Paragonimiasis: Neglected, Re-Emerging or Expanding Frontiers. Lessons from a Case Presenting in Jos, Plateau State.

BACKGROUND AND OBJECTIVES: Paragonimiasis is endemic in Eastern Nigeria. An upsurge was recorded after the Nigeria/Biafra war as protein lack in Biafra forced people to eat fresh water crabs. Its protean manifestations create confusion with several diseases. Elimination was assumed after a while and suspicion index fell. The interest in reporting this case follows its presentation outside the traditional endemic zone. RESULTS: The patient, though living in Eastern Nigeria and manifesting several pointers of Paragonimiasis, was treated as tuberculosis despite negative sputum AFB; without improving. He then presented up-country in Jos where history led to suspicion and confirmation of Paragonimiasis. By this time he had severe cor-pulmonale and died despite treatment. CONCLUSION: In this current economic downturn in Nigeria which may drive people to cheaper protein sources, a high index of suspicion should be raised for paragonimiasis when a patient presents with chronic cough productive of AFB-negative sputum and haemoptysis.

A pilot study for targeted surveillance of bovine spongiform encephalopathy in Nigeria.

Bovine spongiform encephalopathy (BSE), popularly known as 'mad cow disease', led to an epidemic in Europe that peaked in the mid-1990s. Its impact on developing countries, such as Nigeria, has not been fully established as information on livestock and surveillance has eluded those in charge of this task. The BSE risk to Nigeria's cattle population currently remains undetermined, which has resulted in international trade restrictions on commodities from the cattle population. This is mainly because of a lack of updated BSE risk assessments and disease surveillance data. To evaluate the feasibility of BSE surveillance in Nigeria, we carried out a pilot study targeting cattle that were presented for emergency or casualty slaughter. In total, 1551 cattle of local breeds, aged 24 months and above were clinically examined. Ataxia, recumbency and other neurological signs were topmost on our list of criteria. A total of 96 cattle, which correspond to 6.2%, presented clinical signs that supported a suspect of BSE. The caudal brainstem tissues of these animals were collected post-mortem and analysed for the disease-specific form of the prion protein using a rapid test approved by the International Animal Health Organization (OIE). None of the samples were positive for BSE. Although our findings do not exclude the presence of BSE in Nigeria, they do demonstrate that targeted sampling of clinically suspected cases of BSE is feasible in developing countries. In addition, these findings point to the possibility of implementing clinical monitoring schemes for BSE and potentially other diseases with grave economic and public health consequences.

A Targeted Survey for Scrapie in Jos Plateau State, Nigeria.

Scrapie, a disease of sheep and goats with a progressive course and fatal outcome, has not been identified in Nigeria. Anecdotal scrapie reports by livestock workers abound. Livestock diseases like scrapie form huddles in livestock economics of countries. For 8 months we surveyed for scrapie targeting emergency/casualty slaughter sheep and goats in Jos, Nigeria. We clinically examined 510 sheep and 608 goats of local breeds, aged from 12 months to 5 years. In total 31 (5.10%) goats and no sheep were clinically suspicious for scrapie. Caudal brainstem tissues of suspect animals collected postmortem were analyzed for the disease specific form of the prion protein, PrP(Sc), using Bio-Rad's TeSeE ELISA rapid test kit. No sample was positive for scrapie. Fluorescent antibody test for rabies and H&E staining on samples were carried out for differential diagnosis. These showed no pathological lesions indicative for neurological disease. While our findings do not exclude the presence of scrapie in Jos, we demonstrate that targeted sampling of small ruminants for neuroinfectious disease is feasible in developing countries, pointing to the possibility of implementing such a monitoring scheme in Nigeria to prevent economic losses in small ruminant livestock as scrapie caveats from endemic countries have shown.

Prevalence of malaria parasitaemia and associated factors in febrile under-5 children seen in Primary Health Care Centres in Jos, North Central Nigeria.

