Drug resistance profiles of new- and previously treated patients with pulmonary tuberculosis in Ibadan, Nigeria.

BACKGROUND: Information on TB drug resistance profiles and its' associated risk factors are scarce in Nigeria despite the large burden of disease in the country. The study was designed to report drug resistance profiles of new- and previously treated patients with pulmonary tuberculosis (TB) in Ibadan, Nigeria. METHOD: Sputum from consenting pulmonary TB patients were collected and cultured for Mycobacterium tuberculosis (Mtb) at the TB laboratory of the University College Hospital, Ibadan, Nigeria using standard method. Mtb were stored and sent for drug susceptibility testing against first and second-line anti-TB drugs at the MRC Unit, The Gambia and at the Institute of Tropical Medicine, Antwerp, Belgium using BACTEC MGIT 960 and proportion method on solid medium respectively. RESULTS: Of 238 Mtb collected, 124 (52.1%) were viable, 102 (59.65%) non-viable while 12 (7.02%) were contaminated. About half (58.87%) of the Mtb were from previously treated patients, 40 (32.26%) were from new patients while treatment history of 1.1 (8.87%) were unknown. Forty-seven (37.90%) of the 124 Mtb. tested were multidrug resistant (MDR) out of which, 40 (85.10%) were from previously treated patients.. HIV prevalence was 8.69%. Of the 17 MDR-TB from previously treated cases tested for second-line drugs, four (23.53%) were resistant to fluoroquinolones or injectable agents, 13 (76.47%) were susceptible while none was resistant to both of these classes of drugs. CONCLUSION: MDR-TB in Ibadan already demonstrates resistance to second line anti-TB drugs hence management of MDR-TB patients should be strengthened to prevent emergence of extensively drug-resistant TB (XDR-TB).

Outbreaks-of Ebola virus disease in the West African sub-region.

BACKGROUND: Five West African countries, including Nigeria are currently experiencing the largest, most severe, most complex outbreak of Ebola virus disease in history. This paper provided a chronology of outbreaks of Ebola virus disease in the West African sub-region and provided an update on efforts at containing the present outbreak. METHODS: Literature from Pubmed (MEDLINE), AJOL, Google Scholar and Cochrane database were reviewed. RESULTS: Outbreaks of Ebola, virus disease had frequently occurred mainly in Central and East African countries. Occasional outbreaks reported from outside of Africa were due to laboratory contamination and imported monkeys in quarantine facilities. The ongoing outbreak in West Africa is the largest and first in the sub-region; the number of suspected cases and deaths from this single current outbreak is already about three times the total of all cases and deaths from previous known outbreaks in 40 years. Prevention and control efforts are hindered not only by lack of a known vaccine and virus-specific treatment, but also by weak health systems, poor sanitation, poor personal hygiene and cultural beliefs and practices, including myths and misconceptions about Ebola virus disease--all of which are prevalent in affected countries. Constrained by this situation, the World Health Organisation departed from the global standard and recommended the use of not yet proven treatments to treat or prevent the disease in humans on ethical and evidential grounds. CONCLUSION: The large number of people affected by the present outbreak in West Africa and the high case-fatality rate calls for accelerated evaluation and development of the investigational medical interventions for life saving and curbing the epidemic. Meanwhile, existing interventions such as early detection and isolation, contact tracing and monitoring, and adherence to rigorous procedures of infection prevention and control should be intensified.

Genital ulcer diseases among HIV-infected female commercial sex workers in Ibadan, Nigeria.

