Hi Vincent, Dickson and Daniel: Happy New Year.
Great to find a new instalment so soon into the year!
I enjoyed this week’s diversions into the wider mysteries of ‘Life; The Universe, and; Everything’, from Dickson, and Daniel’s African excursions, and all your TWiPS down Memory Lane (Though I have to say, when you get into metabolomics and quantum computing, I get to feel quite inadequate, and as uneasy about believing mathematicians, as I am with magicians and pickpockets that I can’t follow either! 🙂 ).
In hearing, again, your delight with the John Updike poem, it struck me that you might not have picked up the allusion in the title, to the nursery rhyme where he has replaced ‘Jack’ with ‘V.B’.
It might interest you to add more breadth with how some other artists, that you know, also commandeered the ‘be quick’ meme for their own creations:
Apparently, sayeth Wiki, to jump over a lighted candlestick without putting it out, was thought to be good luck, and required skill, speed, and dexterity: very fitting for the fast-working and versatile Prof. Wrigglesworth, I should think!
Cool blue, grey and pink tinged dawn, puffy clouds, here (Do you remember ‘The Land of Grey and Pink’, by the Canterbury band Caravan? The album cover will give you an idea of the sky here at the moment. You’ll find some great word play there too.), with the starlings and sparrows just getting up for a chat and early check on the neighbour’s bird tables. All rather pleasantly peaceful, in fact.
All the best,
From Luton, England.
Caitlin & Carrie write:
We cry foul play. This could be virtually any worm short of a nightcrawler and any disease short of St. Vitus’s Dance. If it were not in Uganda, we would half suspect the patient to be a four-year-old female penguin. Most unfair!
For the differential, we would be entirely within our rights to direct you to the table of contents of Parasitic Diseases, 6th ed., but as loyal listeners we will attempt to winnow out the three or four parasites it couldn’t be.
The obvious helminthic suspects are the notorious Ascaris lumbricoides, hookworm, Strongyloides, and schistosomes, all of which pass through the lungs as part of their life cycle and wreak havoc. Paragonimus lung flukes are also on the table. She could have picked up any of these beasties from the dirt, water, and animals around her. True, these all usually cause other symptoms as well – but in a small child, who knows what will happen and what will be observed first?
On the non-helminthic side, it could be Entamoeba histolytica, Balantidium coli, and Toxoplasma gondii (though the latter two are fairly unlikely to cause the described symptoms and nothing else). It could even be malaria (https://www.ncbi.nlm.nih.gov/pubmed/17154671) although it’s not the stereotypical presentation. Since it’s the end of the rainy season, malaria should be peaking and definitely a possibility, especially as malaria is more likely to present atypically in a child this young.
Our knowledge of Ctrl-Fu fails us here, as Parasitic Diseases has one (1) result for tachycardia, which is a scorpion sting. The thought of lung scorpions is alarming, but blessedly implausible. Ctrl+F “lung” brings up, as discussed earlier, the entire book. Well played, Daniel. Ctrl+F you
On the non-parasitic side, this little girl has lung crackles, fever, a fast heart rate, and a headache. Conclusion: she is sick. Tuberculosis? Influenza? Who knows?
Whatever she has, the other kids visiting the clinic – from a wide area – have it too: we’re expecting the result to be an infection of high incidence amongst children in impoverished communities in this part of Africa, rather than an epidemic in the region of something unusual. That of course narrows it down to… everything we’ve already suggested.
Among the available tests, the malaria and TB ones are the most urgent – the rapid malaria test would be a good start as it’s… rapid. If negative, microscopy could still be a good idea as it can be more sensitive, as well as the TB test. If we weren’t limited to what was available, we would request: a stool O&P, a blood count, a chest X-ray, and a whole wagonload of antibody tests.
