of investigators was deployed from the EHNRI to assess the situation in the affected area. OBJECTIVES: The objective of the trip was to investigate the probable etiological agent(s) for the stated health problem and to suggest possible means of containing the outbreak. METHOD: A case-control epidemiological method was employed in collecting information from the affected (case) area and a non-affected adjacent area (control) using structured questionnaire. Qualitative data was also collected through focus group discussion (FGD) at community as well as woreda level. Samples of biological and environmental nature were also collected from both case and control areas for a subsequent laboratory analysis in order to identify the causative agent of the outbreak. RESULT: The comparative analysis of the various variables and possible exposure factors between the two sites (case vs control village) revealed that both villages were similar in terms of their exposure to most of the suspected factors including exposure to chemicals, food storage and handling practices, and to the use of traditional herbal medicines or consumption of wild edible plants. However, it was observed that the residents in the affected site (over 96%) relied more on unprotected or protected well as a source of drinking water and other household purposes while most in the non-affected depended on fresh water from river or unprotected spring. This difference was significant, p = 0.000 (OR = 840, 95% CI = 50.1, 14095.7). CONCLUSION: Though several of the possible exposure factors to the epidemic appear to be similar for both the case and control villages, the water source they use for drinking and other household purposes differed markedly. It therefore seems plausible that the problem in the case area could be linked to this water source.

Toxicity study and evaluation of biochemical markers towards the identification of the causative agent for an outbreak of liver disease in Tahtay Koraro Woreda, Tigray.

BACKGROUND: A team of experts of the Faculty of Medicine, Addis Ababa University reported the emergence of unidentified fatal liver disease in Tahtay Koraro Woreda, Tigray in the mid of December 2005. The EHNRI has been then instructed to investigate the possible etiological agent that are likely to be responsible in triggering the health problem and a field survey team consisting of experts were went to the affected area to investigate the situations surrounding the disease. OBJECTIVES: This investigation was conducted to determine the possible etiological agent(s) for the stated health problem in the affected village. METHOD: Acute toxicity study was performed on animal model for the various samples used in human consumption, which was followed by histopathological examination of the liver of the sacrificed laboratory animals. In order to facilitate the elucidation of the causative agent for the alleged health problem further tests for clinical markers and antigens were also performed on the serum collected from affected persons. RESULT: Neither death nor toxic symptoms manifestations were observed on laboratory animals when feeding the consumable samples for a period of two weeks, however histopathological examination of the liver of the sacrificed animals that were given the unprotected pond water and Tela samples from the affected village as a drink revealed severe hepatoic necrosis. Biochemical test results of the serum samples revealed raised level of some clinical markers that are highly significant for detecting liver abnormality of toxic origin. Serological test for surface antigen ruled out the possible causes of infectious origin such as viral hepatitis. CONCLUSION: The overall results confirmed that the causative agent for the outbreak of the liver disease was of toxic origin rather than due to infectious agent and this was found to be associated with consumption of contaminated water as well as Tela.

Case Report: Disseminated Strongloides stercoralis Presenting as an Ulcerated Gastric Mass in an HIV-1-infected Patient.

Disseminated Strongloides stercoralis is a common phenomenon among patients with immunosuppression. In this report, we present a case of disseminated Strongloides stercoralis presenting as a gastric mass in a 42-year-old male patient with a known history of HIV-1 infection and type 2 diabetes mellitus (T2DM). The patient presented with symptoms and signs suggestive of acute on chronic erosive gastritis, which included persistent vomiting. Endoscopic examination revealed a gastric mass with no signs of malignancy or dysplasia. There was noted to be chronic inflammation along with morphologic features consistent with the larvae and eggs of Strongloides nematodes in a biopsied gastric mass tissue and duodenum. The disease subsequently resulted in death despite the administration of ivermectin.

HPV genotype distribution among women with normal and abnormal cervical cytology presenting in a tertiary gynecology referral Clinic in Ethiopia.

