Nontuberculous Mycobacteria Isolated from Tuberculosis Suspects in Ibadan, Nigeria.

In Nigeria, one of the highest tuberculosis (TB) burdened nations, sputum smear microscopy is routinely employed for TB diagnosis at Directly Observed Treatment Short-Course (DOTS) Centers. This diagnostic algorithm does not differentiate Mycobacterium tuberculosis complex (MTC) from nontuberculous mycobacteria (NTM). Between December 2008 and January 2009, consecutive patients diagnosed with TB were screened for inclusion at 10 DOTS centers in Ibadan, Nigeria. To verify Mycobacterium species in patients diagnosed, we cultured and identified mycobacterial isolates using PCR, line probe assay, and spoligotyping techniques. From 48 patients screened, 23 met the inclusion criteria for the study. All the 23 study patients had a positive culture. Overall, we identified 11/23 patients (48%) with MTC only, 9/23 (39%) with NTM only, and 3/23 (13%) with evidence of both MTC and NTM. Strains of MTC identified were Latin American Mediterranean (LAM) genotype (n = 12), M. africanum (n = 1), and the genotype family T (n = 1). Four M. avium-intracellulare-M. scrofulaceum complexes, one M. chelonae complex, one M. abscessus, and one M. intracellulare were identified. Our findings underscore the need to incorporate molecular techniques for more precise diagnosis of TB at DOTS centers to improve clinical outcomes and safe guard public health, particularly in TB endemic countries.

Clinical characteristics and predictors of mortality in hospitalized HIV-infected Nigerians.

INTRODUCTION: Human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) is a chief cause of death in sub-Saharan Africa. In this study, the clinical characteristics and predictors of mortality among hospitalized HIV infected adult Nigerians are reported. METHODOLOGY: The records of 354 patients were reviewed for demographic and clinical characteristics. Predictors of mortality using logistic regression in a retrospective study were also reviewed. RESULTS: A total of 109 (30.8%) males and 245 (69.2%) females participated in the study. The mean age of all participants was 35 ± 8 years. Median baseline CD4 cell counts and viral load were 91 cells/mm³ and 63,438 copies/ml respectively. There was a total of 123 (34.8%) deaths while 231 (65.2%) patients were discharged home. Tuberculosis (TB) was the most common diagnosis on admission as well as the leading cause of death. Among all subjects, only male gender (adjusted odds ratio [AOR] 4.67, 95% confidence interval [CI]: 2.63-8.29); CD4 cell count ≤ 200 cells/mm³ (AOR 5.28, 95% CI: 2.99-9.31); length of hospital stay < 3 days (AOR 4.77, 95% CI: 1.35-16.86); and age ≥ 35 years (AOR 2.43, 95% CI: 1.41-4.19) were predictive of death. CONCLUSION: These findings illustrate the need for early diagnosis of HIV infection, appropriate treatment and prevention of opportunistic infections, and improved access to highly active antiretroviral therapy (HAART).

Prevalence of hepatitis B and C seropositivity in a Nigerian cohort of HIV-infected patients.

INTRODUCTION: The clinical and public health implications of the convergence of the human immunodeficiency virus (HIV) epidemic and chronic viral hepatitis in sub-Saharan Africa are poorly understood. This study was designed to determine the seroprevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV), and the impact of co-infection on baseline serum alanine transaminase (ALT), CD4+ T lymphocyte (CD4) count, and plasma HIV-RNA (viral load) in a cohort of HIV-infected Nigerians. METHODS: A retrospective study was conducted, on eligible treatment-naive patients who presented between August 2004 and February 2007 to the University College Hospital (UCH), Ibadan, Nigeria. Demographic data and pre-treatment laboratory results (hepatitis B surface antigen (HBsAg), HCV antibodies (anti-HCV), ALT, CD4 count and viral load) were retrieved from the medical records. Fisher's exact, two sample t-tests, and the Wilcoxon rank sum tests were used to compare groups. A logistic regression model was fitted to explore characteristics associated with co-infection status. RESULTS: A total of 1779 HIV-infected patients (male: female ratio, 1:2) met inclusion criteria. HBsAg was present in 11.9%, anti-HCV in 4.8% and both markers in 1%. HBsAg was more common among males than females (15.4% vs 10.1%, respectively p = 0.001) while anti-HCV was detected in a similar proportion of males and females (5.3% versus 4.6%, respectively p = 0.559). HIV-infected patients with anti-HCV alone had a lower mean baseline CD4 count compared to those without anti-HCV or HBsAg (197 cells/mm3 vs 247 cells/mm3, respectively p = 0.008). Serum ALT was higher among patients with HBsAg compared to those without HBsAg or anti-HCV (43 International Units (IU) vs. 39 IU, respectively p = 0.015). Male gender was associated with HBV co-infection on logistic regression (OR1.786; 95% CI, 1.306-2.443; p < 0.005). CONCLUSION: More HIV-infected females than males presented for care in this cohort. We identified a relatively high prevalence of HBV and HCV co-infection in general, and a higher rate of HBV co-infection among males than females. Pre-treatment CD4 count was significantly lower among those with HCV co-infection, while ALT was slightly higher among those with HBV co-infection. Triple infection with HIV, HBV and HCV was present in a small but significant proportion of patients. These findings underscore the importance of testing for HBV and HCV in all HIV-infected persons in our setting.

A qualitative and quantitative survey of Forensic Medical Examiner workload in the Northumbria Police Force area October 2002-January 2003.

This force-wide study in the Northumbria Police area provides an audit of the quality and quantity of work carried out by Forensic Medical Examiners (FMEs) over a three month period. Approximately 25% of all arrests during the period of the audit resulted in a request for FME assessment of the detainee. About 79% of consultations were performed to establish fitness to detain, in which over 30% of detainees were intoxicated and over 40% addicted to drugs and/or alcohol. Over 30% of those queried for fitness to detain also required advice and occasionally prescription for medication, both for the management of addiction and the treatment of chronic illness. In comparison to prior work this study found lower rates of mental illness in alcohol and drug dependent populations (13% and 6%, respectively). It is hoped this study will provide information in respect of the specific competencies not only required by future FMEs but also nurses working with detainees within the custody suites.