Serum Levels of Interleukin-6 (IL-6) Cytokine in Patients with Classic Fever of Unknown Origin, in Maiduguri, Nigeria.

Aim: To assess whether a significant correlation exists with serum Interleukin-6 cytokine levels in patients with Classic Fever of Unknown Origin (FUO) compared with healthy controls. The levels of IL-6 cytokine were tested as a proinflammatory cytokine which may belong to microorganisms that cause disease. Study Design: This is a case control, single center study. Place and Duration of Study: The study was conducted in the University of Maiduguri Teaching Hospital, Maiduguri, Borno State, Nigeria in patients with classic FUO who were treated between 2009 and 2012 were included in this study. Methodology: A total of 75 patients with classic FUO within the age range of 15 – 65 years were tested for IL-6 cytokine in comparison with 75 healthy controls. The sample size was calculated using Fisher’s formula. Results: In patients with FUO, 39% of patients demonstrated elevated levels of IL-6 while 20% of healthy controls demonstrated elevated levels (>200 pg/ml) of serum IL-6, while 12% and 15% respectively were in standard range of 0 - 6.4 pg/ml which is considered low. Gender differences were noted and mean values of IL-6 were higher in males (FUO mean±SD 136.7±161.8; Healthy controls mean±SD 132.3±183.5) than in females (FUO mean±141.6±133.9; Healthy controls mean±SD 97.8±134.2). Healthy male control had a value of 520.5 pg/ml with little difference to the male patients with FUO (575 pg/ml), p=0.91) while IL-6 concentrations in the female group who had FUO (407.5 pg/ml vs 367.5 pg/ml, p=0.16) showed greater difference in value in comparison to the healthy which trended towards statistical significance. We found that most patients (39%) with FUO have higher values of ≥ 200 pg/ml than the healthy controls. Conclusions: Serum IL-6 cytokine level is generally higher in males than in females and most patients (39%) with FUO have a higher value of ≥ 200 pg/ml than the healthy controls. IL-6 levels trended towards statistical significance and may help to discriminate females with FUO as compared their healthy controls.

Bacterial isolates associated with pelvic inflammatory disease among female patients attending some hospitals in Abuja, Nigeria

Background: Pelvic inflammatory disease refers to any infection in the female lower reproductive tract that spreads to the upper reproductive tract. The disease comprises a spectrum of inflammatory disorders of the upper female genital tract; including any combination of endometritis; salpingitis; tubo-ovarian abscess and pelvic peritonitis. PID is not a notifiable disease in most countries; so accurate statistics are not available. This situation is not in any way different here in Nigeria and more so in the Federal Capital Territory; Abuja where this research was conducted; there had never been any published report so far on PID. It therefore became pertinent that such studies be carried out to evaluate the bacterial organisms which may be associated with the disease in this part of Nigeria so that health care providers could take a better look at this affliction in women. Materials and Methods: Endocervical swabs totalling 100 were aseptically collected from patients with confirmed Pelvic Inflammatory Disease (PID); attending some hospitals in Abuja; Nigeria for detection of bacterial pathogens based on cultural and biochemical characterisation tests. Antibiogram was also conducted on the identified bacterial isolates. Results: Out of the 100 samples analysed; 43 yielded pure cultures of bacterial isolates; 2 yielded mixed cultures while no bacterial growths were recorded from the remaining 55 samples. Organisms encountered were Staphylococcus aureus (16); Escherichia coli (10); Streptococcus faecalis (8); Pseudomonas aeruginosa (4); Streptococcus pyogenes (3); Klebsiella pneumoniae (3); Proteus rettgeri (2) and Proteus mirabilis (1). The highest percentage occurrence of pathogenic isolates was observed in polygamous married patients (90). The age group most affected falls within the mean age 30.5 years (68) while the least affected group falls within the mean age 40.5 years (5). There was a significant difference in the acquisition of PID in relation to marital status (P 0.05). However there was no significant difference in the acquisition of the disease with respect to age (P 0.05). Antibiogram patterns of pathogenic isolates revealed varied resistance to most of the antibiotics employed. Cefotaxime (a new generation cephalosporin antibiotic) was established in this study as the best antimicrobial agent for treatment of PID due to Gram-positive and Gram-negative bacteria isolated from the women examined. Conclusion: In conclusion; Pelvic inflammatory disease is a major health problem in developed or developing countries of the world. PID is not a notifiable disease; as accurate statistics on disease prevalence are rarely available. There is therefore no doubt thousands of young women have salpingitis every year and their sheer number makes it an important health problem. PID hence can be said to be a very serious complication of sexually transmitted disease which should be critically and promptly handled by healthcare providers. The right type sample should be aseptically collected and be appropriately handled for laboratory investigation. Treatment of PID should be initiated as soon as the presumptive diagnosis has been made. Immediate administration of antibiotics has been effective in the long-term sequelae associated with PID; especially new generation antibiotics; such as cefotaxime as recorded in this study

Polio Vaccination in Nigeria: The ‘good’, the ‘bad’ and the ‘ugly’.

With increase in the number of polio cases, Nigeria serves as the primary threat to a polio free world. The “good” the bad” and “the ugly” aspects of polio vaccination in Nigeria is discussed. In the ‘good’ aspect the number of wild poliovirus cases declined by over 90%, cVDPV 2 cases declined by 82%. Similarly, genetic clusters of both wild poliovirus type 1 and type 3 have reduced form 18 and 19 in 2009 to 2 respectively. The Immunity to polioviruses has improved in endemic States and new approaches for better identification of settlements and to promote community participation have been adopted in 2012. On the ‘bad ‘aspect, polio cases have increased from 21 in 2010 to 62 in 2011 and 84 in 2012 (7th September)with on-going transmission of wild poliovirus type 1, 3 and cVDPV2. Declined political oversight at critical juncture and non-Implementation of emergency plans in key infected areas has been observed. Non-compliance to the vaccine seems to be the major contributor to the increasing number of polio cases in the country. Lastly “the ugly” face focuses on the aftermath of the boycott of polio vaccination in northern States in 2003 amidst the rumour that the vaccine contained infertility drugs, causes poliomyelitis and spread HIV. After resolving the crisis, some parents in the north still resist compliance with the polio vaccination. Borrowing a leave from the rally organized by the polio victims, all Nigerians should complement the government efforts in ‘kicking’ polio out of the country.