Nosocomial infections in a neonatal intensive care unit in south-western Saudi Arabia.

A cohort study measured the occurrence and risk factors of nosocomial infections in the neonatal intensive care unit of Abha general hospital, Saudi Arabia. Of 401 neonates who stayed at least 48 hours in the unit, 77 developed infections, a period prevalence of 19.2% and an incidence of 13.7 infections per 1000 patient-days. The most frequent infections were: pneumonia (50.0%), primary bloodstream (40.9%) and skin and soft tissues (6.5%). In logistic regression analysis, mechanical ventilation (OR = 2.69, 95% CI: 1.39-5.19) and total parenteral nutrition (OR = 5.62, 95% CI: 2.78-11.35) were identified as significant risk factors. Neonates suffering from nosocomial infections had more than 3 times the risk of dying compared to neonates free of infection.

Sex differences in the clinical presentation of urban Nigerian patients with pulmonary tuberculosis.

BACKGROUND: Differences in clinical presentation of tuberculosis (TB) have been reported in different age groups, gender and in different parts of the world. Study of gender differences in clinical presentation of patients will assist in targeting those at higher risk and ensure successful TB control planning. OBJECTIVE: To describe the differences in clinical presentation and risk factors for TB in male and female Nigerian patients with pulmonary tuberculosis (PTB). METHODS: Patients with cough of more than three weeks duration attending hospitals in Abuja, Nigeria were interviewed with a structured questionnaire. After clinical examination, sputum samples were examined by smear microscopy and one sample was cultured. Haematological examination, serum chemistries, HIV serology, and chest X-ray evaluation were also evaluated. RESULTS: Of 1186 patients who had sputum culture, 731 (62%) were positive for TB: 437 (60%) males and 394 (40%) females. The mean (SD) age of males was significantly greater than that of females, 34 (11) vs. 31 (12) years, rp = 0.001. Male patients were more likely to be employed and better educated than women. More men than women smoked cigarettes. Women were more likely to be co-infected with HIV and less likely to be smear-positive than men. Male patients had more severe radiological disease. CONCLUSION: More men than women appear to present with TB at hospitals in Abuja. Male patients were older and are more likely to have smear-positive TB, whereas, female patients were more likely to be co-infected with HIV.

Comparison of blood, bone marrow aspirate, stool and urine cultures in the diagnosis of enteric fever.

A total of 288 specimens made up of 84 specimens each of blood, stool, urine and 36 specimens of bone marrow aspirates were collected from enteric fever patients. The blood specimen was used for cultural diagnosis and malaria parasite (MP) test, while serum from the blood was screened by Widal test. The remaining specimens (bone marrow aspirate, stool and urine) were only used for cultural diagnosis, but their cultural diagnostic sensitivity were only calculated from the patients whose Widal tests were positive. The widal test showed that 21(25%) had significant reciprocal titre levels of > 80 and > 160 for O and H antigens respectively. Malaria parasites test also had 23(37.4%) cases positive with 1(4.4%) and 22(95.7%) of them positive and negative by widal test respectively. Stool, blood and bone marrow aspirate were 33%, 28.6% and 38.1% sensitive respectively, while the diagnostic sensitivity of urine was zero. In the diagnosis of enteric fever, it is suggested that the presumptive serology test (Widal) be carried out along with cultures from bone marrow aspirate and stool where the former is affordable and available. Malaria parasite microscopy should also be done because majority of the suspected enteric fevers may actually only be malaria fever in an environment like Nigeria which is endemic for the two diseases (malaria and typhoid fever).

Anti-CagA antibodies in Helicobacter pylori-positive patients and blood donors from Nigeria.

