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Goh YY, Koay S, Goodall J, Oommens G, Ingle G, Parris V, Iodice V, Swanton J, McNamara P. 037 New insight into dysautonomia in GFAP astrocytopathy. J Neurol Neurosurg Psychiatry 2022. [DOI: 10.1136/jnnp-2022-abn.362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
A 17yo Filipino man presented with a rapid onset meningoencephalitic illness, dysautonomia (cardiovas- cular and genitourinary), neuropsychiatric, myoclonus and cerebellar symptoms. Examination revealed lower limb proprioceptive loss and areflexia.CSF showed lymphocytosis, hypoglycorrachia and glial fibrillary acidic protein (GFAP) antibodies. MRI head was normal on D4 and D11, but repeat imaging (D25) showed a reversible splenial T2 hyperintensity, which improved by D40. Neurophysiology showed a sensory neuronopathy. Autonomic function testing confirmed sympathetic cardiovascular failure. Pupillometry showed bilateral Horner’s indicating further sympathetic deficit. Dynamic sweat testing showed evidence of post-ganglionic sudomotor dysfunction.He received treatment with IV methylprednisolone followed by a prednisolone taper with good response.GFAP is an intracytoplasmic protein, found in astrocytes, unmyelinated nerve fibres as well as dorsal root ganglia, in keeping with our patient’s clinical presentation. However, literature review shows signifi- cant heterogenicity in presentation and pathogenicity of the GFAP antibody is unclear, as it could be a bystander protein.Dysautonomia is reported in 24–57% of GFAP astrocytopathy, but has not been well-characterised. We describe the first in-depth autonomic testing in GFAP astrocytopathy which shows sympathetic cardio- vascular failure and evidence of sudomotor post-ganglionic dysfunction.yeeyen.goh@nhs.net|ABN Bursary
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Bulteel N, Henderson N, Parris V, Capstick R, Premchand N, Hunter E, Perry M. HIV testing in secondary care: a multicentre longitudinal mixed methods electronic survey of non-HIV specialist hospital physicians in South-East Scotland and Northern England. J R Coll Physicians Edinb 2021; 51:230-236. [PMID: 34528609 DOI: 10.4997/jrcpe.2021.305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Increasing the uptake of HIV testing in people who may have undiagnosed HIV is essential to reduce the morbidity associated with late HIV diagnosis. METHODS We conducted a multicentre, longitudinal, mixed-methods study, surveying the attitudes, knowledge and practice of non-HIV specialist hospital physicians in South-East Scotland and North-East England with respect to HIV testing. RESULTS We found that although awareness of indications for HIV testing had improved over time, only 13% of clinicians recognised all of the surveyed HIV indicator conditions. Physicians were better at recognising the indicator conditions relevant to their specialty. The perception of working with a low-risk patient population was the most frequently cited barrier to offering an HIV test. Only a third of study respondents had requested more than 10 HIV tests in the preceding year. CONCLUSIONS Our study supports a need for targeted and sustained educational initiatives to increase rates of HIV testing in secondary care.
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Affiliation(s)
| | - Naomi Henderson
- Edinburgh Clinical Infection Research Group, NHS Lothian Infection Service, NHS Lothian
| | | | | | - Nikhil Premchand
- Department of Clinical Infection, Northumbria Healthcare NHS Foundation Trust
| | - Ewan Hunter
- Department of Infection and Tropical Medicine, The Newcastle-upon-Tyne Hospitals NHS Foundation Trust
| | - Meghan Perry
- Edinburgh Clinical Infection Research Group, NHS Lothian Infection Service and Epidemiology Research Group, Usher Institute, University of Edinburgh
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Thi AM, Lee N, Parris V, Marin FP, Roy L, Calapis RW, Ariyoshi K, Parry CM, Cox SE. An observational report of universal GeneXpert testing of inpatients with diagnosed or presumptive TB in the Philippines. Trans R Soc Trop Med Hyg 2021; 114:682-686. [PMID: 32592398 PMCID: PMC7456596 DOI: 10.1093/trstmh/traa044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 03/21/2020] [Accepted: 05/21/2020] [Indexed: 11/26/2022] Open
Abstract
Background The Philippines is a high TB and multidrug-resistant TB burden country. Although the scale-up of GeneXpert testing is occurring, the benefits of universal Xpert-Mycobacterium tuberculosis/ rifampicin (MTB/RIF) testing in inpatients have not been documented. Methods Routine GeneXpert testing irrespective of priority criteria for testing was conducted within a prospective cohort of all adults with known or presumptive TB admitted to a tertiary infectious diseases hospital in Manila. Study-specific TB diagnosis was decided upon bacteriological results, chest x-ray assessment, if already on anti-TB treatment (ATT) at admission and a cough duration of ≥2 wk. Results Of submitted sputum samples, 87.1% (277/318) had valid acid-fast bacilli (AFB) microscopy and Xpert® MTB/RIF results. Xpert® MTB/RIF was positive in 97.7% (n = 87/89) of AFB-positive patients and 25.5% (n = 48/188) of AFB-negative patients. Bacteriological confirmation in smear negative cases not on ATT prior to admission was 25.2% (34/135). Rifampicin resistance was detected in 26/135 Xpert positive cases (19.3%), including nine who might not otherwise have been detected, representing a 53% increase in yield. Conclusion Universal GeneXpert testing in this setting enhanced the yield of bacterial confirmation, revealing a high incidence of rifampicin resistance and suggesting a need for further investigations in Xpert-negative/smear-positive patients who may not have mycobacterial TB.
