Seroprevalence of Legionella pneumophila in pneumonia patients in four major hospitals in Trinidad and Tobago / Seroprevalencia de la legionella pneumophila en pacientes con neumonía en los cuatro hospitales principales de Trinidad

Trinidad and Tobago is an island-state in the Caribbean with a size of 5,128 square kilometers and a population of 1.3 million. Pneumonia is a leading cause of death in Trinidad. This project determined the frequency of Legionella pneumophila in patients with pneumonia, investigated the relationship between pneumonia and selected risk factors. Serum and demographic data were collected from 123 patients, diagnosed with pneumonia. Sera were tested for L pneumophila Ig G/M/A and IgM. All analyses were done using the SPSS statistical package. Of a total of 123 serum samples tested, 39 (31.7) were positive for L pneumophila IgM/G/A while 2 (1.6) were positive for IgM only. Hospitals, gender and ethnicity did not significantly (p > 0.05; chi-squared) affect the seroprevalence of L pneumophila. Overall, the prevalence of L pneumophila assayed was not significantly (p > 0.05, chi-squared) affected by co-morbidities.

Trinidad and Tobago es una isla del Caribe que posee una extension de 4828 kilometros cuadrados y una poblacion de 1.3 millones. La neumonia es una de las principales causas de muerte en Trinidad. Este proyecto determino la frecuencia de Legionella pneumophila en pacientes con neumonia, e investigo la relacion entre la neumonia y los factores de riesgo seleccionados. Se recopilaron datos sericos y demograficos de 123 pacientes, diagnosticados con neumonia. Los sueros fueron sometidos a analisis a fin de determinar la presencia de L. pneumophila Ig G/M/A y Ig M. Todos los analisis se realizaron usando el paquete estadistico SPSS (Statistical Package for the Social Sciences). De un total de 123 muestras de suero analizadas, 39 (31.7%) dieron positivas frente a L. pneumophila Ig M/G/A, mientras que 2 (1.6%) dieron positivo frente a Ig M solamente. Los hospitales, el genero y la etnicidad no afectaron significativamente la seroprevalencia de L. pneumophila (p > 0.05; c2). En general, la prevalencia de L. pneumophila ensayada no fue afectada significativamente por comorbidades (p > 0.05, c2).

Single dose (direct observed) azithromycin therapy for Neisseria gonorrhoeae and Chlamydia trachomatis in STD clinic attenders with genital discharge in Trinidad and Tobago

The purpose of this study was to determine the prevalence and to assess the efficacy of a single one gram oral dose of azithromycin under direct observed therapy of genital discharge due to Neisseria gonorrhoeae and Chlamydia trachomatis infections in STD clinic attenders in Trinidad and Tobago. All patients with genital discharge and their contacts were given one gram oral dose of azithromycin under direct supervision after collection of urethral and cervical swabs for N gonorrhoeae culture and smear and for C trachomatis antigen detection by ELISA. Clinical and microbiological evaluation was done on those who returned after 7-10 days for follow-up. Of the 735 patients who were enrolled in the study, 319 (43.4) had N gonorrhoeae and 100 (13.6) had C trachomatis. Only 151 (36) of the 419 patients with a pathogenic isolate returned for clinical and microbiological assessment. The remaining 268 (64) of the 419 patients were lost to follow-up. One hundred and forty-three patients (94.7) had total abatement of signs and symptoms after taking azithromycin. One patient (0.65), who had both N gonorrhoeae and C trachomatis, improved clinically with the drug. Seven patients (six with N gonorrhoeae and one with C trachomatis) failed to respond clinically to azithromycin. Microbiological eradication was achieved in 115 (100) patients who had single infection with N gonorrhoeae and in 23 patients (96) with C trachomatis infection. Of 12 patients with combined infections, N gonorrhoeae and C trachomatis were eradicated in 10 and 12 patients, respectively, after initial treatment. In two patients with combined infection, N gonorrhoeae continued to be isolated after treatment with azithromycin. A single one gram oral dose of azithromycin under direct supervision is useful in the treatment of uncomplicated genital infection with N gonorrhoeae and C trachomatis in STD clinic attenders in Trinidad.

Methicillin resistant Staphylococcus aureus

The prevalence of methicillin resistant Staphylococcus aureus (MRSA) at the General Hospital, Port-of-Spain, between June 1995 and May 1996 was determined. The MRSA prevalence rate was 4.6of all S aureus isolates, with all but one nosocomially acquired. 15 isolates were associated with infections, and three were colonizing strains. 17 of the 18 patients with MRSA had received antibiotics previously, including 13 who had received multiple antibiotics. Skin and soft tissue were the sites of infection and colonization in 12 cases; and surgical wards and the Intensive Care Unit (ICU) accounted for 16 MRSA isolates. All isolates were sensitive to vancomycin and all but one were resistant to gentamicin. MRSA occurred sporadically in a wide distribution of wards and physicians' services, although the isolation of three strains from the ICU and three strains from a surgical ward were temporally related. Only one of two deaths was attributable to MRSA. Control of the spread of MRSA in this hospital must include the reinforcement of the appropriate use of antibiotics, hand washing and appropriate isolation of patients in the surgical and intensive care wards.

Antibiotic susceptibility of Neisseria gonorrhoeae in Trinidad and Tobago

Treatment failures with standard doses of penicillin have been observed in the Sexually Transmitted Diseases (STD) clinics in Trinidad and Tobago. In the absence of an ongoing surveillance system, the antimicrobial susceptibility of 518 Neisseria gonorrhoeae strains was determined in order to guide treatment. 39 (7.6) strains were resistant to penicillin, including 27 (5.2) positive for beta-lactamase; that is penicillinase-producing Neisseria gonorrhoeae (PPNG). 51 (10) strains were resistant to tetracycline, with 26 (5.0) of these exhibiting high levels of resistance compatible with tetracycline resistant Neisseria gonorrhoeae (TRNG). Six strains showed evidence of having both PPNG and TRNG plasmids, and five strains showed chromosomally-mediated resistance to both penicillin and tetracycline. The overall resistance rate to penicillin and tetracycline was 17.7. There was no resistance to spectinomycin, cefuroxime, ceftriaxone and norfloxacin. The resistance rates demonstrated in this study are sufficiently significant to preclude the use of penicillin and tetracycline in the STD clinics and to justify the use of newer antimicrobials. It is essential that resistance patterns be monitored by continued surveillance.

Eikenella corrodens brain abscess in a child with congenital heart disease

We reported the isolation of Eikenella corrodens from a brain abscess in a child with cuanotic congenital heart disease in Trinidad