Molecular studies of meningococcal and pneumococcal meningitis patients in Ethiopia.

Neisseria meningitidis infections in sub-Saharan Africa usually present with distinct symptoms of meningitis but very rarely as fulminant septicemia when reaching hospitals. In Europe, development of persistent meningococcal shock and multiple organ failure occurs in up to 30% of patients and is associated with a bacterial load of >10/ml plasma or serum. We have prospectively studied 27 Ethiopian patients with meningococcal infection as diagnosed and quantified with real-time PCR in the cerebrospinal fluid (CSF) and serum.

Line-probe assay and molecular typing reveal a potential drug resistant clone of in Ethiopia.

Background: Antimicrobial resistance is a global concern of increasing significance. Multidrug resistant tuberculosis (MDR-TB) is spreading worldwide. It is important to monitor trends of antimycobacterial resistance.

A multicentre, randomised, non-inferiority clinical trial comparing a nifurtimox-eflornithine combination to standard eflornithine monotherapy for late stage Trypanosoma brucei gambiense human African trypanosomiasis in Uganda.

Background: While the combination of nifurtimox and eflornithine (NECT) is currently recommended for the treatment of the late stage human African trypansomiasis (HAT), single-agent eflornithine was still the treatment of choice when this trial commenced. This study intended to provide supportive evidence to complement previous trials.

Methods: A multi-centre randomised, open-label, non-inferiority trial was carried out in the Trypanosoma brucei gambiense endemic districts of North-Western Uganda to compare the efficacy and safety of NECT (200 mg/kg eflornithine infusions every 12 h for 7 days and 8 hourly oral nifurtimox at 5 mg/kg for 10 days) to the standard eflornithine regimen (6 hourly at 100 mg/kg for 14 days).

Molecular epidemiology and drug sensitivity pattern of Mycobacterium tuberculosis strains isolated from pulmonary tuberculosis patients in and around Ambo Town, Central Ethiopia.

Introduction: Tuberculosis (TB) is caused by M. tuberculosis complex and remains a major global public health problem. The epidemic remains a threat to sub-Saharan Africa, including Ethiopia, with further emergence of drug resistant TB.

A phase I, open-label trial on the safety and immunogenicity of the adjuvanted tuberculosis subunit vaccine H1/IC31® in people living in a TB-endemic area.

Background: H1/IC31® is a tuberculosis (TB) subunit vaccine candidate consisting of the fusion protein of Ag85B and ESAT-6 (H1) formulated with the IC31® adjuvant. Previous trials have reported on the H1/IC31® vaccine in M. tuberculosis (Mtb)-naïve, BCG-vaccinated and previously Mtb-infected individuals.

Ex-vivo characterization of regulatory T cells in pulmonary tuberculosis patients, latently infected persons, and healthy endemic controls.

Background: Regulatory T cells (Treg) are an essential arm of adaptive immunity not only in tolerance and autoimmunity but also in infectious diseases. In Tuberculosis (TB), it has been suggested that the frequency of Tregs is higher in the blood of TB patients when compared to healthy controls with subsequent decline after treatment. However, with the discovery that FOXP3, the hallmark marker of Tregs, is not exclusive to Tregs and the lack of specific markers for Tregs, it has been a challenge to fully understand the role of Tregs in TB.

Efficacy and Safety of 'Fixed Dose' versus 'Loose' Drug Regimens for Treatment of Pulmonary Tuberculosis in Two High TB-Burden African Countries: A Randomized Controlled Trial.

Background: There are limited data on the performance of the use of fixed-dose combination (FDC) TB drugs when used under programmatic settings in high TB-endemic countries. We evaluated the efficacy and safety of FDC versus loose formulation (LF) TB treatment regimens for treatment of pulmonary TB (PTB) in the context of actual medical practice in prevailing conditions within programmatic settings in five sites in two high TB-burden African countries.

Methods: A two-arm, single-blind, randomized clinical trial comparing FDCs with separate LFs involving 1000 adults newly diagnosed with culture positive PTB was conducted at five sites in two African countries between 2007 and 2011.

Performance of general health workers in leprosy control activities at public health facilities in Amhara and Oromia States, Ethiopia.

Background: Leprosy is a chronic infectious disease of public health importance and one of the leading causes of permanent physical disability. Nevertheless, the drop in prevalence following multidrug therapy has resulted in the neglect of leprosy. The annual incidence of leprosy has remained the same in Ethiopia since decades with more than 76% of the reported new cases coming from Oromia and Amhara Regional States.

