By Stephanie Menikou, PhD student, Faculty of Medicine
Kawasaki disease (KD) was first identified in 1967 by the Japanese paediatrician Tomisaku Kawasaki. He saw his first case in 1960 and over a period of six years he identified 50 cases of this distinct unusual illness.1 50 years later, we still don’t know its cause, or whether it is caused by an infectious organism, a toxin, a chemical substance or something else. Kawasaki disease has emerged as the most common cause of childhood heart disease in many developed countries.2 Over 60 countries around the globe have reported cases and currently in many countries it’s on the rise. The highest incidence rate currently recorded is in Japan with 264.8/100 000 children, followed by South Korea (134.4/100 000) and Taiwan (74.9/100 000).3 The incidence rate reported in most European countries is somewhat lower (<16/100 000).4
By Professor Thomas Williams, Chair in Haemoglobinopathy Research, Faculty of Medicine, Department of Medicine
Sickle Cell Disease (SCD) is the commonest serious genetic condition of humans. The disease is caused by an inherited defect in haemoglobin, the red pigment within red cells that is important for the carriage of oxygen in the blood, and results in a life-long illness characterised by recurrent pain, ill health and chronic anaemia.
The past three decades have witnessed impressive results in leprosy control through global effort. Early detection of disease through door-to-door survey and treatment by multi-drug therapy (MDT) in domiciliary setting ensured high rates of cure (WHO). The focus was to identify and manage high-risk patients prone to complication likes reactions and peripheral nerve function impairment (NFI).
Khayelitsha, a peri-urban township outside of Cape Town, South Africa, has some of the highest rates of HIV and TB in the world. Many members of this community have had personal experiences with TB and HIV, either being directly infected or as a result of the death of loved ones. This is also the setting for a major clinical research site established by The Clinical Infectious Diseases Research Initiative (CIDRI). The research group, which focusses on finding better ways to intervene in and understand HIV-associated TB, was established by Professor Robert Wilkinson and has laboratory and academic space at the Institute of Infectious Disease and Molecular Medicine (IDM).
By Professor Sarah J Fidler, Professor of HIV and Communicable Diseases at Imperial College London
There are over 37 million people living with HIV globally and in the UK this is now over 100,000 people.
There has been the most dramatic improvement in the treatment and care now available for people living with HIV; a result of combination antiretroviral therapy (ART). This represents a huge success in terms of life expectancy as well as reducing the risk of passing virus infection from an HIV-positive person to their partners or children. In fact, if people start on ART when they first test HIV-positive and remain on treatment so that the level of virus in their blood tests remains below the limit of detection; “undetectable” they can expect to live a normal healthy life and not risk passing the virus on to their partners or children.
Cardiovascular disease (CVD) causes 17.5 million deaths each year. Most of these deaths are from heart attacks and strokes, and many are premature. Although outstanding progress has been made in CVD awareness, prevention and treatment, three out of every 10 deaths this year will still be result of CVD.
A global epidemic, cardiovascular disease is the leading cause of mortality and morbidity worldwide, affecting all regions regardless of income. Low-and middle-income countries make the largest contribution to the burden of CVD, particularly in terms of deaths in people aged 30 to 70 years, and those figures are still rising. However, CVD deaths and disability are not inevitable and up to a quarter could be avoided with more effective strategies for primary and secondary prevention. The ‘what’ is well-known, with a range of well-established, evidence-based and effective interventions. But knowing what to do has not proved enough to ensure effective implementation at scale. The ‘how’ still eludes us in some areas, and for some populations.
Mr Masters Chisale (Mzuzu Central Hospital) and Dr Chris Watson (Queens Universty Belfast) preparing the samples in Mzuzu Central Hospital.
The last week has been very busy in Mzuzu, northern Malawi. Scientists there have been packing blood and urine samples collected from 506 children with pneumonia in preparation for shipment to Dublin, Ireland. These samples will travel 12,000km at -80oC with constant monitoring of their temperature and dry ice being packed around them at stops along the journey to ensure they remain frozen in the warm heat of Africa as they travel across the African and European continents.
Over the past twelve months the researchers from the gHealth Research group based in University College Dublin, Queens University Belfast & Imperial College London have been working with colleagues in Malawi to collect these samples. The BIOTOPE (BIOmarkers TO diagnose PnEumonia) project is an innovative project which received funding from the Gates Foundation Grand Challenges Exploration Fund to investigate new ways to diagnose bacterial and severe pneumonia in the community. 506 children have participated in the research and as part of this, blood and urine samples have been collected and are now being shipped to Ireland for detailed analysis along with novel data from sensors and mobile phone applications monitoring the children’s health. With this approach, new ways to help stop the million children dying each year from pneumonia are being developed along with approaches that will help reduce antibiotic resistance both in Africa and internationally.
Pneumonia continues to be the number one infectious killer of children under the age of 5 years worldwide – more than HIV, TB, Zika, Ebola and malaria combined.
