Browsing by Author "Mugerwa, Roy"

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    Body composition among HIV-Seropositive and HIV-Seronegative adult patients with Pulmonary Tuberculosis in Uganda
    (Elsevier Inc, 2009) Mupere, Ezekiel; Zalwango, Sarah; Chiunda, Allan; Okwera, Alphonse; Mugerwa, Roy; Whalen, Christopher
    Body wasting is a prominent and cardinal feature of tuberculosis (TB) (1, 2) and is a marker of disease severity and outcome. In sub-Saharan Africa, a large proportion of patients with TB also have coinfection with human immunodeficiency virus (HIV) (3). Coinfection may worsen the wasting seen in either TB or HIV infection alone (4, 5). Wasting in TB is associated with reduced caloric intake due to anorexia or loss of appetite and increase in consumption of calories due to altered metabolism induced by inflammation and immune response (6–8). Several studies (9–15) in sub-Saharan Africa have shown the impact of dual infection with HIV and TB on nutritional
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    Burden of tuberculosis in Kampala, Uganda
    (World Health Organization, 2003) Guwatudde, David; Zalwango, Sarah; Kamya, Moses; Debanne, Sara; Mireya, Diaz; Okwera, Alphonse; Mugerwa, Roy; King, Charles; Christopher, Whalen
    Over the past two decades, the number of tuberculosis cases has risen worldwide, especially in the developing countries of southeast Asia and sub-Saharan Africa, where co-infection with human immunodeficiency virus (HIV) and tuberculosis is common (1, 2). Case notification data often are used to assess the burden of tuberculosis. The wide belief, however, is that a substantial number of cases of tuberculosis are not detected by the health care systems in most of these countries (3, 4), and surveys of the prevalence of tuberculosis in some of these countries support this belief (5, 6). Furthermore, the poor peri-urban areas of developing countries, where living conditions are unsatisfactory with overcrowding, poor hygiene and inadequate sanitation, are usually most affected by tuberculosis (7, 8). Such living conditions, coupled with high prevalence of HIV infection and lack of access to health care and/or poor health-seeking behavior (8, 9), may lead to a vicious circle of transmission of diseases, including tuberculosis. National average notification data often do not reveal the overwhelming burden of tuberculosis in these settings.
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    Combination Therapy with Fluconazole and Flucytosine for Cryptococcal Meningitis in Ugandan Patients with AIDS
    (Clinical Infectious Diseases, 1998) Kizza, Harriet Mayanja; Oishi, Kazunori; Mitarai, Satoshi; Yamashita, Hiroshi; Nalongo, Kisembo; Watanabe, Kiwao; Izumi, Takashi; Jungala, Ococi; Augustine, Kaddhu; Mugerwa, Roy; Nagatake, Tsuyoshi; Matsumoto, Keizo
    We performed a randomized trial in which combination therapy with fluconazole and shortterm flucytosine was compared with fluconazole monotherapy in 58 patients with AIDS-associated cryptococcal meningitis (CM). Thirty of these patients were randomized to receive combination therapy with fluconazole, 200 mg once a day for 2 months, and flucytosine, 150 mg/(kg·d) for the first 2 weeks, and 28 were randomized to receive monotherapy with fluconazole at the same dose for 2 months. Patients in both groups who survived for 2 months received fluconazole as maintenance therapy at a dose of 200 mg three times per week for 4 months. The combination therapy prevented death within 2 weeks and significantly increased the survival rate among these patients (32%) at 6 months over that among patients receiving monotherapy (12%) (P = .022). The combination therapy also resulted in a significant decrease in the severity of headache after 1 month of treatment, compared with monotherapy (P = .005). No serious adverse reactions were observed in patients receiving either regimen. These data indicate that treatment with fluconazole and short-term flucytosine is a cost-effective and safe regimen that improves the quality of life for patients with AIDSassociated CM in developing countries where human immunodeficiency virus is endemic.
