Seroprevalence of Legionella pneumophila in pneumonia patients in four major hospitals in Trinidad and Tobago / Seroprevalencia de la legionella pneumophila en pacientes con neumonía en los cuatro hospitales principales de Trinidad

Trinidad and Tobago is an island-state in the Caribbean with a size of 5,128 square kilometers and a population of 1.3 million. Pneumonia is a leading cause of death in Trinidad. This project determined the frequency of Legionella pneumophila in patients with pneumonia, investigated the relationship between pneumonia and selected risk factors. Serum and demographic data were collected from 123 patients, diagnosed with pneumonia. Sera were tested for L pneumophila Ig G/M/A and IgM. All analyses were done using the SPSS statistical package. Of a total of 123 serum samples tested, 39 (31.7) were positive for L pneumophila IgM/G/A while 2 (1.6) were positive for IgM only. Hospitals, gender and ethnicity did not significantly (p > 0.05; chi-squared) affect the seroprevalence of L pneumophila. Overall, the prevalence of L pneumophila assayed was not significantly (p > 0.05, chi-squared) affected by co-morbidities.

Trinidad and Tobago es una isla del Caribe que posee una extension de 4828 kilometros cuadrados y una poblacion de 1.3 millones. La neumonia es una de las principales causas de muerte en Trinidad. Este proyecto determino la frecuencia de Legionella pneumophila en pacientes con neumonia, e investigo la relacion entre la neumonia y los factores de riesgo seleccionados. Se recopilaron datos sericos y demograficos de 123 pacientes, diagnosticados con neumonia. Los sueros fueron sometidos a analisis a fin de determinar la presencia de L. pneumophila Ig G/M/A y Ig M. Todos los analisis se realizaron usando el paquete estadistico SPSS (Statistical Package for the Social Sciences). De un total de 123 muestras de suero analizadas, 39 (31.7%) dieron positivas frente a L. pneumophila Ig M/G/A, mientras que 2 (1.6%) dieron positivo frente a Ig M solamente. Los hospitales, el genero y la etnicidad no afectaron significativamente la seroprevalencia de L. pneumophila (p > 0.05; c2). En general, la prevalencia de L. pneumophila ensayada no fue afectada significativamente por comorbidades (p > 0.05, c2).

Seroprevalence of Legionella pneumophila in pneumonia patients in four major hospitals in Trinidad and Tobago.

Trinidad and Tobago is an island-state in the Caribbean with a size of 5,128 square kilometers and a population of 1.3 million. Pneumonia is a leading cause of death in Trinidad. This project determined the frequency of Legionella pneumophila in patients with pneumonia, investigated the relationship between pneumonia and selected risk factors. Serum and demographic data were collected from 123 patients, diagnosed with pneumonia. Sera were tested for L pneumophila Ig G/M/A and IgM. All analyses were done using the SPSS statistical package. Of a total of 123 serum samples tested, 39 (31.7) were positive for L pneumophila IgM/G/A while 2 (1.6%) were positive for IgM only. Hospitals, gender and ethnicity did not significantly (p > 0.05; chi-squared) affect the seroprevalence of L pneumophila. Overall, the prevalence of L pneumophila assayed was not significantly (p > 0.05, chi-squared) affected by co-morbidities.

Prevalence of Mycoplasma pneumoniae and Chlamydia pneumoniae in pneumonia patients in four major hospitals in Trinidad.

The prevalence of current Mycoplasma pneumoniae and Chlamydia pneumoniae infections in patients with pneumonia in Trinidad, and the relationship between pneumonia and risk factors were investigated. Blood samples were collected from 132 patients diagnosed by attending physicians, as suffering from pneumonia at four hospitals in Trinidad. Serum samples were tested for M. pneumoniae IgM and IgG and C. pneumoniae IgM by the enzyme immunoassay (EIA). In addition, C. pneumoniae IgM and IgG were detected using microimmunofluorescence (MIF). A comprehensive questionnaire which addressed demographic information as well as risk factors for pneumonia was administered to patients. All analyses were done using the Statistical Package for Social Sciences (SPSS), version 9. Seroprevalences of 46.0% (58 of 126) were found for C. pneumoniae Ig M/G, and 66.7% (88 of 132) for M. pneumoniae Ig M/G. The difference was statistically significant (p < 0.01; chi2). Thirty-four percent (43 of 125) for C. pneumoniae Ig M/acute Ig G and 28.8% (36 of 125) of M. pneumoniae IgM were not statistically significant (p > 0.05; chi2). Hospital, gender and ethnicity of patients did not significantly (p > 0.05; chi2) affect the seroprevalence of the bacteria assayed for. However, the prevalence of C. pneumoniae (23.3%) in patients under 21 years old compared to other age groups was statistically significant (p = 0.043; chi2). Overall, the seroprevalence to both pathogens was not significantly (p > 0.05; chi2) affected by comorbidities and signs/symptoms. It was concluded that new infections by C. pneumoniae in pneumonia patients may be an important aetiological agent for the condition in Trinidad.