BACKGROUND: Cervical cancer is the second most prevalent cancer among women of child-bearing age in Ethiopia. The aim of this study was to determine human papilloma virus (HPV) genotype distribution among HIV-negative women with normal and abnormal cervical cytology results. METHODS: We investigated a consecutive of 233 HIV-negative women between December 2008 and March 2009 presenting in a Tertiary Gynecology Referral Clinic in Ethiopia. Screening was done by Pap cytology and HPV detection and genotyping method was nested PCR (direct amplification with MY09/MY11 primers, followed by nested amplification with GP5/GP6 primers) and sequencing of the nested products. Sequencing of the non-purified nested PCR products was performed following re-amplification with Big dye terminator, using the GP6 primer. RESULTS: Of the 233 study participants, 92 (39.5%) had abnormal cytology. All women with abnormal cervical cytology had positive HPV DNA compared to only 48.9% of those presenting with normal cytology. Of these women, the frequency of high-risk (HR)-HPV was 83.2% and its prevalence in women with abnormal cervical cytology was significantly higher than those with normal cytology (92.4% vs. 71%, p < 0.0001). The most frequent genotypes identified were HPV16 (44.1%), followed by HPV35 and HPV45 (each 6.2%), HPV31 (4.4%), HPV56 (3.7%), HPV18 and HPV59 (each 3.1%), HPV58 (2.5%) and HPV39 (1.9%). While the most common HR-HPV infections among women with normal cytology were HPV16 (20.3%), followed by HPV35 (8.7%), HPV56 and HPV58 (each 5.8%), HPV18, HPV31 and HPV39 (each 4.4%), HPV45 (2.9%) and HPV59 and HPV68 (each 1.5%), the most common HR-HPV infections in women with abnormal cytology included HPV16 (62%), followed by HPV45 (8.7%), HPV 31, HPV35 and HPV59 (each 4.4%), and HPV18, HPV52 and HPV56 (each 2.2%). We also noted low prevalence of multiple HPV infections in women with normal or abnormal cytology. Multivariable logistic analysis showed that residing in rural area (OR 3.24, 95% CI: 1.13-9.30), being multipara (OR 7.35, 95% CI: 1.78-30.38) and having abnormal cervical cytology results (OR 6.75, 95% CI: 1.78-25.57) were all independently associated with HPV16 genotype. CONCLUSIONS: Our study revealed a significant risk of infection with HR-HPV, in particular with HPV16 genotype, in women attending a referral center in Ethiopian women presenting with or without abnormal cervical cytology. Moreover, Pap smear cytology missed a significant proportion of women compared to those who were identified by PCR for HR-HPV infections. In addition, the PCR method we used was not suitable for sensitive detection of co-existent multiple infections. Data from the present study indicate that currently available HPV vaccines could prevent nearly 67% of all cervical cancer cases in women in Ethiopia.

Pseudo-Meig's syndrome: parasitic leiomyoma with ascites in a 52-year old lady.

There is a possibility that a pedunculated subserous leiomyoma loses its vascular connection with the uterus and gets new blood vessel supply from other pelvic or nearby structure and continues its parasitic growth. A 52-year-old lady presented with abdominal distension of 12 years duration and laparotomy was done with preoperative diagnosis of possible malignant ovarian tumour. Intraoperative finding was very big non-specific but well demarcated and easily excisable mass located partly in the utero-vesical pouch with blood supply entirely from the greater omentum and anterior abdominal wall. There was about 3600 ml clear ascitic fluid in the paracolic gutters. The mass was sent for histo-pathologic examination and the report was compatible with leiomyoma of uterine origin. Patient's recovery was quiet dramatic and subsequent out patient follow-ups were uneventful. The presence of ascites of different amount doesn't necessarily signify malignancy of any visceral primary or secondary origin. Therefore, benign tumours of ovarian or uterine origin should be included in the differential diagnosis of pelvic or abdominal mass with ascites to come up with scientifically sound deduction and intervention that may bring about remarkable impact on ameliorating mortality and morbidity.