We evaluated the prevalence and association of Genital Ulcer Diseases (GUDs) among HIV-1 infected female commercial sex workers (FCSWs) in Ibadan, Nigeria. A total of 250 FCSWs from brothels in Ibadan were tested for presence of antibodies to HIV and Syphilis. Pelvic examinations for signs of sexually transmitted infections (STIs) were carried out on the subjects. Endocervical and high vaginal swabs were collected from each of the subjects to establish laboratory diagnosis of STIs. Their age ranged from 15 to 55 years (Mean = 25.8 yrs; SD = 3.74). Majority (246/250) were Nigerians, while 1.6% were from neighboring West African countries. Sixty four (25.6%) of the subjects were positive for HIV-1 while seven (2.8%) had dual HIV-1/2 infection. Analysis of the STIs showed that 49 (19.6%) of the CSWs had GUDs. Herpes genitalis was the commonest GUDs as it occurred in 25 (10%) of the subjects. Other STIs identified were chancroid (5.6%), syphilis (4.0%) and lymphogranuloma venerum (LGV) (4%). Sixteen (64.0%) of the CSWs with herpes genitalis had HIV-1 infection. The risk ratio of herpes genitalis for HIV acquisition was 3.0 (95% CI: 2.0 - 4.4). Syphilis and chancroid were also found tobe significantly associated with increased risk of HIV infection (p < 0.0001). The adjusted odd ratios for Herpes genitalis, chancroid, and syphilis were 3.7 (1-13.0, p < 0.05), 19.8 (2.7-13.0, p < 0.05) and 19.1 (1-231.0, p < 0.05) respectively. There is need to educate FCSWs continually to adopt safer sexual behaviours, seek early diagnosis and treatment of GUDs to reduce their risk of transmitting HIV infection.

In vitro antimicrobial properties of coconut oil on Candida species in Ibadan, Nigeria.

The emergence of antimicrobial resistance, coupled with the availability of fewer antifungal agents with fungicidal actions, prompted this present study to characterize Candida species in our environment and determine the effectiveness of virgin coconut oil as an antifungal agent on these species. In 2004, 52 recent isolates of Candida species were obtained from clinical specimens sent to the Medical Microbiology Laboratory, University College Hospital, Ibadan, Nigeria. Their susceptibilities to virgin coconut oil and fluconazole were studied by using the agar-well diffusion technique. Candida albicans was the most common isolate from clinical specimens (17); others were Candida glabrata (nine), Candida tropicalis (seven), Candida parapsilosis (seven), Candida stellatoidea (six), and Candida krusei (six). C. albicans had the highest susceptibility to coconut oil (100%), with a minimum inhibitory concentration (MIC) of 25% (1:4 dilution), while fluconazole had 100% susceptibility at an MIC of 64 microg/mL (1:2 dilution). C. krusei showed the highest resistance to coconut oil with an MIC of 100% (undiluted), while fluconazole had an MIC of > 128 microg/mL. It is noteworthy that coconut oil was active against species of Candida at 100% concentration compared to fluconazole. Coconut oil should be used in the treatment of fungal infections in view of emerging drug-resistant Candida species.

Internal hernia through the broad ligament presenting with acute on chronic intestinal obstruction: A case report.

BACKGROUND: Internal hernias are rare. Their occurrence through the broad ligament is one of the rarest forms. We present a report of a 45 year Nigerian female with acute on chronic intestinal obstruction due to an internal hernia of the broad ligament. METHODS: Patients case notes and a review of relevant literature using manual library and Medline search was used. RESULTS: A 45-year-old multiparous woman presented with a ten-year history of features of partial intestinal obstruction, and no previous abdominal surgery. Examination revealed right iliac fossa tenderness and a plain abdominal radiograph showed air fluid levels. Conservative management was not successful and laparatomy confirmed an internal hernia of the right broad ligament which was repaired with satisfactory outcome. CONCLUSION: This report is to highlight the fact that though rare, internal hernia should be considered in the differential diagnosis of intestinal obstruction.

Hepatitis B surface antigen (HbsAg) in blood and genital secretions of patients with sexually transmitted diseases in Ibadan, Nigeria.