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Affiliation(s)
- Aye Myat Thi
- Faculty of Epidemiology & Population Health, LSHTM, Keppel Street, London, WC1E 7HT, UK.,School of Tropical Medicine & Global Health, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan
| | - Nathaniel Lee
- School of Tropical Medicine & Global Health, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan.,Royal Free Hospital, Pond Street, London, NW3 2QC, UK
| | - Victoria Parris
- Faculty of Epidemiology & Population Health, LSHTM, Keppel Street, London, WC1E 7HT, UK
| | - Flora P Marin
- San Lazaro Hospital, Quiricada Street, Santa Cruz, Manila, 1003, Philippines
| | - Lynsil Roy
- San Lazaro Hospital, Quiricada Street, Santa Cruz, Manila, 1003, Philippines
| | - Rugaiya W Calapis
- Programmatic Management of Drug Resistant Tuberculosis Treatment Center, San Lazaro Hospital, Quiricada Street, Santa Cruz, Manila, 1003, Philippines
| | - Koya Ariyoshi
- Institute of Tropical Medicine, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan
| | - Christopher M Parry
- School of Tropical Medicine & Global Health, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan.,Institute of Infection & Global Health, University of Liverpool, 8 West Derby Street, Liverpool, L69 7BE, UK.,Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Sharon E Cox
- Faculty of Epidemiology & Population Health, LSHTM, Keppel Street, London, WC1E 7HT, UK.,School of Tropical Medicine & Global Health, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan.,Institute of Tropical Medicine, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan
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Gupta-Wright A, Macleod CK, Barrett J, Filson SA, Corrah T, Parris V, Sandhu G, Harris M, Tennant R, Vaid N, Takata J, Duraisingham S, Gandy N, Chana H, Whittington A, McGregor A, Papineni P. False-negative RT-PCR for COVID-19 and a diagnostic risk score: a retrospective cohort study among patients admitted to hospital. BMJ Open 2021; 11:e047110. [PMID: 33563629 PMCID: PMC7874904 DOI: 10.1136/bmjopen-2020-047110] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To describe the characteristics and outcomes of patients with a clinical diagnosis of COVID-19 and false-negative SARS-CoV-2 reverse transcription-PCR (RT-PCR), and develop and internally validate a diagnostic risk score to predict risk of COVID-19 (including RT-PCR-negative COVID-19) among medical admissions. DESIGN Retrospective cohort study. SETTING Two hospitals within an acute NHS Trust in London, UK. PARTICIPANTS All patients admitted to medical wards between 2 March and 3 May 2020. OUTCOMES Main outcomes were diagnosis of COVID-19, SARS-CoV-2 RT-PCR results, sensitivity of SARS-CoV-2 RT-PCR and mortality during hospital admission. For the diagnostic risk score, we report discrimination, calibration and diagnostic accuracy of the model and simplified risk score and internal validation. RESULTS 4008 patients were admitted between 2 March and 3 May 2020. 1792 patients (44.8%) were diagnosed with COVID-19, of whom 1391 were SARS-CoV-2 RT-PCR positive and 283 had only negative RT-PCRs. Compared with a clinical reference standard, sensitivity of RT-PCR in hospital patients was 83.1% (95% CI 81.2%-84.8%). Broadly, patients with false-negative RT-PCR COVID-19 and those confirmed by positive PCR had similar demographic and clinical characteristics but lower risk of intensive care unit admission and lower in-hospital mortality (adjusted OR 0.41, 95% CI 0.27-0.61). A simple diagnostic risk score comprising of age, sex, ethnicity, cough, fever or shortness of breath, National Early Warning Score 2, C reactive protein and chest radiograph appearance had moderate discrimination (area under the receiver-operator curve 0.83, 95% CI 0.82 to 0.85), good calibration and was internally validated. CONCLUSION RT-PCR-negative COVID-19 is common and is associated with lower mortality despite similar presentation. Diagnostic risk scores could potentially help triage patients requiring admission but need external validation.
