ABSTRACT
Citrobacter infection is an uncommon but serious, difficult to treat infection associated with high mortality. Accumulation of pus or fluid in a pericardial space causes restriction of cardiac filling and consequent decrease in cardiac output. We herein report Citrobacter freundii, a rare infectious cause of this uncommon disorder. Our patient is a 10yr old male referred with complaints of cough productive of mucoid sputum and associated chest pain of two weeks duration, difficulty in breathing and orthopnoea for one week. He was acutely ill looking in respiratory distress with tachypnoea and tachycardia. Blood pressure was normal with pulsus alternans, there was increased jugular venous pressure, diffused apex beat and distant heart sounds with pericardial rub. Retroviral screening and gene Xpert for Mycobacterium tuberculosis were negative. Chest radiograph showed enlarged heart of "water bottle" appearance with cardiothoracic ratio of 0.77 and right sided pleural effusion which was drained. Transthoracic Echocardiogram confirm pyopericardium with multiples echoes in cardiac temponade. Echo-guided percutaneous pericardiocentesis yielded 600mls of purulent aspirates. Citrobacter freundii Sensitive to gentamycin, co-amoxiclav but resistant to cefuroxime and cefixime was cultured from pericardial aspirates and sputum. Patient recovered fully after pericardiocentesis and intravenous antibiotics. In this case report, we describe Citrobacter freundii causing cardiac temponade and empyema in a Nigerian immunocompetent child which to our knowledge has thus far not been reported. Pyopericardium may follow rare causes as Citrobacter freundii which require high index of suspicion.
ABSTRACT
BACKGROUND: Increasing age has been hypothesized with wear and tear (weathering) in mothers, which may result to low birthweight of their babies. The prevalence of low birthweight could be heightened if maternal weathering is associated with poor maternal socioeconomic variables. In this current study, we analyzed the effects of maternal weathering on babies' birthweights. METHODS: One hundred and twenty four mother-baby pairs were selected using systematic random sampling method. Maternal age formed part of the demographic data that was obtained from the mothers' case notes and from interviews held with them. Maternal socioeconomic variables were assessed using Oyedeji's parameters and birthweights of babies were determined using bassinet weighing scale. Associations between maternal socioeconomic variables and birthweight of babies were assessed using univariate analysis. Differences in mean birthweight of babies according to their maternal age were evaluated using one-way analysis of variance ANOVA. RESULTS: Among the 124 babies, 66(53.2%) were males and 58(46.8%) females of whom the majority 104(83.9%, had normal birthweight. The mean birthweight of babies was 3.05±0.57 (95% CI, 2.95-3.15) kg, while the mean maternal age was 23.60 (5.2) 95% CI, (22.68-24.52) years. The difference between mean birthweight of babies and mean maternal age was not significant (F=1.35, p=0.255). Similarly, the association between birthweight, maternal education and occupation computed using univariate analysis was not significant (F=2.163, p=0.120) for education and (F=1.825, p=0.166) for occupation. CONCLUSION: In this study, maternal weathering was not found to be associated with LBW outcome. This implies that an increase in maternal age may not be significantly associated with LBW. However, there is need for further research on this subject from different centers using larger sample size in order to enhance the precision of the study.
