Up to 14% of Malawian adults die during the intensive phase of tuberculosis treatment. In a prospective cohort of 199 Malawian adults with microbiologically confirmed pulmonary tuberculosis, clinical and laboratory parameters were compared between those who died or deteriorated with those who had an uneventful recovery. Baseline tumor necrosis factor alpha responses to stimulation with heat-killed Mycobacterium tuberculosis and lipopolysaccharide were reduced among the 22 patients with poor outcome (P = .017). Low body mass index (P = .002) and elevated respiratory rate (P = .01) at tuberculosis diagnosis independently predicted poor outcome. Validation of a clinical score identifying high-risk individuals is warranted, together with further investigation of immunological derangements.

ABSTRACT:Tubifex tubifex has been shown to survive in organic polluted environments, however, not much has been done on its inorganic pollution tolerance. Samples of T. tubifex and their respective sewage sludge were taken from Soche wastewater treatment plant in Blantyre City, Malawi during July 2007 to November 2008. The total number of sludge samples taken was fifty one which was made into seventeen composite samples. A total of seventeen T. Tubifex samples were also collected. The samples were analyzed for copper, lead, manganese, zinc and cadmium using standard methods from American Public Health Association and Association of Official Analytical Chemists. The concentrations of metals in sewage sludge and T. tubifex were on dry weight basis and the metals determined were acid extractable. In general, heavy metals concentration was lower in T. tubifex than in sewage sludge. The range of heavy metals concentrations were (in sludge and (T. tubifex)): zinc 275.3 -361.5 mg/kg (45.0 -82.2 mg/kg), manganese 293.7 -230.1 mg/kg (1.21 -3.69 mg/kg), copper 86.5 -120.1 mg/kg (1.6 -4.7 mg/kg), lead 11.2 -22.4 mg/kg (Below detection limit -0.95 ) and cadmium 1.12 -2.31 mg/kg (1.08 -2.18 mg/kg). The results showed significant differences between the concentrations of manganese, copper, lead and zinc in sewage sludge and T. tubifex (p < 0.05). However there was no significant difference between the concentrations of cadmium in sewage sludge and T. tubifex (p > 0.05). T. tubifex did not show the ability to accumulate heavy metals (attributed to its high defecation and metabolic rate) except for cadmium hence cannot be used as a bioindicator for heavy metal pollution in sludge.