A Randomized Controlled Double Blind Trial of Ciclosporin versus Prednisolone in the Management of Leprosy Patients with New Type 1 Reaction, in Ethiopia.

Background: Leprosy Type 1 (T1R) reactions are immune-mediated events leading to nerve damage and preventable disability affecting hands, feet and eyes. Type 1 Reactions are treated with oral corticosteroids. There is little evidence on alternative treatments for patients who do not respond to steroids or experience steroid adverse effects.

Comparison of Efficacy and Safety of Ciclosporin to Prednisolone in the Treatment of Erythema Nodosum Leprosum: Two Randomised, Double Blind, Controlled Pilot Studies in Ethiopia.

Background: Erythema Nodosum Leprosum (ENL) is a serious complication of leprosy. It is normally treated with high dose steroids, but its recurrent nature leads to prolonged steroid usage and associated side effects. There is little evidence on the efficacy of alternative treatments for ENL, especially for patients who have become steroid resistant or have steroid side effects.

Surveillance of Bacterial Meningitis, Ethiopia, 2012-2013.

Among 139 patients with suspected bacterial meningitis in Ethiopia, 2012-2013, meningococci (19.4%) and pneumococci (12.9%) were the major disease-causing organisms.

A Randomized, Placebo-Controlled Trial Evaluating Safety and Immunogenicity of the Killed, Bivalent, Whole-Cell Oral Cholera Vaccine in Ethiopia.

Killed whole-cell oral cholera vaccine (OCV) has been a key component of a comprehensive package including water and sanitation measures for recent cholera epidemics. The vaccine, given in a two-dose regimen, has been evaluated in a large number of human volunteers in India, Vietnam, and Bangladesh, where it has demonstrated safety, immunogenicity, and clinical efficacy. We conducted a double-blind randomized placebo-controlled trial in Ethiopia, where we evaluated the safety and immunogenicity of the vaccine in 216 healthy adults and children.

Investigation of the high rates of extrapulmonary tuberculosis in Ethiopia reveals no single driving factor and minimal evidence for zoonotic transmission of Mycobacterium bovis infection.

Background: Ethiopia, a high tuberculosis (TB) burden country, reports one of the highest incidence rates of extra-pulmonary TB dominated by cervical lymphadenitis (TBLN). Infection with Mycobacterium bovis has previously been excluded as the main reason for the high rate of extrapulmonary TB in Ethiopia.

Methods: Here we examined demographic and clinical characteristics of 953 pulmonary (PTB) and 1198 TBLN patients visiting 11 health facilities in distinct geographic areas of Ethiopia.

A 24-well plate assay for simultaneous testing of first and second line drugs against Mycobacterium tuberculosis in a high endemic setting.

Background: Early detection of drug resistance is one of the priorities of tuberculosis (TB) control programs as drug resistance is increasing. New molecular assays are only accessible for a minority of the second line drugs and their availability in high endemic settings is also hampered by high cost and logistic challenges. Therefore, we evaluated a previously developed method for drug susceptibility testing (DST) including both first- and second line anti-TB drugs for use in high endemic areas.

A pilot study on detection and genotyping of humanpapilloma virus isolated from clinically diagnosed Ethiopian women having cervical intraepithelial neoplasia.

Background: Human Papilloma virus associated cervical cancers are more prevalent in developing countries compared to developed countries. Cervical cancer is reported as the most frequent malignancy among women visiting hospitals in Ethiopia. This study is a pilot study designed to examine the prevalence and genotypes of HPV in twenty Ethiopian women, clinically diagnosed to have cervical neoplasia, while visiting gynecology unit of a tertiary level referral hospital in Addis Ababa.

Chronic meningitis in immunocompromised adult Ethiopians visiting Tikur Anbessa Teaching Hospital and Ye'huleshet Clinic from 2003-2004.

Background: Chronic meningitis is inflammation of the meninges where signs and symptoms develop and last for at least four weeks without alleviation. Little is known about the current etiology and incidence of the disease in adults living in developing countries.

Objective: The objective of this study was to elucidate the most common etiologies of chronic meningitis in adult Ethiopian patients and give an aid in the empiric therapy.

Recent trends of cutaneous leishmaniasis in Alert Hospital, Addis Ababa.

