Candida meningitis in a suspected immunosuppressive patient--a case report.

Meningitis due to fungal agents represents an AIDS-defining event and occurs typically with very low CD4+ lymphocyte count. Candida meningitis is still a rare clinical condition, although it is becoming frequently reported in the background of immune suppressive states such as: drug addicts, cancer patients, organ transplant recipients and HIV/AIDS patients. In this report we highlight a case of candida meningitis, in a 25- year old female patient. She presented with vulva swelling, vaginal discharge and fever, with rapid progression to tonic-clonic convulsions and loss of consciousness. She fully recovered after treatment with fluconazole.

Bacterial isolates of blood cultures in patients with suspected septicaemia in Ilorin, Nigeria.

Periodic bacteriologic surveillance of blood cultures is a necessity. To determine currently prevalent bacterial pathogens of blood cultures in patients with suspected septicaemia in Ilorin. Nigeria. Three thousand and fifty-seven patients from all age and sex groups with clinical suspicion of septicaemia underwent bacteriologic screening of their blood specimen over a 13 month period starting from January. 2003. Twenty point three percent were positive for bacterial growth. An incidence of 41.7 per 1000 admissions was recorded which was a statistically significant (p< 0.05) marginal increase when compared with the previous incidence of 37.9 per 1000 admissions from this centre. Majority of the isolates were gram negative (51.61%) though the single predominant isolate was Staphylococcus aureus (35.85%). Other isolates included Escherichia coli (32.48%), Klebsiella pneumoniae (11.74%), Proteus spp (0.32%), coagulase negative Staphylococcus (1.61%), Salmonella typhi (0.48%). beta-hemolytic Streptococcus (0.48%) and Acinetobacter spp (0.32%). No anaerobe was isolated. Most isolates were sensitive to fluoroquinolones (ofloxacin, perfloxacin and ciprofloxacin) and third generation cephalosporins (ceftriaxone and ceftazidime) except Acinetobacter that was 100% resistant to both groups of antibiotics. Gram positive isolates were resistant to the second generation cephalosporin, cefuroxime. We hereby recommend the use of combination of a third generation cephalosporin and fluoroquinolones where not contraindicated, in the empiric treatment of septicaemia before sensitivity results are available.

Molecular epidemiology of methicillin-resistant Staphylococcus aureus in Ilorin, Nigeria.

BACKGROUND: Nosocomial infections caused by methicillin-resistant strains of Staphylococcus aureus constitute significant epidemiologic problems. Defining an outbreak requires the use of rapid and highly discriminatory epidemiologic methods to determine the epidemic strains involved in such outbreak. STUDY DESIGN: A descriptive laboratory based surveillance study for MRSA was undertaken. One hundred and forty seven Staphylococcus aureus isolates from clinical specimens were screened for methicillin resistance at the University of Ilorin Teaching Hospital between January and December 2001. Fifty one (34.7%) methicillin resistant strains recovered were epidemiologically characterized using Eco R1 restriction enzyme analysis of their plasmid DNAs. RESULT: Forty five (88.2%) MRSA isolates were associated with infections and 6 (11.8 %) were colonizing strains; 36 (70.6%) and 15 (29.4%) were hospital and community acquired respectively. Skin and soft tissues were sites of infection in 36 (70.6 %) cases and surgical, emergency and ICU accounted for 33 (64.7%) isolates. All isolates were resistant to more than two antibiotics but sensitive to vancomycin. Forty two (82.4 %) isolates contained plasmids including 9 (21.4 %) that contained more than one plasmid. Restriction Enzyme Analysis of the Plasmid DNA (REAP) divided the isolates into 9 Eco R1 profiles, with profile 2 accounting for 41.7% of all nosocomial infections in the wards, implying that it is endemic. The remaining nosocomial profiles occurred less frequently, suggesting that they are sporadic strains originating from outside the hospital. The community strains showed diverse digestion pattern indicating that they are from different clones. CONCLUSION: The spread of MRSA can be controlled through reinforcement of appropriate use of antibiotics, hand washing and laboratory surveillance for MRSA, particularly in the surgical wards and intensive care units, in order to identify sources of outbreaks.