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Affiliation(s)
- Ankur Gupta-Wright
- Institute for Global Health, University College London, London, UK
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
- Department of Infectious Diseases, Ealing Hospital, London North West University Healthcare NHS Trust, London, UK
| | - Colin Kenneth Macleod
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
- Department of Infectious Diseases, Northwick Park Hospital, London North West University Healthcare NHS Trust, Harrow, UK
| | - Jessica Barrett
- Department of Infectious Diseases, Northwick Park Hospital, London North West University Healthcare NHS Trust, Harrow, UK
| | - Sarah Ann Filson
- Department of Infectious Diseases, Northwick Park Hospital, London North West University Healthcare NHS Trust, Harrow, UK
| | - Tumena Corrah
- Department of Infectious Diseases, Northwick Park Hospital, London North West University Healthcare NHS Trust, Harrow, UK
| | - Victoria Parris
- Department of Infectious Diseases, Ealing Hospital, London North West University Healthcare NHS Trust, London, UK
- Department of Infectious Diseases, Northwick Park Hospital, London North West University Healthcare NHS Trust, Harrow, UK
| | - Gurjinder Sandhu
- Department of Infectious Diseases, Ealing Hospital, London North West University Healthcare NHS Trust, London, UK
| | - Miriam Harris
- Department of Infectious Diseases, Northwick Park Hospital, London North West University Healthcare NHS Trust, Harrow, UK
| | - Rachel Tennant
- Department of Acute Medicine, Northwick Park Hospital, London North West University Healthcare NHS Trust, Harrow, UK
| | - Nidhi Vaid
- Department of Acute Medicine, Northwick Park Hospital, London North West University Healthcare NHS Trust, Harrow, UK
| | - Junko Takata
- Department of Elderly Care, Northwick Park Hospital, London North West University Healthcare NHS Trust, Harrow, UK
| | - Sai Duraisingham
- Department of Elderly Care, Northwick Park Hospital, London North West University Healthcare NHS Trust, Harrow, UK
| | - Nemi Gandy
- Department of Radiology, Northwick Park Hospital, London North West University Healthcare NHS Trust, Harrow, UK
| | - Harmeet Chana
- Department of Radiology, Northwick Park Hospital, London North West University Healthcare NHS Trust, Harrow, UK
| | - Ashley Whittington
- Department of Infectious Diseases, Northwick Park Hospital, London North West University Healthcare NHS Trust, Harrow, UK
| | - Alastair McGregor
- Department of Infectious Diseases, Northwick Park Hospital, London North West University Healthcare NHS Trust, Harrow, UK
| | - Padmasayee Papineni
- Department of Infectious Diseases, Ealing Hospital, London North West University Healthcare NHS Trust, London, UK
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Filson SA, Rahim A, Parris V, McGregor A, Papineni P. HIV testing during the COVID-19 pandemic. Clin Med (Lond) 2021; 21:e118-e119. [PMID: 33479099 DOI: 10.7861/clinmed.let.21.1.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
| | - Anika Rahim
- Royal Free London NHS Foundation Trust, London, UK
| | - Victoria Parris
- London North West University Healthcare NHS Trust, London, UK
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Wallis G, Siracusa F, Blank M, Painter H, Sanchez J, Salinas K, Mamuyac C, Marudamuthu C, Wrigley F, Corrah T, Rampling T, Logan S, Goodman A, Miller D, Williams B, McGregor A, Parris V, Sandhu G, John L, Papineni P, Whittington A. Experience of a novel community testing programme for COVID-19 in London: Lessons learnt. Clin Med (Lond) 2020; 20:e165-e169. [PMID: 32680837 DOI: 10.7861/clinmed.2020-0436] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
We describe the London community testing programme developed for COVID-19, audit its effectiveness and report patient acceptability and patient adherence to isolation guidance, based upon a survey conducted with participants.Any patients meeting the Public Health England (PHE) case definition for COVID-19 who did not require hospital admission were eligible for community testing. 2,053 patients with suspected COVID-19 were tested in the community between January and March 2020. Of those tested, 75 (3.6%) were positive. 88% of patients that completed a patient survey felt safe and 82% agreed that community testing was preferable to hospital admission. 97% were able to remain within their own home during the isolation period but just 41% were able to reliably isolate from other members of their household.The London community testing programme allowed widespread testing for COVID-19 while minimising patient transport, hospital admissions and staff exposures. Community testing was acceptable to patients and preferable to admission to hospital. Patients were able to reliably isolate in their home but not from household contacts. The authors believe in the importance, feasibility and acceptability of community testing for COVID-19 as a part of a package of interventions to mitigate a second wave of infection.
