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Background: Neurocysticercosis (NCC) and human immunodeficiency virus (HIV) have high disease burden and are prevalent in overlapping low- and middle-income countries. However, little is known about how these two infections interact, its bearing on disease progression which could impact treatment guidance for people living with HIV/AIDS (PLWH/A) co-infected with NCC. Objective: To evaluate the peripheral immune response associated with T. solium neurocysticercosis in HIV patients, specifically by determining the host pro- and anti-inflammatory cytokines in neurocysticercosis and determine their possible roles as biomarkers. Methods: This on-going study recruits adults living in southern highlands of Tanzania, an area endemic for cysticercosis. Serum was obtained from HIV+ patients and their HIV- controls who were matched for gender, age and living area. Their T. solium antibodies (Ab) were measured using LDBio cysticercosis western blot IgG and antigen (Ag) status was determined using ApDia ELISA test which detects circulating antigens from viable metacestode. Neurocysticercosis (NCC) was determined by computed tomography using standard diagnostic criteria and neurological manifestations were confirmed by a standard neurological examination. The cysticercosis positive criteria was defined as: having a positive T. solium result for both antibody and antigen, antigen alone, imaging alone or a combination of suggestive imaging and positive serology. Using multiplex detection technology, sera from participants were assayed for levels of different inflammatory and regulatory cytokines. In addition, demographic, clinical and neuroimaging data were collected and CD4+ cell counts as well as information on highly active antiretroviral treatment (HAART) were noted. Results: Comparable levels of inflammatory cytokines was observed between HIV+ and HIV- people likely due to 87.7% (1125 out of 1283) being on ART. When we stratified further by T solium infection; levels of inflammatory cytokines (TNF-a, IFN-g, vCAM-1 and IL12) were significantly higher in HIV + positive individuals co infected with T solium cysticercosis compared to those not co-infected with T. solium cysticercosis (p 0.05). Among the HIV+ group, T solium cytokine concentration was not associated with CD4+ cell counts, or duration on ART. Conclusions: HIV patients co-infected with T. solium cysticercosis have an inflammatory immune response profile which may cause a poor disease prognosis. [ABSTRACT FROM AUTHOR]

The primary aims of tuberculosis (TB) control programmes is early diagnosis and prompt treatment of infectious cases to limit transmission. Failure to diagnose and adequately treat TB could lead to premature death and unrecognized transmission of Mycobacterium tuberculosis. The proportion of missed TB cases has not been reported in Tanzania. The objective of this study was to quantify the number of cases of TB identified by autopsy. Deceased morbid bodies from Muhimbili National Hospital were involved. Retrieval of admission, diagnostic and other important records used to manage the patient after admission was done. Demographic information, site and type of disease, past medical history, chest x-ray report, clinical diagnosis and cause of death reported upon death certification were recorded. Lung tissues, lymphnodes and blood clots for HIV testing were collected. Biopsy tissues were processed through Ziehl Nielsen staining and examined by microscopy. The study involved 74 deceased individuals where 56 (75.7%) were males. Information for duration of seeking health care before death was available for 41(55.4%) subjects. Thirty-four (45.9%) cases received diagnosis before death. The main diagnoses were pneumonia 10(13.5%), heart failure 6(8.1%), AIDS-related illnesses 6 (6.8%) and malaria 5 (6.8%). The main clinical findings were wasting (51/74 (68.9%)) and abnormal fluid collection in different body cavities, 61(50.8%). In 24 out of 71(33.8%) biopsies acid fast bacilli (AFB) were detected. Records of lymphnodes examination were available in 63 cases and 22 of them had AFB. Twenty-two (34.9%) from the paratracheal and hilar lymphnodes were observed to have AFB. HIV was detected by ELISA in 19 (33.3%) out of 57 deceased, and 12 (63.2%) of the HIV positive deceased were co-infected with TB. Out of the 22 cases positive for AFB on tissue-biopsies 12 (54.5%) were HIV positive. There is a high number of TB cases diagnosed after death that could not be detected before they died. There is a need for increased awareness and to include postmortem data in the annual statistics of TB for precise reporting of the magnitude of the TB burden in the country. [ABSTRACT FROM AUTHOR]