Bronchopulmonary tuberculosis-laboratory diagnosis and dots strategy outcome in a rural community: a retrospective study

Pulmonary tuberculosis is still a global public health threat. Despite all efforts at its containment; the scourge is still menacing especially in the rural communities and among HIV infected patients. This retrospective study was carried out to determine the case detection rate of pulmonary tuberculosis in a rural community hospital in Nigeria from 2001-2006. A total of 1219 suspected patients were tested for pulmonary tuberculosis by sputum smear stained by Ziehl-Neelsen technique. Out of this number; 350 (28.7) were positive for Acid-Fast Bacilli including 198 males and 152 females. Also 235 of the sputum-smear positive patients were tested for the human immunodeficiency virus (HIV) antibodies by Immunocomb 11 HIV 1 et 2 Bispot and confirmed by Immunocomb 11 HIV 1 et 2 Combfirm and HIV-1 Western Blot kit. Sixty three (26.8) of the sputum-smear positive patients were co-infected with HIV. Two hundred and seventy (77.1) of the AFB positive patients were treated under the Directly Observed Therapy-Short course; 201 of them (74.4) completed the treatment; 39 (14.4) defaulted; 30 (11.1) died before the completion of the treatment; 195 of the patients were declared cured and 6 were declared failed. Case detection rates could be improved upon by providing culture facilities at the DOTS centers. Also efforts should be made to ensure that all positive cases are followed to a logical conclusion and that anti-retroviral drugs are provided for patients co-infected with HIV to reduce the mortality rate of pulmonary tuberculosis

Fluconazole resistant opportunistic oro-pharyngeal Candida and non-Candida yeast-like isolates from HIV infected patients attending ARV clinics in Lagos, Nigeria.

BACKGROUND: Oro-Pharyngeal Candidiasis (OPC) continues to be considered the most common opportunistic fungal disease in HIV/AIDS patients globally. Azole antifungal agent has become important in the treatment of mucosal candidiasis in HIV patients. Presently, antifungal drug resistance is fast becoming a major problem particularly with the immune depleted population. OBJECTIVES: This study was designed to investigate the: existence of OPC, species distribution fluconazole susceptibility profile of yeast cells isolated from oral specimens of HIV/AIDS patients from Lagos Nigeria, between Oct. 2004 and June, 2005. METHODOLOGY: The venous blood samples were screened for HIV antibodies using the Cappillus HIV I and II test kit (Trinity Biotech Plc UK), and Genie II HIV I and II EIA kit (Bio-Rad France). The positive results were subsequently confirmed at the laboratory attached to each of the clinics, using the Nigerian Federal Ministry of Health approved algorithm. The samples from 213 (108 females and 105 males) HIV positive patients were plated onto SD agar. The isolates were identified by morphotyping, microscopy and speciated using germ tube test and battery of biochemical sugar fermentation and assimilation tests. Fluconazole agar diffusion susceptibility testing was carried out on each isolates. RESULTS: Seventy-four (34.7%) isolates were recovered including one person with double isolates. Only 70 (94.6%) of the isolates could be adequately speciated. Candida albicans 30 (40.5%) was the most frequently isolated species, the rest were non-albicans species, with the frequency of C. tropicalis > C. Krusei > C. glabrata and C. neoformans for species for species having up to 4 isolates. Four (30.8%) out of 13 isolates of C. tropicalis showed germ tube formation. While one C. albicans was germ-tube negative. Out of the 74 isolates tested for fluconazole sensitivity, 58 (78.4%) were sensitive, MIC d'' 8 microg/ml, 9 (12.1%) were susceptible Dose Dependent (SDD), MIC 16-32 microg/ml and 7 (9.5%) were resistant, MICs e'' 64 microg/ml. Among the C. albicans isolates, 26 (86.7%) were sensitive to fluconazole. The rank of susceptibility was C. albicans > C. tropicalis > C. Krusei for the most prevalent species. CONCLUSION: We conclude that fluconazole resistant strains of oro-pharyngeal yeast-like cells exist in about 9.5% of HIV/AIDS patients with the above stated species distribution. We therefore, highlight the need for routine antifungal susceptibility testing on HIV patients with cases of initial or repeat episodes of OPC.

Care-seeking behavioural patterns, awareness and diagnostic processes in patients with smear- and culture-positive pulmonary tuberculosis in Lagos, Nigeria.

This study was carried out in 2 chest referral clinics in Lagos, Nigeria, between February 2000 and May 2001 to assess the effects of knowledge, attitude, and practice of 168 newly diagnosed tuberculosis (TB) patients on their care-seeking behaviour. At the onset of symptoms patients sought treatment from one or more of the local private orthodox and traditional health providers, and patent medicine dealers before presenting at a chest clinic. There was a correlation between the level of knowledge and awareness of TB with time of presentation at the chest clinic. Of the 32 patients who presented and were diagnosed at the chest clinics within 4 weeks of onset of symptoms, 50% had knowledge of the aetiological agent of the disease and 60% had some idea of the mode of transmission. Of the 105 patients who presented and were diagnosed 12 weeks after the onset of symptoms, 97% had no knowledge of the aetiological agent and 95% had no idea of the mode of transmission. Overall there was a low level of knowledge and awareness of the disease as well as an apparently high level of improper health care-seeking behaviour amongst the patients studied which probably contributed significantly to the delay in early and accurate diagnosis of most of the cases. These findings indicate an urgent need to educate communities and care providers on the cause and mode of transmission of TB, and the need to attend designated health facilities for early diagnosis and proper treatment.