Given the non-specificity of the symptoms, it is hard to suggest a treatment. If the malaria tests are positive, she should be treated with artemisinin-based combination therapy. If the TB test is positive, an appropriate antibiotic. If neither – well, given the setting, it is very likely that she has some infection which could be treated with albendazole, even if the direct cause of these symptoms isn’t. It would help with quite a few of the things on this list, so it’s as good a stab in the dark as any (there is a reason we are not doctors.)
For what it’s worth, our money’s on malaria, but in this case it really is just a guess.
We’ve both won books at this point, so either leave us out of the draw, or donate it to a library if we win. Not the formal way – just leave it on a shelf or table. Perhaps switch its dust jacket or Dewey Decimal number with that of The Art of the Deal.
This comes from your favourite transatlantic, temporarily parted partnership (it’s hard to listen to TWiP with someone who’s moved another three time-zones away from you) now back in action: Caitlin, now of Seattle, and Carrie, of Newcastle-upon-Tyne, England.
In the last episode’s case, we have seen that even the seemingly straightforward cases aren’t necessarily so trivial, emphasizing the importance of precise diagnosis in order to provide the best treatment. This time the case gives us a wider range of possible diagnoses, yet a much more limited diagnostic (and therapeutic) procedures for the MD in charge. I believe that the four-year-old kid is suffering from acute malaria. The fact that we are now in subsaharan Africa + recent rainy period + common presentation in other individuals + nonspecific signs of generalized infection makes me comfortable to say that. Of the nine tests that Daniel listed, obviously the microscopic examination of the blood smear and a malaria rapid testing come in handy. Since the signs started just a day ago it is probable that the child is still early in the acute phase and that with proper medication – e.g. artesunate, quinine or quinidine, complications like cerebral malaria could be prevented. I read somewhere on the net that up to 10% of deaths in African kids is attributed to malaria!
Dear DVD (Dickson, Vincent, and Daniel),
Let me just correct me here for one mistake in my previous Email. When talking about therapy for mucocutaneous Leishmaniasis, I wrote Vet Parasitology 6th edition, when I meant your Parasitic diseases 6th edition, the book that you’re so kindly giving away now for a while. It’s just that I’m surrounded with so many Vet books now preparing the ECVP board exam… Actually, the only book that is not veterinary and is included in my study list is the Robbins and Cotran Pathologic Basis of Disease Professional Edition (9th Ed), a book that at least Daniel is surely familiar with.
As a final remark, I just wanted to express my admiration for Daniel’s volunteer work in Africa (and of course in other less developed countries). A lot of times we (individuals living in the developed world) think of our lives as difficult and see our problems as big… Yet we rarely realize that there are so many people that indeed fight some real and existential problems. And people like Daniel make their lives at least a bit easier.
Thank you, and I hope I didn’t go too much of the track…
PS – Big like for the previous and current running habits
Ivan from sleepy Zagreb [zah-greb] or /ˈzɑːɡrɛb/
Hello, Drs. TWiP!
I’m writing with both a case guess and a heroine. Feel free to use the attached short biography of Ann Bishop in full or paraphrased as you see fit. Bishop was something of a super-heroine, and I am excited to get to write about her and share her story. Also, it was a pleasure meeting Vincent while he was visiting Madison for his talk and live TWiV. (It is still only moderately cold here, at about 22 degrees Fahrenheit, and the lakes still aren’t completely frozen over.) Thank you very much for speaking to us–I’ll look forward to running into you again!