A total of 100 patients attending the Special Treatment Clinic of the University Teaching Hospital (UCH), Ibadan between October, 1998 and April, 1999 were studied to detect Hepatitis B surface antigen (HbsAg) in the blood and genital discharges. This was with a view of establishing whether infected persons (positive by blood test) also excrete the antigen, HbsAg, in their genital secretions. Urethral swabs were collected from 63 male patients, while High Vaginal and Endocervical swabs were collected from 37 female patients. Blood samples were collected from all the patients. HbsAg was tested for by Enzyme immunoassay technique with Wellcozyme HbsAg kit. Of the 63 male patients, 10 (15.9%) had HbsAg in the urethral secretion while 22 (34.9%) had it in their blood, 70% of these male patients were within the age range 11-30 years. Of the 37 female patients, 34 (92%) had HbsAg in the Endocervical secretions, 6 (16.2%) of them had HbsAg in their blood. Eighty percent of the female patients with positive HbsAg in the genital secretions were within age range 21-40 years. This study documents that Hepatitis B virus can be transmitted sexually in this environment.

Coronary venous intimal thickening in explanted cardiac allografts. Evidence demonstrating that transplant coronary artery disease is a manifestation of a diffuse allograft vasculopathy.

The accelerated coronary artery disease occurring in cardiac allografts is thought to be a form of chronic rejection directed against allogeneic vascular endothelium. If this hypothesis is correct, one would anticipate disease not only in the arteries but in venous structures as well. Accordingly, the degree of myointimal proliferation of both coronary arteries and coronary veins was assessed in 22 explanted or autopsied cardiac allografts by light microscopy. Other factors assessed included clinical cause of death/retransplantation, time posttransplantation, underlying cardiac disease, donor and recipient age, and ischemic time. Thirteen of the 22 hearts had either moderate or severe arterial myointimal thickening. Of these, 10 hearts had associated coronary venous thickening. Of the 9 remaining hearts with either mild or no arterial myointimal thickening, none had venous involvement. The overall correlation between the presence and degree of allograft coronary artery and allograft coronary vein thickening was high (r = 0.80, P = 0.0014). Of the other demographic factors investigated, only length of time posttransplant had a weak correlation with arterial or venous myointimal thickening (r = 0.46, P = 0.045 and r = 0.48, P = 0.039, respectively. These data demonstrate that the usually termed "accelerated transplant atherosclerosis" in the cardiac allograft is a true vasculopathy and involves both the arterial and venous systems.

Recurrence of sarcoidosis in a cardiac allograft: control with augmented corticosteroids.

Sarcoidosis of the heart is an unusual but previously reported indication for heart transplantation. It is clear that sarcoidosis is a systemic disease, but in spite of this, recurrence in the cardiac allograft has not been previously noted. The case presented here is that of a 34-year-old male in whom cardiac sarcoidosis recurred in the allograft 6 months after heart transplantation.

Genital herpes simplex virus infection in females in Ibadan Nigeria.

In a study of female patients attending the Sexually Transmitted Diseases Clinic of the University College Hospital Ibadan, Nigeria, Herpes simplex virus was isolated from the cervix of 5 of 117 patients, a prevalence rate of 4.3%. Two (1.7%) of these patients had HSV in the vagina. The viruses were identified by culture in HEp-2 cell line, chloroform sensitivity test, complement fixation test and indirect immuno-fluorescent antibody technique. Only one (20%) of the five patients has HSV-1 in the endocervix.

Socio-demographic characteristics and sexual behaviour of adolescents attending the STC, UCH, Ibadan: a 5 year review.

As a continuation of the on-going efforts to prevent and control the spread of sexually transmitted diseases (STDs) and the Acquired Immunodeficiency Syndrome (AIDS) in adolescents, this retrospective clinic-based study identifies the socio- demographic characteristics, describes the sexual practices, identifies the common STDs, including drug utilization patterns in this risk group at the special treatment clinic of the University College Hospital, Ibadan. Results reveal that adolescents constituted between 3.3% and 4.8% of the total number of patients seen each year. The characteristics of the subjects were as follows: 54 (38.3%) were aged 19 years, 133 (94.3%) were single, 79 (53.2%) were females and 103 (73.0%) were students. As regards sexual behaviour, 22 (15.71%) denied previous history of sexual intercourse. Vaginal intercourse was reported in all the sexually active youth, 2(1.71%) reported oral sex, while 10 (8.41%) admitted that they had multiple sexual partners. Gonorrhoea was diagnosed in 23 (21.51%) of sexually active youths. Among those who had used drugs before presentation ampicillin was the common drug used for treatment by 14 (26.4%). The importance of encouraging adolescents to present at STD clinics is highlighted. Health workers need to have a sympathetic attitude and assure them of confidentiality. The need for more community-based education is shown, including the importance of proper and complete documentation of hospital records.