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Affiliation(s)
- Gabriel Wallis
- London North West University Healthcare NHS Trust, Harrow, UK
| | | | - Michael Blank
- London North West University Healthcare NHS Trust, Harrow, UK
| | - Helena Painter
- London North West University Healthcare NHS Trust, Harrow, UK
| | - Javier Sanchez
- London North West University Healthcare NHS Trust, Harrow, UK
| | - Kelcy Salinas
- London North West University Healthcare NHS Trust, Harrow, UK
| | | | | | | | - Tumena Corrah
- London North West University Healthcare NHS Trust, Harrow, UK
| | - Tommy Rampling
- The Hospital for Tropical Diseases, London, UK; and University College London Hospitals NHS Foundation Trust, London, UK
| | - Sarah Logan
- The Hospital for Tropical Diseases, London, UK; and University College London Hospitals NHS Foundation Trust, London, UK
| | - Anna Goodman
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - Bhanu Williams
- London North West University Healthcare NHS Trust, Harrow, UK
| | | | - Victoria Parris
- London North West University Healthcare NHS Trust, Harrow, UK
| | | | - Laurence John
- London North West University Healthcare NHS Trust, Harrow, UK
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Mattia JG, Vandy MJ, Chang JC, Platt DE, Dierberg K, Bausch DG, Brooks T, Conteh S, Crozier I, Fowler RA, Kamara AP, Kang C, Mahadevan S, Mansaray Y, Marcell L, McKay G, O'Dempsey T, Parris V, Pinto R, Rangel A, Salam AP, Shantha J, Wolfman V, Yeh S, Chan AK, Mishra S. Early clinical sequelae of Ebola virus disease in Sierra Leone: a cross-sectional study. Lancet Infect Dis 2015; 16:331-8. [PMID: 26725449 DOI: 10.1016/s1473-3099(15)00489-2] [Citation(s) in RCA: 126] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 11/19/2015] [Accepted: 11/25/2015] [Indexed: 01/09/2023]
Abstract
BACKGROUND Limited data are available on the prevalence and predictors of clinical sequelae in survivors of Ebola virus disease (EVD). The EVD Survivor Clinic in Port Loko, Sierra Leone, has provided clinical care for 603 of 661 survivors living in the district. We did a cross-sectional study to describe the prevalence, nature, and predictors of three key EVD sequelae (ocular, auditory, and articular) in this cohort of EVD survivors. METHODS We reviewed available clinical and laboratory records of consecutive patients assessed in the clinic between March 7, 2015, and April 24, 2015. We used univariate and multiple logistic regression to examine clinical and laboratory features of acute EVD with the following outcomes in convalescence: new ocular symptoms, uveitis, auditory symptoms, and arthralgias. FINDINGS Among 277 survivors (59% female), median age was 29 years (IQR 20-36) and median time from discharge from an EVD treatment facility to first survivor clinic visit was 121 days (82-151). Clinical sequelae were common, including arthralgias (n=210, 76%), new ocular symptoms (n=167, 60%), uveitis (n=50, 18%), and auditory symptoms (n=67, 24%). Higher Ebola viral load at acute EVD presentation (as shown by lower cycle thresholds on real-time RT-PCR testing) was independently associated with uveitis (adjusted odds ratio [aOR] 3·33, 95% CI 1·87-5·91, for every five-point decrease in cycle threshold) and with new ocular symptoms or ocular diagnoses (aOR 3·04, 95% CI 1·87-4·94). INTERPRETATION Clinical sequelae during early EVD convalescence are common and sometimes sight threatening. These findings underscore the need for early clinical follow-up of survivors of EVD and urgent provision of ocular care as part of health systems strengthening in EVD-affected west African countries. FUNDING Canadian Institutes of Health Research.