Here is my guess for the case of the Ugandan four-year-old:
I believe this young child with one day of fever, headache, and cough, with a rapid heart rate and crackly lungs, is suffering infection with Ascaris lumbricoides. A pneumonia-like syndrome can develop during the early phase of infection, when the larvae migrate into the lungs before being coughed up and swallowed back into the intestines. The sudden onset of the fever, cough, and rapid heart rate and the ill appearance of the the child probably indicate the child was recently infected, and thus the larvae have reached the lungs; the child might be experiencing Loffler’s syndrome. Adult female ascaris worms can produce up to 200,000 very hardy eggs per day, which exit the host in feces, so it is no wonder that there were many others from the area showing similar symptoms, especially given the children’s stream-swimming pastime (or maybe just because kids play in dirt). I would imagine the rainy season helped wash eggs from the soil into the stream, resulting in widespread infection. For diagnosis, I would order a stool O&P to look for ascaris eggs, although I do not think there would be eggs in the feces yet at this stage of the worms’ life cycle. So if O&P was negative, I would use ultrasound to look for worms in the liver or pancreas or perhaps the lungs. I would treat this child (and all the others similarly ill) with a single dose of albendazole (400 mg) or mebendazole (500 mg). Hopefully, with the rainy season ending, eggs remaining in the environment will have long exposure to sunlight, one of the few ways to destroy them. The parasitic differential for the case includes hookworms and Strongyloides stercoralis, both of which can result in a pneumonia-like syndrome and both of which can be found in Uganda, though I believe the clinical picture and story fits better with A. lumbricoides. The non-parasitic differential includes all the bacteria and viruses that can cause respiratory symptoms in young children.
I spent a little time working in Uganda. A physician with whom I worked told me she avoided becoming ill from worms by taking a dose of albendazole every six months, and she encouraged me to do the same. Is this a practice Dr. Griffin follows on the completion of his trips?
Thanks as always for your wonderful and informative podcast!
In Eastern Uganda (Bududa district) at the tail end of the rainy season a four-year-old child with a day’s worth of fever, cough, headache comes to clinic where Dr. Griffin notes tachycardia and right lower lobe crackles on auscultation.
For someone unfamiliar with tropical pediatrics, how can such nebulosities, such maddening generalities, be made clear? Medicine, though aspiring to be a science, usually turns out to be a series of (sometimes miserable) compromises. The confluence of incomplete information and poor or nonexistent clinical histories, misleading symptoms, absence of proven therapies, false negative lab tests, cognitive biases, and many other deficiencies can occasionally turn medicine into a proverbial dog’s breakfast. Fortunately, despair, with a little massaging, can be reformed into a path forward.
Corny and fusty as it may seem, a review of Hippocrates’ Aphorism II might help: “Wherefore respect must be had to the region, time, age, and diseases, in which it is agreeable or not.”
Likelihoods in this case will guide us. According to Lowlaavar (2016) The most common clinician assigned diagnoses (for hospitalized Ugandan children age 6 months-5 y/o) included clinical malaria (49.7%) pneumonia (31.4%) and gastroenteritis/diarrhea (7.8%). In Uganda, malaria accounts for 30-50% of all outpatient visits, 35% of all hospital visits, and 9-14% of all hospital deaths (half of those being children under five years of age.)
The region: Uganda has one of the highest ‘entomological inoculation rates’ in the world, meaning exposure to infectious mosquitos.
The Season: according to Yeka (2012) malaria transmission does not have significant seasonal variation in Uganda. Contradicting this is Kamya (2015) who clearly notes peak malaria transmission following the two rainy seasons (March–May and August–October), and states, “We found highly seasonal transmission and varied relationships between measures of transmission, infection, and disease.”
The patient age: Age under five years is a risk factor for severe malaria and mortality due to malaria. This vulnerability is in part due to inadequate protective immunity.
The probability is that this child has falciparum malaria. The early presentation has a typical constellation of non-specific symptoms. Pulmonary findings are common in malaria and can become quite marked in ‘severe malaria’. The dilemma here is deciding if this child has concurrent pneumonia (relevant references pertaining to malaria/pneumonia co-infection are in the endnotes.) Available and relevant diagnostic tests in our case are blood smear and malaria molecular rapid test. The blood smear can occasionally be negative, so the availability of the rapid test is reassuring. Since urinalysis is available, this might be of value to check for bilirubin (to assess hemolysis) and specific gravity (to assess hydration status). If the patient has not been HIV tested, this will have a future benefit and may also guide pneumonia therapy. I will not digress into the world of other co-infections (charmingly described as ‘polyparasitism’ in the Kwan reference), but there are some interesting disease associations to consider. Likewise, co-infection with TB, HIV, childhood enanthems and exanthems and other respiratory viruses will be dispensed with in the interest of time.
