Drug resistance profiles of new- and previously treated patients with pulmonary tuberculosis in Ibadan, Nigeria.

BACKGROUND: Information on TB drug resistance profiles and its' associated risk factors are scarce in Nigeria despite the large burden of disease in the country. The study was designed to report drug resistance profiles of new- and previously treated patients with pulmonary tuberculosis (TB) in Ibadan, Nigeria. METHOD: Sputum from consenting pulmonary TB patients were collected and cultured for Mycobacterium tuberculosis (Mtb) at the TB laboratory of the University College Hospital, Ibadan, Nigeria using standard method. Mtb were stored and sent for drug susceptibility testing against first and second-line anti-TB drugs at the MRC Unit, The Gambia and at the Institute of Tropical Medicine, Antwerp, Belgium using BACTEC MGIT 960 and proportion method on solid medium respectively. RESULTS: Of 238 Mtb collected, 124 (52.1%) were viable, 102 (59.65%) non-viable while 12 (7.02%) were contaminated. About half (58.87%) of the Mtb were from previously treated patients, 40 (32.26%) were from new patients while treatment history of 1.1 (8.87%) were unknown. Forty-seven (37.90%) of the 124 Mtb. tested were multidrug resistant (MDR) out of which, 40 (85.10%) were from previously treated patients.. HIV prevalence was 8.69%. Of the 17 MDR-TB from previously treated cases tested for second-line drugs, four (23.53%) were resistant to fluoroquinolones or injectable agents, 13 (76.47%) were susceptible while none was resistant to both of these classes of drugs. CONCLUSION: MDR-TB in Ibadan already demonstrates resistance to second line anti-TB drugs hence management of MDR-TB patients should be strengthened to prevent emergence of extensively drug-resistant TB (XDR-TB).

Outbreaks-of Ebola virus disease in the West African sub-region.

BACKGROUND: Five West African countries, including Nigeria are currently experiencing the largest, most severe, most complex outbreak of Ebola virus disease in history. This paper provided a chronology of outbreaks of Ebola virus disease in the West African sub-region and provided an update on efforts at containing the present outbreak. METHODS: Literature from Pubmed (MEDLINE), AJOL, Google Scholar and Cochrane database were reviewed. RESULTS: Outbreaks of Ebola, virus disease had frequently occurred mainly in Central and East African countries. Occasional outbreaks reported from outside of Africa were due to laboratory contamination and imported monkeys in quarantine facilities. The ongoing outbreak in West Africa is the largest and first in the sub-region; the number of suspected cases and deaths from this single current outbreak is already about three times the total of all cases and deaths from previous known outbreaks in 40 years. Prevention and control efforts are hindered not only by lack of a known vaccine and virus-specific treatment, but also by weak health systems, poor sanitation, poor personal hygiene and cultural beliefs and practices, including myths and misconceptions about Ebola virus disease--all of which are prevalent in affected countries. Constrained by this situation, the World Health Organisation departed from the global standard and recommended the use of not yet proven treatments to treat or prevent the disease in humans on ethical and evidential grounds. CONCLUSION: The large number of people affected by the present outbreak in West Africa and the high case-fatality rate calls for accelerated evaluation and development of the investigational medical interventions for life saving and curbing the epidemic. Meanwhile, existing interventions such as early detection and isolation, contact tracing and monitoring, and adherence to rigorous procedures of infection prevention and control should be intensified.

