Microbial Profile of Wound Infections in a Nigerian Teaching Hospital

Background: This study set out to investigate the aerobic and facultative anaerobic microbial profile of wound infections in the University of Port Harcourt Teaching Hospital. Methods: A total of 202 wound swabs samples were randomly collected from both in and out-patients presenting at the facility. One hundred and thirteen(55.9) of the samples were collected from males while 89(44.6) were from females. The age of the patients ranged from 32 days to 80 years. Samples were processed following standard operating protocols in the microbiology laboratory. Results: Of the 202 samples examined; 164(81.2) had microbial isolates while 38(18.8) yielded no growth. Among the 164 samples with positive microbial growth; 124(75.6) had single isolates while 40(24.4) had polymicrobial growth. Of the 113 males studied; 90(79.7) had microbial growth while 23(20.4) had no growth. Similarly; of the 89 females studied; 74(83.2) had microbial growth while 15(16.9) had no growth. Furthermore; the total microbial isolates from the study was 206. Gram-negative bacterial organisms accounted for 124(60.1) as against 82(39.9) from the Gram-positive's (p

Live Adult Loa-Loa in the Anterior Chamber of a Nigerian female

Background: Live adult loa loa is not usually found in the anterior chamber of the eye. Where this occurs the diagnosis may be missed because of its rare occurrence. As such there has to be a high index of suspicion to be able to make a diagnosis of ocular loaiasis. Aim: To report a case of live adult loa-loa in the anterior chamber of the left eye of a 23-year-old Nigerian female and discuss the management and visual outcome following treatment. Setting: Department of Ophthalmology; University of Port-Harcourt Teaching Hospital; Port Harcourt. Case Report: A case report of live adult loa-loa in the anterior chamber of a 23-year-old Nigerian female is here presented. In May 2006; a 23 year old female presented at the Eye Clinic with a 3-week history of pain; itching and redness and a one-week history of poor vision in the left eye. Her presenting visual acuity was hand movement on the left and 6/5 on the right. She had a steamy cornea with a sluggishly reactive pupil and an elevated left intra-ocular pressure. An initial diagnosis of pan-uveitis with secondary glaucoma was made and patient commenced on treatment. Patient came back two days and a live adult loa-loa was extracted from the anterior chamber of the left eye. Patient's vision however remained at Counting Fingers despite aggressive treatment with topical and systemic steroids; and systemic diethylcabamazine. Conclusion: Ophthalmologist working in this environment should entertain loaiasis as a differential diagnosis of uveitis since it could masquerade as one and also know the current mode of treatment

Cutaneous Larva Migrans in an Eleven-Year-Old Boy in an Urban Setting in Rivers State

Background: Cutaneous larva migrans is a tropical infectious disease that is usually acquired from contact with soil contaminated with larvae of nonhuman hookworms or Strongy-loides usually from faeces of dogs and cats. Aim: To report a case of a boy who presented with pruritic migratory serpiginous skin lesions. Case report: An eleven year old boy with a linear skin lesion was initially misdiagnosed as having an allergy at a private clinic. There was a history of playing regular football in a field contaminated by dog's urine and faeces. Later it was highly suspected that he had cutaneous larva migrans. He responded to treatment with albendazole. Conclusion: Physicians should be aware that such infestations are endemic in Nigeria and should be familiar with the typical features

The bacteriology of diabetic foot ulcers in Port Harcourt, Nigeria.

BACKGROUND: Diabetic foot ulcer and/or gangrene is a common cause of morbidity and mortality in Nigeria. The lesions are usually infected and early treatment of the infection will reduce the associated problems. The study was carried out to determine the common bacteriological flora of diabetic foot ulcers in Port Harcourt. The antimicrobial sensitivity pattern of the isolates was determined to enhance possible empirical treatment. METHODS: Deep wound swabs were collected from 60 consecutive diabetic patients admitted with foot ulcers and/or gangrene into the medical wards of the University of Port Harcourt Teaching Hospital from January 2001 to April 2002. The bacteriological isolation and antimicrobial sensitivity tests of the isolates was carried out by standard microbiological methods. RESULTS: Aerobes and anaerobes constituted 95.4% and 4.6% of the total bacterial isolates respectively. Staphylococcus aureus was the commonest bacterial isolate; it was cultured from 32 (56.1%) of infected patients and constituted 24.4% of the total isolate. The mean bacterial isolate per patient infected was 2.3. The aerobic isolates showed significant sensitivity to ciprofloxacin (78.4%), pefloxacine (71.2%), ceftazidime (73.6%) and cefuroxime (69.6%). All the anaerobic isolates were sensitive to metronidazole and clindamycin. CONCLUSION: Infections of diabetic foot ulcers are usually polymicrobial. From the in vitro antimicrobial susceptibility pattern of the bacterial isolates, diabetic patients presenting with foot ulcers and/or gangrene could be commenced empirically on a combination of clindamycin or metronidazole and either a fluoroquinolone (ciprofloxacin or pefloxacine) or a second or third generation cephalosporin (e.g. cefuroxime or ceftazidime).