Treatment should be with artemisinin-based combination therapy (ACT). If the patient develops more severe symptoms treatment with parenteral artesunate is recommended. If there is clinical suspicion of pneumonia (common culprits are Strep pneumoniae and H. influenza) antibiotic therapy should be started in addition to ACT. Amoxicillin has been recommended by the WHO.
This case became much more dramatic for me when I saw the 2016 U5MR (under-5 mortality rate=the probability per 1000 live births that a newborn will die before age 5) for Uganda (53/1000) versus the United States (7/1000).
Thanking TWiP educators and disease fighters.
ENDNOTES AND REFERENCES
Malaria in Uganda: challenges to control on the long road to elimination. I. Epidemiology and current control efforts, Adoke Yeka, Acta Trop. 2012 Mar; 121(3): 184–195. OPEN ACCESS:
“Malaria is reported by the Ministry of Health (MOH) as the leading cause of morbidity and mortality in Uganda, accounting for approximately 8–13 million episodes per year, 30–50% of outpatient visits at health facilities, 35% of hospital admissions, 9–14% of hospital deaths (nearly half of those in children less than 5 years of age) and a great many deaths occurring outside of health-care settings…FALCIPARUM LEADS BY ALL MEASURES=Although all four species of malaria parasites exist in Uganda, P. falciparum is responsible for the vast majority of cases (Uganda Ministry of Health, 2005). Other species appear to each account for <5% of cases, with a few percent of infections due to mixed species. In 2009 determinations based on blood smears, 99% of infected children had P. falciparum, 2% P. vivax, 2% P. malariae, and <1% P. ovale; 3% carried mixed species infections (Uganda Bureau of Statistics, 2010) ….The climate in Uganda allows stable, year round malaria transmission with relatively little seasonal variability in most areas. Malaria is highly endemic in ~95% of the country, representing ~90% of the population of ~33 million (Figure 1). Indeed, some of the highest recorded entomological inoculation rates (EIR, infective mosquito bites per person year) in the world have been seen in Uganda..”
Variation in malaria transmission intensity in seven sites throughout Uganda, Okello PE, et al., Am J Trop Med Hyg. 2006;75:219–225.
“Clear differences in annual entomological inoculation rates (AEIR) were observed between the study sites, ranging from 4 infective bites per person per year in the southwestern part of the country to >1,500 infective bites per person per year in a swampy area near the Nile River.” Regarding season and transmission: The daily EIR (entomological inoculation rate) showed seasonal fluctuations depending on the study site. The lowest values were observed at the end of the long dry season (February).”
Respiratory Manifestations of Malaria, Walter R. J. Taylor et al, Chest. 2012 Aug;142(2):492-505
“40% of children with severe falciparum malaria have respiratory distress. Its diverse causes include respiratory compensation of metabolic acidosis, noncardiogenic pulmonary edema, concomitant pneumonia, and severe anemia….ARDS is rare in young children…The best antimalarial treatment of severe malaria† is IV artesunate
Definition of severe malaria=multi-organ dysfunction (e.g. cerebral malaria, metabolic acidosis, renal failure, acute lung injury, severe anemia) In children: more common is–severe anemia, convulsions, hypogycemia…
LUNG Sx=20-50% have dry cough (vivax or falcip) Respiratory distress can be caused by severe anemia, fever, metabolic acidosis, concurrent pneumonia, aspiration pneumonia, fluid overload. In African children, respiratory distress is associated with a fourfold increase in the risk of death….African children presenting with severe falciparum malaria…7-16% had resp. distress. The incidence of respiratory distress is lower in vivax malaria (between 1-10%)”
( † see definition of ‘severe malaria’ at end of Malaria Reference section)
“I feel so bad but have nothing to do.” Exploring Ugandan caregivers’ experiences of parenting a child with severe malaria and subsequent repeated uncomplicated malaria, Nakitende, Ann et al. Malar J (2018) 17:360
A sort of sociological study of how childhood malaria affects parents and particularly mothers of sick or repeatedly sick children. Contains some heartbreaking anecdotes.