The prevalence of antibodies to CagA protein was evaluated in 174 Helicobacter pylori-positive. subjects: 110 patients submitted to upper gastrointestinal endoscopy and 64 male blood donors. The patients were from different regions of Nigeria: Jos, North, Benue,West and East and the blood donors were from Jos. Sera were assayed for anti-CagA antibodies using Helicobacter p120, CagA ELISA (Viva Diagnostika, Hürth, Germany). Anti-CagA antibodies were detected in 104 (94.5%) patients and in 61 (95.3%) blood donors (P=1.0). Patients from the Benue region presented a lower frequency of anti-CagA antibodies than patients from the other regions (P=0.0004). When the subjects were stratified by age, a significant increase in IgG concentration was observed among the men (P=0.03) but not among the women (P=0.57) or among the blood donors (P=0.83). In conclusion, similarly toAsian countries, CagA-positive H. pylori infection is highly frequent in Nigeria.

Hippurate hydrolysis and Christie, Atkins, Munch-Peterson tests as epidemiological diagnostic tools for Streptococcus agalactiae carriage in pregnancy.

OBJECTIVE: To evaluate the Christie, Atkins, Munch-Peterson (CAMP) and hippurate hydrolysis reactions as diagnostic tools for Streptococcus agalactiae carriage in pregnancy. DESIGN: Observational, analytical case-control study. SETTING: Hospital-based study in a primary and a tertiary health care institution. PATIENTS: One hundred and six pregnant and 56 non-pregnant (controls) women were included in the study. The participants were of different socio-economic status. A volunteer sample was used. About 800 subjects were contacted and 162 participated in the study. RESULTS: The sensitivity of the screening test varied from 25% for the CAMP test to 77.78% for the hippurate hydrolysis reaction. The specificity was the same for both tests at (50%). A significant difference in positivity between the CAMP and hippurate hydrolysis reactions (95% confidence limit, P < 0.05) was observed. The predictive values of the positive test were 66.6% (CAMP) and 87.55% (hippurate hydrolysis) while the negative test were 14.29% (CAMP) and 33.30% (hippurate hydrolysis). Pregnant women had 0.33 chances of being GBS carriers with the CAMP compared to 3.5 with the hippurate hydrolysis. CONCLUSION: The hippurate hydrolysis test is highly recommended since the reagents are easily available and the organism was easily isolated using this method. The presence of GBS in the anorectum and endocervix is likely to induce systemic and local immunity in the female genital tract. This can contribute to the development of a mucosal vaccine for GBS diseases.

Neonatal meningitis.

OBJECTIVE: To determine the prevalent bacterial agents of neonatal meningitis and their antibiotic susceptibility in a referral intensive care unit in Assir Central Hospital, Saudi Arabia, during the years 1993-1998. METHODS: Records of newborn infants with positive cerebrospinal fluid culture during the period were retrospectively studied. RESULTS: There were 1473 nursery admissions, of which 32 episodes of meningitis occurred amongst 31 neonates. Klebsiella pneumoniae (31%) and Serratia marcescens (21%) were the main pathogens. The incidence of concurrent septicemia among these infants was 58%. Klebsiella pneumoniae appears to dominate in both early and late onset infections. The sex incidence was equal and the mortality rate was 48%. CONCLUSION: The survey identifies Klebsiella pneumoniae and Serratia sp. as the leading bacterial agents of neonatal meningitis in our environment. The relatively high frequency of Serratia infection in the present survey appears unique as this organism is comparatively rare in other reports across the globe. No Group B Streptococcus was isolated, which is in contrast to reports obtained in Europe, America and Australia where it is the predominant organism of neonatal sepsis or meningitis. Antibiogram identified imipenem and cefotaxime as the empirical antibiotics in infants with a clinical diagnosis of neonatal sepsis in our hospital; no more conventional use of ampicillin. In view of the changing bacterial pattern of infant infection with time even in the same environment, a periodic review of this subject is advocated.

Neonatal meningitis.

