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HIGHLANDS MALARIA AMONG INTERNALLY DISPLACED REFUGEES IN MOUNTAIN AREAS OF KENYA, RWANDA AND BURUNDI

Vysokohorská malária u presídlených utečencov z horských oblastí Kene, Rwandy a Burundi


Daria KIMULI2,3, Maria KOMLOSI1, Ivan SZABO3, Frantisek BAUER2,3, Marian KARVAJ6, Jana OTRUBOVA2,3, Mario JANCOVIC1,2, Monika JANKECHOVA2, Kristína PAUEROVA1,2, Jaroslava POLONOVA2, Frantisek MATEICKA3, Marian BARTKOVJAK2, Vladimir KRCMERY2,7, Gertruda MIKOLASOVA2, Eva SMREKOVA1, Juraj BENCA2,3, Barbora DURCOVA2,  Dominik DORKO2, Miroslava BEDNARIKOVA3, Miriam SCHIFFERDECKER1,4, Daniela BARKASI1,4, Vitalis OKOTH3 and Michaela MULERA3

1St. Elisabeth University Tropical Programme, Gasura and Rutovu, Burundi
2 Slovak Tropical Institute, SEU, Bratislava, Slovakia
3St. Elisabeth Tropical Programme, St. Lesley College, Eldoret, Kenya
4St. Elisabeth Tropical Programme, Bigugu, Rwanda
5HIA Association and Charles Lwanga Clinic, Buikwe, Uganda
6St. Lesley College, Nove Zamky, Slovakia, EU
7Institute of Microbiology, School of Medicine, Comenius University, Bratislava, SK, EU

SUMMARY
Objectives: To assess the occurrence and clinical picture of highland malaria in marginalized patients living in the altitude of 2,000 metres and higher without travel history, in mountain areas of Kenya, Burundi and Rwanda.
Patients and methods. Within last 5 years number of admissions in all 4 CHCs (Bigugu, Rutovu, Eldoret, Kiziba) was similar with 8,500 – 10,000 patients per centre per year (2010 – 2015). Malaria diagnosis was set microscopically (according to WHO guidelines) and confirmed by rapid diagnostic test (RDT) performed according to manufacturer’s instructions. Proportion of malaria cases was compared in 4 CHCs (Bigugu - Rwanda, located in 2,100 m. a. s.; Rutovu - Burundi, in 2,000 m. a. s.; Eldoret - Kenya, in 2,050 m. a. s., Kiziba – Rwanda).
Results. Proportion of “true” HLM (that means in those without travel history to lowland within last 2 months) was in (negative?) correlation with altitude. HLM was the least frequent in HC Bigugu (1,8%) in comparison to Eldoret (3,1%), Rutovu (4,1%). However, the differences were not significant. Only cases with clinical symptoms, microscopically and RDT positive were assessed. Concerning other infectious diseases in the centres, respiratory tract infections were responsible for 42 – 64% of all visits and the highest proportion was in correlation with altitude and was in HC Bigugu (Rwanda, 2100 m. a. s.). From 33 cases only 2 (6,6%) died and 3 (9%) had severe hypoglycaemia, 31 of 33 cases had severe anaemia.
Conclusion. The smallest occurrence of HLM was in CHC Bigugu, Rwanda which is located in the highest altitude – 2,100 m. a. s. (1,8% of all admissions). This proportion was increased in Eldoret, Kenya (3,1%), Rutovu, Burundi (4,1%), and Kiziba – Rwanda (5%). The occurrence of HLM correlated with the altitude. The “true” HLM is still very rare if patients with travel history to and from highlands are excluded.
Key words: highland malaria.
Lek Obzor (Med Horizon), 2019, 68(4): 149-150

IS THE HOMELESS SHELTERED POPULATION A PUBLIC HEALTH THREAT?

Sú bezdomovci ohrozením verejného zdravia?