Antibiotic disc sensitivity pattern of pseudomonas aeruginosa isolates obtained from clinical specimens in Ilorin, Nigeria.

The choice of antibiotics used for first line treatment of infectious disease depends largely on previously known antibiogram within a specified locality among other factors. Antibiotic sensitivity pattern of Pseudomonas aeruginosa isolates obtain from clinical specimen in Ilorin, Nigeria was studied over a 12 month period, starting from January 2003. A total of 102 isolates were recovered from various clinical specimens and their antibiotic sensitivity patterns were determined by disc diffusion method on antibiotic sensitivity agar (ASA). Single antibiotic discs (AD) were used. The isolates were incubated at 37 degrees C for 18-24 hours following inoculation on ASA and application of AD before the results were read. Most isolates were sensitive to ofloxacin (77.6%), cefuroxime (76.6%), ciprofloxacin (75.3%), perfloxacin (66.0%), streptomycin (64.0%) and gentamicin (59.8%). Appreciable resistance to ceftazidime (50.7%) and increasing resistance to gentamicin (40.2%) than is previously known, were recorded. Urinary isolates were generally more resistant than isolates from other sources. Majority of the isolates were recovered from patients attending the general out-patient department of the hospital indicating extension of multi-drug resistant microbial isolates beyond hospital settings. Review of antibiotic sensitivity pattern of clinical isolates regularly and the antibiotics prescribing policy in the country is advocated. Combination of quinolones and aminoglycosides, where these are no contraindications, is recommended for first line treatment of suspected cases of Pseudomonas aeruginosa infections because of non-availability of anti-pseudomonad drugs in the country.

Diagnosis and Management of Chancroid in Nigeria.

There is a broad group of venereal disease that is referred to as the "Tropical Venereal Disease". They are so-called because they are most frequently seen in the tropical and sub-tropical areas of the world. Among them are conditions like chancroid, lymphogranuloma venereum (LGV or climatic bubo) and granuloma inguinale (chronic venereal sores). Chancroid is variously called "soft sore" or "soft chancre" because it bleeds easily and "ulcus moile".1 It is an acute infection and auto-innoculable disease. The extent of chancroid genital ulceration in Nigeria is greater in the Northern partly due to permissive sexual practices especially for men.

Cryptosporidium infection in undernourished children with HIV/AIDS in Jos, Nigeria

Background: AIDS and Protein energy malnutrition (PEM) severely impair the immune systemCryptosporidium has over the last two decades emerged as a life threatening disease. The study attempts to determine the prevalence of Cryptosporidium infection in malnourished children with HIV/AIDS. Method: Blood and stool samples of 52 HIV-seropositive children and another 52 HIV-sero-negative childrenaged 0-5 years were collected and screened for HIV and Cryptosporidium oocysts respectively. The sera were screened by double ELISA and the stool by the modified Ziehl-Neelsen method.Results: Out of the 52 HIV-seropositive undernourished, under-five children, none (0%) excreted Cryptosporidium oocyst in their stools while 2 (3.8%) of the control group excreted the oocyst. Conclusion: Cryptosporidium infection seems to be uncommon among undernourished under five children with HIV/AIDS in Jos

Prevalence of cryptosporidium infection among undernourished children in Jos, Central Nigeria.

This prospective study aimed at determining the prevalence data of Cryptosporidium infection in undernourished children, its seasonality and its relative frequency in diarrhoeic stool in Jos, Central Nigeria. One hundred and seventy each of undernourished and well nourished children aged 0-5 years were recruited into the study. Stool samples and clinical data were obtained using questionnaires. Results were analysed using Chi-square test. The prevalence of the infection was found to be 4.8% and all infections occurred in diarrhoeic stool. No infection with this pathogen was recorded in the well-nourished group. There was a defined seasonality of the infection. The high prevalence suggests the importance of introducing routine screening of this group of patients for cryptosporidium infection to facilitate their management.