OBJECTIVE: To determine the prevalent bacterial agents of neonatal meningitis and their antibiotic susceptibility in a referral intensive care unit in Assir Central Hospital, Saudi Arabia, during the years 1993-1998. METHODS: Records of newborn infants with positive cerebrospinal fluid culture during the period were retrospectively studied. RESULTS: There were 1473 nursery admissions, of which 32 episodes of meningitis occurred amongst 31 neonates. Klebsiella pneumoniae (31%) and Serratia marcescens (21%) were the main pathogens. The incidence of concurrent septicemia among these infants was 58%. Klebsiella pneumoniae appears to dominate in both early and late onset infections. The sex incidence was equal and the mortality rate was 48%. CONCLUSION: The survey identifies Klebsiella pneumoniae and Serratia sp. as the leading bacterial agents of neonatal meningitis in our environment. The relatively high frequency of Serratia infection in the present survey appears unique as this organism is comparatively rare in other reports across the globe. No Group B Streptococcus was isolated, which is in contrast to reports obtained in Europe, America and Australia where it is the predominant organism of neonatal sepsis or meningitis. Antibiogram identified imipenem and cefotaxime as the empirical antibiotics in infants with a clinical diagnosis of neonatal sepsis in our hospital; no more conventional use of ampicillin. In view of the changing bacterial pattern of infant infection with time even in the same environment, a periodic review of this subject is advocated.

Antibody levels to Salmonella typhi and paratyphi in Nigerians.

OBJECTIVE: To determine the antibody titre levels to typhoid/paratyphoid fever organisms among apparently healthy volunteers. DESIGN: Cross sectional study. SETTING: General community and University Teaching Hospital. PARTICIPANTS: Volunteer sample of 323 apparently healthy individuals with body temperatures < or = 37.8 degrees C. MAIN OUTCOME MEASURES: Questionnaire administration to classify volunteers into three socio-economic status (SES). RESULTS: There were 35.29% of the apparently healthy population in Jos community with antibodies to typhoid/paratyphoid fever organisms. The presence of these antibodies were neither sex nor SES related. Normal antibody titres were up to 1:40 and 1:80 for O and H Salmonella antigens respectively. Contrary to the general belief, typhoid/paratyphoid fevers have not affected virtually everybody in Nigeria. The difference between those without previous history and those with previous history was significant (p < 0.05) with those in the former category having a higher percentage. CONCLUSION: For a single sero-diagnosis to have any diagnostic value in Jos community and its environs, only a four-fold rise to what has been found to be normal should be significant. This means that only titres of 1:160 and 1:320 and above for O and H antigens should be considered significant.

Fungal carriage in lizards.

The occurrence of fungi was investigated in the gut of 200 common garden lizards (Agama agama). The most important pathogenic fungus isolated was Basidiobolus haptosporus, an aetiological agent of subcutaneous zygomycosis. It was recovered from the intestinal contents of 112 (56%) lizards. Other important fungi isolated included Aspergillus spp. in 24 (12%) lizards, Candida spp. in 12 (6%), Penicillium spp. in 12 (6%) and Fusarium spp. in 12 (6%). Mucor spp. were isolated from eight (4%) male lizards only. Agamid lizards are plentiful in rural and urban areas of Nigeria. As they live in close vicinity to man, they are likely to play an important role in the spread of disease that may be caused by these fungi and its transmission to man. None of the animals investigated that yielded fungal cultures revealed any external fungal infection.

Clinical pattern of human immunodeficiency virus infection (HIV) in pulmonary tuberculosis patients in Jos, Nigeria.

A study of determine the seroprevalence rate and clinical presentation of HIV-associated pulmonary tuberculosis was carried out in Jos between October 1990 and September 1991. Out of the 180 newly diagnosed pulmonary tuberculosis patients, 11(6.1%) were confirmed seropositive for HIV-1 and 2. The peak age range for both tuberculosis and HIV infection in both sexes is 20-40 years. The risk of HIV infection was associated with multiple sex partners and blood transfusion. There was no significant difference in the clinical presentation of pulmonary tuberculosis between HIV-seropositive and seronegative patients (P > 0.1). However, diarrhoea, lymphadenopathy and marked weight loss were found to be significantly associated with HIV infection (P < 0.05). The mean lymphocyte count of HIV seropositives was significantly lower than seronegatives (P < 0.01).