Diverse genetic subtypes of HIV-1 among female sex workers in Ibadan, Nigeria

Genetic diversity is the hallmark of HIV-1 infection. It differs among geographical regions throughout the world. This study was undertaken to identify the predominant HIV-1 subtypes among infected female sex workers (FSWs) in Nigeria. Methods: Two hundred and fifty FSWs from brothels in Ibadan Nigeria were screened for HIV antibody using ELISA. All reactive samples were further tested by the Western Blot Techniques. Peripheral Blood Mononuclear Cells (PBMCs) were separated from the blood samples of each subject. Fragments of HIV Proviral DNA was amplified and genetic subtypes of HIV-1 was determined by direct sequencing of the env and gag genes of the viral genome followed by phylogenetic analysis . Results: The age of the FSWs ranged from 15 to 55 years old (Mean = 25.8years; SD =3.74). Majority were Nigerians while others (1.6 ) were from neighboring West Africa countries. Four ( 1.6 ) of the FSWs were active for less than one year as sex workers; and the mean length of sex work was 2.80 years ( Range = 1.0 - 15.0 years ). Sixty-four (25.6) of the 250 CSWs were positive for HIV-1 while 7 (2-8) had dual infections to HIV-1 / HIV-2. Among the 34 HIV-1 strains characterized by sequencing; 19 (55-9) were subtype G; 9 (26.5) CRF02_A/G; 3 (8.8) CRF06_cpx while 1 (2.9) each were identified as subtype C; CRF01_A/E and CRF09_cpx respectively. Nineteen (55.9) of the FSWs with subtype G had been active in the sex work for between one to five years. The youngest of the HIV -1 infected FSWs with sexual activity of less than a year had subtype G strain. There is a significant probability that infection with this subtype occurred with a short incubation period (p 0.05). Conclusion: This study showed a wide range of HIV- 1 subtypes among FSWs in Nigeria. The situation poses serious challenge for the design of HIV vaccine candidate for use in Nigeria

Outbreaks-of Ebola virus disease in the West African sub-region

BACKGROUND: Five West African countries, including Nigeria are currently experiencing the largest, most severe, most complex outbreak of Ebola virus disease in history. This paper provided a chronology of outbreaks of Ebola virus disease in the West African sub-region and provided an update on efforts at containing the present outbreak. METHODS: Literature from Pubmed (MEDLINE), AJOL, Google Scholar and Cochrane database were reviewed. RESULTS: Outbreaks of Ebola, virus disease had frequently occurred mainly in Central and East African countries. Occasional outbreaks reported from outside of Africa were due to laboratory contamination and imported monkeys in quarantine facilities. The ongoing outbreak in West Africa is the largest and first in the sub-region; the number of suspected cases and deaths from this single current outbreak is already about three times the total of all cases and deaths from previous known outbreaks in 40 years. Prevention and control efforts are hindered not only by lack of a known vaccine and virus-specific treatment, but also by weak health systems, poor sanitation, poor personal hygiene and cultural beliefs and practices, including myths and misconceptions about Ebola virus disease--all of which are prevalent in affected countries. Constrained by this situation, the World Health Organisation departed from the global standard and recommended the use of not yet proven treatments to treat or prevent the disease in humans on ethical and evidential grounds. CONCLUSION: The large number of people affected by the present outbreak in West Africa and the high case-fatality rate calls for accelerated evaluation and development of the investigational medical interventions for life saving and curbing the epidemic. Meanwhile, existing interventions such as early detection and isolation, contact tracing and monitoring, and adherence to rigorous procedures of infection prevention and control should be intensified

Chlamydia Infection; Plasma Peroxidation and Obesity in Tubal Infertility

Background: Genital tract infections and obesity are both sources of oxidative stress. Alterations in immune and antioxidant parameters may arise from this or from an indeterminate autoimmune mechanism. Objective: This study aimed to investigate the association of Chlamydial infection; obesity and oxidative response with tubal infertility in Nigerian women. Methods: It was a case-control study of 40 women with tubal infertility and 32 fertile women; respectively; recruited from the Infertility and Family Planning Clinics respectively; of the University College Hospital; Ibadan; Nigeria. Anthropometric indices were measured in each subject and endocervical swabs were taken to screen for current genital tract infection. Antioxidant; hormonal and immunologic analysis were performed on serum. Results: None of the subjects had current genital tract infections. Chlamydia trachomatis IgG positivity was significantly higher in infertile than in fertile subjects [OR 4.33; 95CI (0.078-0.681)]. No significant variations were observed in the anthropometric indices; antioxidant parameters and hormones between infertile and the fertile women. Body mass index correlated positively with oxidative stress in infertile subjects. Waist and hip circumferences correlated negatively with oestradiol in women with tubal infertility. Conclusion: Chlamydial infection is associated with tubal factor infertility; however; obesity seems to increase oxidative stress and reduce fertility potential in women with tubal factor infertility

Genital ulcer diseases among HIV-infected female commercial sex workers in Ibadan, Nigeria.