Over-Diagnosis And Co-Morbidity Of Severe Malaria In African Children: A Guide For Clinicians, Samson Gwer, Am J Trop Med Hyg. 2007 Dec; 77(6 Suppl): 6–13. , Open Access
Study location: Kenya ” We believe that routine use of parenteral antibiotics among children with a positive malaria slide and life-threatening disease is warranted because invasive bacterial infections are likely to be under-ascertained and are associated with increased mortality.”
Regarding artemisinin-based combination therapy (ACT)
Definition of ‘severe malaria’: =multi-organ dysfunction (e.g. cerebral malaria, metabolic acidosis, renal failure, acute lung injury, severe anemia) from Chest 2012 review cited above.
ii. PNEUMONIA AND RESPIRATORY INFECTION
Childhood pneumonia in developing countries, Rasa Izadnegahdar et al, Lancet Respir Med 2013; 1: 574–84
Nearly 1·2 million children younger than 5 years die every year from pneumonia.
Bacterial aetiology and outcome in children with severe pneumonia in Uganda. Nantanda R, et al Ann Trop Paediatr. 2008 Dec;28(4):253-60
S. aureus, S. pneumoniae and H. influenzae are common bacterial causes of severe pneumonia.
Home and community management of acute respiratory infections in children in eight Ugandan districts, Källander K et al, Ann Trop Paediatr. 2005 Dec;25(4):283-91.
“Acute respiratory infections (ARI), especially pneumonia, are the second largest child killer in sub-Saharan Africa. Symptoms, including cough and difficult/rapid breathing, frequently overlap those of malaria. In Uganda, the Home-Based Management (HBM) strategy treats all childhood fevers as malaria in the community, ignoring the pneumonia symptom overlap….”
The study addresses the ‘family care practice’ of treating all fevers in children under five years of age as due to malaria. “To increase prompt and appropriate treatment of malaria, the Home-Based Management of Fever (HBM) strategy was adopted in Uganda in 2002, providing prepacked antimalarials (‘Homapaks’) through village drug distributors and instructing mothers to treat all fevers in children under-5 in the home.”
Pneumonia among children under five in Uganda: symptom recognition and actions taken by caretakers, Doreen Tuhebwe, Afr Health Sci. 2014 Dec; 14(4): 993–1000.
“These general danger signs include: inability to feed, incessant vomiting, lethargy/unconsciousness and convulsions while the pneumonia specific danger signs include lower chest wall in drawing and stridor.”
The integrated management of childhood illness in western Uganda, P.R. Kolstad et al, Bulletin of the World Health Organization, 1997, 75 (Supplement 1): 77-85
No seasonal variation was noted in pneumonia incidence between cold/wet vs warm/dry season
Seroepidemiology of helminths and the association with severe malaria among infants and young children in Tanzania.,Kwan JL et al, PLoS Negl Trop Dis. 2018 Mar 26;12(3)
“Co-infection with filarial (Wucheria bancrofti) or Strongyloides stercoralis is a risk factor for the development of severe malaria. In Tanzania Wucheria bancrofti and Plasmodium falciparum share the same vector (Anopheles mosquito). In Tanzania up to 11% of school children are co-infected with Wucheria. In their study, 2 ½ year…in Tanzania (O.volvulus, S mansoni, S haematobium, soil nematodes/Strongyloides… The significant association between filarial sero-status at 6 months and subsequent severe malaria infection highlights the need for further investigation to assess whether the increased risk is due to a shared vector or if immune modulation is occurring.”
