PATTERN OF MULTIDRUG RESISTANT BACTERIA ASSOCIATED WITH INTENSIVE CARE UNIT INFECTIONS IN IBADAN, NIGERIA.

BACKGROUND: Patients admitted into the intensive care unit (ICU) usually have impaired immunity and are therefore at high risk of acquiring hospital associated infections. Infections caused by multidrug resistant organisms now constitute a major problem, limiting the choice of antimicrobial therapy. OBJECTIVES: This study was aimed at determining the antimicrobial resistance pattern of pathogens causing ICU infections in University College Hospital (UCH), Ibadan, Nigeria. The aetiological agents, prevalence and types ICU infections were also determined. METHODS: One year hospital associated infections surveillance was conducted in the ICU of UCH, Ibadan. Blood, urine, tracheal aspirate and wound biopsies specimens were collected under strict asepsis and sent to the Medical Microbiology laboratory of the same institution for immediate processing. All pathogens were isolated and identified by standard microbiological methods. Disk diffusion antibiotic susceptibility testing was performed and interpreted according to Clinical and Laboratory Standards Institute (CLSI) guidelines. RESULTS: The overall prevalence of ICU infections was 30.9% out of which 12.9% were bloodstream infections, 31.5% urinary tract infections, 38.9% pneumonia, and 16.7% skin and soft tissue infections. Klebsiella species andEscherichia coli were the predominant pathogens. Multidrug resistant organisms constituted 59.3% of the pathogens, MDR Klebsiella spp and MDR E. coli were 70.8% and 71.4% respectively. Resistance to Cefuroxime was the highest (92.9%) while Meropenem had the least resistance (21.4%). CONCLUSION: There is a high prevalence of multidrug resistant bacteria causing ICU infections. Application of more stringent infection control procedures and institution of functional antimicrobial stewardship are recommended to combat this problem.

Drug resistance profiles of new- and previously treated patients with pulmonary tuberculosis in Ibadan, Nigeria.

BACKGROUND: Information on TB drug resistance profiles and its' associated risk factors are scarce in Nigeria despite the large burden of disease in the country. The study was designed to report drug resistance profiles of new- and previously treated patients with pulmonary tuberculosis (TB) in Ibadan, Nigeria. METHOD: Sputum from consenting pulmonary TB patients were collected and cultured for Mycobacterium tuberculosis (Mtb) at the TB laboratory of the University College Hospital, Ibadan, Nigeria using standard method. Mtb were stored and sent for drug susceptibility testing against first and second-line anti-TB drugs at the MRC Unit, The Gambia and at the Institute of Tropical Medicine, Antwerp, Belgium using BACTEC MGIT 960 and proportion method on solid medium respectively. RESULTS: Of 238 Mtb collected, 124 (52.1%) were viable, 102 (59.65%) non-viable while 12 (7.02%) were contaminated. About half (58.87%) of the Mtb were from previously treated patients, 40 (32.26%) were from new patients while treatment history of 1.1 (8.87%) were unknown. Forty-seven (37.90%) of the 124 Mtb. tested were multidrug resistant (MDR) out of which, 40 (85.10%) were from previously treated patients.. HIV prevalence was 8.69%. Of the 17 MDR-TB from previously treated cases tested for second-line drugs, four (23.53%) were resistant to fluoroquinolones or injectable agents, 13 (76.47%) were susceptible while none was resistant to both of these classes of drugs. CONCLUSION: MDR-TB in Ibadan already demonstrates resistance to second line anti-TB drugs hence management of MDR-TB patients should be strengthened to prevent emergence of extensively drug-resistant TB (XDR-TB).

Measles vaccine potency and sero-conversion rates among infants receiving measles immunization in Ilorin, Kwara State, Nigeria.

