Outbreak of Multidrug-resistant Acinetobacter baumannii in a Tertiary Health Center from Northwestern Nigeria.

Background: In spite of its global notoriety and WHO alarm, Acinetobacter baumannii is still an understudied critical-priority pathobiont in Nigeria. We characterized its antimicrobial susceptibility profile and resistance genes during an outbreak. Materials and Methods: This cross-sectional study involved collection of patients' urine samples and swabs from unit staff's hands and ward environments for the identification of A. baumannii strains using standard morphologic and biochemical methods. The disk diffusion method was used to assess the antimicrobial susceptibility profile of the isolates with the production of extended-spectrum beta-lactamases (ESBLs) confirmed by the combined disk test screening method. Characterization of the resistance genes of the ESBL producers was carried out using polymerase chain reaction polymerase chain reaction technique. Results: A.total of eight (six clinical and two nonclinical) A. baumannii isolates were identified. The overall isolate susceptibility and resistance rates to all the antimicrobial agents was 56.3% (27/48) and 35.4% (17/48), respectively. Similarly, all (8/8; 100.00%) isolates were susceptible to meropenem and 75.0% (6/8) to ampicillin-sulbactam while 62.5% (5/8) were resistant to trimethoprim-sulfamethoxazole and 50.0% (4/8) to each of ciprofloxacin and ceftazidime. In addition, 37.5% (3/8) of the isolates were multidrug resistant (MDR) with nonclinical isolates exhibiting more antimicrobial resistance than their clinical counterparts (9/12%-75.0% vs. 8/36%-22.2%). Phenotypic detection and molecular characterization revealed three ESBL-producing isolates that each harbored blaSHV and blaTEM genes with blaCTX-M gene being absent. Conclusion: MDR strains of A. baumannii harboring blaSHV and blaTEM genes were recovered from clinical and environmental sources during the outbreak, which was contained with preventive measures recommended.

Résumé En dépit des alertes faites par l'organisation mondiale de la Santé (OMS), Acinetobacter baumannii demeure un pathobiont sous-étudié et très peu priorisé au Nigeria. Nous avons procedé à sa caractérisation phénotypique et génotypique en dressant son profil de sensibilité aux antimicrobiens et ainsi que les gènes de résistance impliqués au cours d'une épidémie. Matériel et méthodes: Cette étude transversale a consisté à collecter des échantillons d'urine de patients et des écouvillons des mains du personnel des soins et de l'environnement hospitalier. L'identification des souches d' A. baumannii était faite par des méthodes bactériologiques standard. le profil de sensibilité aux antimicrobiens des isolats a été faite par la méthode de diffusion de disque , les bêta-lactamases à spectre étendu (BLSE) étaient recherchée par la méthode de dépistage combinée de disque ainsi que leur caractérisation moléculaire par la mise en évidence des gènes de résistance BLSE à l'aide d'une PCR (réaction en chaîne par polymérase). Résultats: Au total, huit isolats d'A. baumannii (6 cliniques et 2 de l'environnement) ont été identifiés. Les taux globaux de sensibilité et de résistance des isolats à tous les agents antimicrobiens étaient respectivement de 56,3 % (27/48) et de 35,4 % (17/48). De même, tous les isolats (8/8 ; 100,00 %) étaient sensibles au méropénème et 75,0 % (6/8) à l'ampicilline-sulbactam, tandis que 62,5 % (5/8) étaient résistants au triméthoprime-sulfaméthoxazole et 50,0 % (4/8) à la ciprofloxacine et à la ceftazidime. En outre, 37,5 % (3/8) des isolats étaient multirésistants (MDR), les isolats non cliniques présentant une plus grande résistance aux antimicrobiens que leurs homologues cliniques (9/12 %-75,0 % contre 8/36 %-22,2 %). La détection phénotypique et la caractérisation moléculaire ont révélé trois isolats producteurs de BLSE qui hébergeaient chacun les gènes blaSHV et blaTEM, le gène blaCTX-M étant absent. Conclusion: Des souches multirésistantes d'A. baumannii portant les gènes blaSHV et blaTEM ont été identifiées sur des prélevements cliniques et environnementaux au cours de l'épidémie, qui a été gerée grâce aux mesures préventives recommandées. Mots-clés: Surveillance de la résistance aux antimicrobiens, blaSHV carbapénème, pathogène ESKAPE, infections associées aux soins de santé, pratiques de prévention et de contrôle des infections, one health, uropathogènes.

Disseminated Gonococcal Infection Caused by a Multidrug-Resistant Pathogen Presenting with Hemorrhagic Manifestation: A Case Report.