Single dose (direct observed) azithromycin therapy for Neisseria gonorrhoeae and Chlamydia trachomatis in STD clinic attenders with genital discharge in Trinidad and Tobago

The purpose of this study was to determine the prevalence and to assess the efficacy of a single one gram oral dose of azithromycin under direct observed therapy of genital discharge due to Neisseria gonorrhoeae and Chlamydia trachomatis infections in STD clinic attenders in Trinidad and Tobago. All patients with genital discharge and their contacts were given one gram oral dose of azithromycin under direct supervision after collection of urethral and cervical swabs for N gonorrhoeae culture and smear and for C trachomatis antigen detection by ELISA. Clinical and microbiological evaluation was done on those who returned after 7-10 days for follow-up. Of the 735 patients who were enrolled in the study, 319 (43.4) had N gonorrhoeae and 100 (13.6) had C trachomatis. Only 151 (36) of the 419 patients with a pathogenic isolate returned for clinical and microbiological assessment. The remaining 268 (64) of the 419 patients were lost to follow-up. One hundred and forty-three patients (94.7) had total abatement of signs and symptoms after taking azithromycin. One patient (0.65), who had both N gonorrhoeae and C trachomatis, improved clinically with the drug. Seven patients (six with N gonorrhoeae and one with C trachomatis) failed to respond clinically to azithromycin. Microbiological eradication was achieved in 115 (100) patients who had single infection with N gonorrhoeae and in 23 patients (96) with C trachomatis infection. Of 12 patients with combined infections, N gonorrhoeae and C trachomatis were eradicated in 10 and 12 patients, respectively, after initial treatment. In two patients with combined infection, N gonorrhoeae continued to be isolated after treatment with azithromycin. A single one gram oral dose of azithromycin under direct supervision is useful in the treatment of uncomplicated genital infection with N gonorrhoeae and C trachomatis in STD clinic attenders in Trinidad.

Single dose (direct observed) azithromycin therapy for Neisseria gonorrhoeae and Chlamydia trachomatis in STD clinic attenders with genital discharge in Trinidad and Tobago.

The purpose of this study was to determine the prevalence and to assess the efficacy of a single one gram oral dose of azithromycin under direct observed therapy of genital discharge due to Neisseria gonorrhoeae and Chlamydia trachomatis infections in STD clinic attenders in Trinidad and Tobago. All patients with genital discharge and their contacts were given one gram oral dose of azithromycin under direct supervision after collection of urethral and cervical swabs for N gonorrhoeae culture and smear and for C trachomatis antigen detection by ELISA. Clinical and microbiological evaluation was done on those who returned after 7-10 days for follow-up. Of the 735 patients who were enrolled in the study, 319 (43.4%) had N gonorrhoeae and 100 (13.6%) had C trachomatis. Only 151 (36%) of the 419 patients with a pathogenic isolate returned for clinical and microbiological assessment. The remaining 268 (64%) of the 419 patients were lost to follow-up. One hundred and forty-three patients (94.7%) had total abatement of signs and symptoms after taking azithromycin. One patient (0.65%), who had both N gonorrhoeae and C trachomatis, improved clinically with the drug. Seven patients (six with N gonorrhoeae and one with C trachomatis) failed to respond clinically to azithromycin. Microbiological eradication was achieved in 115 (100%) patients who had single infection with N gonorrhoeae and in 23 patients (96%) with C trachomatis infection. Of 12 patients with combined infections, N gonorrhoeae and C trachomatis were eradicated in 10 and 12 patients, respectively, after initial treatment. In two patients with combined infection, N gonorrhoeae continued to be isolated after treatment with azithromycin. A single one gram oral dose of azithromycin under direct supervision is useful in the treatment of uncomplicated genital infection with N gonorrhoeae and C trachomatis in STD clinic attenders in Trinidad.

Methicillin resistant Staphylococcus aureus.