We evaluated the prevalence and association of Genital Ulcer Diseases (GUDs) among HIV-1 infected female commercial sex workers (FCSWs) in Ibadan, Nigeria. A total of 250 FCSWs from brothels in Ibadan were tested for presence of antibodies to HIV and Syphilis. Pelvic examinations for signs of sexually transmitted infections (STIs) were carried out on the subjects. Endocervical and high vaginal swabs were collected from each of the subjects to establish laboratory diagnosis of STIs. Their age ranged from 15 to 55 years (Mean = 25.8 yrs; SD = 3.74). Majority (246/250) were Nigerians, while 1.6% were from neighboring West African countries. Sixty four (25.6%) of the subjects were positive for HIV-1 while seven (2.8%) had dual HIV-1/2 infection. Analysis of the STIs showed that 49 (19.6%) of the CSWs had GUDs. Herpes genitalis was the commonest GUDs as it occurred in 25 (10%) of the subjects. Other STIs identified were chancroid (5.6%), syphilis (4.0%) and lymphogranuloma venerum (LGV) (4%). Sixteen (64.0%) of the CSWs with herpes genitalis had HIV-1 infection. The risk ratio of herpes genitalis for HIV acquisition was 3.0 (95% CI: 2.0 - 4.4). Syphilis and chancroid were also found tobe significantly associated with increased risk of HIV infection (p < 0.0001). The adjusted odd ratios for Herpes genitalis, chancroid, and syphilis were 3.7 (1-13.0, p < 0.05), 19.8 (2.7-13.0, p < 0.05) and 19.1 (1-231.0, p < 0.05) respectively. There is need to educate FCSWs continually to adopt safer sexual behaviours, seek early diagnosis and treatment of GUDs to reduce their risk of transmitting HIV infection.

Chlamydial infection, plasma peroxidation and obesity in tubal infertility.

BACKGROUND: Genital tract infections and obesity are both sources of oxidative stress. Alterations in immune and antioxidant parameters may arise from this or from an indeterminate autoimmune mechanism. OBJECTIVE: This study aimed to investigate the association of Chlamydial infection, obesity and oxidative response with tubal infertility in Nigerian women. METHODS: It was a case-control study of 40 women with tubal infertility and 32 fertile women, respectively, recruited from the Infertility and Family Planning Clinics respectively, of the University College Hospital, Ibadan, Nigeria. Anthropometric indices were measured in each subject and endocervical swabs were taken to screen for current genital tract infection. Antioxidant, hormonal and immunologic analysis were performed on serum. RESULTS: None of the subjects had current genital tract infections. Chlamydia trachomatis IgG positivity was significantly higher in infertile than in fertile subjects [OR 4.33; 95%CI (0.078-0.681)]. No significant variations were observed in the anthropometric indices, antioxidant parameters and hormones between infertile and the fertile women. Body mass index correlated positively with oxidative stress in infertile subjects. Waist and hip circumferences correlated negatively with oestradiol in women with tubal infertility. CONCLUSION: Chlamydial infection is associated with tubal factor infertility, however, obesity seems to increase oxidative stress and reduce fertility potential in women with tubal factor infertility.

Genital ulcer diseases among HIV_infected female commercial sex workers in Ibadan, Nigeria

We evaluated the prevalence and association of Genital Ulcer Diseases (GUDs) among HIV-1 infected female commercial sex workers (FCSWs) in Ibadan; Nigeria. A total of 25O FCSWs from brothels in Ibadan were tested for presence of antibodies to HIV and Syphilis. Pelvic examinations for signs of sexually transmitted infections (STIs) were carried out on the subjects. Endocervical and high vaginal swabs were collected from each of the subjects to establish laboratory diagnosis of STIs. Their age ranged from 15 to 55 years (Mean = 25.8yrs; SD =3.74). Majority (246/250) were Nigerians; while 1.6were from neighboring West African countries. Sixty four (25.6) of the subjects were positive for HIV-1 while seven (2.8) had dual HIV-1/2 infection. Analysis of the STIs showed that 49 (19.6) of the CSWs had GUDs. Herpes genitalis was the commonest GUDs as it occurred in 25 (10) of the subjects. Other STIs identified were chancroid (5.6); syphilis (4.0) and lymphogranuloma venerum (LGV) (4). Sixteen (64.0) of the CSWs with herpes genitalis had HIV-1 infection. The risk ratio of herpes genitalis for HIV acquisition was 3.0 (95CI: 2.0 - 4.4). Syphilis and chancroid were also foundto be significantly associated with increased risk of HIV infection (p0.0001). The adjusted odd ratios for Herpes genitalis; chancroid; and syphilis were 3.7(1-13.0; p0.05); 19.8 (2.7-13 .0; p0.05) and 19.1(1-231.0; p 0.05) respectively. There is need to educate FCSWs continually to adopt safer sexual behaviours; seek early diagnosis and treatment of GUDs to reduce their risk of transmitting HIV infection