Maria HARDY3, Marian MARTKOVJAK1, Anna BERESOVA3,7, Eliska KNOSKOVA3, Libusa RADKOVA1, Jana OTRUBOVA1,  
Lenka RABAROVA1,7, Alexandra TOPOLSKÁ1, Jaroslava POLONOVA1, Dagmar KALATOVA2, Gertruda MIKOLASOVA1,3,5,
Katarina PROCHAZKOVA1,5, Petra STANKOVA3, Anna LISKOVA1, Mariana MRAZOVA1,5, Michal Valach1,5, Michal OLAH4,5, Vladimir KRCMERY1,6, Maria JACKULIKOVA3, Jaroslava DRGOVA2, Milica PALENIKOVA2,3, Daniela BARKASI1, Bea BUGYIKOVA1, Blanka HOFBAUEROVA1, Miriam SCHIFFERDECKER7, Zuzana HATAPKOVA1 and Robert KOVAC2,3

1St. Elizabeth University Programe for PhD, MHA
2St. John Neumann Institute, Pribram, Czech Republic
3St. Elisabeth Shelter for Homeless Mea Culpa and Vagus, Bratislava Slovakia
4Shelters for Homeless Resoty, Mons. Srholec, Podunajské Biskupice
5Shelter for homeless in St. Louisa de Marillac, Bratislava
6School of Medicine, Institute of Microbiology, Bratislava, Slovakia
7Martin Luther College, SEU, Petrovac, Serbia
SUMMARY
Objective:  The aim of the study is to determine if homeless shelter based population represents risk for public health systems in Bratislava, with citizens of about 500 000.
Methods: Homeless population in the shelters in Bratislava underwent vaccination for 2 main respiratory pathogens, influenza and TB. This study aimed to assess the proportion of respiratory pathogens in 130 sheltered patients in two shelters in Bratislava and seek for multiresistant pathogens.
Results:  Only 1 homeless client was colonized by PRP (0,7%), and only one TB contact has been confirmed in 2017. No major outbreak of respiratory or gastrointestinal infections was noted in both shelters, one full board and one half board.
Conclusion: The study failed to document that sheltered homeless population in Bratislava represent public health problem. Concerning alert on respiratory pathogens, however, may not be valid in non-sheltered homeless population on the streets or camping outside.
Key words: homeless, respiratory pathogens, public health, TB.


Lek Obzor (Med Horizon), 2019, 68(4): 151-152

REVERSIBILITY OF ANTIBIOTIC RESISTANCE AMONG ORPHANS OF GENOCIDE SURVIVORS WITH AIDS
IN 2003 – 2017 IN PHNOM PENH, CAMBODIA

Reverzibilita antibiotickej rezistencie u sirôt s AIDS po genocíde v Phnom Penh (2003-2017), Kambodža


Hoang CHENG HOIN3,4 , Martina BENCOVA1, Veronika SLADECKOVA1,4, Jirina KAFKOVA3, Andrea KALAVSKA1,
Vladimir KRCMERY4, Frantisek MATEICKA3, Zuzana DUDOVA1, Barbora DURCOVA1, Erich KALAVSKY1, Petra STANKOVA,3, Dagmar KALATOVA2,3, Petra SLAVIKOVA3, Jana OTRUBOVA2,  Marian KARVAJ2, Alexandra TOPOLSKA3, Juraj BENCA1,3,
Michal KUNOSIK3, Anna LISKOVA1,3, Miriama BALAZOVA3, Maria KOMLOSI3, Lenka RABAROVA1,3, Milica PALENIKOVA3,
Blanka HOFBAUEROVA5 and Andrea SHAHUM1,3