The prevalence of methicillin resistant Staphylococcus aureus (MRSA) at the General Hospital, Port-of-Spain, between June 1995 and May 1996 was determined. The MRSA prevalence rate was 4.6% of all S aureus isolates, with all but one nosocomially acquired. 15 isolates were associated with infections, and three were colonizing strains. 17 of the 18 patients with MRSA had received antibiotics previously, including 13 who had received multiple antibiotics. Skin and soft tissue were the sites of infection and colonization in 12 cases; and surgical wards and the Intensive Care Unit (ICU) accounted for 16 MRSA isolates. All isolates were sensitive to vancomycin and all but one were resistant to gentamicin. MRSA occurred sporadically in a wide distribution of wards and physicians' services, although the isolation of three strains from the ICU and three strains from a surgical ward were temporally related. Only one of two deaths was attributable to MRSA. Control of the spread of MRSA in this hospital must include the reinforcement of the appropriate use of antibiotics, hand washing and appropriate isolation of patients in the surgical and intensive care wards.

Methicillin resistant Staphylococcus aureus

The prevalence of methicillin resistant Staphylococcus aureus (MRSA) at the General Hospital, Port-of-Spain, between June 1995 and May 1996 was determined. The MRSA prevalence rate was 4.6of all S aureus isolates, with all but one nosocomially acquired. 15 isolates were associated with infections, and three were colonizing strains. 17 of the 18 patients with MRSA had received antibiotics previously, including 13 who had received multiple antibiotics. Skin and soft tissue were the sites of infection and colonization in 12 cases; and surgical wards and the Intensive Care Unit (ICU) accounted for 16 MRSA isolates. All isolates were sensitive to vancomycin and all but one were resistant to gentamicin. MRSA occurred sporadically in a wide distribution of wards and physicians' services, although the isolation of three strains from the ICU and three strains from a surgical ward were temporally related. Only one of two deaths was attributable to MRSA. Control of the spread of MRSA in this hospital must include the reinforcement of the appropriate use of antibiotics, hand washing and appropriate isolation of patients in the surgical and intensive care wards.

Antibiotic susceptibility of Neisseria gonorrhoeae in Trinidad and Tobago

Treatment failures with standard doses of penicillin have been observed in the Sexually Transmitted Diseases (STD) clinics in Trinidad and Tobago. In the absence of an ongoing surveillance system, the antimicrobial susceptibility of 518 Neisseria gonorrhoeae strains was determined in order to guide treatment. 39 (7.6) strains were resistant to penicillin, including 27 (5.2) positive for beta-lactamase; that is penicillinase-producing Neisseria gonorrhoeae (PPNG). 51 (10) strains were resistant to tetracycline, with 26 (5.0) of these exhibiting high levels of resistance compatible with tetracycline resistant Neisseria gonorrhoeae (TRNG). Six strains showed evidence of having both PPNG and TRNG plasmids, and five strains showed chromosomally-mediated resistance to both penicillin and tetracycline. The overall resistance rate to penicillin and tetracycline was 17.7. There was no resistance to spectinomycin, cefuroxime, ceftriaxone and norfloxacin. The resistance rates demonstrated in this study are sufficiently significant to preclude the use of penicillin and tetracycline in the STD clinics and to justify the use of newer antimicrobials. It is essential that resistance patterns be monitored by continued surveillance.

Invasive streptococcal infections. Report of four cases occurring in Trinidad.

Many countries are reporting a resurgence of virulent streptococcal strains but there is little information from the Caribbean. Four cases of severe invasive streptococcal infections, three of them fatal, are reported. The portal of entry was infected scabatic lesions in one patient and infected mosquito bites in another patient who developed cellulitis and gangrene; but no portal of entry was detected in the other patients. Group A beta haemolytic Streptococcus (GAS) was isolated from the blood of three patients, one of them GAS M type 3, which had the genome for streptococcal pyrogenic exotoxins A (SPeA) and B (SPeB). GAS M type 72, which had the genome for SPeB and SPeC, were isolated from the tissues (but not from the blood) of the patient who developed cellulitis and who was the sole survivor. Physicians in the Caribbean must be alerted to the presence of these virulent streptococcal strains, and must be prepared to manage serious invasive disease.

Antibiotic susceptibility of Neisseria gonorrhoeae in Trinidad and Tobago.

Treatment failures with standard doses of penicillin have been observed in the Sexually Transmitted Diseases (STD) clinics in Trinidad and Tobago. In the absence of an ongoing surveillance system, the antimicrobial susceptibility of 518 Neisseria gonorrhoeae strains was determined in order to guide treatment. 39 (7.6%) strains were resistant to penicillin, including 27 (5.2%) positive for beta-lactamase; that is penicillinase-producing Neisseria gonorrhoeae (PPNG). 51 (10%) strains were resistant to tetracycline, with 26 (5.0%) of these exhibiting high levels of resistance compatible with tetracycline resistant Neisseria gonorrhoeae (TRNG). Six strains showed evidence of having both PPNG and TRNG plasmids, and five strains showed chromosomally-mediated resistance to both penicillin and tetracycline. The overall resistance rate to penicillin and tetracycline was 17.7%. There was no resistance to spectinomycin, cefuroxime, ceftriaxone and norfloxacin. The resistance rates demonstrated in this study are sufficiently significant to preclude the use of penicillin and tetracycline in the STD clinics and to justify the use of newer antimicrobials. It is essential that resistance patterns be monitored by continued surveillance.

