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Biomedical subjects

H Nsanze

Publications and source records attributed to H Nsanze.

At least 55 records · Page 3Linked to original sources
PubMed1981

Genital ulcers in Kenya. Clinical and laboratory study.

Of 97 patients with genital ulcers attending a special treatment clinic in Nairobi, Kenya, 60 harboured Haemophilus ducreyi, four herpes simplex virus, and five Neisseria gonorrhoeae. Eleven patients had serological evidence of syphilis; of these one case was confirmed by darkfield microscopy. In the remaining cases no aetiological agent was identified. An enriched chocolate agar with vancomycin and serum was a useful medium for primary isolation of H ducreyi. Tetracycline was generally ineffective in the treatment of ulcers, but sulfadimidine was successful in almost 80% of cases.

Adult↗
PubMed1980

Gonorrhea and female infertility in rural Uganda.

We studied sociocultural and medical factors in the Teso District in eastern Uganda and the Ankole District in western Uganda to discover the cause of the low and high fertility rates in these respective districts. The findings related to gonorrhea in women are presented in this article. Gonococcal cervicitis and clinical evidence of salpingitis occurred significantly more frequently in Teso (18.3% and 19%, respectively) than in Ankole (2.4% and 5.9%) women. Significantly more of the husbands of the gonococcal-negative infertile women compared to gonococcal-negative fertile women were found to have active gonorrhea, a past history of urethral discharge, and bilaterally thickened epididymides.

Adult↗
PubMed1980

Problems and approaches in the surveillance and control of sexually transmitted agents associated with pelvic inflammatory disease in Africa.

The problems in surveillance of sexually transmitted disease (STD) in Africa are numerous and are based mainly on socioeconomic barriers. Policies for controlling STD are either inadequate or nonexistent in many African countries. Gonococci are becoming increasingly insusceptible to penicillin and other drugs because of widespread use of inadequate therapy. Gonorrhea is recognized as the major pathogen of pelvic inflammatory disease in Africa. The magnitude of the PID problem is so great that current efforts are directed at case treatment rather than surveillance and control. The formation of the African Union Against Venereal Diseases and Treponematoses is an important step, and its suggestions and resolutions form a sound basis for improved STD control in Africa.

Africa↗
PubMedDate not supplied

Clinical features of Crimean-Congo haemorrhagic fever in the United Arab Emirates.

Crimean-Congo haemorrhagic fever (C-CHF) re-emerged recently in the United Arab Emirates. The clinical outcome of 11 cases of viral haemorrhagic fever patients admitted to hospital between June 1994 and January 1995 is described. Four cases were laboratory confirmed retrospectively as C-CHF, the other patients were diagnosed likely to have the same disease on epidemiological and clinical grounds. In 72.7% of the patients, infection was fatal. Symptoms started 3.5 days before hospitalization. On admission, 81.8% of patients had high fever, 45.5% were vomiting, 63.6% had diarrhoea, 45.5% had haemorrhagic signs, and 18.2% had throat pain. Fatalities occurred 6.8 days after admission. Survivors were hospitalized for 9.3 days. Nosocomial transmission was not observed.

Adolescent↗
PubMedDate not supplied

Short-course and single-dose antimicrobial therapy for chancroid in Kenya: studies with rifampin alone and in combination with trimethoprim.

Tetracyclines and sulfonamides are no longer effective for the treatment of chancroid in many parts of the world. Rifampin and trimethoprim both possess in vitro activity against Haemophilus ducreyi, the causative agent of chancroid. In a randomized, controlled study, 22 patients with H. ducreyi-positive genital ulcers received 600 mg of rifampin once daily for three days, and 32 patients received 600 mg of rifampin plus 160 mg of trimethoprim once daily for three days. Both regimens rapidly eradicated H. ducreyi from ulcers, with subsequent healing of ulcers and buboes. Two relapses of ulcers and one therapeutic failure were observed in the rifampin-trimethoprim group, whereas no relapses or failures were noted in the rifampin group. In addition, all of 16 H. ducreyi-negative ulcers responded rapidly to treatment with either regimen. In an uncontrolled, open study, 22 H. ducreyi-positive ulcers were treated with a single dose of rifampin (600 mg) plus trimethoprim (160 mg). Ulcers and buboes resolved by day 14 in all but one patient. Thus, these short-course and single-dose regimens are effective against chancroid.

Adolescent↗
PubMedDate not supplied

Comparison of media for the primary isolation of Haemophilus ducreyi.

The rates of isolation of Haemophilus ducreyi from patients with presumed chancroid has been low, and improved cultural techniques are required. We determined the isolation rates of H. ducreyi from 38 patients with clinical chancroid and compared gonococcal agar supplemented with bovine hemoglobin to Mueller-Hinton agar supplemented with chocolated horse blood, each with and without 5% fetal calf serum. The rate of isolation and the qualitative and quantitative growth of strains was best on gonococcal agar with added fetal calf serum (GC-HgS). However, three strains were isolated only on Mueller-Hinton base (MH-base). GC-HgS was compared with MH-HB for the isolation of H. ducreyi from 201 patients with clinical chancroid. Seventy-one percent of cultures were positive on GC-HgS, and 61% were positive on MH-HB (P less than .005); however, 10% of cultures were positive only on MH-HB. The use of the two media together increased the yield of positive cultures to 81%. Thus maximal rates of isolation of H. ducreyi from clinical specimens requires the use of two media, GC-HgS and MH-HB.