Interesting word used in this article: polyparasitism
Pediatric in-Hospital Death from Infectious Disease in Uganda: Derivation of Clinical Prediction Models, Nasim Lowlaavar, PLoS ONE 11(3) 2016: e0150683. https://doi.org/10.1371/journal.pone.0150683
2 hospitals in Mbarara, Uganda n=1,824 children 6 months to 5 years… The most common clinician assigned diagnoses included clinical malaria (49.7%) pneumonia (31.4%) and gastroenteritis/diarrhea (7.8%).
Schistosomiasis in infants and pre-school-aged children in sub-Saharan Africa: implication for control, Ekpo UF, Parasitology. 2012 Jun;139(7):835-41
” These studies point to a growing body of evidence that in many endemic communities, schistosomiasis
infection – contrary to previous beliefs – starts in early childhood. The presence of infection, points
to the fact that infants and pre-schoolers are also at risk of infection like their older school-aged counterparts. The growing concern here is that infection in infants and pre-school-aged children may persist
until the child starts school if left untreated…. Studies on water-contact activities and risk factors for infants and pre-school-aged children are scanty. In many of the studies reported thus far, water-contact activities were investigated through questionnaires and focus discussion groups (FDGs) with guardians and caregivers and with older preschool-aged children. These studies have pointed to the fact that mothers and caregiver expose their infants to infested water in the absence of other safer sources.”
United Nations Inter-agency Group for Child Mortality Estimation (UN IGME), ‘Levels & Trends in Child Mortality: Report 2017, Estimates Developed by the UN Inter-agency Group for Child Mortality Estimation’, United Nations Children’s Fund, New York, 2017.
The under-5 mortality rate, 2016: Uganda=53/1000, United States 7/1000 [Definition. The under-five mortality rate is the probability (expressed as a rate per 1,000 live births) of a child born in a specified year dying before reaching the age of five if subject to current age-specific mortality rates. The World Bank Group.]
iv. FACTS, LISTS, GENERAL PEDANTRY
I would discourage attempting a direct Google search when seeking technical medical information. Though one can be lucky with a shotgun Google search and occasionally obtain some usable results, the signal to noise ratio quickly leads to frustration and reader fatigue. PubMed is the best first search strategy, and I highly recommend the advanced search option and the use of the index names (what used to be called MeSH headings). Here you can construct a very specific search and modify the results as needed. If you are interested in historical information I highly recommend google books : https://books.google.com/. Quite a few contemporary medical texts are viewable here (though usually not in entirety, and not downloadable). Regarding historical sources however, especially 18th century medical treatises, it is a free-for-all with a wealth of downloadable texts that were originally scanned at Harvard, Stanford, and many other major libraries.
Mortality tables for the United States 2016 ( page 33), National Vital Statistics Reports, Vol. 67, Table 6. Number of deaths from selected causes, by age: United States, 2016
All cause deaths in the entire United States for the age 1-4 year/old group= 4,045. This is a total number of deaths, not a rate. To compare, in 2015 the estimated under 5 y/o malaria mortality in Uganda was estimated to be 6,375 (again, this figure is a total, not a rate.)
Lists the many infectious risks in Uganda: cholera, Hep A,B, malaria, meningococcus, HIV, typhoid, rabies, yellow fever, sleeping sickness, African tick fever (rickettsia), Chikungunya, dengue, tuberculosis
Malaria facts: Uganda
Uganda Severe malaria facts—
- Severe anemia in children increased by 1.5% from 4.6% (2014) to 6.1% (2016), but an overall decrease from 9.7% (2009)
- Uganda has moved from 3rd (2010) to the 6th (2012) highest number of annual deaths from malaria in Africa
- Contributes to about 5% of global malaria deaths
- Case fatality in children under 5 malaria admissions decreased from 3.5% in 2011 to 0.72% in 2013, well below the targeted 1% set for 2015
- Inpatient malaria data are not readily available and the impact of malaria control interventions on severe malaria and deaths cannot be ascertained
- 2009 – 2014: national prevalence of malaria decreased from 42% to 19%
- Severe anemia improved from 9.7% in 2009 to 4.6% in children 0–59 months of age (<8.0 g/dL)
- Malaria upsurge from April – June 2015: 50/112 districts saw an 80% increase in malaria admissions compared to the baseline
Uganda Malaria burden source: WHO World Malaria Report 2015, 2016 & 2017
Inpatient Cases (2015): 621,737
Reported Deaths: 5,635
Estimated Deaths: 12,060
Presumed and Confirmed Cases: 9,385,132
Suspected cases: 7,770,000
Under 5 mortality (2015): 6,375*
*Maternal and Child Epidemiology Estimation
from CDC Yellow Book:
Malaria in Uganda: Areas with malaria: All, Estimated relative risk of malaria for US travelers: High. Drug resistance4: Chloroquine. Malaria species: P. falciparum >85%; remainder P. malariae, P. ovale, and P. vivax. Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.