The incidence of disseminated gonococcal infection (DGI) is rising in some parts of the world, but there is paucity of data on its true incidence from sub-Saharan Africa. DGI has varied manifestations in different population group. We report a case of a 30-year-old sexually active woman presenting with hemorrhagic symptoms 2 weeks after a surgery on account of diagnosis of uterine fibroid made at a peripheral hospital. A multidrug-resistant Neisseria gonorrhoeae was isolated from the wound on her surgical site and blood sample. She was managed with intravenous meropenem, pressure dressing, and blood products, with the patient making a full recovery after a week. This case is presented because it is a rare one. Moreover, there is the need to revive the awareness of clinicians on the existence of multidrug-resistant gonococcus in our environment. We herein report a case of DGI from Nigeria.

Spectrum of thyroid function test among type 2 diabetic patients attending a rural health facility, southwest Nigeria: A hospital-based study.

Objectives: The thyroid gland produces hormones that have significant influence on carbohydrate metabolism; its disorders may affect carbohydrate metabolism in type 2 diabetic patients (T2DM) more than the non-diabetic (NDM) patients as reported in various studies. We determined the spectrum of thyroid function tests (TFTs) profile among T2DM in our rural health facility. Methods: T2DM patients and NDM patients were recruited for the study. The age, educational level, occupation, marital status, and duration of diabetes were extracted from interviewer's administered questionnaire. The weight, height, body mass indices (BMIs), and the waist and hip circumferences were measured. Waist-hip ratios (WHR) were calculated for all participants. Venous blood was collected and assayed for free triiodothyronine (fT3), free thyroxine (fT4), and thyroid stimulating hormone (TSH) using a Chemiluminescence Immunoassay (CLIA) 2nd Generation Autoanalyzer. The mean, standard deviation, frequencies, and percentages were calculated for the variables. The student's t-test and chi-square test were also determined as appropriate. Results: Seventy-eight patients made up of 56 T2DM and 22 NDM were evaluated in this study. Fifty-one were males while 27 were females; 67.9% and 59.1% of the female participants were T2DM and NDM, respectively. The WHR was significantly higher in T2DM than NDM (0.92 ± 0.05 versus 0.88 ± 0.06). The TSH was higher in T2DM than the NDM. Forty-four (78.6%) of the T2DM had euthyroid (normal) biochemical pattern; 12 (21.4%) showed abnormal biochemical pattern of euthyroid sick syndrome, subclinical hyperthyroid, and subclinical hypothyroid. Thirty (53.6%) of the T2DM were diagnosed less than five years ago. The value of TSH was increasing with the duration of diabetes but not in a statistically significant way. None of the T2DM showed overt hypothyroid or hyperthyroid test result. Conclusion: Thyroid function test may identify diabetics with altered thyroid hormone status that may impact on their metabolic control. Knowledge of the functional state of the thyroid gland can help in achieving a better metabolic control and attenuate the development of complications in T2DM.

Maternal serum uric acid: a reliable prognostic indicator of foetal outcome among pre-eclamptic patients in a low resource setting.

BACKGROUND: Pre-eclampsia is a major cause of maternal and fetal morbidity and mortality in both developed and developing countries. Hyperuricemia is often associated with pre-eclampsia and when this occurs, fetal outcome may become worse. We evaluated the role of maternal serum uric acid as a prognostic indicator of fetal outcome in pre-eclamptic mothers. METHODS: A prospective case-control study in which 55 eligible pre-eclamptic patients at term were matched in maternal age and gestational age with 55 consecutive normotensive pregnant women. Venous blood samples were obtained and analyzed for serum uric acid. Following delivery, the fetal outcomes in the pre-eclamptic group and controls were determined. Data analysis was carried out using SPSS (version 21) and the level of statistical significance was set at p-value <.05. RESULTS: The mean serum uric acid levels of the pre-eclamptic subjects was significantly higher compared to their normotensive counterparts (12.7 ± 7.8 vs. 4.9 ± 1.2 mg/dL, p = .000). Babies with low birth weight, poor Apgar scores (at 1st and 5th minute of life) and those who required neonatal unit admission occurred more significantly among the pre-eclamptic women when compared with the controls (p = .000). However, the live birth rate of the case and control groups was comparable (94.5% vs. 100%, p = .079), Binary logistic regression analysis revealed a positive association between hyperuricemia and pre-eclampsia (OR = 18.8; 95% CI = 1.22-289.35, p = .035). Pre-eclamptic mothers with hyperuricemia had 4.41 odds of delivering babies with low birth weight when compared with pre-eclamptics without hyperuricemia (OR = 4.41; 95% CI = 0.76-25.5, p = .097); but Apgar scores and need for neonatal admission showed no association with maternal serum uric acid levels. CONCLUSION: This study therefore suggests that hyperuricemia is a strong prognostic indicator of LBW babies among women with pre-eclampsia.

