Control of skin infection in HIV positive individuals and AIDS patients

HIV prevalence is still increasing in many parts of the world. Poverty and inequity still prevail; and drugs are inaccessible to the majority of people living with HIV. Opportunistc infections constitute the major problem which makes their lives uncomfortable. At a Catholic Community Health Care giving health services to about 500;000 people living in the slums of Nairobi city; it has been observed that the main health problems facing HIV/ADS patients are: recurrent skin infection due to exfoliative staphylococcus aureus which presents as itchy rashes and pseudomycosis; development of cellulities or black pigmentation of skin; recurrent herpes zoster infection; chest infection and diarrhoea. This staph aureus is resistant to affordable topical antibiotics. Applying 2 percent chlorohexidine/cetrimide (savlon) once daily is useful when itching and rashes start; before they become septic. When the rashes are gone; savlon is applied once or twice in a week to keep the load of Staph aureus within normal range. If the patient develops superficial or deep cellulitis he is treated with neomycin/cetrimide ointment (oral erythromycin is added if the patient is having boils). Once the skin is back to normal the patient is also maintained as above. This management has proved quite effective in reducing recurrent skin infection. There is less use of topical antibiotics; antifungal drugs and hydrocortisone due to pseudomycosis compared with the previous period before the above managment was started

The microbial and physical quality of recycled gloves.

Plastic surgical gloves reprocessed at the Kenyatta National Hospital (KNH) were tested for microbiological and physical quality, using standard, disposable, factory sterilised surgical gloves as reference. The microbiological tests were carried out using slightly modified British Pharmacopoeia method. The tests to check on the physical integrity of the gloves were designed in our laboratories. A total of 48 pairs of each group were tested. 41.67% of the reprocessed gloves and 12.5% of the reference glove failed sterility test, whereas 47.9% of the former and 0% of the latter had physical defects. These results show significant difference in the microbiological and physical quality of the reprocessed and reference gloves. The reprocessing of plastic surgical gloves is therefore, potentially dangerous and it is strongly recommended that it is discontinued at all levels of health-care institutions.

Control of spread of Methicillin Resistant Staphylococcus aureus (MRSA) in Burns Units

Results of four years' studies from a number of hospitals in Kenya have shown that nosocomial infections in burns units are due to Methicillin Resistant Staphylococcus aureus (MRSA). Through chromosomal DNA and plasmid DNA; the stain is highly resistant to sulphonamide ointment and other antibiotics. 90 per cent of patients admitted in burns units get colonized or infected with MRSA. The strain prolongs the duration of patients in hospitals. The burns degenerate to second and third degree burns; thereby necessitating skin grafting. The environment has been found to be contaminated with this strain with some staff members having chronic throat infections. Minocycline was found to be effective in treating the infected staff members. Cleaning this environment with Sodium dichloroisocyanurate (precepts)/Sodium hypochlorite (JIK) reduced drastically the mechanical transmission of bacteria in the units. The duration of stay of the patient was reduced. This shows that MRSA which is spread in government and private hospitals can cheaply be controlled by the proper use of disinfectants; antiseptics; and use of effective antibiotics when necessary

Enterotoxin-like factors of Aeromonas species isolated in Kenya

Three out of thirteen Aeromonas strains tested have a heat-labile enterotoxin-like factor which does not cross-react with cholera toxin serologically; but evokes fluid accumulation in the gut of infant mouse; and causes Chinese Hamster Ovary cell elongation

Minimum inhibitory concentration of antibiotics against bacteria associated with childhood diarrhoea in children attending a district hospital in Kenya

A study to determine the in vitro activity of antibiotics to bacterial pathogens isolated from diarrhoea stools of 125 patients reporting to the Paediatric Filter Clinic at Malindi District Hospital with acute diarrhoea was done. The ages of the patients ranged from one to five years. Samples of diarrhoea stools were collected before drug administration. 33 strains of Enterobacteriacea comprising 12 strains of pathogenic Escherichia coli; 13 strains of Salmonella SPP and 8 strains of Shigella SPP were isolated and minimum inhibitory concentration of five antibiotics determined. 5 pure antibiotic powders; namely; ampicillin; tetracycline; kanamycin; trimethoprim-sulfamethoxazole and nalidixic acid were tested using the agar dilution method (Muellerinton agar). The minimum inhibitory concentration (MIC) of the 5 antibiotics used ranged between 8#gml-1 and 128#gml-1 excep for t trimethoprin-sulfamethoxazole which had a MIC range of 0.25#gml-1 to 16#gml-1. Hyper resistance of the isolates was observed for ampicillin; tetracycline; kanamycin and nalidixic acid. The results of this work suggest that there is circulation of resistant strains of bacteria causing diarrhoea within the community around Malindi