Epidemic yellow fever in Borno State of Nigeria: characterisation of hospitalised patients.

BACKGROUND: In 1990, an outbreak of a febrile illness with high mortality was reported in border villages, later spreading to other areas of Borno State of Nigeria. OBJECTIVE: To present a report of the investigation of that outbreak, with emphasis on the characterisation of hospitalised patients. METHODS: Selected centres reporting cases of acute febrile illness during the months of August to December, 1990 were visited, to establish surveillance. Case investigation forms were used to obtain clinical and demographic data; and blood samples were obtained from patients for analyses. Only hospitalised patients with adequate clinical information from three centres were included in the analysis. RESULTS: The outbreak, which involved five of the six health zones in the state, and spread into adjoining Gongola state and the Cameroun Republic, was caused by the yellow fever virus. Fever, central nervous system (CNS) involvement, jaundice and haemorrhage were the most common clinical manifestations of 102 hospitalised patients. Eighty -three (81%) of hospitalised patients died and most within two days of admission. CNS manifestations were more common in dying patients than in survivors. CONCLUSION: The reasons for this rare outbreak of yellow fever in the dry Savannah belt of Borno State remain unclear. Improved surveillance and more effective prevention strategies are needed to avert the recurrence of such outbreaks.

Relevance of moldy fungi as agents of chronic lower respiratory tract infection in patients seen in Maiduguri, Nigeria.

BACKGROUND: In Maiduguri, Nigeria in the 1990's, we had available to us only the direct Acid Fast Bacilli (AFB) smear method to diagnose tuberculosis (TB), and no facility for TB culture. Because the clinical and radiologic manifestations of lower respiratory tract (LRT) fungal infections are difficult to differentiate from those of LRT TB, it was not clear how many of the direct AFB smear negative patients had fungal infections, or were true negatives for TB. OBJECTIVE: To assess sputum samples from patients with suspected lower respiratory tract infection for non-candidal fungal isolates as well as Mycobacterium tuberculosis. METHODS: Smears of sputum samples were examined microscopically for fungal hyphae and AFB. Sputum samples were also plated onto different fungal culture media. Isolation data were correlated with clinical and radiological data, to determine their clinical significance. RESULTS: Of the 274 patients seen, 41(15%) had positive sputum for AFB, while 61(22.3%) had positive sputum for fungal isolates. The most common fungal isolates were Aspergillus spp (42.9%), Scopulariopsis (14.3%), Chrysosporium (8.9%), Penicillium (7.1%), Fusarium (7.1%) and Acremonium (5.4%). No patient with mold isolate had cavitary lung disease, while 62.5% of TB patients had cavitary disease. Extensive disease (54.2%) and abnormal chest x-ray (91.7 %) were characteristic of patients with TB but very rare in patients with fungal infection. CONCLUSION: We therefore conclude that serious lower respiratory tract fungal infection was rare and that extensive or cavitary disease was usually due to pulmonary TB. The clinical diagnosis of TB under defined conditions, as in our setting, still has great utility.

Seroepidemiology of human immunodeficiency virus infection in Borno State of Nigeria by sentinel surveillance.

A serosurvey for human immunodeficiency virus (HIV) infection was carried out in three well-separated population centers in Borno State of Nigeria in 1989-1990. The study subjects were 1,259 made up of sexually transmitted disease (STD) clinic attenders, pregnant women, female prostitutes, and blood donors. Sera were screened by enzyme-linked immunosorbent assay and confirmation was done by Western blotting. The overall seroprevalence was 1.67% (21/1,259), with no significant differences from one population center to another. There were, however, significant differences among the population groups studied: prostitutes, 4.24%; STD clinic attenders, 1.67%; blood donors, 0.71%; and pregnant women, 0.24%. Of the 21 seropositives, 18 were positive for HIV-1 only; 1 was positive for HIV-2 only; and 2 were positive for both HIV-1 and HIV-2. All three HIV-2-positive sera were from prostitutes. Prevalence rates found in this study showed marked increases from 2 to 3 years earlier. There is therefore the need for a vigorous and sustained intervention program.

A retrospective study of nine years' hospital records of schistosomiasis in north-eastern Nigeria.