Herpetic urethritis in male patients in Ibadan.

In a study of 151 male patients attending a sexually transmitted disease clinic, 40 (26.4%) had non-gonococcal urethritis. Herpes simplex virus was isolated in tissue culture of HEp-2 cell line from 10 of the patients with non-gonococcal urethritis, and identified by complement fixation and indirect immunofluorescent anti body tests. Of the isolates, 30% were Herpes simplex virus type 1 (HSV-1), while 70% were Herpes simplex virus types (HSV-2).

Bacterial agents of discharging ears and antimicrobial sensitivity patterns in children in Ibadan, Nigeria.

Bacteriological studies were carried out on ear swabs from 361 cases of children with discharging ears at the Microbiology Department of the University College Hospital, Ibadan between March 1995 and February 1997. 308 (85.3%) had positive cultures. 78.6% of these yielded one isolate, 19.2% yielded two isolates while 2.2% had three isolates. Pseudomonas spp. Was the predominant agent of CSOM and ASOM. This was followed by Staphylococcus aureus. Other commonly isolated organisms were Proteus and Klebsiella species. Ofloxacin and ciprofloxacin showed the highest activity to all isolates, while two third of the isolates were sensitive to azithromycin, cefuroxime, ceftriazone and gentimicin.

Non-gonococcal urethritis (NGU) due to trichomonas vaginalis in Ibadan.

Two hundred and sixty two male patients attending the Special Treatment Clinic (STC) of the University College Hospital, Ibadan between July and December 1989, were examined for Trichomonas vaginalis as a cause of non-gonococcal urethritis using both microscopic and culture methods. Thirteen of the 262 male patients were the sexual partners of trichomonas vaginalis infected women. While 47(17.9) percent of the 262 men investigated had gonococcal urethritis, 215(82.1 percent) had non-gonococcal urethritis out of whom 18(8.4 percent) had trichomonal urethritis. The age range of peak incidence among the patients investigated is 20-29 years. A significant difference (P < 0.001) between the number of male sexual contacts that were positive for trichomoniasis (38 percent) and other male patients included in this study (8.4 percent) was demonstrated. Culture of the samples from the male patients investigated gave the highest proportion (100 percent) of positive results. This indicates the superiority of culture methods over other methods of diagnosing trichomoniasis such as microscopic method routinely used in our centre.

Review of cases of children with gonorrhoea--source of infection.

This is a retrospective study to determine what effort was put into identifying the source of infection in children with gonorrhoea in Ibadan. The case files of eighty-four children aged 1 to 10 years who had gonococcal genital infections between 1983 and 1998 and presented at the Special Treatment Clinic of the University College Hospital, Ibadan were studied. Clinical manifestations of the 84 children include vaginal discharge (97.6%), urethritis (2.4%) and combined genital and eye infection (8.3%). A total of 103 relatives of 61 index subjects were examined. Of those in whom specimens were collected for microscopy culture and sensitivity, 27 (26.2%) had gonorrhoea. A history of sexual contact in the children studied was recorded in only (10.7%) cases, while four (4.7%) others without history of sexual intercourse had torn hymen. Sexual abuse or child neglect was suspected in this group. None of the named contacts was traceable by the health visitors. The recognition of a child with gonococcal infection identifies a cluster of family members who are at increased risk of having gonorrhoea. This study indicates that more effort will be required to find the source and mode of transmission of gonorrhoea in children.

