Background Schistosoma haematobium is a waterborne parasite that may cause female genital schistosomiasis (FGS), characterized by genital mucosal lesions. There is clinical and epidemiological evidence for a relationship between FGS and HIV. We investigated the impact of FGS on HIV target cell density and expression of the HIV co-receptor CCR5 in blood and cervical cytobrush samples. Furthermore we evaluated the effect of anti-schistosomal treatment on these cell populations.DesignThe study followed a case-control design with post treatment follow-up, nested in an on-going field study on FGS.MethodsBlood and cervical cytobrush samples were collected from FGS negative and positive women for flow cytometry analyses. Urine samples were investigated for schistosome ova by microscopy and polymerase chain reaction (PCR).ResultsFGS was associated with a higher frequency of CD14+ cells (monocytes) in blood (11.5% in FGS+ vs. 2.2% in FGS-, p = 0.042). Frequencies of CD4+ cells expressing CCR5 were higher in blood samples from FGS+ than from FGS- women (4.7% vs. 1.5%, p = 0.018). The CD14+ cell population decreased significantly in both compartments after anti-schistosomal treatment (p = 0.043). Although the frequency of CD4+ cells did not change after treatment, frequencies of CCR5 expression by CD4+ cells decreased significantly in both compartments (from 3.4% to 0.5% in blood, p = 0.036; and from 42.4% to 5.6% in genital samples, p = 0.025).ConclusionsThe results support the hypothesis that FGS may increase the risk of HIV acquisition, not only through damage of the mucosal epithelial barrier, but also by affecting HIV target cell populations, and that anti-schistosomal treatment can modify this.

A previously healthy 74-year-old Caucasian man with penicillin allergy was admitted with evolving headache, confusion, fever, and neck stiffness. Treatment for bacterial meningitis with dexamethasone and monotherapy ceftriaxone was started. The cerebrospinal fluid showed negative microscopy for bacteria, no bacterial growth, and negative polymerase chain reaction for bacterial DNA. The patient developed hydrocephalus on a second CT scan of the brain on the 5th day of admission. An external ventricular catheter was inserted and Listeria monocytogenes grew in the cerebrospinal fluid from the catheter. The patient had severe neurological sequelae. This case report emphasises the importance of covering empirically for Listeria monocytogenes in all patients with penicillin allergy with suspected bacterial meningitis. The case also shows that it is possible to have significant infection and inflammation even with negative microscopy, negative cultures, and negative broad range polymerase chain reaction in cases of Listeria meningitis. Follow-up spinal taps can be necessary to detect the presence of Listeria monocytogenes.

Background: Uganda Prisons Service (UPS) is responsible for the health of approximately 32,500 inmates in 233 prisons. Inmates turn over frequently with approximately 100,000 entering/exiting the system per year; 55% are on remand awaiting trial. The 2011World Health Organization Ugandan TB incidence estimate was 193/100,000. A 2008 rapid prison assessment estimated TB prevalence at 654/100,000. However, little is known about TB treatment completion in sub-Saharan African prisons. We analyzed national UPS data to determine TB incidence and treatment completion in Ugandan prisons.Methods & Materials: We conducted a retrospective study of all TB-diagnosed prisoners > 18 years of age recorded in UPS TB registers from June 2011-November 2012. Registers were analyzed for TB diagnosis, TB-HIV co-morbidity, and treatment outcome, which included: i) treatment completion (full prescribed duration documented), ii) default, iii) death, or iv) failure. We tracked transferred patients between prisons and recorded those released.Results: A total of 469 prisoners were diagnosed with TB, resulting in an incidence of 955/100,000 person-years. Ninety-eight percent were male and 58% [95% confidence interval (CI): 53-62%] were HIV co-infected. Of 466 prisoners starting TB treatment: 48% [CI: 43-52%] completed treatment, 43% [CI: 39-48%] defaulted, 5% [CI: 3-7%] died, and 4% [CI: 2-5%] were still on treatment. During treatment, of 199 prisoners remaining in the same prison, 12% [CI: 7-16%] defaulted, and of 137 prisoners transferred, 53% [CI: 45-62%] defaulted. Of those defaulting in prison 77% [CI: 69-86%] defaulted after transfer. Of 130 prisoners released during treatment, 81% [CI: 74-88%] were lost to follow-up. In multivariable analysis, the odds for TB treatment default were 8.4 times greater among transferred prisoners than among prisoners who were not transferred during TB treatment. Sex, age, HIV status, and disease class were not associated with default.Conclusion: TB incidence in Uganda prisons is five-fold higher than the general population and treatment completion is lower (48% versus 67%). Among those defaulting on treatment while in prison, the majority defaulted after prison transfer. Improved follow-up is urgently needed within prisons to ensure treatment completion post-transfer, and public clinic linkage upon release, to prevent possible development of multidrug-resistant TB.