This study was designed to assess the seroconversion rate of measles vaccine among infants receiving measles immunization in Ilorin, Nigeria. The pre- and post-measles vaccination sera of the children were tested using the Haemagglutination Inhibition test. The measles vaccines administered at the immunization centre were also tested for their potency using in-vitro titration method. Only 286 (71.5%) of the vacinees returned to give post-vaccination samples. All the infants screened had low pre-vaccination measles antibody titers. Thirty one (8.0%) of the infants had measles prior to vaccination. The seroconversion pattern showed that 196 (68.6%) of the infants developed protective antibody titers. Low seroconversion rate reported in this study was due to low vaccine potency. The titers of vaccines with low potency ranged between log10(-1.0)-log10(-2.25) TCID/per dose. This was beside other non specific antiviral substances exhibited virus neutralizing activity. Only 3 (50%) of the 6 vaccine vials tested had virus titers of log10(-3.25) to log10(-3.5), which fell above the cut-off point recommended by the World Health Organization for measles vaccines. The sero-conversion rate of 68.6% observed among vaccinees is far lower than the immunity level of 95% required stopping measles transmission in an endemic community. Failure of 31.4% of these infants to sero-convert post vaccination can be attributed partly to administration of sub-potent vaccines. There is need for improvement and maintenance of effective vaccine cold chain system in Nigeria. There is need also for periodic monitoring of post-vaccination antibody titers as well as vaccine potency status in order to ensure development of protective seroconversion rates.

Diverse genetic subtypes of HIV-1 among female sex workers in Ibadan, Nigeria

Genetic diversity is the hallmark of HIV-1 infection. It differs among geographical regions throughout the world. This study was undertaken to identify the predominant HIV-1 subtypes among infected female sex workers (FSWs) in Nigeria. Methods: Two hundred and fifty FSWs from brothels in Ibadan Nigeria were screened for HIV antibody using ELISA. All reactive samples were further tested by the Western Blot Techniques. Peripheral Blood Mononuclear Cells (PBMCs) were separated from the blood samples of each subject. Fragments of HIV Proviral DNA was amplified and genetic subtypes of HIV-1 was determined by direct sequencing of the env and gag genes of the viral genome followed by phylogenetic analysis . Results: The age of the FSWs ranged from 15 to 55 years old (Mean = 25.8years; SD =3.74). Majority were Nigerians while others (1.6 ) were from neighboring West Africa countries. Four ( 1.6 ) of the FSWs were active for less than one year as sex workers; and the mean length of sex work was 2.80 years ( Range = 1.0 - 15.0 years ). Sixty-four (25.6) of the 250 CSWs were positive for HIV-1 while 7 (2-8) had dual infections to HIV-1 / HIV-2. Among the 34 HIV-1 strains characterized by sequencing; 19 (55-9) were subtype G; 9 (26.5) CRF02_A/G; 3 (8.8) CRF06_cpx while 1 (2.9) each were identified as subtype C; CRF01_A/E and CRF09_cpx respectively. Nineteen (55.9) of the FSWs with subtype G had been active in the sex work for between one to five years. The youngest of the HIV -1 infected FSWs with sexual activity of less than a year had subtype G strain. There is a significant probability that infection with this subtype occurred with a short incubation period (p 0.05). Conclusion: This study showed a wide range of HIV- 1 subtypes among FSWs in Nigeria. The situation poses serious challenge for the design of HIV vaccine candidate for use in Nigeria

Genital ulcer diseases among HIV-infected female commercial sex workers in Ibadan, Nigeria.

We evaluated the prevalence and association of Genital Ulcer Diseases (GUDs) among HIV-1 infected female commercial sex workers (FCSWs) in Ibadan, Nigeria. A total of 250 FCSWs from brothels in Ibadan were tested for presence of antibodies to HIV and Syphilis. Pelvic examinations for signs of sexually transmitted infections (STIs) were carried out on the subjects. Endocervical and high vaginal swabs were collected from each of the subjects to establish laboratory diagnosis of STIs. Their age ranged from 15 to 55 years (Mean = 25.8 yrs; SD = 3.74). Majority (246/250) were Nigerians, while 1.6% were from neighboring West African countries. Sixty four (25.6%) of the subjects were positive for HIV-1 while seven (2.8%) had dual HIV-1/2 infection. Analysis of the STIs showed that 49 (19.6%) of the CSWs had GUDs. Herpes genitalis was the commonest GUDs as it occurred in 25 (10%) of the subjects. Other STIs identified were chancroid (5.6%), syphilis (4.0%) and lymphogranuloma venerum (LGV) (4%). Sixteen (64.0%) of the CSWs with herpes genitalis had HIV-1 infection. The risk ratio of herpes genitalis for HIV acquisition was 3.0 (95% CI: 2.0 - 4.4). Syphilis and chancroid were also found tobe significantly associated with increased risk of HIV infection (p < 0.0001). The adjusted odd ratios for Herpes genitalis, chancroid, and syphilis were 3.7 (1-13.0, p < 0.05), 19.8 (2.7-13.0, p < 0.05) and 19.1 (1-231.0, p < 0.05) respectively. There is need to educate FCSWs continually to adopt safer sexual behaviours, seek early diagnosis and treatment of GUDs to reduce their risk of transmitting HIV infection.