1House of family and House of Hope, SEU programmes, Phnom Penh and Sihanoukville, Cambodia
2St. Lesley College, Nove Zamky, SK
3St. Elizabeth University PhD and MSc Program, Bratislava, Slovakia
4Comenius University, School of Medicine, Institute of Microbiology, Bratislava Slovakia
5Martin Luther College, SEU, Bački, Petrovac, Serbia
SUMMARY
Objective: Purpose of the study was to assess antimicrobial resistance dynamics and reversibility in the group of children with AIDS in Cambodia in 2003 - 2017.
Patients: Correlation between antimicrobial (ATB) resistances in 667 commonest respiratory isolates from 140 children and duration of antiretroviral therapy was studied from 2003 to 2017 in 667 isolates.
Results: All but 3 (98%) children showed a sustained CD4 increase after introduction of antiretroviral therapy (ART) followed by a decrease of ATB resistance. In our group of children restoration of the immune system decreased the number of infection diseases episodes and the proportion of multi-resistant bacterial strains.
Conclusions: Less frequent use of antimicrobial therapy probably led to the decrease of multi-resistance and restoration of susceptibility of studied respiratory bacterial isolates in HIV positive orphans.
Key words: HIV, AIDS, antimicrobial resistance.
Lek Obzor (Med Horizon), 2019, 68(4): 153-154

MIGRANTS AND REFUGEES FROM SYRIA AND IRAQ,
VIA BALKAN ROUTE ARE NOT A PUBLIC HEALTH THREAT (RESEARCH NOTE)

Migranti a utečenci zo Sýrie a Iraku cez „balkánsku trasu“ nepredstavujú hrozbu pre verejné zdravie (výskumná poznámka)


Peri HAJ ALI1,3, Jan BYDZOVSKY1,4, Ladislav BUCKO1, Kristina PAUEROVA1, Mario JANCOVIC1, Maria JACKULIKOVA1,3,4,
Jose SUVADA1, Katrin ZOLLER1, Daniela BARKASI1, Natasa BUJDOVA1, Lenka RABAROVA1, Alexandra TOPOLSKA2,3,
Monika JANKECHOVA1, Adriana DUDLOVA1, Juraj BENCA1, Michal VALACH1, Marian BARTKOVJAK1, Jana OTRUBOVA1,
Ludmila MATULNIKOVA1, Dagmar KALATOVA1, Jan CULKA3,4, Marian KARVAJ1, Vladimir KRCMERY4,5, Anna LISKOVA1,5,
Petra STANKOVA1, Petra SLAVIKOVA1, Jaroslava DRGOVA1, Milica PALENIKOVA1, Mariana MRAZOVA1,
Miriam SCHIFFERDECKER1, Ferenc BAUER1 and Gyorgi HERDICS1,3

1Migrant and refugee health program of SEU and St. Lesley College, Nové Zámky, Gabcikovo, Slovakia and St. John Neumann Institute, Pribram, Czech Republic
2UNHCR DobovaII, SEUC, Refugee Camp Dobova, Slovenia
3Health post Vamosszabadi and Hegyeshalom, Hungary
4 ICRC (Red Cross) Health posts Nickelsdorf, Austria
5Institute of Microbiology, School of Medicine, Comenius University, Bratislava, and National Centre of ATB Resistance, Nitra, Slovakia
SUMMARY
Background: Migrant crisis was acussed to be a potential cause of spreading resistant bacteria to Europe.
Patients and methods: About 319500 refugees from Syria, Iraq (95%) and Afghanistan (5%) visited health posts in Nickelsdorf (Austria), Hegyeshalom (Hungary) with symptomatic respiratory tract infections. Oropharyngeal swabs from these symptomatic patients were assessed for presence of resistant pathogens.
Results: In total, 6321 (2%) symptomatic patients presented with respiratory infections to the doctor. 9 of them were reffered due to severe or lower respiratory tract infection and 599 of them tested for respiratory isolates. Only 5 MRSA and 1 Streptococcus pneumoniae resistant to antibiotics (0.9% vs 0.2%) were isolated, together with one multiresistant Klebsiella pneumoniae.
Conclusions: Migrants and refugees from Middle East had not been identified as carriers of multiresistant pathogens.
Keywords: refugees, migrants, migrant health.
Lek Obzor (Med Horizon), 2019, 68(4): 155-156

