Swab and aspiration specimen collection methods and antibiogram in chronic suppurative otitis media at Jos University Teaching Hospital: Which is superior?

BACKGROUND: Chronic suppurative otitis media is a very common otologic problem in our environment. Appropriate methods for obtaining sample specimens for specific bacteria isolation has generated a lot of controversy. The simplest method available in our environment is the traditional swab method which, however, has been condemned on the basis of introducing contaminants. The objectives of this study were to compare the bacterial yield and the antibiogram of two specimen collection methods: the traditional swab method and aspiration method. METHOD: This was a 3-month prospective study involving outpatients seen at both the emergency and outpatients' clinics of the Jos University Teaching Hospital in the period between May 2008 and July 2008. The biodata, duration of discharge and sites of samples were recorded in the study data form after obtaining consent from the patients or the parents of child. RESULTS: Eighty patients were studied comprising 40 each for aspiration and swab technique. This consists of 30 males (37.5%) and 50 females (62.5%) with a male to female ratio of 1:1.7. There were 24 (30%) children (14 males, 10 females). Six (4 males, 2 females) and 74 (26 males, 48 females) patients had bilateral and unilateral ear discharges, respectively. A total of 86 specimens were obtained in all, consisting of 42 left and 44 right ears. There were 68 bacteria isolates comprising Pseudomonas (30), Staphylococcus (18), Proteus (12), and (8) Klebsiella species. Two were incidental fungal isolates of (Candida species), (8) cultures grew contaminants and (10) specimens had no growth at all. Each of the swab and aspiration techniques had (44) specimens. CONCLUSIONS: Despite the controversy surrounding the sampling technique in literature, swab technique has been found to be as good as the aspiration technique in our study. The organisms isolated are the same as those obtained in other places. Contaminants found were few and occurred in equal amount in the same patients in the two methods.

Frequency of cryptococcal meningitis in HIV-1 infected patients in north central Nigeria.

BACKGROUND: Cryptococcal meningitis (CM) is the most common severe life threatening fungal infection in AIDS patients. It is an important cause of morbidity and mortality There is paucity of data on the prevalence of CM in Nigeria. We aimed to determine the frequency of CM, the clinical presentation and immunological profile. METHODS: A cross sectional study was carried out at the Jos University Teaching Hospital (JUTH). A total of 100 HIV-1 infected patients suspected of having meningitis or meningoencephalitis were subjected to cerebrospinal fluid (CSF) analysis (including Indian ink preparation and fungal culture by conventional methods) and CD4 count was determined using flow cytometry (count bit Y-R 1004 Partec Muster Germany). RESULTS: The freguency of CM was 36% in our cohort. The commonest clinical presentation included headache (100.0%), neck stiffness (77.8%), fever (72.0%), vomiting 55.6%), personality changes (55.6%), photophobia (27.8%) and convulsions (27.8%). The mean duration of symptoms was 24 +/- 22 days with a median of 17 days. The mean CD4 count was 89 +/- 60 cells/mm3 with a median of 82 cells/mm3. CONCLUSION: The high prevalence of CM and the associated severe immunosuppression underscores the importance of early diagnosis of HIV infection which may reduce the incidence of CM. There is the urgent need for access to Amphotericin B and fluconazole in resource constrained settings in addition to a wide access to HAART.

Presentation and survival of patients with AIDS-related Kaposi's sarcoma in Jos, Nigeria.

AIDS-related Kaposi's sarcoma (AIDS-KS) remains a significant cause of morbidity and mortality. We describe the pattern of presentation and survival in Jos, Nigeria. We identified 48 HIV-positive patients with AIDS-KS and matched them for age and sex with an equal number of HIV-positive patients without AIDS-KS. We compared their clinical, immunological, virological characteristics and survival. They were similar in age and body mass index profile but patients with AIDS-KS had more tuberculosis co-infection (P, 0.02), lower median CD4 count (P, 0.003) and higher mortality (P, 0.002). Surprisingly, patients with AIDS-KS had lower levels of median viral load (29,347 copies/mL) compared with controls (80,533 copies/mL). We recommend specific AIDS-KS therapy in addition to highly active antiretroviral therapy in order to improve survival.

Direct observation therapy-highly active antiretroviral therapy in a resource-limited setting: the use of community treatment support can be effective.

This study examines the use of various direct observation therapy-HAART treatment support modalities in Jos, Nigeria. A 12-month observational study enrolling 175 antiretroviral naïve patients into four arms of direct observation therapy-HAART (highly active antiretroviral therapy); daily observed therapy (DOT), twice weekly observed therapy (TWOT), weekly observed therapy (WOT) and self-administered therapy (SAT), examined community treatment support using family and community members. Treatment outcomes were much better in the treatment-supported groups compared with the control self-therapy group. CD4 cell increases were 218/microL (DOT), 267/microL (TWOT), 205/microL (WOT) versus 224/microL (SAT), whereas plasma HIV-1 RNA reached undetectable levels (<400 copies/mL) in 91%, 88%, 84% versus 79% of patients in the DOT, TWOT, WOT versus SAT groups, respectively, at 48 weeks. We, therefore, strongly support the use of treatment support in our settings.

Multiple drug resistant strains of Shigella isolated in Jos, central Nigeria.

The objective of this study is to highlight the alarming rise in antimicrobial resistance among Shigella species in Jos, Plateau State. Stool samples of eight hundred and ten patients who presented at the Jos University Teaching Hospital with diarrhoea/dysentery were analysed using standard bacteriological techniques. The antimicrobial susceptibility of the isolates were determined. 25 Shigella species were isolated representing 3.1% isolation rate. The male to female ratio is 1.3:1, children aged 0-10 years constituted 16(64%) of the cases. Shigella flexneri (48%) was the most common sero-group. This was followed by S. boydii (24%), then S. sonnei (20%), and S. dysenteriae (8%). Most strains of shigella species were resistant to Ampicillin (96.0%). Chloramphenicol (96.0%), Cotrimoxazole (88%), Nalidixic acid (84%) and Tetracycline (75%). All strains were found to be sensitive to Ciprofloxacin. The drugs of choice in the treatment of Shigella infection in this environment should be Ciprofloxacin and Ofloxacin. Gentamicin was the third drug of choice its use is limited since the infection is not systemic. To avoid continuous abuse of antibiotics in our country there should be an effective legislation by the government to control the indiscriminate purchase of antibiotics.