Chancroid↗
PubMedDate not supplied

The clinical diagnosis of genital ulcer disease in men in the tropics.

Since the clinical diagnosis of genital ulcers without laboratory confirmation is not reliable in developed countries, we postulated that clinical diagnosis alone would be no more reliable in developing countries. A presumptive clinical diagnosis of chancroid, genital herpes, syphilis, or lymphogranuloma venereum was made for 100 male patients at the Special Treatment Clinic in Nairobi, Kenya. This diagnosis was then compared to the final diagnosis determined by laboratory identification of the pathogen, by culture, or by serologic response. In 64 patients, a final diagnosis of either chancroid, syphilis, or genital herpes was established. The diagnostic accuracy varied from 75% for chancroid to 42% for syphilis and 43% for herpes. The overall diagnostic accuracy was 66%. The predictive values of positive clinical diagnoses were 84% for chancroid, 60% for syphilis, and 75% for herpes. Thus, clinical diagnosis of genital ulcer disease was not sufficiently reliable in this study.

Chancre↗
PubMedDate not supplied

Cefotaxime treatment of Haemophilus ducreyi infection in Kenya.

The authors conducted a double-blind randomized clinical trial comparing single-dose cefotaxime (1 g im) plus daily placebo injections with cefotaxime (1 g im on each of three days). Each regimen was given with probenicid (1 g orally) for the treatment of chancroid. Twenty Haemophilus ducreyi culture-positive men received the single-dose cefotaxime regimen; in eight patients ulcers or buboes failed to respond to therapy. Nineteen H. ducreyi culture-positive men received cefotaxime on each of three days; H. ducreyi was eradicated from all patients, but one had a continuing ulcer and another had a bubo that failed to respond. Thus cefotaxime (1 g im daily for three days) plus probenicid (1 g orally) is effective therapy for chancroid. The lack of efficacy for chancroid of the single-dose cefotaxime regimen is surprising, given the remarkable susceptibility of H. ducreyi to cefotaxime; presumably the half-life of cefotaxime is too short for predictable eradication of H. ducreyi from the ulcer with a single-dose regimen.

Adolescent↗
PubMedDate not supplied

Treatment of gonorrhea with single-dose thiamphenicol in Kenya.

The efficacy of a single 2.5-g dose of thiamphenicol against infection with penicillinase-producing strains of Neisseria gonorrhoeae (PPNG) or non-penicillinase-producing strains (non-PPNG) was studied in a two-phase clinical trial in Nairobi. The first phase included men who had had a urethral discharge for less than seven days, were infected with either PPNG or non-PPNG, and had not received previous treatment. The second phase included men with PPNG infections that had not responded to treatment with penicillin. The overall cure rate (determined by follow-up examinations and cultures three and ten days after treatment) was 90.6% in the first phase of the study and 92.1% in the second phase. A second 2.5-g dose of thiamphenicol was administered to four of the six patients in the second phase whose cultures yielded gonococci after the initial dose; the infections of all four patients were cured. The results of disk diffusion tests of gonococcal isolates did not correlate well with the outcome of treatment.

Adult↗
PubMedDate not supplied

Prostitutes are a major reservoir of sexually transmitted diseases in Nairobi, Kenya.

Prostitutes are a major reservoir of sexually transmitted diseases in many developing nations. In Nairobi we found that 16%, 28%, and 46%, respectively, of upper-, middle-, and lower-social strata prostitutes were infected with Neisseria gonorrhoeae. Genital ulcers and infections with Haemophilus ducreyi were more prevalent among prostitutes of the middle and lower social strata. A group of 97 prostitutes of the lower social strata were followed longitudinally to determine the rate of reinfection with N. gonorrhoeae. The mean time to acquisition of a new infection was 12.0 +/- 9.2 days. These results show that in Nairobi prostitutes are a readily identifiable group of high-frequency transmitters of gonococcal infection. Strategies based on intervention in the prostitute reservoir could prove to be an effective means of control of gonococcal infections in developing nations.

Chancroid↗
PubMedDate not supplied

Parents of infants with ophthalmia neonatorum: a high-risk group for sexually transmitted diseases.

One hundred forty-nine mothers and 74 fathers of infants who presented at the Special Treatment Clinic (Nairobi) with ophthalmia neonatorum were evaluated. Neisseria gonorrhoeae was isolated from 60 (40%) of 149 mothers and Chlamydia trachomatis was isolated from 31 (21%). Twenty-six mothers (17.5%) had clinical evidence of endometritis or pelvic inflammatory disease. Mothers with endometritis and/or pelvic inflammatory disease were more often infected with N. gonorrhoeae (65%) than were mothers without these conditions (24%) (P less than or equal to .001). N. gonorrhoeae was isolated from ten (14%) and C. trachomatis from three (9%) of 32 fathers, and nongonococcal urethritis was diagnosed in an additional 21 fathers (28%). Seven of ten men with gonococcal urethritis and 18 of 21 with nongonococcal urethritis had no symptoms. These data confirm that the presence of ophthalmia neonatorum in a neonate should be considered as a strong indicator of sexually transmitted disease in the parents. Although most infections in fathers were asymptomatic, the mothers were at high risk for complications.

