Sputum concentration improves diagnosis of pulmonary tuberculosis cases in children at a tertiary care institution in Rwanda

Introduction: A great concern exists about the emergence of antibiotic resistant organisms. The goal of this study is to delineate antibiotic sensitivity patterns at King Faisal Hospital. Methods: A three years study; from Jan 2009 to Dec 2011 was conducted in the Microbiology unit; department of Laboratory; King Faisal hospital; Rwanda. All the specimens and antibiotic sensitivity were processed according to the standard guidelines. Microorganisms and their sensitivity data were reviewed and compiled by using hospital information system. Results: Over the 3-year period; several Enterobacteriaceae pathogens declined in susceptibility to various antimicrobial agents. A total of 2153 Enterobacteriaceae were isolated. Most common isolate was Escherichia coli check for this species in other resources (1413) followed by Klebsiella check for this species in other resources species (550); Enterobacter check for this species in other resources species (110); Proteus check for this species in other resources species (165); Citrobacter check for this species in other resources Species (79); Shigella check for this species in other resources species (110) and other species. Most notable were the decreased sensitivities to cefuroxime: E. coli (84 to 72); Klebsiella (78 to 33); Enterobacter (50 to 41) Proteus(67 to 59) and Shigella to ciprofloxacin (100 to 96). And also decreased sensitivities to Imipenem: E. coli (100 to 98) and Klebsiella species (100 to 94). Conclusion: These decreased antibiotic sensitivities reflect increased bacterial selection pressure as a result of widespread antibiotic use. A combined approach involving infection-control specialists; infectious disease physicians; and hospital administrators is necessary to address this increasingly difficult problem

Prevalence of six Periodental Pathogens in Rwandan Women's Gingival Crevicular Fluide

Periodontium or periodontal tissues; are tissues that surround; support and maintain the teeth in the maxillary and mandibular bones. Like other tissues; the periodontal tissues are subject to a number of diseases. The most periodontal pathogens associated with periodontal disease are Tannerella forsythia check for this species in other resources ; Porphyromonas gingivalis check for this species in other resources ; Treponema denticola check for this species in other resources ; Prevotella Intermedia check for this species in other resources ; Fusobacterium nucleatum check for this species in other resources and Agregatibacter actinomycetemcomutans check for this species in other resources . Female hormones have been suggested to play an important role in periodontal disease infection. The objective of this study was to identify the prevalence of the above periodontal pathogens associated with periodontal disease in a population of Rwandan women. This study requested the participation of randomly selected women admitted in the department of obstetric-gynecology of the teaching hospital of Butare in Rwanda. Gingival crevice fluid was collected from four teeth (16; 26; 36; 46) with filter paper strips by inserting the strips into the base of the pocket for one minute per tooth. PCR was used for the detection of the presence of the 6 target bacteria in GCF. F. nucleatum was the most prevalent with 86.2 ; P. intermedia (73.5); T. forsythia (47.6 ); A. actinomycetemcomutans (45 ); P. gingivalis (28.4) and T. denticola with (24.3 ). One hundred and eighty six (93.0 ) of the patients harboured at least one of the six periodontopathogens. This study showed that there is an urgent need to improve oral health care and research in Rwanda; on the African continent in general and especially in women who are more exposed to periodontal diseases than men

Oral Health Care Habits and its Role in Preventing Adverse Prenancy Outucomes in Rwanda

More than 20 million infants in the world (15.5 of all births) are born preterm with low birth weight (PLBW). Ninety-five of them are in developing countries and the rate of PLBW in developing countries is more than double (16.5) that in developed countries. It has been suggested that oral infection can act as the site of origin for dissemination of periodontopathogens and their toxins as well as induce inflammatory mechanisms to distant body sites; thus linking periodontal diseases to pre-term delivery of low birth weight (PLBW) infants. The objective of this study was to assess the general oral health care habit of pregnant mothers in order to determine its association with premature delivering of low birth weight infants.Methods: Study participants were asked to complete a questionnaire to obtain information regarding their oral health care habits and the responses linked to their gestation term and time of delivery. In addition; their mouths were examined for gingival inflammation and / or bleeding which might be attributed to lack of oral health care. Results and conclusion: Although in this study oral health care habits of the mothers did not appear to directly influence the gestation period and birth weight of the infants; the resulting gingival inflammation and bleeding showed a significant correlation with PLBW (p = 0.004). Therefore maternal dental care during pregnancy and good oral hygiene habits could be highly recommended. Also more detailed examination and assessment of the oral health status of mothers with particular emphasis on periodontal disease and its association with adverse pregnancy outcomes are needed

Management Challenges of Pediatric Infective Endocarditis at Tertiary Level in Rwanda

Background: Management of Infective Endocarditis (IE) has been of great challenge for many years. Rapid diagnosis; effective treatment; and prompt recognition of complications are essential to good patient outcome as this condition is associated with a high morbidity and mortality in both adults and pediatric patients. In limited resources settings; management of IE is still a challenge due to early inappropriate antibiotherapy and therefore difficulties in its diagnosis and treatment. Objectives: To elicit challenges in management of patients suspected of IE at tertiary level in Rwanda. Methods: We report four patients with IE. For these patients; Duke's criteria were considered in making the diagnosis. Results and Conclusion: IE has protean clinical symptoms and signs; and can be of challenging diagnosis. The patients reported constituted a clinical challenge in the diagnosis and management of IE but most of them had had favorable outcome. The main clinical challenge was the prolonged stay to peripheral settings with inappropriate antibiotherapy which made most of the blood cultures falsely negative. Echocardiography and serial blood cultures provide the key to diagnosis as per Dukes criteria. Being alert to this mentioned challenge is crucial. As the key investigations are not steadily available in most peripheral health facilities; we strongly recommend early referral to tertiary level for all cases of suspected IE before initiation of antibiotherapy

Prevalence of bacterial vaginosis in women with vaginal symptoms in South Province, Rwanda

This is a prospective study of 297 Consecutive High Vaginal Swab (HVS) specimen from patients with vaginal symptoms at the laboratory of Butare University Teaching Hospital; South Province; Rwanda. The aim of the study was to evaluate the prevalence of bacterial vaginosis and the role of some micro-organisms and laboratory indices associated with it. The age range was 16-57 years with a mean of 30.8 years. The overall prevalence of bacterial vaginosis was 17.8and the highest percentage of 52.8(28) found in the age group of 21-30 years compared with the lowest percentage of 1.9(1) in the age group less than 20 years. Almost half of patients with trichomoniasis were found to have bacterial vaginosis (P0.05). The demonstration Clue cells in wet mount was found in significantly higher numbers (90.5) in women with bacterial vaginosis (P0.001; positive predictive value 90.4) while low sensitivity and positive predictive value were seen for vaginal discharge for detecting infection with bacterial vaginosis ( p 0.05; positive predictive value 26.0). Bacterial vaginosis is common among women with vaginal symptoms in Rwanda as showed by gram stain examination. Further research into this pathology in other Rwandan women populations is needed