Background: Cutaneous leishmaniasis is endemic to many parts of the world and has re-emerged in a number of endemic countries in recent years. Environmental changes, immune status of the host and treatment failure are the three most important risk factors associated with the re-emerging and spread of Leishmaniasis. Cutaneous leishmaniasis (CL) ranges from localized, self-healing type to the disfiguring mucocutaneous and diffuse cutaneous type.

Tuberculosis among Addis Ababa city bus drivers and cash collectors.

Background: The risk of transmission of tuberculosis is high in crowded conditions. Addis Ababa has a relatively high burden of tuberculosis and its city buses are often filled with commuters. Tuberculosis is a potential occupational hazard for city bus drivers and cash collectors.

T cell response to alpha crystallin and Mycobacterium tuberculosis specific antigens using ex-vivo elispot assay for detecting latent tuberculosis infection in Addis Ababa, Ethiopia.

Background: Mycobacterium tuberculosis (Mtb) persists in a state of non-replication or stationary phase, but resulting in active tuberculosis (TB) when the immune system is suppressed. Alpha-crystallin (ACR) is one of the bacterial antigens characterized known to be related to shifting of the bacilli from growth to a non-replicating persistent state.

Objective: To compare the ex-vivo responsiveness of active TB patients, close household contacts and healthy controls to specific Mtb antigens.

Characterization of the etiological agents of tuberculous lymphadenitis in Dera Woreda, North Showa, Ethiopia.

Background: Tuberculous lymphadenitis (TBLN) is a common form of extra pulmonary tuberculosis where lymph nodes particularly from cervical, axillary and inguinal sites are mostly involved, however, its diagnosis poses a major challenge in resource limited settings.

Objective: To identify the etiological species of Mycobacteria responsible for TBLN in Derra area, a rural district in Ethiopia, where the status of TBLN is unknown.

Materials And Methods: A total of 153 patients who were clinically suspected for TBLN, between the periods of August 2004 and February 2005 were included in the study.

Human immunodeficiency virus infection among new smear positive pulmonary tuberculosis patients in Addis Ababa, Ethiopia.

Background: It has been few years since the launching of provider-initiated HIV counselling and testing (PICT) for all tuberculosis (TB) suspected patients and patients presenting with signs and symptoms of TB. However, little is known about the prevalence of HIV in new smear positive confirmed TB cases in Addis Ababa.

Objective: To determine the proportion of HIV among newly diagnosed smear positive TB cases, who were screened between February 2007 and July 2010 in Addis Ababa.

Seroprevalence of Brucellosis and Q-Fever in Southeast Ethiopian Pastoral Livestock.

To assess seroprevalences of and in pastoral livestock in southeast Ethiopia, a cross-sectional study was carried out in three livestock species (cattle, camels and goats). The study was conducted from July 2008 to August 2010, and eight pastoral associations (PAs) from the selected districts were included in the study. Sera from a total of 1830 animals, comprising 862 cattle, 458 camels and 510 goats were screened initially with Rose Bengal plate test (RBPT) for .

Parasitic infection may be associated with discordant responses to QuantiFERON and tuberculin skin test in apparently healthy children and adolescents in a tuberculosis endemic setting, Ethiopia.

Background: M. tuberculosis remains one of the world's deadliest pathogens in part because of its ability to establish persistent, latent infections, which can later reactivate to cause disease. In regions of the globe where disease is endemic, as much as 50% of the population is thought to be latently infected, complicating diagnosis and tuberculosis control.

Development of a proof of concept immunochromatographic lateral flow assay for point of care diagnosis of Mycobacterium tuberculosis.

Background: Despite major public health initiatives and the existence of efficacious treatment regimes, tuberculosis (TB) remains a threat, particularly in resource-limited settings. A significant part of the problem is the difficulty of rapidly identifying infected individuals, and as a result, there has been renewed interest in developing better diagnostics for infection or disease caused by Mycobacterium tuberculosis. Many of the existing tools, however, have limitations such as poor sensitivity or specificity, or the need for well-equipped laboratories to function effectively.

Mycobacterial lineages causing pulmonary and extrapulmonary tuberculosis, Ethiopia.

Molecular typing of 964 specimens from patients in Ethiopia with lymph node or pulmonary tuberculosis showed a similar distribution of Mycobacterium tuberculosis strains between the 2 disease manifestations and a minimal role for M. bovis. We report a novel phylogenetic lineage of M.