Pulmonary tuberculosis among health care workers at two designated DOTS Centers in urban city of Ibadan, Nigeria.

BACKGROUND & OBJECTIVES: Tuberculosis (TB) infection control interventions are not routinely implemented in many Sub-Saharan African countries including Nigeria. This study was carried out to ascertain the magnitude of occupationally-acquired pulmonary TB (PTB) among health care workers (HCWs) at two designated DOTS centers in Ibadan, Nigeria. METHODS: One year descriptive study (January-December 2008) was carried out at the University College Hospital and Jericho Chest Hospital, both located in Ibadan, Nigeria. A pre-tested questionnaire was used to obtain socio-demographic data and other relevant information from the subjects. Three sputum samples were collected from each subject. This was processed using Zeihl-Neelsen (Z-N) stains. One of the sputum was cultured on modified Ogawa egg medium incubated at 37 ° C for six weeks. Mycobacterium tuberculosis was confirmed by repeat Z-N staining and biochemical tests. RESULTS: A total of 271 subjects, 117 (43.2%) males and 154 (56.8%) females were studied. Nine (3.3%) had their sputum positive for acid fast bacilli (AFB) while six (2.2%) were positive for culture. The culture contamination rate was 1.8 per cent. Significantly, all the six culture positive samples were from males while none was obtained from their female counterparts. About half of the AFB positive samples were from subjects who have spent five years in their working units. Eight AFB positive cases were from 21-50 yr age group while students accounted for seven AFB positive cases. INTERPRETATION & CONCLUSIONS: The study shows that occupationally-acquired PTB is real in Ibadan. Further studies are needed to ascertain and address the magnitude of the problem.

Risk factors for pulmonary tuberculosis among health-care workers in Ibadan, Nigeria.

Data on TB infection control programs is limited in many of the TB high burden countries. We carried out a one-year cross sectional epidemiological study (January-December, 2008) to determine the prevalence of occupationally-acquired pulmonary tuberculosis (PTB) among Health- Care Workers (HCWs) in Ibadan, Nigeria. This information is important for planning preventive strategies. All consenting HCWs at two TB centres in Ibadan--the University College Hospital (UCH) and Jericho Chest Hospital were enrolled into the study. A well structured questionnaire was used to obtain information on socio-demographic characteristics of the subjects including their medical and social data. Three sputum samples collected from each subject were processed for acid-fast bacilli (AFB) and culture on selective medium. Isolates were confirmed as M. tuberculosis by standard biochemical tests. Of the 271 subjects recruited, nine (3.3%) had their sputum positive for AFB while six (2.2%) were positive for culture. Subjects aged 20 years and above, female gender and unskilled professionals had higher risk for occupationally-acquired PTB than those who were 20 years and below, male gender and skilled professionals (Odd Ratio OR = 1.9, 95% Confidence Interval, 95% CI = 0.23-16.3, Fisher's exact P = 0.37; OR = 1.1, 95% CI = 0.28-4.0, p = 0.01; OR = 1.05, 95% CI = 1.02-1.08, p = 3.43) respectively. Multivariate logistic regression analysis showed that subjects who received BCG vaccination were less likely to have occupationally-acquired PTB than those without vaccination (OR = 0.86, 95% CI = 0.20-3.6, p = 0.83 for microscopy; OR = 0.76, 95% CI = 0.13- 0.44, p = 0.76 for culture). Even though the risk for occupationally-acquired PTB was lower in subjects who had not spent up to two years in their units, the association was not statistically significant (OR = 0.84, 95% CI = 0.20-3.5, p = 0.82 for microscopy and OR = 1.21, 95% CI = 0.22-0.65, p = 0.82 for culture). There is a need to develop and implement affordable and cost-effective TB infection control strategies in Nigeria in order to reduce the burden of occupationally-acquired PTB in the country.