website of the Holy Innocents Children’s Hospital in Uganda
a very sobering web page:
- Malaria is a life-threatening parasitic disease transmitted by mosquitoes.
- Malaria is the leading cause of death in Uganda.In Uganda, 35,000 – 50,000 children under 5 die of malaria each year. Yet it is a preventable, treatable disease.
- Without treatment, a child with acute malaria may die within 24 hours.
- Malaria accounts for 40% of Ugandan public health expenditure, 30-50% of inpatient admissions, and up to 50% of outpatient visits in areas with high malaria transmission.
- In industry and agriculture, malaria accounts for more than 50% of all man hours lost. This affects production and revenue for the industry, families and the nation. Malaria is therefore a leading cause not only of ill health and death in Uganda but also of poverty.
- Malaria is eminently treatable. Children can be saved if immediate hospitalization and treatment is available, typically for just a few days or a week.
§§ Respiratory Diseases/Pneumonia
Respiratory diseases are the second-highest cause of death in children under 5 in Uganda. Twenty-one percent of all under-5 deaths in Uganda are due to respiratory infection. According to the Uganda Bureau of Statistics, early diagnosis and treatment with antibiotics can prevent a large proportion of deaths caused by respiratory infection.
Dysentery is another prevalent cause of death in children under 5 in Uganda. Seventeen percent of all under-5 deaths in Uganda are due to dehydration brought on by dysentery, even though dysentery can be easily treated with oral rehydration therapy. In the southwest region of Uganda, where Mbarara is located, only half of children with dysentery are currently treated by health providers. Holy Innocents Children’s Hospital now provides additional capacity to treat these children.
FIRMC (Foundation for International Relief of Children)
Bududa district in eastern Uganda—MEDIUM TO HIGH ENDEMICITY DISTRICT (ACCORDING TO YEKA 2012)
A TERMINAL CURIOSITY:
He is said to prevent the progress of a disease in its beginning, that is not ignorant of its origin. Explanation: He that considers the original cause of a disease, will easily find a Remedy. C J Sprengell 1708, translation of the Sentences of Celsus.
Hi TWIP team,
I’m a new TWIP listener in Atlanta, Georgia where I’m finishing my M.S. in public health and hoping for Microbiology PhD program acceptances.
To diagnose this infection, I’d request a stool specimen and conduct a stool examination to look for my suspect, Ascaris lumbricoides. This soil-transmitted helminth, commonly known as roundworm, while often asymptomatic, is known to cause all of the mentioned symptoms: fever, headache, cough, tachycardia, and crackles as well as myalgia, malaise, shortness of breath, wheezing, and chest pain. Of note, a stool examination will only yield eggs if the patient has been infected for a while, usually about 40 days.
To treat ascaris, I’d suggest mebendazole and/or albendazole.
Lastly, to toss some public health in here, ascaris infects approximately 1.2 billion people around the world. It’s susceptible to mass drug administration of albendazole, along with hookworm and whipworm, as well as improvements in water, sanitation, and hygiene.
Lisa E. Emerson
Co-leader | Rollins School of Public Health Ambassadors
MSPH Candidate 2019 | Global Epidemiology
Rollins School of Public Health | Emory University