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    Heritability Analysis of Cytokines as Intermediate Phenotypes of Tuberculosis
    (The Journal of infectious diseases, 2003) Stein, Catherine M.; Guwatudde, David; Nakakeeto, Margaret; Peters, Pierre; Elston, Robert C.; Tiwari, Hemant K.; Mugerwa, Roy; Whalen, Christopher C.
    Numerous studies have provided support for genetic susceptibility to tuberculosis (TB); however, heterogeneity in disease expression has hampered previous genetic studies. The purpose of this work was to investigate possible intermediate phenotypes for TB. A set of cytokine profiles, including antigen-stimulated whole-blood assays for interferon (IFN)–g, tumor necrosis factor (TNF)–a, transforming growth factor (TGF)–b, and the ratio of IFN to TNF, were analyzed in 177 pedigrees from a community in Uganda with a high prevalence of TB. The heritability of these variables was estimated after adjustment for covariates, and TNF-a, in particular, had an estimated heritability of 68%. A principal component analysis of IFN-g, TNF-a, and TGF-b reflected the immunologic model of TB. In this analysis, the first component explained 138% of the variation in the data. This analysis illustrates the value of such intermediate phenotypes in mapping susceptibility loci for TB and demonstrates that this area deserves further research.
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    Human Nutrition and Metabolism Severity of Human Immunodeficiency Virus Infection Is Associated with Decreased Phase Angle, Fat Mass and Body Cell Mass in Adults with Pulmonary Tuberculosis Infection in Uganda
    (Journal of Nutrition, 2001) Shah, Snehal; Whalen, Christopher; Kotler, Donald P.; Mayanja, Harriet; Namale, Alice; Melikian, George; Mugerwa, Roy; Semba, Richard D.
    Although coinfection with tuberculosis and human immunodeficiency virus (HIV) is emerging as a major problem in many developing countries, nutritional status has not been well characterized in adults with tuberculosis and HIV infection. We compared nutritional status between 261 HIV-positive and 278 HIV-negative adults with pulmonary tuberculosis in Kampala, Uganda, using anthropometry and bioelectrical impedance analysis. Among 163 HIV-positive and 199 HIV-negative men, intracellular water–to–extracellular water (ICW:ECW) ratio was 1.48 6 0.26 and 1.59 6 0.48 (P 5 0.006) and phase angle was 5.42 6 1.05 and 5.76 6 1.30 (P 5 0.009), respectively. Among 98 HIV-positive and 79 HIV-negative women, ICW:ECW was 1.19 6 0.16 and 1.23 6 0.15 (P 5 0.11) and phase angle was 5.35 6 1.27 and 5.43 6 0.93 (P 5 0.61), respectively. There were no significant differences in BMI, body cell mass, fat mass or fat-free mass between HIV-positive and HIV-negative adults. Among HIV-positive subjects, BMI, ICW:ECW, body cell mass, fat mass and phase angle were significantly lower among those with CD41 lymphocytes # 200 cells/ m L compared with those who had .200 cells/ m L. In sub- Saharan Africa, coinfection with pulmonary tuberculosis and HIV is associated with smaller body cell mass and intracellular water, but not fat-free mass, and by large differences in ICW:ECW and phase angle
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    Lean Tissue Mass Wasting is Associated With Increased Risk of Mortality Among Women With Pulmonary Tuberculosis in Urban Uganda
    (Elsevier Inc., 2012) Mupere, Ezekiel; Malone, Lashaunda; Zalwango, Sarah; Chiunda, Allan; Okwera, Alphonse; Parraga, Isabel; Stein, Catherine M.; Tisch, Daniel J.; Mugerwa, Roy; Boom, W. Henry; Mayanja, Harriet; Whalen, Christopher C.