Prevalence of otomycosis in Ibadan: a review of laboratory reports.

Otomycosis has typically been described as fungal infection of the external auditory canal with infrequent complications involving the middle ear. Because of the dearth of data on the prevalence of Otomycosis in this environment and increased rate of immunosuppression, this study was aimed at finding the prevalence and fungal etiological agents responsible for this condition. Aretrospective review of the laboratory reports of ear swabs of patients that presented with signs and symptoms suggestive of fungal infections of the ear like otorrhoea, otalgia and aural fullness were done. The diagnosis of otomycosis was made on the basis of the recognizable and characteristic appearance of fungal hyphae and fruiting bodies under microscopy. The swabs were cultured on the Sabouraud Dextrose agar kept at room temperature (27-30 degrees C). Fungi growth occurred within 48 hours to 3 weeks. The data collected were analyzed with the aid of SPSS version 12.0 computer software. Level of significance was set at p<0.05. A total of 53 patients with documented diagnosis of otomycosis were included in the analysis and consisted of 31 (58.5%) females and 22 (41.5%) males. The ages at diagnosis ranged from 2 to 68 years (Mean: 28.9 yrs; Median: 30.0 yrs). Otalgia and otorrhoea were the most common symptoms, followed by hearing loss and aural fullness. The prevalence of otomycosis among the patients in this hospital was 39.6%. Candida albicans was the most common fungal isolate in these patients as it occurred in 28.3% (15/53). Other isolates in order of frequency were Aspergillus fumigatus (5.7%), A. niger (1.9%), Penicillium spp. (1.9%) and Mucor spp.(1.9%). Candida albicans was also the most common fungus identified in all age group. There was no statistical significance associated between age of presentation and types of fungi isolated (p = 0.054). Even though, there was no statistical significance between sex and fungi isolated (p > 0.05), it was noted that all the fungi were commonly isolated from female gender irrespective of their age. Candida albicans and Aspergillus species were the most commonly identified fungal pathogens of otomycosis in U.C. H., Ibadan, Nigeria. High index of suspicion should be demonstrated by General practitioners and Otorhinolaryngologists. Patients' specimens should be sent to the laboratory as early as possible for prompt diagnosis.

Strongyloidiasis: prevalence, risk factors, clinical and laboratory features among diarrhea patients in Ibadan Nigeria.

Strongyloidiasis is a parasitic infection caused by Strongyloides stercoralis. The infection is usually mild or asymptomatic in normal immunocompetent individuals, but could be very severe or even fatal due to hyper infection in individuals who are immunosuppressed. This study aimed at determining the prevalence, risk factors and features of strongyloidiasis among diarrhea patients in Ibadan. This is a descriptive cross-sectional study of diarrhea patients from a teaching hospital, three major government hospitals and one mission hospital in Ibadan. Self administered questionnaire, clinical assessment and laboratory investigations were used to confirm health status and presence of S. stercoralis. Diagnosis was made by microscopic examination of stool in saline preparation and formol-ether concentration. One thousand and ninety patients, (562 (51.6%) males and 528 (48.4%) females) consisting 380 (34.9%) children and 710 (65.1%) adults who had diarrhea were studied. The prevalence rate for the parasite among diarrhea patients was 3.0%. While the risk factor for infection remains contact with contaminated soil, malnutrition, steroid therapy, HIV/AIDS, lymphomas, tuberculosis, and chronic renal failure. Others are maleness, institutionalism and alcoholism. Predominant clinical presentations are abdominal pain, chronic diarrhea, and bloating and weight loss, Strongyloides stercoralis should be considered in diarrhea patients who are either malnourished or immunosuppressed.