COLONISATION OF MIGRANTS WITH MARINE BUT
NOT HUMAN PATHOGENS IN NORTHERN GREECE REFUGEE CAMPS VERIA AND ALEXANDRIA

Kolonizácia migrantov morskými – ale nie ľudskými patogénmi v utečeneckých táboroch Veria a Alexandria v severnom Grécku


Thomas SIMONEK2,3, Anna LISKOVA1,5, Mariana MRAZOVA1,2, Michal VALACH1, Michal KUNOSIK1,2, Jan BYDZOVSKY1,2, Dagmar KALATOVA1, Helena KALATOVA1, Alexandra TOPOLSKA1,2, Blanka HOFBAUER1,2, Selvaraj SUBRAMANIAM1, Milica PALENIKOVA1,2, Ferdinand SASVARY1,2, Miriam SCHIFFERDECKER1,2, Peri HAJ ALI1,2,3, Görgi HERDICS2, Maria JACKULIKOVA2,3, Barbora DURCOVA1, Veronika TOLNAY1, Ladislav BUCKO1,2, Vladimir KRCMERY4 and Katrin ZOLLER2,3

1St. Elisabeth Univ. Migrant Health Programme, Bratislava,
2St. John Neumann Institute Rescue program for refugees Dobova, Slovenia, Pribram Czech Republic
3UNHCR Camp Veria, Alexandria and Lesbos, Greece
4Institute of Microbiology, School of Medicine, Comenius University, Bratislava, and National Ref. Lab. for ATB Resistance, Nitra, Slovakia
SUMMARY
Objective: The purpose of this study  was to assess if regufees during their staying  in UNHCR camps are endogenous source of potential infectious diseases outbreaks, or just colonized by environmental pathogens.
Patients and methods: In the period of May 1. 2016 to April 30. 2017 (one year period) we have examined respiratory samples of all intpatients visits in two refugee camps in northern Greece with the capacity of 7000 and 500 migrants, asylum seekers and refugees from Syria/Iraq.
Results: 501 samples were obtained. No resistant respiratory human pathogens have been detected, such as S. aureus, Candida spp, however rare marine bacteria such as Plesiomonas shigelloides, Aeromonas hydrophila and Vibrio vulnificus were isolated. This most probably indicates their travel through sea and camping outside in the nature. This study didn‘t prove, that migrants from Syria/Iraq are source of resistant pathogens.
Key words: migrants, refugee health, marine strains.
Lek Obzor (Med Horizon), 2019, 68(4): 157-158

STRESS RELATED POSTTRAUMATIC SYNDROME WAS THE COMMONEST DISEASE IN THE ACUTE DISASTER SETTINGS, VERSUS CHRONIC LONG-TERM REFUGEES
IN LEBANON AND YEMEN

Stresový posttraumatický syndróm ako najbežnejšia choroba pri akútnej katastrofe versus chronický dlhodobý stress utečencov v Libanone a Jemene


Jozef SUVADA1,3, Thomas SIMONEK1,3, Magdalena SMET1,3, Martina VANDERBERGHE1,3, Mariana MRAZOVA2,
Vladimir KRCMERY1,2, Marian BARTKOVJAK1, Alex TOPOLSKA1, Juraj BENCA2, and Peri HAJ ALI1,3      