PIP: While tuberculosis (TB) is already a highly common disease in developing countries, the advent and spread of HIV/AIDS has further increased the incidence of TB worldwide, especially in Africa. Findings are presented from a study conducted to determine the seroprevalence rate and clinical presentation of HIV-associated pulmonary TB among 180 newly diagnosed pulmonary TB patients at Jos University Teaching Hospital, Nigeria, between October 1990 and September 1991. 11 (6.1%) patients were confirmed seropositive for HIV-1 and HIV-2 infection, with the peak age range for both TB and HIV infection in both sexes being 20-40 years. The risk of HIV infection was associated with multiple sex partners and blood transfusion. No significant difference was observed in the clinical presentation of pulmonary TB between HIV-seropositive and seronegative patients. However, diarrhea, marked weight loss, and lymphadenopathy were significantly associated with HIV infection. The mean lymphocyte count of HIV seropositive individuals was significantly lower than among seronegative individuals.

The aetiological agents of superficial cutaneous mycoses in Jos, Plateau State of Nigeria.

A survey of superficial skin mycoses was carried out among miners and office workers employed in different establishments in Jos, Nigeria. Mycotic infection was demonstrable by microscopy and culture in 45 (10.4%) subjects: 20 males and 25 females. Malassezia furfur was the predominant aetiological agent, followed by Candida albicans and Trichophyton soudanense. Other aetiological agents frequently recovered were T. rubrum., T. mentagrophytes., Microsporum audouinii and Trichosporon beigelii.

Transmission of cytomegalovirus in the Gambia.

One hundred and seventy-eight Gambian women in their late 3rd trimester plus babies born to them, and later on some 11 randomly selected CMV positive and 11 CMV negative infants with their mothers and siblings, were examined serologically, and virologically for the evidence of cytomegalovirus infection with a view to determining who is infecting who and how, in this community. There was significant correlation between CMV positive infants and CMV infection in their siblings, whereas there was no such correlation between these infants and their CMV positive mothers. Children under five years excreted more CMV and for a longer time in all their samples than the corresponding samples and in all specimens from their mothers. Urine had the highest amount of CMV both in the children and adults. It is concluded that children were more likely to transmit CMV to the infants and that urine through bed-wetting, was the most likely route of such transmission in Gambia and probably also in West Africa.

Serological and cultural examination for human leptospirosis in Plateau State, Nigeria.

In a serological examination of 710 serum samples collected from human volunteers in Plateau State, Nigeria, 128 (18.0pc) had leptospiral antibody titres of 1:100 and above. The prevalence of antibodies to individual serovars were: hardjo 28 (21.9pc), pomona 18 (14.1pc), canicola 17 (13.3pc), grippotyphosa 15 (11.7pc), pyrogenes 13 (10.2pc), icterohaemorrhagiae 12 (0.4pc) and autumnalis 8 (6.3pc). There was no statistical difference in the prevalence rate of leptospirosis in the different local government areas (p greater than 0.05; X2). Among the occupational groups examined, the abattoir workers were particularly at risk with a prevalence rate of 29.5pc. A leptospiral variant of strain Hardjoprajitno was also isolated from the midstream urine of an abattoir worker who was apparently healthy. The isolation of Leptospira interrogans serovar hardjo in man is the first such report in Nigeria.

Mycoplasmas among clients attending a family planning clinic in Zaria, Nigeria.

The effect of contraception in the incidence of genital tract mycoplasma infection was studied in 150 women practicing contraception and another 50 women attending a gynecological clinic, using no contraception. Using the chi-squared method, there was no statistically significant difference between total mycoplasma recovery in family planning clients versus the controls. The only statistically significant difference was between total positive mycoplasma in the oral contraceptive group versus IUD users.