We have studied reports of new cases at 11 State Government Hospitals in the state of Borno, over a period of 9 years from 1976 to 1984. Urinary schistosomiasis was the second most common communicable disease, while intestinal schistosomiasis ranked sixth. The rise in prevalence of schistosomiasis since 1979 probably reflects increased public awareness of the beneficial role of hospitals. The decline in the number of cases seeking treatment in 1982 and 1983 may be due to the decline in rainfall and thus of agricultural and fishing activities involving contaminated irrigation ponds.

Determination by Widal agglutination of the baseline titre for the diagnosis of typhoid fever in two Nigerian states.

This study was carried out in Borno and Plateau States of Nigeria to determine the baseline titre for the diagnosis of typhoid fever using a single Widal test. Of 172 patients with symptoms and signs of typhoid fever, 92.4% and 90.7% had reciprocal O and H antibody titres respectively of 160 or above. On the other hand, 95.3% and 66.3% of the 937 healthy control subjects had reciprocal O and H antibody titres respectively of 80 or less. The results of this study suggest that in Borno and Plateau States of Nigeria a reciprocal O antibody titre of 160 and above in persons with illness whose symptoms and signs are compatible with typhoid fever could be considered diagnostic using the single Widal test.

Human immunodeficiency virus type 1 (HIV-1) infection among female prostitutes in Borno State of Nigeria: one year follow-up.

Serological investigations on female prostitutes resident in Borno State in northeastern Nigeria have shown that the seroprevalence of HIV-1 infection has increased 9.81%--fold in one year. The highest sero-prevalence rates were found amongst prostitutes who had not benefited from previous health education campaigns. Prostitution appears to be on the increase in spite of AIDS probably because of the difficulty in finding alternative means of making a living. Attempts to halt the spread of HIV infection are hampered by the fact that most prostitutes are indifferent to the use of condoms and do not appreciate the importance of protecting themselves from the risks of HIV infection. Their frequent mobility also poses a problem as it makes it difficult for them to benefit from health education campaigns. The prevalence of HIV-1 infection among female prostitutes in Borno State (as indeed in other States in Nigeria) is likely to rise sharply in the next few years unless serious efforts are made to intensify health education campaigns targeted at the high risk groups.

PIP: The purpose of this study was to assess the value of a health education campaign on the prevalence of HIV-1 infection in Nigeria and to provide an up-to-date status report on HIV-1 infection among female prostitutes to make future health education campaigns more effective. 353 female prostitutes residing in hotels in Maiduguri, in Borno State, Nigeria were studied in April, 1988. 77 prostitutes screened in March 1987 and found to be seronegative, were selected for the health education campaign. From the total 298 were Nigerian, while 55 were foreigners from other African countries. 18 of the 353 were confirmed seropositive for HIV-1 infection; 14 were Nigerians and 4 were foreigners. 73.% were 20-29, 1.13% were 40-49 and 14.7% were between 10-19. 54.12% were divorced while 3.12% were still married. Those married were in prostitution to support their families; 27.8% had no children while 72.5% had between 1-8 children through marriage or illegitimate means. 62.89% had heard about AIDS through gossip. Condom use varied between the 2 populations: 140 of the 276 prostitutes (50.7%) who had not taken part in the health education campaign used the condom while 136 (49.3%) never used it. 53 of the 77 (68.8%) prostitutes screened in 1987 used the condom while 24 never used it. The data demonstrates that AIDS is increasing in Nigeria. The results of this study strengthen the need to intensify health education campaigns, 1.3% of those who benefitted from previous health education campaigns were seropositive while 6.16% of those who did not participate were seropositive for HIV-1 infection. The need for more information about AIDS is now critical because of the 50% increase in prostitution during the past year due to the lack of economic opportunities. (Author's modified).

Comparison of commercial kits for the detection of antibody to human immunodeficiency virus type 1 (HIV-1) in Nigeria.

Four commercial kits for the detection of antibodies to HIV-1 were compared with regard to their sensitivity, specificity and positive predictive value. The Wellcozyme competitive enzyme immunoassay was the least sensitive (62.5%), while Roche EIA, was the most sensitive (100%). All the commercial kits gave false negative results except the Roche EIA system. The Serodia particle agglutination test had the least positive predictive value of 26.9% while Roche EIA had the highest (88.9%). Our results show that commercial HIV-I antibody test kits are not equally sensitive in detecting positive sera. The practice of using Wellcozyme EIA alone for screening blood meant for transfusion should be discouraged because it does not detect all positive sera and might therefore increase the chances of transfusing HIV-I positive blood. The Roche EIA system appears to be the most reliable for screening blood. Test systems which detect HIV-2 should also be used for screening blood meant for transfusion.