In vitro antimicrobial properties of coconut oil on Candida species in Ibadan, Nigeria.

The emergence of antimicrobial resistance, coupled with the availability of fewer antifungal agents with fungicidal actions, prompted this present study to characterize Candida species in our environment and determine the effectiveness of virgin coconut oil as an antifungal agent on these species. In 2004, 52 recent isolates of Candida species were obtained from clinical specimens sent to the Medical Microbiology Laboratory, University College Hospital, Ibadan, Nigeria. Their susceptibilities to virgin coconut oil and fluconazole were studied by using the agar-well diffusion technique. Candida albicans was the most common isolate from clinical specimens (17); others were Candida glabrata (nine), Candida tropicalis (seven), Candida parapsilosis (seven), Candida stellatoidea (six), and Candida krusei (six). C. albicans had the highest susceptibility to coconut oil (100%), with a minimum inhibitory concentration (MIC) of 25% (1:4 dilution), while fluconazole had 100% susceptibility at an MIC of 64 microg/mL (1:2 dilution). C. krusei showed the highest resistance to coconut oil with an MIC of 100% (undiluted), while fluconazole had an MIC of > 128 microg/mL. It is noteworthy that coconut oil was active against species of Candida at 100% concentration compared to fluconazole. Coconut oil should be used in the treatment of fungal infections in view of emerging drug-resistant Candida species.

Internal hernia through the broad ligament presenting with acute on chronic intestinal obstruction: A case report.

BACKGROUND: Internal hernias are rare. Their occurrence through the broad ligament is one of the rarest forms. We present a report of a 45 year Nigerian female with acute on chronic intestinal obstruction due to an internal hernia of the broad ligament. METHODS: Patients case notes and a review of relevant literature using manual library and Medline search was used. RESULTS: A 45-year-old multiparous woman presented with a ten-year history of features of partial intestinal obstruction, and no previous abdominal surgery. Examination revealed right iliac fossa tenderness and a plain abdominal radiograph showed air fluid levels. Conservative management was not successful and laparatomy confirmed an internal hernia of the right broad ligament which was repaired with satisfactory outcome. CONCLUSION: This report is to highlight the fact that though rare, internal hernia should be considered in the differential diagnosis of intestinal obstruction.

Hepatitis B surface antigen (HbsAg) in blood and genital secretions of patients with sexually transmitted diseases in Ibadan, Nigeria.

A total of 100 patients attending the Special Treatment Clinic of the University Teaching Hospital (UCH), Ibadan between October, 1998 and April, 1999 were studied to detect Hepatitis B surface antigen (HbsAg) in the blood and genital discharges. This was with a view of establishing whether infected persons (positive by blood test) also excrete the antigen, HbsAg, in their genital secretions. Urethral swabs were collected from 63 male patients, while High Vaginal and Endocervical swabs were collected from 37 female patients. Blood samples were collected from all the patients. HbsAg was tested for by Enzyme immunoassay technique with Wellcozyme HbsAg kit. Of the 63 male patients, 10 (15.9%) had HbsAg in the urethral secretion while 22 (34.9%) had it in their blood, 70% of these male patients were within the age range 11-30 years. Of the 37 female patients, 34 (92%) had HbsAg in the Endocervical secretions, 6 (16.2%) of them had HbsAg in their blood. Eighty percent of the female patients with positive HbsAg in the genital secretions were within age range 21-40 years. This study documents that Hepatitis B virus can be transmitted sexually in this environment.