People of any age in any country are at risk of contracting pneumonia but the vast majority (>90%) of childhood deaths from pneumonia occur in poor countries.
Antibiotic resistance is present in every country in the world and as recently as the 21st September 2016 the UN held a general assembly on antibiotic resistance. This was only the fourth such General Assembly high-level event in the history of the UN to focus on a health issue highlighting the serious nature of this problem.(more…)
‘Oncho blind’ – 60 years ago blind older people were led by children
There are five neglected tropical diseases (NTDs) which are the scourge of Africa, the Indian sub-continent, the Far East and South America. Onchocerciasis is one of these 5 and until the late 20th century caused millions of people to gradually lose their sight and eventually go blind. The parasite is spread by infected Simulium blackflies which when they bite a human, transfer microscopic larvae to the human host, where they develop into adult worms and females produce millions of new larvae during their lifetime. It is these larvae that are the cause of irreversible blindness in as many as 25% of the adult population in several countries in Africa. Onchocerciases was also prevalent in some countries in South America.
Another cause of blindness in the poorest populations globally is the NTD trachoma. Caused by certain subtypes of the Chlamydia infection, it is spread through contact with discharge from the eyes or nose of an infected person. In developing countries, eye-seeking flies are a major cause of transmission, particularly in areas where water to wash is in short supply.
‘Trachoma flies’ – After conjunctivitis eyelashes scratch the cornea causing blindness.
The remaining three major NTDs, schistosomiasis, lymphatic filariasis and soil-transmitted helminths do not directly affect eye health but overlap geographically with onchocerciasis and trachoma and debilitate in other harmful ways.
All 5 of these NTDs can be controlled by the annual administration of safe oral medications. Onchocerciasis, and the resulting blindness and itching caused by the larvae are controlled by an annual dose of Mectizan (Ivermectin). Trachoma is controlled by an annual does of Zithromax, and schistosomiasis is controlled by an annual dose of praziquantel. Albendazole treats both lymphatic filariasis and soil-transmitted helminths. All four medications are generously donated by the pharmaceutical companies which manufacture them (Merck Sharp Dom, Pfizer, E.Merck and GSK respectively). In 2015 almost 1 billion individuals globally have benefitted from treatment directly resulting from these donations. (more…)
‘Back in 2011, my research team published the results of the largest trial of critically ill children ever undertaken in Africa (FEAST trial), a trial that examined fluid resuscitation strategies in children with severe febrile illnesses (including malaria and bacterial sepsis). Contrary to expectation, the trial showed that fluid boluses were associated with an increased mortality compared to no-bolus (control), the greatest effect was in children with the most severe forms of shock. We were delighted when the FEAST trial won the prestigious 2011 BMJ Research Paper of the Year award and expected that doctors around the world would sit up and take notice – and guidelines for management of children suffering from shock due to sepsis would change.
However, five years on, I have to say that I am disappointed that the WHO guidelines in resource-poor settings are still largely unaltered. Although the humanitarian aid charity Medicins sans Frontieres changed its own procedures within nine months of our results becoming public, the directing and coordinating agency for international health of the United Nations has so far left existing guidelines in place. This is despite the fact that we found that the intervention of rapidly administering fluids was actually harmful to children in our study which was robust and based on sound scientific evidence. One statistician said it was the most consistent he had ever seen. (more…)
Chronic obstructive pulmonary disease (COPD) is characterised by chronic airflow obstruction and is the third most common cause of death worldwide, especially in low and middle income countries (LMICs). The main risk factor for this disease is tobacco smoking. However, smoking is still uncommon in many LMICs and more than 20% of people with COPD do not have a history of smoking.
What could then be causing COPD among people who do not smoke? Some have advocated that the high number of deaths by COPD among non-smokers, especially in LMICs, could easily be explained by a high exposure to smoke from burning biomass for cooking, heating and lighting. However, large studies have ailed to find an association of airflow obstruction with use of biomass.
Others have suggested that infectious diseases, which are still common in LMICs, could have a role in COPD. Pulmonary tuberculosis (TB) is the leading cause of mortality due to respiratory infection worldwide, but with its death rate decreasing since 1990 several millions of people are saved every year. Broadly speaking there is considerable overlap between regions with high incidence of TB and high mortality from COPD, therefore it makes sense to improve our understanding of the relationship between these two diseases.
Kawasaki disease (KD) was first identified in 1967 by the Japanese paediatrician Tomisaku Kawasaki. He saw his first case in 1960 and over a period of six years he identified 50 cases of this distinct unusual illness.1 50 years later, we still don’t know its cause, or whether it is caused by an infectious organism, a toxin, a chemical substance or something else. Kawasaki disease has emerged as the most common cause of childhood heart disease in many developed countries.2 Over 60 countries around the globe have reported cases and currently in many countries it’s on the rise. The highest incidence rate currently recorded is in Japan with 264.8/100 000 children, followed by South Korea (134.4/100 000) and Taiwan (74.9/100 000).3 The incidence rate reported in most European countries is somewhat lower (<16/100 000).4