PIP: 4 commercial kits for detection of antibodies to human immunodeficiency virus type 1 (HIV-1) were compared with regard to their sensitivity, specificity, and positive predictive value (PPV). The Wellcozyme competitive enzyme immunoassay (EIA) was the least sensitive (62.5%), while Roche EIA was the most sensitive (100%). All the commercial kits gave false negative results except the Roche EIA system. The Serodia particle agglutination test had the least PPV of 26.9%, while Roche EIA had the highest (88.9%). Results show that commercial HIV-1 antibody test kits are not equally sensitive in detecting positive sera. The practice of using Wellcozyme EIA alone for screening blood meant for transfusion should be discouraged because it does not detect all positive sera and might, therefore, increase the chances of transfusing HIV-1 positive blood. The Roche EIA system appears to be the most reliable for screening blood. Test systems which detect HIV-2 should also be used for screening blood meant for transfusion. 176 sera were used. 80 serum samples were gathered from female prostitutes; 30 from prisoners; 20 from patients with a sexually transmitted diseases; and 46 from blood donors. None of the blood came from anyone who had acquired immunodeficiency syndrome symptoms. The 4 commercial tests used were Wellcozyme, Elavia, Roche, and Serodia.

Prevalence of transmissible blood infections among blood donors at the University of Maiducuri Teaching Hospital, Maiduguri, Nigeria.

Before the advent of the Acquired Immune Deficiency Syndrome (AIDS), many countries of the world transfused blood without seriously considering the potential risks of transmission of infectious agents. Even after it was shown that the Human Immunodeficiency virus(HIV) could be transmitted through blood and blood products, many hospitals and clinics in Nigeria still continue to transfuse unscreened blood. This study was therefore initiated to highlight the risks of transmitting infectious agents through blood transfusion and the category of infectious agents which could be transfused in blood in this area. A total of 364 healthy blood donors were counselled, bled and screened for HIV-1, HIV-2, HBsAg, Treponema pallidum, Plasmodium falciparum and microfilaria. The results show that the three most common infections transmissible through blood transfusion are Hepatitis B(14.9%), HIV-1 (5.8%) and P.falciparum (4.1%). Thirteen of the 364 blood donors (3.6%) and antibodies to T. pallidum. There were no donors with HIV-2 or filarial infection. Infection of donors by hepatitis B virus (HBV), T. pallidum and HIV-1 was not significant dependent on promiscuity, polygamy, previous blood transfusion or local surgery. However, there was a significant difference between donors with no risk factors and those with risk factors with regard to seroprevalence to HBV, T. pallidum and HIV-1 (p = 0.0053). The results confirm that transfusion of unscreened blood carries severe risks of transmitting serious infectious agents and that is a need to enforce laws for transfusing blood in Nigeria. Meanwhile, in the absence of screening facilities, proper counselling of blood donors in order to ascertain their risk behaviour should be used to select donors and reduce this risk.

Effect of dietary cyclopropene fatty acids on the amino acid uptake of the rainbow trout (Salmo gairdneri).

The rate of uptake of 3H-lysine in rainbow trout on 50 ppm dietary cyclopropene fatty acid (CPFA) was not significantly different from that of the control group. However, at 300 ppm CPFA treatment, the uptake of 3H-lysine was significantly lower than those in control or 50 ppm fed fish. Reduced ATP formation resulting from abnormal mitochondria may be responsible.

Detergent solubilization of the respiratory nitrate reductase of Bacillus stearothermophilus.