A flowchart for managing sexually transmitted infections among Nigerian adolescent females.

OBJECTIVE: To devise a flowchart suitable for assessing risk of trichomoniasis, chlamydia and gonorrhoea in an adolescent population, not all of whom will be sexually experienced or currently in a relationship. METHODS: The data used to derive the flowchart were generated from cross-sectional microbiological surveys of girls aged 14-19 years in Port Harcourt, Nigeria. The flowchart screened on the basis of: (i) sexual experience; (ii) recent sexual activity; (iii) a positive urine leukocyte esterase (LE) test; and (iv) among LE negatives, a history of malodorous/pruritic discharge. FINDINGS: Using this flowchart, we found that 26.2% of all adolescents screened would receive treatment for cervicitis and vaginitis. Chlamydial, gonococcal, and trichomonal infections were correctly diagnosed in 37.5%, 66.7%, and 50% of the cases, respectively. CONCLUSION: Although the flowchart is more suitable for an adolescent population than the vaginal discharge algorithm used in syndromic management protocols, it still lacks precision and needs adapting to local settings.

Protecting adolescent girls against tetanus.

PIP: An estimated 8 million infants and 2 million children and adults may die from tetanus during the 1990s despite efforts by the World Health Organization (WHO) to eliminate it by 1995. Vaccination to prevent postabortal and maternal tetanus has been neglected. The immunization of preschool children and of pregnant women has omitted adolescent girls, who are therefore at risk. Data collected on 1101 cases of maternal tetanus in developing countries between 1958 and 1990 indicated that 27% were attributed to postabortal and 67% to postpartum sepsis. In southeastern Nigeria where abortion rates are high, a high proportion of girls were also seronegative for tetanus antibodies. Many unvaccinated pregnant women cite the lack of money for obtaining vaccination when obtaining prenatal services. The WHO is promoting vaccination of women of reproductive age by screening their tetanus toxoid status, but adolescents are poorly covered because they are not regular attenders. Expressly targeting girls would be feasible, as it would require 5 injections providing protection for life. Even 4 injections may protect for 20 years if delivered at the end of primary school. Thus a school health service delivering tetanus vaccination may improve the vaccination of adolescent girls. This could be combined with distribution of vitamin A and antihelminthics whereby the response to the vaccine could be improved significantly. In addition, it has also been suggested that a late dose of an acellular pertussis vaccine and a second dose of measles vaccine given in adolescence would reduce the pool of susceptible girls, just as girls have been targeted for rubella vaccination. Implementation of tetanus vaccination would require local schools vaccination days, immunization cards, high potency primary vaccination, and tetanus boosters free of charge with a system to monitor antibody responses.^ieng

Reproductive tract infections and abortion among adolescent girls in rural Nigeria.

Few studies from developing countries have investigated reproductive tract infections or other indicators of sexual health among unmarried adolescent girls in rural areas. We have obtained baseline demographic, clinical, and microbiological data on reproductive tract infections and induced abortion in girls in a rural area of southeast Nigeria, in order to assess the need for health care for adolescents. 868 females attended for interview and examination: 458 aged 20 and above and 410 aged 12-19, the latter representing 93.4%of the adolescent population. 43.6% of those < 17 and 80.1% aged 17-19 years were sexually active and at least 24.1% had undergone an induced abortion; only 5.3% had ever used a modern contraceptive. Vaginal discharge was reported by 82.4%, though few sought treatment. 94.1% of sexually active adolescents and 97.6% of sexually active women 20 years old or over were gynaecologically examined and screened for reproductive tract infections. Of those aged less than 17, 19.8% had symptomatic candida and 11.1% trichomonas infections. Among those aged 17-19 years, chlamydia was detected in 10.5%, and symptomatic candidosis in 25.6%; this was the group most likely to have any infection (43.8%). 42.1% of sexually active adolescents had experienced either an abortion or a sexually transmitted disease. Syphilis was the only infection for which the incidence clearly increased with age. Health-care services for adolescents in this community are needed and should include sex education, contraceptive provision (especially barrier methods), and access to treatment for reproductive tract infections. Investments in health for this age group will have an effect on subsequent reproductive health.