Risk factors for pulmonary tuberculosis among health-care workers in Ibadan, Nigeria

Data on TB infection control programs is limited in many of the TB high burden countries. We carried out a one-year cross sectional epidemiological study (January-December, 2008) to determine the prevalence of occupationally-acquired pulmonary tuberculosis (PTB) among Health- Care Workers (HCWs) in Ibadan, Nigeria. This information is important for planning preventive strategies. All consenting HCWs at two TB centres in Ibadan--the University College Hospital (UCH) and Jericho Chest Hospital were enrolled into the study. A well structured questionnaire was used to obtain information on socio-demographic characteristics of the subjects including their medical and social data. Three sputum samples collected from each subject were processed for acid-fast bacilli (AFB) and culture on selective medium. Isolates were confirmed as M. tuberculosis by standard biochemical tests. Of the 271 subjects recruited, nine (3.3%) had their sputum positive for AFB while six (2.2%) were positive for culture. Subjects aged 20 years and above, female gender and unskilled professionals had higher risk for occupationally-acquired PTB than those who were 20 years and below, male gender and skilled professionals (Odd Ratio OR = 1.9, 95% Confidence Interval, 95% CI = 0.23-16.3, Fisher's exact P = 0.37; OR = 1.1, 95% CI = 0.28-4.0, p = 0.01; OR = 1.05, 95% CI = 1.02-1.08, p = 3.43) respectively. Multivariate logistic regression analysis showed that subjects who received BCG vaccination were less likely to have occupationally-acquired PTB than those without vaccination (OR = 0.86, 95% CI = 0.20-3.6, p = 0.83 for microscopy; OR = 0.76, 95% CI = 0.13- 0.44, p = 0.76 for culture). Even though the risk for occupationally-acquired PTB was lower in subjects who had not spent up to two years in their units, the association was not statistically significant (OR = 0.84, 95% CI = 0.20-3.5, p = 0.82 for microscopy and OR = 1.21, 95% CI = 0.22-0.65, p = 0.82 for culture). There is a need to develop and implement affordable and cost-effective TB infection control strategies in Nigeria in order to reduce the burden of occupationally-acquired PTB in the country

Genital ulcer diseases among HIV_infected female commercial sex workers in Ibadan, Nigeria

We evaluated the prevalence and association of Genital Ulcer Diseases (GUDs) among HIV-1 infected female commercial sex workers (FCSWs) in Ibadan; Nigeria. A total of 25O FCSWs from brothels in Ibadan were tested for presence of antibodies to HIV and Syphilis. Pelvic examinations for signs of sexually transmitted infections (STIs) were carried out on the subjects. Endocervical and high vaginal swabs were collected from each of the subjects to establish laboratory diagnosis of STIs. Their age ranged from 15 to 55 years (Mean = 25.8yrs; SD =3.74). Majority (246/250) were Nigerians; while 1.6were from neighboring West African countries. Sixty four (25.6) of the subjects were positive for HIV-1 while seven (2.8) had dual HIV-1/2 infection. Analysis of the STIs showed that 49 (19.6) of the CSWs had GUDs. Herpes genitalis was the commonest GUDs as it occurred in 25 (10) of the subjects. Other STIs identified were chancroid (5.6); syphilis (4.0) and lymphogranuloma venerum (LGV) (4). Sixteen (64.0) of the CSWs with herpes genitalis had HIV-1 infection. The risk ratio of herpes genitalis for HIV acquisition was 3.0 (95CI: 2.0 - 4.4). Syphilis and chancroid were also foundto be significantly associated with increased risk of HIV infection (p0.0001). The adjusted odd ratios for Herpes genitalis; chancroid; and syphilis were 3.7(1-13.0; p0.05); 19.8 (2.7-13 .0; p0.05) and 19.1(1-231.0; p 0.05) respectively. There is need to educate FCSWs continually to adopt safer sexual behaviours; seek early diagnosis and treatment of GUDs to reduce their risk of transmitting HIV infection

Emergence of a community-associated methicillin-resistant Staphylococcus aureus strain with a unique resistance profile in Southwest Nigeria.

