ABSTRACT
INTRODUCTION: Leprosy remains a public health problem, mainly in Africa, Asia and Latin America. Leprosy has many complications that include leprosy reactions, development of plantar and hand ulcerations, lagophthalomus and corneal anesthesia. OBJECTIVES: In Ethiopia there is scarce information on the pattern of bacterial isolates and drug sensitivities of infected ulcers in patients with leprosy. This study was undertaken to identify the bacteriology of infected ulcers and to determine their antimicrobial susceptibility pattern. STUDY DESIGN: A descriptive cross-sectional study was conducted in 245 informed and consented leprosy patients with infected ulcers visiting ALERT, Kuyera and Gambo hospitals during the period August 2006 to May 2007. MATERIAL AND METHODS: Wound aspirate specimens were collected from ulcers of each patient aseptically and inoculated into standard bacteriological media. Antimicrobial susceptibility testing was performed for all isolates according to the criteria of the National Committee for Clinical Laboratory Standards (NCCLS) by disk diffusion method. RESULTS: Of the 245 patients investigated, 64.1% were males and 35.9% females (P < 0.05). The average age of the patients was 50 years (age range 13 to 92 years). According to Ridley-Jopling classifications, patients presented with TT (3.7%), BT, (31.4%), BL (44.5%) and LL (15.9%) types of leprosy. Plantar and hand ulcers were observed in 92.2% and 7.8% of patients, respectively. According the patients, the commonest cause of their ulcers was 'spontaneous' (56.7%). There were 44% Gram-positive and 56% Gram negative bacteria (P > 0.05). Proteus spp. accounted for 29.5% of the total isolates followed by Staphylococcus spp. (28.8%), beta-hemolytic streptococci (15.1%) and different types of Gram-negative bacteria (26.2%). Multiple organisms (two or three) were isolated from 19.6% patients. Of the 212 wound samples cultured anaerobically, 5.2% were positive for anaerobic culture. In this study both Gram-positive and Gram negative bacteria showed decreased sensitivity to most antimicrobial agents tested. CONCLUSION: Proteus spp. was the most common isolate from infected ulcers. Ciprofloxacin, norfloxacin and gentamicin were the most effective drugs against the tested bacteria mainly for Gram-negative bacteria. This refers to the in vitro-sensitivity during the study period. The results of this study may help inform clinicians about the selection of an antibiotic in situations where use of an antibiotic may be indicated.
Subject(s)
Gram-Negative Bacteria/drug effects , Gram-Positive Bacteria/drug effects , Leprostatic Agents/pharmacology , Leprosy/microbiology , Ulcer/microbiology , Adolescent , Adult , Aged , Aged, 80 and over , Bacterial Infections/drug therapy , Bacterial Infections/epidemiology , Bacterial Infections/microbiology , Ciprofloxacin/pharmacology , Cross-Sectional Studies , Culture Media , Disk Diffusion Antimicrobial Tests , Drug Resistance, Multiple, Bacterial , Ethiopia/epidemiology , Female , Gentamicins/pharmacology , Gram-Negative Bacteria/isolation & purification , Gram-Negative Bacteria/pathogenicity , Gram-Positive Bacteria/isolation & purification , Gram-Positive Bacteria/pathogenicity , Hospitals/trends , Humans , Informed Consent , Leprosy/epidemiology , Leprosy/etiology , Male , Middle Aged , Ulcer/complications , Ulcer/drug therapy , Ulcer/epidemiology , Young AdultSubject(s)
Antineoplastic Agents/adverse effects , Data Collection , Leprostatic Agents/adverse effects , Pharmacists/legislation & jurisprudence , Physicians/legislation & jurisprudence , Thalidomide/adverse effects , Abnormalities, Drug-Induced , Drug Prescriptions , Female , Humans , Informed Consent , Liability, Legal , Male , Patient Education as Topic , Pharmaceutical Services , Pharmacists/ethics , Physicians/ethics , Pregnancy , Risk Management , United States , United States Food and Drug AdministrationABSTRACT
The HIV/ARC/AIDS story continues to unfold. It is both the old, sadly familiar experience of plague and disease, of lepers isolated as unclean, of smallpox decimating the American Indians, of a Black Death sweeping medieval Europe, of the 1918 influenza. It is also a new story, one in which medical scientists rather quickly identified the causative infectious agent but, as yet, have been unable to cure the infection, although some amelioration of the basic course of the illness appear possible if treatment with AZT is begun relatively early. The ethical problems are numerous and constantly change as the understanding of the disease and its potency evolves. The social answers have, after initial delay, received positive action on an official level. On the more personal level of the average American there remains animosity, prejudice, and a deeply rooted fear, the ancient fear of the leper, of the plague victim. The health professionals have also officially responded well to the challenge of AIDS. Personally, as in society generally, there has been a mixed response. We believe that the ethical concerns enumerated in this article will be resolved in favor of persons with AIDS. Nevertheless, the personal, spiritual, emotional, and economic isolation experienced by persons with AIDS and their families challenge us about what kind of society we wish to be. We will ultimately be measured as a civilization by the way in which we treated the least fortunate. America's track record in this regard has been mixed. AIDS presents us with a chance to change.