Ureaplasma urealyticum as a cause of non-gonococcal urethritis: the Ibadan experience.

Two hundred and eighteen men with confirmed urethritis were investigated for Ureaplasma urealyticum at the Special Treatment Clinic, University College Hospital, Ibadan between 5th January and 28th December 2000. Sixty-four (29.35%) of the 218 patients had gonococcal urethritis whilst 154 (70.65%) had non-gonococcal urethritis (NGU) out of which 22 (14.3%) had U. urealyticum urethritis and 10(6.5%) had Trichomonal urethritis. The difference in the occurrence of U. urealyticum between the patients and the control group was highly statistically significant (p<0.001). The age range of peak incidence among the patients investigated was 20-29 years. There was evidence of urethritis in all the 22 U. urealyticum positive cases as shown by the presence of increase in the number of polymorphonuclear leucocytes in the specimens collected. A significant difference in the nature of the urethral discharge in men with gonorrhoeae compared with U. urealyticum positive NGU patients was also demonstrated. Treatment of those patients found to be positive for U. urealyticum with a course of oral Tetracyline was successful but then the problems posed by the asymptomatic Ureaplasma urethritis still remained unanswered.

Penicillinase producing Neisseria gonnorhoeae: the review of the present situation in Ibadan, Nigeria.

All the isolates of Neisseria gonorrhoeae from patients that attended special treatment Clinic, University College Hospital, Ibadan, Nigeria between 15th January 1997 and 15th December 1999 were studied so as to review the present prevalence rate of penicillinase producing Neisseria gonorrhoeae (PPNG) in Ibadan. Of the 214 patients that had gonococcal infections, 161 were male (75.2%) and 53 (24.8%) were female. Ninety-two (57.1%) of the male and 28(52.8%) of the female were aged between 20- 29 years while 19.9% of the male and 15.1 % of the female were in the age of 40 and above. The sex difference is not statistically significant (chi2=2.19, df=3, p=0.53). The present study revealed that PPNG strains have increased dramatically to 98.6 per cent. This has posed a great threat to the usefulness of penicillin and ampicillin as the drugs of choice in gonococcal therapy in Nigeria.

Non-gonococcal urethritis due to Chlamydia trachomatis: the Ibadan experience.

Using a qualitative amplified enzyme-linked immunoassay, two hundred and eighty-nine male patients with symptoms and signs suggestive of urethritis were investigated for Chlamydia trachomatis as a cause of non-gonococcal urethritis (NGU). Ninety-one (31.49%) of the 289 male patients investigated had gonococcal urethritis whilst 198 (68.51%) had NGU out of which 112 (56.60%) had chlamydial urethritis and 14 (7.1%) had Trichomonal urethritis. Two (6.7%) of the control subjects had C. trachomatis in their urethral swabs. The difference in the occurrence of C. trachomatis between the patients and the controls was highly statistically significant (P<0.001). The age range of peak incidence among the patients investigated was 20-29 years. Thirteen of the men treated for gonorrhoea still had watery urethral discharge and irritation and were diagnosed as having post-gonococcal urethritis (PGU), eleven (84.6%) of whom had C. trachomatis demonstrated in their urethral swabs. We were able to demonstrate a significant difference in clinical symptoms in men with gonorrhoea and NGU but only a slight difference between men with chlamydia-positive NGU and chlamydia-negative NGU.

Pattern of sexually transmitted diseases among commercial sex workers (CSWs) in Ibadan, Nigeria.

The purpose of this study was to determine the pattern of STDs among commercial sex workers (CSWs) in Ibadan, Nigeria. The subjects were 169 CSWs randomly selected from 18 brothels, majority of who were examined and investigated in their rooms. Another 136 women without symptoms who visited the special treatment clinic, University College Hospital, Ibadan were selected as a normal control group. Vaginal candidiasis was the most common STD diagnosed in both CSWs and the control group. The other STDs in their order of frequency were HIV infection 34.3%, non-specific vaginosis 24.9%, trichomoniasis 21.9% and gonorrhoea and "genital ulcers" had an incidence of 16.6% each. Other important conditions were tinea cruris 18.9%, scabies 7.7% genital warts 6.5% and 4.1% of them had syphilis sero-positivity. All the 13 CSWs that had scabies, the 4 (36.4%) with genital warts and the 19 (67.9%) with "genital ulcers" had HIV infection. While there was no significant difference between the CSWs with vaginal candidiasis, gonorrhoea, trichomoniasis and the control group, the HIV positivity was significantly higher (P < 0.001) in CSWs than in the control subjects. These findings suggest that women who exchange sexual services for money can no longer be ignored, and should therefore be identified and made to participate in STD prevention and control programmes.