OBJECTIVE: This study was carried out to determine the prevalence of malaria in febrile under-5 children attending Primary Health Care Centres in relation to some demographic factors, duration of symptoms, previous antimalarial intake, presence of pyrexia, exclusive breast-feeding, mid upper arm circumference and body temperature. METHODS: Giemsa-stained thick and thin blood films prepared from blood specimens of 260 febrile under-5 children selected randomly from 5 Primary Health Care Centres in Jos, North Central Nigeria were examined microscopically for malaria parasite. RESULTS: A prevalence of 56.9% was recorded in this study, and only Plasmodium falciparum was encountered. Educational status of their mothers is high as only 3.8% are illiterates. Duration of illness before the visit to the centres lasted from 1 day (12.3%) to 4 days representing 39.2%. Fever, malaise, vomiting and diarrhoea are the clinical symptoms found in the patients. Majority of the patients were infants (0-12 months) representing 53.1% of the screened population and had a malaria prevalence of 52.2%. The other age groups; 13-24, 25-36, 37-48 and 49-60 months recorded 57.1%, 63.6%, 81.8% and 75% respectively (P<0.05). The males recorded a prevalence of 57.9% as against 55.9% in female (P>0.05). Prevalence in relation to duration of symptoms was 64.9% for 3 days, while the least prevalence of 42.9% was for the 2 days' duration (P>0.05). Patients with no previous antimalarial intake had a prevalence of 56.8% while those with previous antimalarial intake recorded 57% (P>0.05). Patients who had pyrexia at the time of presentation had a prevalence of 56.3% as against 57.5% in those without pyrexia (P>0.05). Patients on exclusive breast feeding had 58.3% as against 42.6% in those not on exclusive breast feeding (P<0.05). Only 16 (6.2%) of the patients had a MUAC of 12 cm and recorded the highest prevalence of 87.5%, 137 (52.7%) with a MUAC of 13-15 cm recorded 72.3%, while 107 (41.2%) with a MUAC of >15 cm had a malaria parasitaemia prevalence of 32.7% (P<0.05). Patients with body temperatures of 370 degrees C recorded the highest prevalence of 60.4%, while those with 37.1 degrees C-38 degrees C, 38.1 degrees C-39 degrees C and 39.1 degrees C-40 degrees C recorded prevalences of 60.2%, 55.6% and 23.1% respectively. CONCLUSION: The presence of a high prevalence of malaria parasitaemia in very vulnerable under-5 children in an urban centre calls for an urgent and serious implementation of various control measures against malaria; so as to reduce the sequelae and complications associated with this infection. The cause of fever in the absence of identifiable malaria parasite suggests that other infectious agents might be responsible for the pyrexia.

Intestinal parasitism in Magama Gumau rural village and Jos township in north central Nigeria.

OBJECTIVE: To determine the prevalence of intestinal parasitosis in one rural village and one urban centre in North Central Nigeria. METHODS: A total of 111 single stool specimens from all the volunteered rural dwellers and 93 specimens from randomly selected urban dwellers were examined using Formol-ether and modified Ziehl-Neelsen techniques; during the months of June and July 2005. A questionnaire was completed for each subject and the nutritional status of the adults was assessed using the anthropometric measurements (weight and height for age and Biomass index). RESULTS: The results suggest very high prevalence rates of intestinal parasitosis of 72.1% and 69.9% for the rural and urban populations respectively. All the age groups were infected. The males in the rural area had a prevalence of 69.2% as against 74.6% in females (P>0.05); while in the urban area, the males were more significantly infected (77.4%) compared with the females with 66.1% (P< 0.05). Those with normal BMI (18.5-24.9 kg/m2) had the highest prevalence of 79.3% and 72.4% for the rural and urban populations respectively. The prevalence of the parasites in the rural and urban populations respectively were: Entamoeba coli (16.2% and 9.7%); E. histolytica (18.9% and 18.3%); E. hartmani (1.8% ad 0.0%); Endolimax nana (16.2% and 18.3%); Iodamoeba butschlii (0.0% and 1.1%); Giardia lamblia (7.2% and 4.3%); Schistosoma mansoni (9.9% and 0.0%); Strongyloides stercoralis (0.9% and 0.0%); Hookworm (4.5% and 5.4%); Ascaris lumbricoides (1.8% and 0.0%); Enterobius vermicularis (0.0% and 1.1%); Cryptosporidium parvum (29.7% and 19.4%); and Enterocytozoon bieneusi/Encephalitozoon intestinalis (39.6% and 47.3%). Polyparasitism was recorded in 48.6% of the rural subjects and 36.6% of the urban subjects. CONCLUSION: The study has shown a very high prevalence of intestinal parasitosis in both the rural and urban populations and that C. parvum and E. bieneusi/E. intestinalis are harboured by apparently healthy individuals.

Comparison of the OptiMAL rapid test and microscopy for detection of malaria in pregnant women in Nigeria.

Malaria during pregnancy causes anaemia in pregnant women and low birthweight in infants. The purpose of this study was to evaluate the OptiMAL rapid malaria test in comparison with standard microscopy for malaria diagnosis in 268 pregnant women attending antenatal clinics at the Jos University Teaching Hospital and the Federal Medical Centre-Gombe in Nigeria. Positive results by either method were confirmed using a polymerase chain reaction assay for malaria. Although the OptiMAL assay did not detect malaria in the blood of pregnant women with low levels of parasitaemia, it may be useful for the detection of placental malaria which predisposes to low birthweight infants.

Prevalence of Malaria Parasitaemia in Screened Blood Donors at Jos University Teaching Hospital; Nigeria

The prevalence of malaria parasitaemia was investigated among screened blood donors at Jos University Teaching Hospital between April and June 2003. A total of 200 blood donors that were systematically selected were examined for malaria parasitaemia. Twenty two samples were positive giving a prevalence of 11.0

Current aetiology of neonatal sepsis in Jos University Teaching Hospital.