Biochemical pattern of thyroid function test and clinical impression of thyroid disorder in a rural tertiary health institution in Nigeria.

Background: Thyroid disorders are one of the most common endocrine disorders seen globally. Diagnostic challenge may arise both clinically and biochemically because of the multiple function of thyroid hormones (THs). Request for thyroid function test (TFT s) may be based on clinical impression that may suggest thyroid dysfunction or obvious symptoms and signs that are diagnostic of hyperthyroidism or hypothyroidism. Materials and Methods: This retrospective study looks at the biochemical patterns of TFTs and the clinical impression of thyroid disorders in a rural tertiary institution. Information extracted from the laboratory register includes indication for the test, the hospital number, the gender, the age, and the THs assayed. The corresponding biochemical pattern of the TFT result was established. Results: A total of 297 requests were submitted for TH assay; 34 were excluded from the present study because there were no clinical information. There were 239 females and 24 males giving a female-to-male ratio of 9.9:1. Majority of the requests (36.5%) were for goiters, followed by gynecological disorders (20.9%) and clinical thyroid disorders (17.9%). About 46% (45.8%) of the goiter cases were biochemically euthyroid, whereas 13.5% were biochemically primary hyperthyroid. Among the 47 cases of thyroid disorders by the physician's clinical impression, 27.7% were euthyroid, 17% were biochemically hyperthyroid, and 10.6% were hypothyroid. Of the 55 gynecological disorders assessed, only 7.3% show biochemical evidence of TH alteration with 56.4% being euthyroid. About 47% (46.6%) of those that did routine medical examination had altered TH level that includes hyperthyroidism and hypothyroidism. Conclusion: Goiter is the most prevalent thyroid disorder in this environment. Biochemical pattern of thyroid function test in our environment was mostly euthyroid despites clinical features suggestive of thyroid disorders.

RésuméContexte: Les troubles thyroïdiens sont l'un des troubles endocriniens les plus courants dans le monde. Un défi diagnostique peut survenir à la fois cliniquement et biochimiquement en raison de la fonction multiple des hormones thyroïdiennes (TH). La demande de tests de la fonction thyroïdienne (TFT) peut être basée sur impression qui peut suggérer un dysfonctionnement thyroïdien ou des symptômes et signes évidents diagnostiquant une hyperthyroïdie ou une hypothyroïdie. Matériaux et Méthodes: Cette étude rétrospective examine les schémas biochimiques des TFT et l'impression clinique des troubles thyroïdiens dans un institution tertiaire rurale. Les informations extraites du registre de laboratoire comprennent l'indication du test, le numéro de l'hôpital, le sexe, l'âge, et les TH analysés. Le schéma biochimique correspondant du résultat TFT a été établi. Résultats: Un total de 297 demandes ont été soumises pour le test TH; 34 ont été exclus de la présente étude car il n'y avait aucune information clinique. Il y avait 239 femmes et 24 hommes donnant un ratio femmes / hommes de 9,9: 1. La majorité des demandes (36,5%) concernaient des goitres, suivies de troubles gynécologiques (20,9%) et cliniques troubles thyroïdiens (17,9%). Environ 46% (45,8%) des cas de goitre étaient biochimiquement euthyroïdiens, tandis que 13,5% étaient biochimiquement primaries hyperthyroïdien. Parmi les 47 cas de troubles thyroïdiens selon l'impression clinique du médecin, 27,7% étaient euthyroïdiens, 17% étaient biochimiquement hyperthyroïdienne et 10,6% étaient hypothyroïdiennes. Sur les 55 troubles gynécologiques évalués, seulement 7,3% présentent des preuves biochimiques d'altération TH 56,4% étant euthyroïdiens. Environ 47% (46,6%) de ceux qui ont subi un examen médical de routine avaient modifié le niveau de TH, y compris l'hyperthyroïdie et l'hypothyroïdie. Conclusion: Le goitre est le trouble thyroïdien le plus répandu dans cet environnement. Schéma biochimique de la fonction thyroïdienne test dans notre environnement était principalement euthyroïdien malgré les caractéristiques cliniques suggérant des troubles thyroïdiens.