Phenotypic, genotypic, and toxin gene analyses have not yet been done all in one for the Nigerian Staphylococcus aureus population. This study provides a comprehensive overview of the molecular epidemiology and genetic diversity of S. aureus strains at the largest university clinic in Ibadan, Nigeria. From 1,300 patients' clinical samples collected at the University Teaching Hospital in Ibadan, Nigeria, during a 1-year-surveillance in 2007, 346 nonduplicate S. aureus isolates were obtained. All isolates underwent antibiotic susceptibility testing, toxin gene analysis, multilocus sequence typing, agr group typing, and spa typing. For methicillin (meticillin)-resistant S. aureus (MRSA), staphylococcal cassette chromosome mec (SCCmec) typing was also performed. Of the 346 isolates, 20.23% were methicillin resistant. Thirty-three patients' isolates (47.15%) fulfilled the definition criteria for community-associated MRSA (CA-MRSA) according to a review of the medical charts. The majority of MRSA strains analyzed were isolated from surgical or pediatric patients. The commonest types of MRSA infection identified were surgical-site infections (>70%), whereas those for CA-MRSA were conjunctivitis and otitis (19 patients [57.6%]) and accidental skin and subcutaneous tissue infections (14 patients [42.4%]). The methicillin-susceptible S. aureus strains (ST1, ST5, ST15, ST7, ST8, ST25, ST30, ST72, ST80, ST121, and ST508) were heterogeneous by phenotypic and genotypic analyses. The first report of a Panton-Valentine leukocidin-positive ST88 strain (agr III, SCCmec IV) in Nigeria, as well as genetic analyses of this strain, is presented in this study. The ST88 strain was resistant to trimethoprim-sulfamethoxazole as well as to penicillin and oxacillin. CA-MRSA infections are increasing rapidly among young patients with ophthalmologic and auricular infections. Urban regions with populations of lower socioeconomic status and evidence of overcrowding appear to be at high risk for the emergence of this clone.

Invasive pneumococcal disease in children aged <5 years admitted to 3 urban hospitals in Ibadan, Nigeria.

BACKGROUND: Streptococcus pneumoniae remains a major cause of childhood morbidity and mortality in the world. The introduction of pneumococcal conjugate vaccine in developing countries will be facilitated by a clearer understanding of the disease burden for bacterial causes of pneumonia and meningitis and the prevalent serotypes of S. pneumoniae. METHODS: We conducted a prospective, hospital-based surveillance for a 2-year period involving children aged 2-59 months at 3 urban hospitals in Ibadan, Nigeria, using standard microbiological methods with confirmation and further testing of isolates at the Medical Research Council Laboratories in The Gambia. RESULTS: There were 1210 cases overall: 481 (39.8%) were meningitis, 399 (33.0%) were pneumonia, and 330 (27.2%) were bacteremia clinical syndromes. There were 24 cases of definite meningitis, of which 9 were caused by S. pneumoniae, 11 by Haemophilus influenzae type b, and 4 by Klebsiella species. Of the 90 culture-positive pneumonia cases, 9 were caused by S. pneumoniae, 2 by H. influenzae type b, and 79 by other species. Among cases of bacteremia, the pathogen isolation rate was 28.8% (95 of 330); the isolated species included S. pneumoniae (3 isolates), Staphylococcus aureus (20 isolates), Klebsiella species (13 isolates), Salmonella species (15 isolates), and Escherichia coli (6 isolates). Of the 23 S. pneumoniae isolates, 11 were serotyped; the serotypes found were 5 (5 isolates), 19F (3 isolates), and 4 (3 isolates), and 1 isolate was nontypeable. These isolates were all susceptible to penicillin. Eight of 9 patients with definite pneumococcal meningitis died, whereas all patients with pneumococcal pneumonia and septicemia survived. CONCLUSIONS: Of the pneumococcal serotypes identified, 55% were covered by the licensed 7-valent pneumococcal conjugate vaccine, whereas all are covered by the 10- and 13-valent vaccines.

Enhanced diagnosis of pneumococcal meningitis with use of the Binax NOW immunochromatographic test of Streptococcus pneumoniae antigen: a multisite study.