PIP: Neisseria gonorrhoeae from many areas of the world have developed resistance to a wide variety of antibiotics over the past 2 decades. The incidence of treatment failures with standard doses of penicillin observed in Trinidad and Tobago's sexually transmitted disease (STD) clinics suggests that such resistance also exists in Trinidad. 518 Neisseria gonorrhoeae strains were isolated from 1502 male and female patients attending the 7 STD clinics throughout Trinidad during May-October 1992, and tested to identify their antimicrobial susceptibility. 39 strains were resistant to penicillin, including 27 which were positive for beta-lactamase, indicating infection with penicillinase-producing Neisseria gonorrhoeae (PPNG). 51 strains were resistant to tetracycline, of which 26 exhibited high levels of resistance compatible with tetracycline-resistant Neisseria gonorrhoeae (TRNG). 6 strains showed evidence of having both PPNG and TRNG plasmids, and 5 strains showed chromosomally-mediated resistance to both penicillin and tetracycline. The overall resistance rate to penicillin and tetracycline was 17.7%, and there was resistance to neither spectinomycin, cefuroxime, ceftriaxone, nor norfloxacin. The resistance rates observed in this study are significant enough to warrant the cessation of penicillin and tetracycline use in STD clinics, and the use of newer antimicrobials. Neisseria gonorrhoeae resistance patterns demand ongoing monitoring.

Haemophilus influenzae laboratory diagnosis

Haemophilus influenzae (HI) is a small, pleomorphic, encapsulated, non-motile, gram negative bacillus which was first isolated from respiratory tract secretions by Pfeiffer in 1893(AU)

Eikenella corrodens brain abscess in a child with congenital heart disease

We reported the isolation of Eikenella corrodens from a brain abscess in a child with cuanotic congenital heart disease in Trinidad

The relative importance of rotavirus and other pathogens in the etiology of gastroenteritis in Trinidadian children.

Over a 2-year period, 300 infants less than 3 years old with gastroenteritis admitted to hospitals in Trinidad were investigated for the presence of certain microorganisms in the feces, along with an equal number of age- and sex-matched controls. Rotavirus was detected in 23% of cases and 1% of controls; Salmonella in 7% of cases and in 1% of controls; Shigella in 4% of cases and in no controls and two serotypes of enteropathogenic E. coli in 7% of cases and in 2% of controls. Campylobacter fetus subspecies jejuni was cultured from 7 out of 60 cases and from 1 of 60 controls. Enterotoxigenic E. coli, most strains of enteropathogenic E. coli, cytopathic enteroviruses and adenoviruses and fecal parasites were not significantly associated with diarrhea. Rotaviruses were detected throughout the year but were more prevalent in the dry than in the rainy season. They were found less often in children younger than 6 months than in those aged 6 to 35 months and were present in 6 of the 20 children who died.

Contaminated roof-collected rainwater as a possible cause of an outbreak of salmonellosis.

Roof-collected rainwater is a common water source in subtropical regions and has not been associated with human illness. In Trinidad, the West Indies, a church group, attending a rural camp, developed gastrointestinal illness, caused by Salmonella arechevalata. This rare serotype was isolated from stool specimens of campers, foods eaten at the camp, and a water tap, which was supplied by a storage tank of roof-collected rainwater. The surface of the roof, used as water catchment, was covered with bird faeces. It is postulated that rainwater, falling on the roof, washed off animal excrement which contained S. arechevalata and led to the outbreak of salmonellosis through camper ingestion of contaminated food and water.

WHO collaborative study on the sero-epidemiology of rubella in Caribbean and Middle and South American populations in 1968.

Knowledge of the rubella antibody profiles of female populations of various ages and in various geographical areas is essential for an intelligent and effective administration of rubella vaccine. The investigation reported was undertaken to extend a previous WHO collaborative study to include additional areas of the Americas. As in the other mainland areas included in the earlier study, the presence of rubella haemagglutination-inhibiting antibody was found to be a likely event in over 80% of the females of child-bearing age in Argentina, Brazil, Chile, urban Peru (Lima) and Uruguay. Antibody rates were significantly lower in Jamaica, Panama, rural Peru and Trinidad. These data confirm and extend earlier findings of low levels of rubella immunity in certain island or isolated populations.