1SEU Refugee and Migrant Health Programe in Yemen and Kurdistan
2Slovak Tropical Institute of Slovak Medical University
3St. Charles Foucould Little sisters of Jesus OPD
SUMMARY
Objectives: War conflicts are in acute phase accompanied by waterborne and foodborne outbreaks or vaccine-shortage related communicable diseases such as cholera, typhoid, hepatitis A, leptospirosis and in chronic phase often followed by psychosocial stress related non-communicable diseases (diabetes mellitus, hypertension, coronary heart disease, asthma), to replace the infectious diseases.
Patients and methods: The purpose of this survey was to assess, if non-communicable diseases related to acute stress due to war conflicts in Yemen and long term Syrian and Iraqi refugees are prevalent over infectious diseases.
Results and discussion: In the acute phase camps related to ISIS military operations and refugee flow, majority of diseases were non-infectious such as posttraumatic stress disorder (PTSD), hypertension, asthma and diabetes. In „chronic“ phase refugee camps (3rd generation refugees from war conflict in Lebanon in 1960-1999, plus refugees from Syria and Yemen 2014-2018) among 5499 cases, again neuropsychiatric disorders - PTSD plus stress related neuropsychiatric diseases plus chronic depression represented up to 28% of all patient visits/OPD cases.
Conclusion: Surprisingly non-infectious diseases were more prevalent and expected acute war related outbreaks such as contaminated wound infections, crush syndromes, sepsis, water-related outbreaks have not been observed. Neuropsychiatric disorders - PTSD plus stress related neuropsychiatric diseases and chronic depression represented up to 28% of all patient visits/OPD cases.
Key words: refugees, migrant, health, posttraumatic stress syndrome.
Lek Obzor (Med Horizon), 2019, 68(4): 159-161

DECREASE OF TUBERCULOSIS FOLLOWING AND DECLINE OF THE AIDS AFTER IMPLEMENTING PREVENTIVE STRATEGY 2009-2017 IN DISPLACED POPULATION AFTER TRIBAL CONFLICT IN NORTH WESTERN KENYA

Zníženie výskytu tuberkulózy po poklese AIDS po vykonaní preventívnej stratégie 2009-2017 u vysídlenej populácie po kmeňovom konflikte v severo-západnej Keni


Katarina MULAMA1,2, Michaela MULERA1,3, Frantisek MATEICKA1, Tomas RUSNAK1, Iveta GAGOVA4, Peter VASKO1, Mario JANCOVIC1, Kristina PAUEROVA1,4, Barbora SILHAROVA3, Viktor NAMULANDA1,2, Vladimir KRCMERY3, Marian KARVAJ2,
Jose SUVADA1,3, Daria KIMULI1,2 and Vitalis OKOTH1

1Mary Immaculate Centre and VCT centre, Nairobi, Kenya
2St. Elisabeth University, Slovak Tropical Institute, St. Lesley College, Nove Zamky, Slovakia
3Institute of Microbiology of Comenius University, Bratislava, Slovakia
4Naivasha Maternity Clinic, SEU Maternity Health Programme, Naivasha, Kenya
SUMMARY
Objective: Purpose of the study was to compare typical opportunistic infection in highly endemic AIDS region before and after highly active antiretroviral therapy (HAART) was used within visiting. Councelling and testing programme (VCT)
Patients and methods: In 1998 – 2007 and 2008 – 2017 two decades of incidence and occurrence of OI in patients diagnosed with AIDS was compared. A) Mary Immaculate Clinic VCT AIDS in  internally displaced economic migrants from rural and other Kenya (group 1), 1998 – 2007, before HAART was started and B) HIV in North Kenya within Eldored in an area of displaced population after tribal conflict in 2007 between Luo and Kalenjin  tribes.
Results: First cohort consisted of patients in Mukuru Slums Nairobi6 In 1998 – 2007 was composed of 99,317 outpatient visits and second cohort in Eldoret, of 89,979 outpatient visits. HIV incidence was about 2,100/100,000 in MIC Nairobi and 2,080/100,000 in Eldoret respectively in 1998-2007, and decreased significantly to 1,200-800/100,000 for 2015-2017. The decrease of AIDS (absolute counts – 110 in 2009 to 59 in 2017 one per 5-10,000 visits) was followed with the decrease of the occurrence of lung tuberculosis (TBC) from 37 (2009) to 11 (2017).
Conclusion: The only two atypical opportunistic infections diagnosed in AIDS patients in North-western Kenya in an OPD clinic in Eldoret, 1) oropharyngeal candidiasis and 2) lung tuberculosis. We have not observed any single case of Cryptococcus or Toxoplasma CNS infections or Pneumocystis jirovecii pneumonia after 2008.
Key words: AIDS, tuberculosis.
Lek Obzor (Med Horizon), 2019, 68(4): 162-164