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Affiliation(s)
- John G Mattia
- National Eye Health Program, Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone; Christian Blind Mission, Baptist Eye Hospital Lunsar and Lowell and Ruth Gess UMC Eye Hospital, Kissy, Freetown, Sierra Leone
| | - Mathew J Vandy
- National Eye Health Program, Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | | | | | | | | | - Tim Brooks
- Public Health England Port Loko Laboratory, Port Loko, Sierra Leone
| | | | - Ian Crozier
- World Health Organization, Sierra Leone Ebola Response Team, Freetown, Sierra Leone; Infectious Diseases Institute, Mulago Hospital Complex, Kampala, Uganda
| | - Robert A Fowler
- World Health Organization, Sierra Leone Ebola Response Team, Freetown, Sierra Leone; Department of Medicine, University of Toronto, Toronto, Canada
| | - Amadu P Kamara
- National Eye Health Program, Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone; Christian Blind Mission, Baptist Eye Hospital Lunsar and Lowell and Ruth Gess UMC Eye Hospital, Kissy, Freetown, Sierra Leone
| | - Cindy Kang
- Partners in Health, Port Loko, Sierra Leone
| | | | - Yealie Mansaray
- National Eye Health Program, Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone; Christian Blind Mission, Baptist Eye Hospital Lunsar and Lowell and Ruth Gess UMC Eye Hospital, Kissy, Freetown, Sierra Leone
| | | | | | - Tim O'Dempsey
- World Health Organization, Sierra Leone Ebola Response Team, Freetown, Sierra Leone; Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Ruxandra Pinto
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Audrey Rangel
- International Medical Corps, Port Loko, Sierra Leone
| | | | - Jessica Shantha
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, USA
| | | | - Steven Yeh
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, USA
| | - Adrienne K Chan
- World Health Organization, Sierra Leone Ebola Response Team, Freetown, Sierra Leone; Department of Medicine, University of Toronto, Toronto, Canada; Dignitas International, Toronto, Canada
| | - Sharmistha Mishra
- World Health Organization, Sierra Leone Ebola Response Team, Freetown, Sierra Leone; Department of Medicine, University of Toronto, Toronto, Canada.
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Chadwick DR, Sarfo FS, Kirk ESM, Owusu D, Bedu-Addo G, Parris V, Owusu AL, Phillips R. Tenofovir is associated with increased tubular proteinuria and asymptomatic renal tubular dysfunction in Ghana. BMC Nephrol 2015; 16:195. [PMID: 26627687 PMCID: PMC4666076 DOI: 10.1186/s12882-015-0192-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 11/24/2015] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND HIV infection is associated with increased risk of renal dysfunction, including tubular dysfunction (TD) related to antiretroviral therapy (ART). Tenofovir disoproxil fumarate (TDF) is becoming available for ART in sub-Saharan Africa, although data on its long-term safety there is limited. We aimed to study the prevalence of HIV-associated renal dysfunction in Ghana and explore associations between proteinuria or TD and potential risk factors, including TDF use. METHODS A single-centre cross-sectional observational study of patients taking ART was undertaken. Creatinine clearance (CrCl) was calculated and proteinuria detected with dipsticks. Spot urinary albumin and protein:creatinine ratios (uACR/uPCR) were measured and further evidence of TD (defined as having two or more characteristic features) sought. Logistic regression analysis identified factors associated with proteinuria or TD. RESULTS In 330 patients, of whom 101 were taking TDF (median 20 months), the prevalence of CrCl < 60 ml/min/1.73 m(2), dipstick proteinuria and TD was 7 %, 37 % and 15 %. Factors associated with proteinuria were baseline CD4-count [aOR 0.86/100 cell increment (95 % CI, 0.74-0.99)] and TDF use [aOR 2.74 (95 % CI, 1.38-5.43)]. The only factor associated with TD was TDF use [aOR 3.43 (95 % CI, 1.10-10.69)]. In a subset with uPCR measurements, uPCRs were significantly higher in patients taking TDF than those on other drugs (10.8 vs. 5.7 mg/mmol, p < 0.001), and urinary albuin:protein ratios significantly lower (0.24 vs. 0.58, p < 0.001). CONCLUSIONS Both proteinuria and TD are common and associated with TDF use in Ghana. Further longitudinal studies to determine whether proteinuria, TD or TDF use are linked to progressive decline in renal function or other adverse outcomes are needed in Africa.