BACKGROUND: Periodic bacteriologic surveillance in neonatal units is a necessity. OBJECTIVE: To determine the currently prevalent pathogens of neonatal sepsis in the Special Care Baby Unit of Jos University Teaching Hospital, and their antibiotic susceptibility profiles. METHODOLOGY: One hundred and twenty two neonates with clinical suspicion of sepsis underwent bacteriologic screening over a 4 month period. RESULTS: One hundred and fourteen bacteria were isolated from 66 (54.1%) of the infants. Forty two (36.8%) isolates were gram positive (predominantly Staphylococcus aureus), while 72 (63.2%) were gram negative (predominantly Escherichia coli). Gentamicin was most useful antibiotic, though effective against only 67% of both gram positive and gram negative bacteria. The susceptibilities of both gram positive and gram negative bacteria to the third generation cephalosporins were particularly poor (less than 10%). CONCLUSION: Our data show a change in the predominant gram negative bacterial pathogen compared with an earlier report from our unit, and an alarming overall decline in the susceptibilities of both gram positive and gram negative pathogens to the commonly used antibiotics.

Parasitic agents in childhood diarrhoea and malnutrition.

In a prospective survey, 1130 children were studied for parasitic infections associated with acute diarrhoea and/or protein energy malnutrition at the Jos University Teaching Hospital, Jos, Nigeria. Intestinal parasites were isolated in 29.2% of the children with E. histolytica, S. mansoni, Hookworm and A. lumbricoides predominating. Children with diarrhoea marginally harbour parasites more frequently than those without diarrhoea, particularly the diarrhoeagenic parasites. The prevalence and pattern of parasitic infections was similar between the malnourished children and their controls reflecting similar environmental influence. We therefore conclude that significant number of children are infected with intestinal parasites and these contribute to morbidity and mortality by precipitating or aggravating diarrhoeal disease or malnutrition. The need for improving sanitation, community awareness, and periodical mass treatment of pre-school and school age children with antiprotozoal and anti-helminthic drugs is advocated.

Open clinical trial of roxithromycin in patients of Plateau Hospitals, Jos in upper and lower respiratory tract infections.

An open clinical study to assess the efficacy and tolerance of Roxithromycin 150 mg twice daily was carried out amongst Nigerian patients with upper and lower respiratory tract infections at Plateau Hospital Jos. Twenty-two patients aged between 13 and 86 years comprising of twelve women, seven men and three children completed the study. 18 (81.8%) had bronchopulmonary infections, 3 (13.6%) had tonsillitis and 1 (4.6%) had otitis media. Pathogens isolated included streptococcus Pneumonia (22.7%), Streptococcus pyogenes (13.6%), Bramhella Catarrhalis (9.1%), Haemophilus influenzae (9.1%), Staphylococcus Aureus (4.6%), Klebsiella species (4.6%), Pseudomonas Aeruginosa (4.6%). There was 88.2% bacteriological cure and patients responded fast, with no major adverse reactions. Roxithromycin is therefore concluded to be an effective well tolerated drug for treatment of respiratory tract infections in Nigerians.

Open clinical trial of roxithromycin amongst patients of Jos University Teaching Hospital with lower and upper respiratory tract infections.

An open non-comparative clinical study to determine the efficacy and tolerance of Roxithromycin 150 mg twice daily was carried out amongst Nigerian patients with acute upper and lower respiratory tract infections. Twenty-four (24) patients (mean age 21.6 years, male 13; females 11 who completed the study presented with acute tonsillitis (33.3%, acute bronchitis (12.5%), lober pneumonia (12.5%), Otitis media (8%), acute pharyngitis (4%) and acute sinusitis (4%). Most of the patients had normal bacterial flora isolated (50.3%). Pathogens isolated included streptococcus pyogenes (21%), moraxella catarhalis (8.3%), streptococcus pneumonia (8.3%) and Klebsiella pneumonia (4%). The quick clinical response, lack of major adverse drug reactions and susceptibility of the bacterial isolates to Roxithromycin were very significant attributes of the drug. In addition, there was complete recovery in 95.8% of the patients. Roxithromycin is therefore a well tolerated and effective drug for the treatment of acute respiratory tract infections in Nigerian patients.

Mastomys natalensis and Tatera gambiana as probable reservoirs of human cutaneous leishmaniasis in Nigeria.

Leishmania sp. was isolated from the livers and spleens of 4 of 56 Mastomys natalensis and one of 21 Tatera gambiana in Keana District, Nigeria; none of the rodents had cutaneous lesions. Parasites were not found in 42 Rattus rattus. Experimentally infected mice developed cutaneous lesions characteristic of L. major infection. The organisms could not be cultivated in vitro.

Acanthocephalan infection in man in northern Nigeria.

Acanthocephalan ova, indistinguishable from the ovoid eggs of Moniliformis moniliformis, were detected in the stools of a 45-year-old man at the University of Jos Health Clinic, Nigeria. The patient complained of general body weakness, occasional giddiness and intermittent burning sensations around the umbilicus. Successful treatment with niclosamide and the possible source of infection are communicated.