BACKGROUND: Accurate etiological diagnosis of meningitis in developing countries is needed, to improve clinical care and to optimize disease-prevention strategies. Cerebrospinal fluid (CSF) culture and latex agglutination testing are currently the standard diagnostic methods but lack sensitivity. METHODS: We prospectively assessed the utility of an immunochromatographic test (ICT) of pneumococcal antigen (NOW Streptococcus pneumoniae Antigen Test; Binax), compared with culture, in 5 countries that are conducting bacterial meningitis surveillance in Africa and Asia. Most CSF samples were collected from patients aged 1-59 months. RESULTS: A total of 1173 CSF samples from suspected meningitis cases were included. The ICT results were positive for 68 (99%) of the 69 culture-confirmed pneumococcal meningitis cases and negative for 124 (99%) of 125 culture-confirmed bacterial meningitis cases caused by other pathogens. By use of culture and latex agglutination testing alone, pneumococci were detected in samples from 7.4% of patients in Asia and 15.6% in Africa. The ICT increased pneumococcal detection, resulting in similar identification rates across sites, ranging from 16.2% in Nigeria to 20% in Bangladesh. ICT detection in specimens from culture-negative cases varied according to region (8.5% in Africa vs. 18.8% in Asia; P< .001), prior antibiotic use (24.2% with prior antibiotic use vs. 12.2% without; P< .001), and WBC count (9.0% for WBC count of 10-99 cells/mL, 22.1% for 100-999 cells/mL, and 25.4% for >or=1000 cells/mL; P< .001 by test for trend). CONCLUSIONS: The ICT provided substantial benefit over the latex agglutination test and culture at Asian sites but not at African sites. With the addition of the ICT, the proportion of meningitis cases attributable to pneumococci was determined to be similar in Asia and Africa. These results suggest that previous studies have underestimated the proportion of pediatric bacterial meningitis cases caused by pneumococci.

Childhood bacterial meningitis in Ibadan, Nigeria--antibiotic sensitivity pattern of pathogens, prognostic indices and outcome.

Bacterial meningitis remains a major cause of morbidity, mortality and neurodisability in childhood, particularly in the developing world where effective vaccines against the usual pathogens responsible for the disease are not in routine use. To describe the patterns and outcome of bacterial meningitis among children admitted into the University College Hospital (UCH), Ibadan, Nigeria. All children who satisfied the case definition for meningitis, admitted into the paediatric wards of the University College Hospital, UCH, Ibadan over a period of 30 months were prospectively enrolled and blood and CSF samples were taken for bacteriological analyses. A total of 97 children, 62 males and 35 females were studied. Their ages ranged between 2 months and 12 years, mean age 33.0 (SD=41.7) months, with 80.4% of the cases below the age of 5 years. Haemophilus influenzae type b (Hib) was the leading pathogen, found in 16 (55.1%) of the 29 cases of definite meningitis. Other isolates include Streptococcus pneumoniae (24.1%), Klebsiella spp (7.0%), Staphylococcus aureus (7.0%), Escherichia coli (3.4%) and Pseudomonas spp. (3.4%). Hib and pneumococcus showed varying degrees of resistance to chloramphenicol, penicillin and cotrimoxazole. Twenty six (26.8%) of the cases died and 67.6% of the survivors developed significant neurological sequele. Bacterial meningitis remains a major cause of childhood mortality and neurodisability. Hib and pneumococcus remain the major pathogens responsible for this dreadful disease in Ibadan, Nigeria. The increasing emergence of antibiotic resistance calls for institution of adequate control measures, particularly routine childhood immunisation against the disease.

Strongyloidiasis in children five years and below.

INTRODUCTION: Strongyloidiasis is one of the major human intestinal infections caused by a minute nematode, Strongyloides stercoralis. It is a soil-transmitted nematode of worldwide distribution, which resides in the small intestines of humans and is acquired by tissue penetration by the infective stage, filariform larva, of the worm. In the immunocompetent hosts, Strongyloides stercoralis infects only the mucosal of the small intestines and persists as an asymptomatic often chronic infection. In contrast, in the presence of immune suppression it has ability to multiply within the human host, known as hyperinfection. Its occurrence has been reported more commonly among adults. AIM/OBJECTIVE: This study was undertaken to find the occurrence of Strongyloides stercoralis among children 0-5years who presented with diarrhea and then relate it to their nutritional status. MATERIALS AND METHOD: Following ethical approval, two hundred and twenty seven children, 118 boys and 109 girls, with complaints of diarrhoea, were randomly selected. A structured questionnaire was completed for each child. Anthropometric measurement was taken. Clinical assessment/diagnosis by the attending physician was also recorded. Stool specimen was collected and examined by wet preparation and formol-ether concentration methods. Infected children were treated. RESULTS: Twelve (5.3 %) of all the children with diarrhoea were found to have Strongyloides stercoralis. All the infected children were malnourished while none of the normal nourished children had Strongyloides stercoralis (p=0.001). CONCLUSION: Strongyloidiasis is a possible complication of Malnutrition in children who presented with diarrhoea.

