Browsing by Author "Mihret Wude"

Now showing 1 - 2 of 2
  • No Thumbnail Available
    Item
    Etiology, Disease Severity and Diagnostic Challenges of Bacterial Meningitis during Non-epidemic Seasons in Ethiopia
    (Addis Ababa Universty, 2017-06) Mihret Wude; Petros Beyene (Professor)
    Bacterial meningitis (BM) is a severe infectious disease of the nervous system that needs urgent medical attention. Ethiopia, a country located at the eastern end of the “meningitis belt”, is frequently affected by meningitis epidemics. Studies have rarely focused on nonepidemic season strains of BM and use of less sensitive diagnostic tools have impeded characterization of its causative organisms. A prospective case-based study was launched from 2012-2013 on 139 patients clinically diagnosed with BM. The objective of the study was to obtain recent data on the frequent etiologies of BM, diagnostic challenges and disease severity in Ethiopia during non-epidemic seasons. Cerebrospinal fluid (CSF) samples taken from the study participants were subjected to bacterial culture, molecular and immunological lab analyses while sera were evaluated by immunological assays. The patient’s ages were varying from 2 days to 78 years old and > 50% of the total study population were in ≤ 12 years old age category. Younger age groups than olders, males than females faced higher level of BM induced disease severity (i.e. death or sequelae). Bacterial culture detection test performed at the research lab recovered 14 (10.1%) live isolates out of 139 CSFs. These comprises of N. meningitidis (n = 5, serogroups A (n = 4) + W-135 (n = 1)), S. pneumoniae (n= 8), and H. influenzae (n =1) from the CSFs of the patients. Real time PCR (RT-PCR) detected a total of 46 (33.1%) etiologic agents of BM composing N. meningitidis in 27/46 (58.7%), genogroups A (11/27, 40.7%), W-135 (7/27, 26%), C (1/27, 3.7%), X (1/27, 3.7%) and non-groupable (7/27, 26%), S.pneumoniae in 18/46 (39.1%) and H. influenzae in 1/46 (2.2%). Hospital lab versus research lab results for 50 patients whose clinical lab data were found were compared and the hospital lab results showed less specificity for N. meningitidis (91% versus 100%) and S. pneumoniae (95% versus 100%), decreased PPV for N. meningitidis (50% versus 100%) and S. pneumoniae (33% versus 100%), decreased NPV for N. meningitidis (66% versus 68%) and S. pneumoniae (85% versus 93%) respectively. Levels of IL-4, IL-8, IL- 12/p70, INF-g, MCP-1, MIP-1α, MIP-1β, RANTES, TRAIL and MMP9 in the CSF were significantly elevated in BM caused by S. pneumoniae compared to that of N.meningitidis, consistent with a worsened outcome by the former. Significantly different (P < 0.05) levles of median endotoxin activities (measured by Limulus Amoebocyte Lysate/LAL) were detected among N. meningitidis positive patients with different clinical conditions. Streptococcus pneumoniae positive patients who died (n = 3) had significantly high (P < 0.05) levels of MMP9 and IL-1b compared to the survived ones. Fifty patients out of 139 were reported to develop sequelae in age groups £4 (epilepsy, n = 1), £ 4 (raised intracranial pressure, n = 1), ³ 40 (quadriparesis, n = 1), 20-29 (confusion in age group, n = 20-29), while seizure was reported in age groups £4 (n = 22), 5-12 (n = 7), 13- 19 (n = 4), 20-29 (n = 7) and ³ 40 (n = 4). Seventeen patients out of the 48 with specifically reported sequelae were RT-PCR confirmed positive for BM etiologic agents. Types of sequelae were not specifically reported for two patients. Three N. meningitidis and 6 S. pneumoniae positive patients who experienced sequelae showed increased trends of IL-1b, IL-6 and IL-1ra compared to those with no sequelae and negative controls. Affordable, multivalent meningitis vaccines composed of serogroups A, C, W-135 and X are urgently needed for use in Ethiopia and possibly in all countries within the African meningitis belt.
  • No Thumbnail Available
    Item
    Seroprevalence of Herpes Simplex Virus (HSV) Type 2 in Adult Ethiopians: Its Association With HIV, HSV-L, Syphilis And Some Other Risk Factors
    (Addis Ababa University, 2001-05) Mihret Wude; Petros Beyene (Professor)
    This paper reports a preliminary data on HSV type 2 and type I from a retrospective cross sectional study on 1168 (530 female and 638 male) subjects aged 15-66, living at Akaki and Higher 23 (located at the vicinity of All African Leprosy Educational Research and Training (ALERT)), places around Addis Ababa, Ethiopia. The plasma samples were tested for antibodies against HSV-2 and HSV-l, by using glycoprotein g (gG2 and gGl) specific ELISA kit. Prevalence of antibodies against HSV type 2 was 44.5% (520/1168) in both sexes while the prevalence of antibodies against HSV-l was found to be as high as 94.7% (2311244). HSV-2 serological data is presented in the context of HI V, syphilis, genital ulcer, genital discharge and various socioepidemiological information. An overall HSV-2 seroprevalence of 64% (124/193) in women 35-44 years old and 50% (28/56) in men 45-66 years old were determined. On the other hand seroprevalence of HSV-2 antibodies in women seropositive for HIV-l antibodies was 80% (40/50) versus 47.5% (228/480) among HIV -negatives. Among the HIV positive men, the prevalence was 70% (46/66) and 36% (206/572) in the HIV-seronegatives. HSV-2 seropositivity was 71.3% (72/101) and 45.7% (196/429) in women seropositive and seronegative for syphilis antibodies respectively. In the men, it was 60% (94/157) and 32.8% (158/481) among the syphilis seropositives and syphilis-seronegatives respectively (P < 0.00 I). It was concluded that being older, HIV seropositive, and syphilis seropositive, were significantly associated (P < 0.05) with HSV -2 seropositivity in both sexes. Highly significant (P < 0.05) association was observed between HSV -2 seroposititvity and the various sociodemographic factors examined in both women and men sUbjects.