    OBJECTIVES: We assessed the impact of wasting on survival in patients with tuberculosis by using a precise height-normalized lean tissue mass index (LMI) estimated by bioelectrical impedance analysis and body mass index (BMI). METHODS: In a retrospective cohort study, 747 adult pulmonary patients with tuberculosis who were screened for HIV and nutritional status were followed for survival. RESULTS: Of 747 patients, 310 had baseline wasting by BMI (kg/m2) and 103 by LMI (kg/m2). Total deaths were 105. Among men with reduced BMI, risk of death was 70% greater (hazard ratio [HR] 1.7, 95% confidence interval [95% CI] 1.03–2.81) than in men with normal BMI. Survival did not differ by LMI among men (HR 1.1; 95% CI 0.5–2.9). In women, both the BMI and LMI were associated with survival. Among women with reduced BMI, risk of death was 80% greater (HR 1.8; 95% CI 0.9–3.5) than in women with normal BMI; risk of death was 5-fold greater (HR 5.0; 95% CI 1.6–15.9) for women with low LMI compared with women with normal LMI. CONCLUSIONS: Wasting assessed by reduced BMI is associated with an increased risk for death among both men and women whereas reduced LMI is among women with tuberculosis.
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    Secondary Attack Rate of Tuberculosis in Urban Households in Kampala, Uganda
    (PLoS ONE, 2011) Whalen, Christopher C.; Zalwango, Sarah; Chiunda, Allan; Malone, LaShaunda; Eisenach, Kathleen; Joloba, Moses; Boom, W. Henry; Mugerwa, Roy
    Tuberculosis is an ancient disease that continues to threaten individual and public health today, especially in sub-Saharan Africa. Current surveillance systems describe general risk of tuberculosis in a population but do not characterize the risk to an individual following exposure to an infectious case. Methods: In a study of household contacts of infectious tuberculosis cases (n = 1918) and a community survey of tuberculosis infection (N = 1179) in Kampala, Uganda, we estimated the secondary attack rate for tuberculosis disease and tuberculosis infection. The ratio of these rates is the likelihood of progressive primary disease after recent household infection. Results: The secondary attack rate for tuberculosis disease was 3.0% (95% confidence interval: 2.2, 3.8). The overall secondary attack rate for tuberculosis infection was 47.4 (95% confidence interval: 44.3, 50.6) and did not vary widely with age, HIV status or BCG vaccination. The risk for progressive primary disease was highest among the young or HIV infected and was reduced by BCG vaccination. Conclusions: Early case detection and treatment may limit household transmission of M. tuberculosis. Household members at high risk for disease should be protected through vaccination or treatment of latent tuberculosis infection.
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    Wasting among Uganda men with pulmonary tuberculosis is associated with linear regain in lean tissue mass during and after treatment in contrast to women with wasting who regain fat tissue mass: prospective cohort study
    (Bio med central, 2014) Malone, LaShaunda; Zalwango, Sarah; Okwera, Alphonse; Nsereko, Mary; Tisch, Daniel J; Parraga, Isabel M; Stein, Catherine M.; Mugerwa, Roy; Boom, Henry W.; Mayanja, Harriet K; Whalen, Christopher C; Mupere, Ezekiel
    Background: Nutritional changes during and after tuberculosis treatment have not been well described. We therefore determined the effect of wasting on rate of mean change in lean tissue and fat mass as measured by bioelectrical impedance analysis (BIA), and mean change in body mass index (BMI) during and after tuberculosis treatment. Methods: In a prospective cohort study of 717 adult patients, BMI and height-normalized indices of lean tissue (LMI) and fat mass (FMI) as measured by BIA were assessed at baseline, 3, 12, and 24 months. Results: Men with wasting at baseline regained LMI at a greater rate than FMI (4.55 kg/m2 (95% confidence interval (CI): 1.26, 7.83 versus 3.16 (95% CI: 0.80, 5.52)) per month, respectively during initial tuberculosis therapy. In contrast, women with wasting regained FMI at greater rate than LMI (3.55 kg/m2 (95% CI: 0.40, 6.70) versus 2.07 (95% CI: -0.74, 4.88)), respectively. Men with wasting regained BMI at a rate of 6.45 kg/m2 (95% CI: 3.02, 9.87) in the first three months whereas women, had a rate of 3.30 kg/m2 (95% CI: -0.11, 6.72). There were minimal changes in body composition after month 3 and during months 12 to 24. Conclusion: Wasted tuberculosis patients regain weight with treatment but the type of gain differs by gender and patients may remain underweight after the initial phase of treatment