Non-penicillinase producing Neisseria gonnorhoeae: are they still in existence in Ibadan, Nigeria?

In an attempt to evaluate the current prevalence rate of penicillinase producing Neisseria gonorrhoeae (PPNG) and whether non-PPNG strains are still in existence in Ibadan, Nigeria, all isolates of Neisseria gonorrhoeae from patients that attended our clinic between January and December 1997 were studied. Of the 155 patients that had gonococcal infections, 118 were male (76.1%) and 37 (23.9%) were female with 31 (83.8%) being the partners of infected men. Sixty-four (54.2%) of the male and 19 (51.4%) of the female were aged between 20 and29 years while 21.2% of the male and 16.2% of the female were in the age of 40 and above. The sex difference is not statistically significant (chi2=1.47,P=-0.69). The present study revealed that non-PPNG strains have reduced considerably to 5.4% from 100% in 1977. This has posed a great threat to the usefulness of penicillin and ampicillin as the drugs of choice in gonococcal therapy in Nigeria.

Childhood gastroenteritis due to Aeromonas hydrophila in Ibadan, Nigeria.

This is a prospective study spanning a period of six months where stools of 400 diarrhoeic children and 100 non-diarrhoeic children aged 0-5 years were screened for Aeromonas hydrophila and other enteric pathogens. Out of the 400 diarrhoeic stools only three (0.75%) were positive for Aeromonas hydrophila while none was positive in the control group. No other enteric pathogen was isolated from these positive samples, indicating that Aeromonas hydrophila is responsible for their diarrhoea. Continuous surveillance of this agent of diarrhoea in this environment will further reveal any threat the organism may poise in the nearest future.

Review of cases of children with gonorrhoea--source of infection.

This is a retrospective study to determine what effort was put into identifying the source of infection in children with gonorrhoea in Ibadan. The case files of eighty-four children aged 1 to 10 years who had gonococcal genital infections between 1983 and 1998 and presented at the Special Treatment Clinic of the University College Hospital, Ibadan were studied. Clinical manifestations of the 84 children include vaginal discharge (97.6%), urethritis (2.4%) and combined genital and eye infection (8.3%). A total of 103 relatives of 61 index subjects were examined. Of those in whom specimens were collected for microscopy culture and sensitivity, 27 (26.2%) had gonorrhoea. A history of sexual contact in the children studied was recorded in only (10.7%) cases, while four (4.7%) others without history of sexual intercourse had torn hymen. Sexual abuse or child neglect was suspected in this group. None of the named contacts was traceable by the health visitors. The recognition of a child with gonococcal infection identifies a cluster of family members who are at increased risk of having gonorrhoea. This study indicates that more effort will be required to find the source and mode of transmission of gonorrhoea in children.

Comparative in-vitro activities of commonly available quinolones and other antibiotics on bacterial isolates in Ibadan, Nigeria.

The 4-quinolones, many of which are now available in Nigeria under different trade names, have a broad spectrum of activity. An evaluation is made of the comparative in-vitro activities of these quinolones and other antibiotics against 125 strains of bacteria commonly isolated from clinical specimens in University College Hospital, Ibadan, by using the Stroke's disc sensitivity method, and MIC estimation. The quinolones showed greater activity than the cephalosprins against Klebsiella spp., Proteus spp. and Escherichia coli, but were found to be equipotent against Pseudomonas spp. the MIC results revealed ciprofloxacin (Ciprotap) as the most active of the quinolones. Though some strains of Klebsiella spp. and Pseudomonas spp. were found to be resistant to all the antibiotics tested, majority of the strains of the gram-negative bacilli from clinical specimens were highly susceptible to all the quinolones. This emphasizes the need to monitor regularly the emergence of resistance associated with the use of antibiotics in the developing countries.