Risk factors for HIV infection among special treatment clinic attendees in Ibadan, Nigeria.

Control of sexually transmitted infections (STIs) is an important factor in the prevention of sexual transmission of HIV infection. Despite a close link between the two disease entities, not enough data are however available on risk factors for HIV infection among STI clinic patients in Nigeria. This information is important for planning preventive measures. All consenting patients that attended special treatment clinic (STC), University College Hospital (UCH), Ibadan from March to November 2001 were enrolled into the study. Using a structured interview assisted questionnaire, information on socio-demographic characteristics, sexual and reproductive history and other potential risk factors for HIV infection were obtained. Urethral swab, endocervical swab and high vaginal swab were also obtained and processed by standard laboratory methods. HIV tests were carried out by double ELISA tests. Of the 210 subjects, 180 (85.7%) were diagnosed as having STI while 46 (21.9%) screened positive for HIV. Co-infection was found in 41(19.5%) of all subjects. The risk of HIV was higher in subjects with STIs. Multivariate logistic regression analysis indicated that subjects who were not infected with gonorrhoea (OR = 0.685, 95% CI = 0.47- 0.99, p = 0.045) and those with negative history of blood transfusion (OR= 0.1,95% CI = 0.02-0.5, p=0.009) were less at risk of HIV infection while those with lower occupation had a higher risk (OR = 1.126,95% CI = 0.32-3.9, p = 0.085). The results of this study emphasize the need for adequate management of STIs and the importance of upgrading blood transfusion services in order to curtail the spread of HIV infection.

Human immunodeficiency virus and invasive external otitis--a case report.

Acute invasive external otitis is an uncommon life-threatening infection of the external auditory canal (EAC), most often affecting the elderly diabetic patients. Although few reports have been made in HIV-positive/Aids patients among the caucasians. We present here a 25 year old nursing mother with a month history of fever, persistent otalgia with acutely inflammed EAC, gross facial cellulitis, mastoid abscess and facial paresis, following a minor left ear trauma with a matchstick. This unusual course of ear infection in an otherwise healthy young adult prompts a search for an immunodepressing factor which was confirmed to be Human Immunodeficiency Virus (HIV). This article highlights the clinical peculiarities and the management of invasive external otitis in an HIV-positive patient.

Ureaplasma urealyticum as a cause of non-gonococcal urethritis: the Ibadan experience.

Two hundred and eighteen men with confirmed urethritis were investigated for Ureaplasma urealyticum at the Special Treatment Clinic, University College Hospital, Ibadan between 5th January and 28th December 2000. Sixty-four (29.35%) of the 218 patients had gonococcal urethritis whilst 154 (70.65%) had non-gonococcal urethritis (NGU) out of which 22 (14.3%) had U. urealyticum urethritis and 10(6.5%) had Trichomonal urethritis. The difference in the occurrence of U. urealyticum between the patients and the control group was highly statistically significant (p<0.001). The age range of peak incidence among the patients investigated was 20-29 years. There was evidence of urethritis in all the 22 U. urealyticum positive cases as shown by the presence of increase in the number of polymorphonuclear leucocytes in the specimens collected. A significant difference in the nature of the urethral discharge in men with gonorrhoeae compared with U. urealyticum positive NGU patients was also demonstrated. Treatment of those patients found to be positive for U. urealyticum with a course of oral Tetracyline was successful but then the problems posed by the asymptomatic Ureaplasma urethritis still remained unanswered.