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Affiliation(s)
- David R Chadwick
- Centre for Clinical Infection, James Cook University Hospital, Middlesbrough, TS4 3BW, UK.
| | - Fred S Sarfo
- Kwame Nkrumah University of Science & Technology, Kumasi, Ghana. .,Komfo Anokye Teaching Hospital, Kumasi, Ghana.
| | - Elaine S M Kirk
- Centre for Clinical Infection, James Cook University Hospital, Middlesbrough, TS4 3BW, UK.
| | - Dorcas Owusu
- Kwame Nkrumah University of Science & Technology, Kumasi, Ghana.
| | - George Bedu-Addo
- Kwame Nkrumah University of Science & Technology, Kumasi, Ghana. .,Komfo Anokye Teaching Hospital, Kumasi, Ghana.
| | - Victoria Parris
- Centre for Clinical Infection, James Cook University Hospital, Middlesbrough, TS4 3BW, UK.
| | | | - Richard Phillips
- Kwame Nkrumah University of Science & Technology, Kumasi, Ghana. .,Komfo Anokye Teaching Hospital, Kumasi, Ghana.
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Abstract
Cryptococcal meningitis causes morbidity and mortality worldwide. The burden of disease is greatest in middle- and low-income countries with a high incidence of human immunodeficiency virus (HIV) infection. Patients taking immunosuppressive drugs and some immunocompetent hosts are also at risk. Treatment of cryptococcal meningitis consists of three phases: induction, consolidation, and maintenance. Effective induction therapy requires potent fungicidal drugs (amphotericin B and flucytosine), which are often unavailable in low-resource, high-endemicity settings. As a consequence, mortality is unacceptably high. Wider access to effective treatment is urgently required to improve outcomes. For human immunodeficiency virus-infected patients, judicious management of asymptomatic cryptococcal antigenemia and appropriately timed introduction of antiretroviral therapy are important.
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Affiliation(s)
- Derek J Sloan
- Tropical and infectious Disease Unit, Royal Liverpool University Hospital, Liverpool, UK
| | - Victoria Parris
- Tropical and infectious Disease Unit, Royal Liverpool University Hospital, Liverpool, UK
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Parris V, Michie K, Andrews T, Nsutebu EF, Squire SB, Miller AR, Beadsworth MB. Schistosomiasis japonicum diagnosed on liver biopsy in a patient with hepatitis B co-infection: a case report. J Med Case Rep 2014; 8:45. [PMID: 24521427 PMCID: PMC3930008 DOI: 10.1186/1752-1947-8-45] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Accepted: 12/30/2013] [Indexed: 12/28/2022] Open
Abstract
Introduction Chronic hepatitis B virus and schistosomiasis are independently associated with significant mortality and morbidity worldwide. Despite much geographic overlap between these conditions and no reason why co-infection should not exist, we present what is, to the best of our knowledge, the first published report of a proven histological diagnosis of hepatic Schistosomiasis japonicum and chronic hepatitis B co-infection. A single case of hepatitis B and hepatic Schistosomiasis mansoni diagnosed by liver biopsy has previously been reported in the literature. Case presentation A 38-year-old Chinese man with known chronic hepatitis B virus infection presented with malaise, nausea and headache. Blood tests revealed increased transaminases and serology in keeping with hepatitis B virus e-antigen seroconversion. A liver biopsy was performed because some investigations, particularly transient elastography, suggested cirrhosis. Two schistosome ova were seen on liver histology, identified as S. japonicum, probably acquired in China as a youth. His peripheral eosinophil count was normal, schistosomal serology and stool microscopy for ova, cysts and parasites were negative. Conclusion Hepatic schistosomiasis co-infection should be considered in patients with hepatitis B virus infection who are from countries endemic for schistosomiasis. Screening for schistosomiasis using a peripheral eosinophil count, schistosomal serology and stool microscopy may be negative despite infection, therefore presumptive treatment could be considered. Transient elastography should not be used to assess liver fibrosis during acute flares of viral hepatitis because readings are falsely elevated. The impact of hepatic schistosomiasis on the sensitivity and specificity of transient elastography measurement for the assessment of hepatitis B is as yet unknown.
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Affiliation(s)
- Victoria Parris
- Tropical and Infectious Disease Unit, Royal Liverpool University Hospital, Prescot Street, Liverpool, Merseyside L7 8XP, UK.
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