Pellagra is a clinical syndrome caused by a deficiency of niacin (nicotinic acid) and/or its precursor tryptophan. The cardinal manifestations are 4 D’s: dermatitis, diarrhoea, dementia and in worst case death. Increased use of isoniazid prophylaxis along with antiretroviral therapy in countries where latent tuberculosis is common has been associated with increased presentations with pellagra.

Although the COVID-19 pandemic has left no country untouched there has been limited research to understand clinical and immunological responses in African populations. Here we characterise patients hospitalised with suspected (PCR-negative/IgG-positive) or confirmed (PCR-positive) COVID-19, and healthy community controls (PCR-negative/IgG-negative). PCR-positive COVID-19 participants were more likely to receive dexamethasone and a beta-lactam antibiotic, and survive to hospital discharge than PCR-negative/IgG-positive and PCR-negative/IgG-negative participants. PCR-negative/IgG-positive participants exhibited a nasal and systemic cytokine signature analogous to PCR-positive COVID-19 participants, predominated by chemokines and neutrophils and distinct from PCR-negative/IgG-negative participants. PCR-negative/IgG-positive participants had increased propensity for Staphylococcus aureus and Streptococcus pneumoniae colonisation. PCR-negative/IgG-positive individuals with high COVID-19 clinical suspicion had inflammatory profiles analogous to PCR-confirmed disease and potentially represent a target population for COVID-19 treatment strategies.

Background Compared to the abundance of clinical, molecular, and genomic information available on patients hospitalised with COVID-19 disease from high-income countries, there is a paucity of data from low-income countries. Methods We enrolled a cohort of patients with PCR confirmed COVID-19 disease at Queen Elizabeth Central Hospital, the main hospital for southern Malawi, between July 2020 and September 2021. The recruitment period covered three waves of SARS-CoV-2 infections in Malawi. Clinical and diagnostic data were collected using the ISARIC clinical characterization protocol for COVID-19. The viral material from PCR-positive swabs was amplified with a tiling PCR scheme and sequenced using the MinION sequencer in Malawi. Consensus genomes were generated using the ARTIC pipeline and lineage assignment was performed using Pangolin. Results Sequencing data showed that wave one was predominantly B.1 (8/11 samples), wave two consisted entirely of Beta variant of concern (VOC) (6/6), and wave three was predominantly Delta VOC (25/26). Patients presenting in the second and third waves had progressively fewer underlying chronic conditions, and patients in the third wave had a shorter time to presentation (2 days vs 5 in the original wave). Multivariable logistic regression demonstrated increased mortality in wave three, dominated by the Delta VOC, compared to previous waves (OR 6.6 [CI 1.1-38.8]). Conclusions Patients hospitalised with COVID-19 in Blantyre during the Delta wave had more acute symptom onset; fewer underlying conditions; and were more likely to die. Whilst we demonstrate the value of linking virus sequence data with clinical outcome data in a low-income setting, this study also highlights the considerable barriers to establishing sequencing capacity in a setting heavily affected by disruptions in supply chain and inequity of resource distribution.

BackgroundAs global population of the elderly continues to rise, a critical need to provide it with health services, including dermatology, will be significant, especially in developing countries like Tanzania. To adequately meet their dermatologic needs, knowledge of local patterns of skin conditions is vital. This study was aimed to describe the spectrum of skin diseases among elderly patients attending skin clinic at the Regional Dermatology Training Centre (RDTC) in Northern Tanzania.MethodsA descriptive hospital based cross-sectional study was conducted between January 2013 and April 2013 at RDTC and included all patients aged 55 years and above who consented to be examined. Diagnoses were clinical, diagnostic tests being done only when necessary. Ethical clearance to conduct the study was granted.ResultsA total of 142 patients, age ranges 55–99 years, median age of 67.5 years were seen. Eczemas were the leading disease group (43.7 %), with unclassified eczemas (33.9 %) predominating. Papulosquamous disorders (15.4 %) were second with psoriasis (50 %) being the leading disease. Infections (11.3 % with fungal infections the leading group representing 5.6 % of all diseases), tumours (9.8 %: Kaposi’s sarcoma 4.2 %), vascular disorders 9.1 % (lymphedema 4.9 %), autoimmune disorders 7.7 % (connective tissue diseases 4.9 %), vitiligo 4.2 %, nutritional diseases 2.1 % (pellagra 0.7 %), urticaria 0.7 % and drug reactions 0.7 %.ConclusionsEczemas are the most common group of disorders among elderly patients presenting at RDTC.