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
The purpose of this study was to assess the vitamin D status of Fulani men and women in northern Nigeria. The Fulani are seminomadic pastoralists whose culture, economy, and diet are centered on cattle. Most of the foods consumed by the Fulani are not good sources of vitamin D. Also being Muslim, the women do not derive much benefit from the vitamin D-generating effects of sunlight due to their dress habits. Furthermore, childhood rickets is common in the region. Serum was collected from 22 Fulani men (age, 47.6 +/- 8.3 years; body mass index [BMI], 21.1 +/- 3.2 kg/m2) and 29 women (age, 55.5 +/- 13.5 years; BMI, 21.6 +/- 3.1 kg/m2) in rural northern Nigeria and analyzed for 25-hydroxyvitamin D2 and D3 using ultraperformance liquid chromatography coupled with mass spectrometry Eighty-three percent of the women and 45% of the men had serum 25-hydroxyvitamin D levels in the hypovitaminosis D range (10-30 ng/mL). In the males, there was a strong negative correlation between serum vitamin D and BMI (r = -0.49, p = .022) and percent body fat (r = -0.51, p = .015). No such correlations were observed in the Fulani women. Our main conclusion is that about half the men and most of the women in the Fulani community where this study was conducted are inadequately nourished with respect to vitamin D. A high prevalence of hypovitaminosis D indicates an elevated risk for rickets in children and bone fractures in adults.
