3. Electronic Theses and Dissertations (ETDs) - All submissions
Permanent URI for this communityhttps://wiredspace.wits.ac.za/handle/10539/45
Browse
3 results
Search Results
Item The effect of fortified food, e'pap, on oral candidiasis in adult TB patients attending clinics in Alexandra, Johannesburg, South -Africa(2014-08-26) Phyo, U Wai LinIntroduction The association between tuberculosis (TB) and malnutrition is well known. Malnutrition also weakens the immune system increasing the chance of latent TB progressing to active disease. Nutritional interventions can help improve overall quality of life and can reduce susceptibility to opportunistic infections including all forms of Oral Candidiasis (OC) which includes: (1) pseudomembranous candidiasis (oral thrush), (2) atrophic (erythematous) candidiasis, (3) hyperplastic candidiasis, and (4) angular cheilitis. This secondary data analysis of a longitudinal follow-up study evaluates the impact of a fortified supplementary food on OC among adult TB patients over a three month period. Results At baseline, an overall prevalence of 33% of OC (27 out of 83) was found in 83 adult TB patients; (pseudo-membranous 46% (16 out of 35), erythematous 26% (9 out 35), angular chelitis 20% (7 out 35) and hyperplastic 8% (3 out of 35). Thirty five different types of OC were found in 27 of the subjects some of whom manifested with more than one type of OC. Almost 89% of these TB patients had low levels of malnutrition (8% for selenium, 55% for iron, 62% for Vit-A, 42% for albumin, 47% for Vit-D and 34% for zinc). Their p values related to OC were (p=0.64 for selenium, p=0.74 for iron, p=0.19 for Vit-A, p=1 for albumin, p=1 for Vit-D and p=0.09 for zinc) showing no statistically significant difference for malnutrition in each different type of micronutrient related to OC at baseline. However, there was a statistically significant difference in HIV status (p=0.01) related to OC among factors such as sex (p=0.34), employment status (p=0.74), ARV status (p=0.46) and wellbeing (p=0.18) at baseline. OC was statistically significant at both 2nd and 3rd visits using univariate analysis p=0.04 (95%CI 0.22 to 0.97) and p=0.00 (95%CI 0.06 to 0.43) and also multivariate analysis p=0.01(95%CI 0.17 to 0.85) and p=0.00 (95%CI 0.04 to 0.34) with reference to the 1st visit (the prevalence of OC was significantly decreased in both 2nd and 3rd visits). For different types of clinical OC, pseudomembranous candidiasis was the only type of OC that showed statistically significant difference at the 3rd visit in both univariate analysis (p= 0.01, 95%CI 0.01 to 0.46) and multivariate analysis (p= 0.00, 95%CI 0.01 to 0.38) with reference to 1st visit. Discussion and Conclusions This study found no significant association between overall micronutrient level and the presence of OC at baseline. However, micronutrient interventions to the 83 adult TB patients receiving treatment at Johannesburg city clinics located in Alexandra showed a decrease in prevalence of different types of OC in both 2nd and 3rd visits. This analysis showed encouraging results which indicated a beneficial effect of e’Pap in adult TB patients.Item The relationship between oral candidiasis and micronutrient deficiency in an adult TB cohort in Alexandra, Johannesburg(2013-01-25) Thekiso, Maphefo DesireeTuberculosis (TB) is a major public health problem worldwide, and particularly in South Africa. Micronutrient deficiency (malnutrition) is caused by insufficient supply of vitamins and minerals for normal cell function in the body. Nutritional deficiencies in minerals, vitamins and diets rich in carbohydrates have been implicated in the pathogenesis of oral candidal infections. Malnutrition and wasting are associated with TB, and HIV/TB co-infection may potentially worsen the wasting that occurs in TB or HIV infection alone. Aim of the study was to investigate the relationship between micronutrient deficiency and Oral Candidiasis (OC) in adult TB patients. The prevalence of OC and its association with malnutrition in terms of Zinc (Zn), Iron (Fe), Albumin, Selenium (Se),Vitamin A (Vit A) and Vitamin D (Vit D) deficiencies were evaluated in a cross sectional study among eighty eight (n=88) TB adult patients. Patients underwent a complete oral examination for presence and type of OC and blood collection was done for serum nutritional assessment for levels of the micronutrients (Zn, Fe, Albumin, Se, Vit A and Vit D). Results: The mean age was 36 years of age, with the majority being females (60%) and HIV positive (69.3%). The prevalence of OC was 60% with pseudomembranous OC (48%) being the most common. Serum concentrations for Zn deficiency (< 8.2 μmol/L) was 69.4%, Vit A deficiency (< 1.05 μmol/L) was 52.3%, Albumin deficiency (< 35 g/L) was 69%, Se deficiency (< 46 μg/L) was 93.2%, Fe deficiency (< 9 μmol/L) was 53.7% and Vit D deficiency (< 49 nmol/L) was 45.1%. OC was prevalent in 40% (Zn deficiency), 25% (Vit A deficiency), 32% (Albumin deficiency), 33% (Se deficiency), 31% (Fe deficiency) and 36% (Vit D deficiency). However, there was no significant association between micronutrient deficiency and OC (p > 0.05). Conclusion: These data demonstrate that OC in TB adult patients is not associated with micronutrient malnutrition. Longitudinal studies are required to investigate the relationship between micronutrient deficiency and OC in adult TB patients further.Item Candida infection in oral lesions of kaposi sarcoma(2011-11-11) Sibda, ArshaadBackground Oral candidiasis is the most common infection of the oral mucosa of HIV-seropositive patients, although its frequency is rapidly decreasing with the advent of highly active antiretroviral therapy (HAART). Many questions regarding its complex pathogenesis remain unanswered. The diagnosis is usually established with non-invasive techniques such as mucosal smears. Oral lesions of HIV-associated Kaposi sarcoma (HIV-KS) are routinely biopsied and frequently show secondary infection with Candida albicans or other Candida species. Aims and objectives The aim of this investigation was to determine the frequency and histomorphology of secondary Candidal infection of the surface epithelium of oral HIV-associated KS lesions (HIV-KS), which are routinely biopsied in HIV infected patients. Materials and methods Haematoxylin and eosin (HE), and Periodic Acid-Schiff (PAS) stains of 133 cases of oral Kaposi sarcoma diagnosed between the period 2003 and 2007 within the Division of Oral Pathology were examined histologically for intensity and morphology of Candidal colonisation, depth of invasion, number of organisms, epithelial reactions and associated inflammatory response. The depth of Candidal invasion and severity of infection were correlated with the available CD4 T cell counts of HIV seropositive patients at the time of biopsy. Results Almost forty one percent (40.62%) of all oral HIV-KS cases were secondarily infected with Candida species. The intensity varied from an isolated single pseudohyphus to matted colonies of vegetative yeasts and psuedohyphae. Whilst in most cases the organisms did not invade beyond the parakeratin layer, pseudohyphae were noted extending into the stratum spinosum in 2 cases, and a single case showed a pseudohyphus within the lamina propria. A further 2 cases showed pseudohyphae growing in the pyogenic membrane. Neutrophilic permeation of the epithelium and Munro micro-abscess formation, features commonly associated with Candidal infection, were frequently present even in the absence of Candidal infection. Candidal organisms were often present in the absence of inflammation. Conclusion Oral lesions of HIV-KS are commonly secondarily infected with large numbers of Candidal organisms. The morphological characteristics of secondary Candidal infection within the surface epithelium of HIV-KS lesions suggest an altered pathogenetic pathway. Further studies are necessary in this regard.