Nosocomial infections: methicillin resistant Staphylococcus auerus in wound infection in Ibadan, Nigeria.

In a study of 188 cases of wound infection seen in the University College Hospital, Ibadan, between December 1994 and April 1995, 78 strains of Staphylococcus aureus were methicilin resistant (MRSA). The disc sensitivity pattern of the MRSA was determined using the method of Kirby et al., and the MICs of common antibacterial agents to the MRSA were determined by agar dilution method. Vancomycin, ofloxacin and ciprofloxacin offered the best effective treatment for MRSA wound infections, and are recommended as reserved drugs while gentamicin and cotrimoxazole are first line drugs.

Pattern of gram negative rods bacteraemia in diabetic patients in Ibadan, Nigeria.

In a study of 100 patients in Ibadan between July and December 1995 to evaluate bacteraemia due to gram-negative bacilli, 64% were culture positive, 44 (68.8%) of these yielded gram-negative rods. The isolates were Klebsiella species (43.2%), Escherichia coli (27.3%), Pseudomonas aeruginosa (13.6%), Proteus species (11.4%) and Bacteroides melaninogenious (4.15%) by standard bacteriological methods. Antimicrobial sensitivity results suggested ofloxacin or ceftriaxone with metronidazole as empirical antibiotic therapy.

Efficacy of pefloxacin in the treatment of postoperative sepsis in gynaecology.

Twenty four women with postoperative sepsis following gynaecological surgery were recruited into a study designed to determine the efficacy of Pefloxacin. With the standard oral dose of Pefloxacin, clinical cure or improvement occurred in 98% of the patients. In-vitro, 90% of bacterial isolates were sensitive to Pefloxacin. No adverse effect was encountered in any of the patients. We concluded that Pefloxacin is effective in the treatment of postoperative bacterial infections following gynaecological surgery.

Childhood gastroenteritis due to Aeromonas hydrophila in Ibadan, Nigeria.

This is a prospective study spanning a period of six months where stools of 400 diarrhoeic children and 100 non-diarrhoeic children aged 0-5 years were screened for Aeromonas hydrophila and other enteric pathogens. Out of the 400 diarrhoeic stools only three (0.75%) were positive for Aeromonas hydrophila while none was positive in the control group. No other enteric pathogen was isolated from these positive samples, indicating that Aeromonas hydrophila is responsible for their diarrhoea. Continuous surveillance of this agent of diarrhoea in this environment will further reveal any threat the organism may poise in the nearest future.

Comparative in-vitro activities of commonly available quinolones and other antibiotics on bacterial isolates in Ibadan, Nigeria.

The 4-quinolones, many of which are now available in Nigeria under different trade names, have a broad spectrum of activity. An evaluation is made of the comparative in-vitro activities of these quinolones and other antibiotics against 125 strains of bacteria commonly isolated from clinical specimens in University College Hospital, Ibadan, by using the Stroke's disc sensitivity method, and MIC estimation. The quinolones showed greater activity than the cephalosprins against Klebsiella spp., Proteus spp. and Escherichia coli, but were found to be equipotent against Pseudomonas spp. the MIC results revealed ciprofloxacin (Ciprotap) as the most active of the quinolones. Though some strains of Klebsiella spp. and Pseudomonas spp. were found to be resistant to all the antibiotics tested, majority of the strains of the gram-negative bacilli from clinical specimens were highly susceptible to all the quinolones. This emphasizes the need to monitor regularly the emergence of resistance associated with the use of antibiotics in the developing countries.

Pattern of bacterial pathogens in surgical wound infections.

Wound swabs from surgical patients were studied from 1989 to 1991 to review the pattern of nosocomial infection in the University College Hospital, Ibadan, Nigeria. The prevalence rate of nosocomial infection was 4.9%. The ratio of gram-negative to gram-positive organisms in wound infection was 3:1 with klebsiella species and Pseudomonas species emerging as the most important gram-negative organisms. Staphylococcus aureus was the single most prevalent organisms in surgical would infections. Recommendations on control measures are given.