Biochemical pattern of thyroid function test and clinical impression of thyroid disorder in a rural tertiary health institution in Nigeria

Thyroid disorders are one of the most common endocrine disorders seen globally. Diagnostic challenge may arise both clinically and biochemically because of the multiple function of thyroid hormones (THs). Request for thyroid function test (TFT s) may be based on clinical impression that may suggest thyroid dysfunction or obvious symptoms and signs that are diagnostic of hyperthyroidism or hypothyroidism. Materials and Methods: This retrospective study looks at the biochemical patterns of TFTs and the clinical impression of thyroid disorders in a rural tertiary institution. Information extracted from the laboratory register includes indication for the test, the hospital number, the gender, the age, and the THs assayed. The corresponding biochemical pattern of the TFT result was established. Results: A total of 297 requests were submitted for TH assay; 34 were excluded from the present study because there were no clinical information. There were 239 females and 24 males giving a female-to-male ratio of 9.9:1. Majority of the requests (36.5%) were for goiters, followed by gynecological disorders (20.9%) and clinical thyroid disorders (17.9%). About 46% (45.8%) of the goiter cases were biochemically euthyroid, whereas 13.5% were biochemically primary hyperthyroid. Among the 47 cases of thyroid disorders by the physician's clinical impression, 27.7% were euthyroid, 17% were biochemically hyperthyroid, and 10.6% were hypothyroid. Of the 55 gynecological disorders assessed, only 7.3% show biochemical evidence of TH alteration with 56.4% being euthyroid. About 47% (46.6%) of those that did routine medical examination had altered TH level that includes hyperthyroidism and hypothyroidism. Conclusion: Goiter is the most prevalent thyroid disorder in this environment. Biochemical pattern of thyroid function test in our environment was mostly euthyroid despites clinical features suggestive of thyroid disorders

Prevention practices influencing frequency of occurrence of vaso-occlusive crisis among sickle cell patients in Abeokuta South Local Government Area of Ogun State, Nigeria.

BACKGROUND: Africa is the most affected continent with 200,000 new born affected by sickle cell anemia annually with of 5% of under five deaths. Nigeria has the largest sickle cell gene pool in the world with about 2% of all babies born to Nigerian parents. This study therefore sets out to assess the prevention practices influencing the frequency of occurrence of vaso-occlusive crisis among patients in Ogun State. METHODS: This study is a descriptive cross-sectional study conducted in Abeokuta South Local Government Area Ogun State. A consecutive non randomized sampling of all the sickle cell patients that attend the selected facilities was recruited into the study. Data were collected with the use of questionnaires which were interviewer administered. A total of 415 patients were recruited into the study. Statistical analyses were conducted using SPSS for Windows version 20.0. RESULT: Two- third [64.8%] of study participants have crisis twice or more in a month. The frequency of crisis was statistically significantly associated with the age of the child [p = 0.006], use of anti-malaria prophylaxis [p = 0.006], analgesics [p = 0.0001], taking of plenty fluid [p = 0.001] and soothing herbs [p = 0.0001]. Lifestyle factors such as giving balance diet [p = 0.217], restriction from strenuous activities [p = 0.08], and attending Clinic appointments regularly [p = 0.126] were not statistically associated with reduction in the frequency of crisis. Logistic regression analysis shows that predictors of frequent crisis were individuals who were using prophylaxis antimalarial drugs [OR = 0.12, CI = 0.05-0.33] and analgesics [OR = 0.15, C.I = 0.06-0.34]. CONCLUSION: The study reveals that majority of the participants have high frequency of crisis in a month. Drug prophylaxis rather than lifestyle factors may be more important in the prevention of vaso-occlusive crisis among sickle cell patients.

Electrocardiographic correlates of microalbuminuria in adult Nigerians with essential hypertension.

Microalbuminuria (MA) is a predictor of excess cardiovascular morbidity and mortality in non-diabetic hypertensive patients. This study evaluated the electrocardiographic correlates of MA in adult non-diabetic Nigerians with essential hypertension. Ninety-six newly diagnosed hypertensive patients who consented and met the inclusion criteria for the study were recruited. Ninety-six age- and gender-matched normotensive controls were also studied. Resting 12-lead electrocardiogram of all patients and controls was done and the tracings analyzed by the authors for left ventricular hypertrophy with or without repolarization abnormalities, QTc prolongation, conduction abnormalities and cardiac arrhythmias such as atrial fibrillation. MA was present in 31 (32.3%) of the hypertensive patients and in only six (6.25%) of the normotensive controls. Electrocardiographic left ventricular hypertrophy (ECG LVH) was significantly more commonly found in patients with MA than in patients without it (74.2% vs 40%, p = 0.002). Left ventricular hypertrophy with ischemic pattern was significantly more frequent in the microalbuminuric hypertensive subset than in non-microalbuminuric patients (32.3% vs 13.8%, p = 0.03). The mean QTc were 0.464 +/- 0.02 s and 0.428 +/- 0.017 s for microalbuminuric and non-microalbuminuric patients respectively (p = 0.01). This study shows that MA is associated with ECG abnormalities such as left ventricular hypertrophy, ischemic pattern ST-T changes and QTc prolongation. This subset of hypertensive patients constitutes a higher risk group and needs intensive monitoring and follow-up. Screening for MA should constitute part of the routine investigation of adult Nigerians with hypertension.