Four detergents (octyl glucoside, zwittergent, Triton X-100, and Nonidet P-40) were examined with regard to their efficiency in solubilizing and retaining the activity of the nitrate reductase of Bacillus stearothermophilus. At a concentration of between 0.4 and 0.6%, the non-ionic detergent octyl glucoside solubilized only 64% of the membrane proteins. However, about 100% of the nitrate reductase activity was recovered in the soluble fraction. In contrast, the zwitterionic detergent 3-(alkyldimethylammonio)-1-propanesulphonate (3-16) solubilized 100% of the membrane proteins, but only 77% of the nitrate reductase activity was recovered. Two other non-ionic detergents, Triton X-100 and Nonidet P-40 also solubilized 100% of the membrane proteins, but there was a dramatic increase in total enzyme activity following solubilization. The enzyme activity was not stable in any of the four detergents for more than 2 days. Nevertheless, octyl glucoside was preferred because of the additional advantage of ammonium sulphate fractionation.

A review of data on measles cases from sentinel surveillance sites in north-western Nigeria.

This review was carried out to evaluate the impact of the revised Expanded Programme on Immunisation (EPI) against measles in the six north-western states of Nigeria through the sentinel surveillance system. The revised EPI was launched in all states by 1985, with a strategy of phased acceleration to reach all local government areas by 1987, and to achieve 80% vaccine coverage of children under two years, with 50% reduction in EPI disease morbidity by 1990. Results of the review showed a dramatic decrease in measles cases in each state: 70% overall from 1985 to 1988. Of 918 cases with known measles vaccination status, 90.6% were unvaccinated and 9.4% had documented immunisation. One concern is that 19% of cases occur in unimmunised infants under nine months. Although a suitable vaccine for children under nine months is available, it is not yet in use in Nigeria and these cases are therefore not preventable. At present, our best strategy is to increase coverage through a vigorous EPI campaign, concentrating on underserviced and hard-to-reach areas, and to strengthen surveillance so that measles outbreaks are identified early and action taken.

Human immunodeficiency virus (HIV) infection in patients attending a sexually transmitted diseases clinic in Borno State of Nigeria.

Results of a study to determine if patients attending sexually transmitted diseases (STD) clinics are at high risk to human immunodeficiency virus (HIV) infection are presented. The 206 patients who attended the STD clinic at the Maiduguri General Hospital consisted of 200 males and 6 females, most of whom were aged between 20 and 29 years and were single. Only one of the 206 serum samples (0.49%) was confirmed seropositive for HIV-1 antibodies. However, cultures from 143 of 174 swabs taken from the subjects yielded significant growth of which Staphylococcus aureus was the predominant isolate followed by Neisseria gonorrhoea. Antibodies to Treponema pallidum were also detected in 3.9% of the serum samples. This study shows that HIV-1 infection is relatively rare in Borno state of Nigeria. In spite of this, a well-planned health education campaign for STD patients is indicated if HIV infection is to be effectively controlled.

Impact of health education on prostitutes' awareness and attitudes to acquired immune deficiency syndrome (AIDS).

PIP: 767 female prostitutes in Maiduguri, Nigeria responded to a questionnaire on AIDS. Their motives and activities, awareness of HIV, transmission, prevention, and cure of AIDS and attitudes towards HIV carriers were examined. Researchers administered this questionnaire after the prostitutes had attended health education sessions on AIDS. Approximately 78% of the prostitutes were under 30 years old and 72.6% were married or had been married. 74.58% were mothers. 27% originated from neighboring countries. Patrons included civil servants, businessmen, petty traders, and craftsmen. On average, each prostitute entertained 3.3 customers/day and had sex with 1046 customers/year. 85.92% of the prostitutes claimed financial reasons such as supporting their children, for practicing prostitution. The majority of the women indicated that they generally received injections of antibiotics to prevent sexually transmitted diseases (STDs) via reused syringes and needles. 7.04% admitted to having had an STD in the past, but the researchers believe the percentage is too low. No prostitute claimed to use any hard drugs. Even though the prostitutes were receptive to health education, only 7.1% remembered that AIDS is caused by a virus and 84.3% just could not remember the causative agent. The majority (75.7%) did remember that sexual intercourse is a mode of transmission, but only 50% realized that infected blood and blood products were modes of transmission. The majority of the prostitutes indicated that they would use a condom when having sex. In addition, all stated that, if they later learn that they carry HIV, they would stop practicing prostitution. Most of the women wanted some form of restriction for HIV carriers, such as confinement or hospitalization until a cure is found. These results suggest that health education is needed and must reach the general population.^ieng