SLOW PROGRESSORS AND LATE PRESENTERS OF PEDIATRIC AIDS AMONG STREETCHILDREN SHELTERED
IN PHNOM PENH AND SIHANOUKVILLE, CAMBODIA

Pomaly progredujúci a neskoro sa prejavujúci detský AIDS medzi “deťmi ulice” sústredenými v Phnom Penh a Sihanoukville, Kambodža


Andrea SHAHUM1, 4, Peri HAJ ALI1,4, Maria CHABADOVA1, Erich KALAVSKY1,4, Juraj BENCA1,4, Mariana MRAZOVA2, Silvia DOBRODENKOVA1,2, Selvaraj SUBRAMANIAM2,4, Mario JANCOVIC1,2, Gertruda MIKOLASOVA2, Zuzana DUDOVA2, Vladimir KRCMERY1,3 and Lenka PANDYA1,2

1 House of Family and House of Hope, Phnom Penh and Sihanoukville, Cambodia
2SEUC MsC and PHD programme, Bratislava, Slovakia
3Institute of Microbiology, Comenius University, Bratislava, Slovakia
4 IGAP Vienna and St. Elisabeth University MsC program, Kuala Lumpur, Malaysia
SUMMARY
Objective: Slow progressors and late presenters of AIDS in are rarely seen in Southeast Asia, because children at age of 10 - 15 years without suppression of HIV die. The purpose of this paper was to review a group of children with AIDS - late presenters and slow progressors, coming to our programme in Phnom Penh and Sihanoukville and to compare clinical parameters and mortality to other children with AIDS.
Patients and methods: Children with AIDS and opportunistic infections who presented to our projects and started antiretroviral therapy too late according to the guidelines valid in 2003 – 2005 (< 200 CD4 per cubic millimetre) were compared to non-late presenters – children with AIDS.
Results: Relatively high proportion of slow progressors was found among HIV-infected sheltered orphans in two AIDS pediatric programs in Cambodia. Mortality in late presenters is higher than in non-late presenters and also opportunistic infections were higher in the group of late presenters, including HZV and TB.
Keywords: HIV in children, late presenters, HIV mortality.
Lek Obzor (Med Horizon), 2019, 68(4):165-167

VACCINATIONS AND OTHER TRAVEL MEDICINE PREPARATIONS OF MISSIONAIRES AND HUMANITARIAN WORKERS BEFORE ACUTE TRAVEL FOR TROPICS

Vakcinácia a zdravotná príprava humanitárnych pracovníkov pred akútnou cestou do trópov


Marian BARTKOVJAK1, Vladimir KRCMERY1,2

1 Slovak Tropical Institute of St. Elisabeth University, Bratislava, Slovakia
2 School of Microbiology, Commenius University, Bratislava, Slovakia
SUMMARY
Number of missionaires and humanitarian workers leaving to work or volunteer to tropical low income countries is increasing. Their health protection is essential, especially when leaving within humanitarian emergency without sufficient time to prepare to protect themselves against deadly tropical diseases, such as tuberculosis, HIV, malaria, yellow fever, ebola, rabies etc. This minireview discuss possibilities for routine or acute action for infection prevention of humanitarian staff travelling for missions worldwide.
Keywords: humanitarian aid, travel medicine, travel prophylaxis, preventive vaccines.

Lek Obzor (Med Horizon), 2019, 68(4): 168-171