Adult↗
PubMedDate not supplied

Clinical and microbiologic studies of genital ulcers in Kenyan women.

The etiology of genital ulcers in women in tropical regions is poorly understood. Eighty-nine women, presenting to a sexually transmitted disease clinic in Nairobi (Kenya) with a primary complaint of genital ulcers, were evaluated prospectively in a clinical and laboratory study. A final etiologic diagnosis was possible for 60 (67%) of the women. Culture for Haemophilus ducreyi was positive for 43 women, eight had secondary syphilis with ulcerated condyloma latum, three had primary syphilis, one had both chancroid and syphilis, two had moniliasis, two had herpetic ulceration, and one had a traumatic ulcer. The clinical characteristics that best distinguished chancroid from secondary syphilis were ulcer excavation and a rough ulcer base. No etiologic diagnosis was established for 29 patients. However, the clinical and epidemiologic features of these patients suggested that they were similar if not identical to the patients with H. ducreyi culture-positive chancroid. Further studies are necessary to determine the etiology of ulcers in females in whom no pathogen was identified.

Chancroid↗
PubMedDate not supplied

Single-dose ceftriaxone therapy of gonococcal ophthalmia neonatorum.

Ceftriaxone (125 mg) given as a single intramuscular dose without topical therapy was evaluated in seven infants with smear-positive gonococcal ophthalmia neonatorum. Neisseria gonorrhoeae was isolated from the eyes of six infants, and four of these isolates were penicillinase-producing N. gonorrhoeae. Two infants had concomitant ocular infection with Chlamydia trachomatis. All seven infants, when seen at follow-up, showed marked clinical improvement. Conjunctivitis resolved completely in four infants. One infant was lost to subsequent follow-up, while two infants had persistent ophthalmia due to C. trachomatis. Follow-up eye cultures for N. gonorrhoeae were all negative.

Ceftriaxone↗
PubMedDate not supplied

Single-dose therapy with trimethoprim-sulfametrole for chancroid in females.

Women with genital ulcer disease who were culture-positive for Haemophilus ducreyi were treated with a single dose of the drug combination trimethoprim-sulfametrole; the dosage was 640 mg of trimethoprim and 3,200 mg of sulfametrole. All 27 women who were treated with this regimen and adequately followed were cured. Thus a single dose of trimethoprim-sulfametrole appears to be an effective treatment regimen for women with chancroid in Kenya.

Adult↗
PubMedDate not supplied

Advances in the diagnosis and management of chancroid.

Improved technologies for the cultural diagnosis of chancroid have resulted in increased interest in the management and control of genital ulcer disease. New treatment regimens have been identified, and new control strategies have evolved. These strategies now permit localized introductions of chancroid into developed countries to be contained rapidly. However, additional work is still necessary in developing countries.

Anti-Bacterial Agents↗
PubMedDate not supplied

A comparison of single-dose spectinomycin with five days of trimethoprim-sulfamethoxazole for the treatment of chancroid.

In a controlled trial 32 patients with ulcers culture-positive for Haemophilus ducreyi were treated with a single 2-g dose of spectinomycin, and 20 patients were treated with a five-day course of trimethoprim-sulfamethoxazole (TMP-SMZ; 160/800 mg) twice daily. Both regimens rapidly eradicated H. ducreyi from ulcers, with subsequent healing of ulcers and buboes. The cure rates 14 days after initiation of therapy were 94% for spectinomycin and 95% for TMP-SMZ. Patients with H. ducreyi-negative ulcers who were treated with the same regimens also healed and did not show a significantly different efficacy for either regimen. Thus we found that the one-day regimen of spectinomycin was as effective for the treatment of chancroid as was TMP-SMZ given for five days. Further studies on a larger number of patients are needed to confirm our findings.

Adult↗
PubMedDate not supplied

Aetiology of onychomycosis in Al Ain, United Arab Emirates.

A 1-year study was conducted on 151 patients with finger- or toenail disease attending a dermatology clinic in Al Ain, United Arab Emirates. Nail scrapings and or clippings were collected and investigated with a KOH preparation for direct microscopy and cultured for fungi. Eighty-nine (59%) patients were females. Most females (62%) presented with fingernail disease while in men the toenails were involved in 76%. Fungi were isolated in 78 (52%) of all cases and the fingernails were more commonly positive than toenails. Of the 78 isolates, 49 (63%) were yeasts, including eight Candida species, dermatophytes accounted for 22 (28%) and seven (9%) were other moulds. Non-dermatophyte moulds constituted 20% of male isolates but only 4% of female isolates. Eighty-one per cent of Candida species were from fingernails, while 87% of all the dermatophytes were from toenails.

Candida↗