Male infertility among sexually transmitted diseases clinic attendees in Ilorin, Nigeria.

The fertility status of 456 men who attended the sexually transmitted diseases clinic of the University of Ilorin Teaching Hospital (UITH), Ilorin because of infertility was studied using their seminal fluid analysis. 159 (34.8%) and 297 (65.2%), presented with primary and secondary infertility respectively. 108 (23.7%) of them were infertile, or azospermic while 207 (45.3%) were sub-fertile or oligospermic. Of the infertile men, a significant proportion (45.4%) were non-indigenes. 49.5% of the sub-fertile subjects had mild oligospermia and could benefit from simple therapeutic procedures. The study recorded 7% bacteriospermia which may have contributed to male infertility in his environment. The importance of these findings are discussed with positive suggestions towards prevention and control of male infertility.

Hepatitis B surface antigenaemia in Ilorin, Kwara State, Nigeria.

OBJECTIVE: To determine the prevalence of HBsAg among blood donors in Ilorin, in the middle belt area of Nigeria. DESIGN: Cross sectional. SETTING: University of Ilorin Teaching Hospital. SUBJECTS: 100 patients from antenatal clinic, 100 patients from STD clinic and 295 healthy blood donors from UITH. MAIN OUTCOME MEASURES: Prevalence of HBsAg. RESULTS: One hundred and sixteen (23.4pc) of the subjects were positive for HBsAg. These included 16pc of ANC patients, 36pc of STD patients and 21.7pc of blood donors. The positivity rate among STD patients was significantly higher than among ANC patients (p < 0.01) and blood donors (p < 0.01). The positivity rate among patients above 34 years of age was higher than in those of 15 to 34 years. CONCLUSION: The above positivity rates are higher than those previously reported in Nigeria and may indicate increasing prevalence. The highest rate found among STD clinic patients may have identified them as a reservoir group to which control programmes need to be targeted.

Sexual behaviour and condom acceptance among Nigerian drivers.

A survey of 180 randomly selected drivers was carried out in June 1994 in Ilorin, Nigeria in order to gain information about high-risk sexual behaviours, to ascertain condom use and to identify obstacles to condom acceptance so as to facilitate the design of an intervention to prevent Sexually Transmitted Diseases/Acquired Immuno-deficiency Disease in this target population. Data was collected through face-to-face interview. Three-quarters of the respondents were married. Multiplicity of sexual partners including casual and commercial contacts, was common. Half of the respondents engaged in high-risk sexual behaviour and a high proportion of them (60 percent) reported unwillingness to use the condom. This was mainly due to general dislike and lack of knowledge of the method. Risk perception was poor. These findings support the need for male reproductive health services especially for this sub-population.

PIP: 180 public transport drivers randomly selected from major motor parks in Ilorin, Nigeria, were surveyed in June 1994 to learn about their high-risk sexual behaviors, condom use, and obstacles to the acceptance of condoms. Data were collected through face-to-face interviews. The men were of mean age 33 years with a range of 19-53 years. 39.4% drove buses, 36.7% a car, 13.3% a truck or trailer, and 19% a lorry. 76.6% worked in urban areas. In the preceding 12 months, 16% of the single men had no sexual intercourse. However, 91% of the single sexually active men had multiple sex partners. Of the 98 (71.5%) married men who had extramarital sexual relationships, at least 72% had multiple extramarital sex partners. The prevalences of casual and commercial sex were 43% and 30.6%, respectively. Half of the drivers were involved in unstable sexual relationships. However, despite the high incidence of high-risk sex behavior, 60% reported being unwilling to use condoms, mainly due to their general dislike and ignorance of the method. The men poorly perceived the extent to which they were at risk of contracting HIV/AIDS and other sexually transmitted diseases through their sexual behavior.

Chloramphenicol-resistant Haemophilus influenzae meningitis in young urban Nigerian children.

In a developing country like Nigeria, the unusual emergence of Haemophilus influenzae type b, resistant to cost-effective antimicrobials, is of serious concern. We report three cases of H. influenzae type b meningitis in young Nigerian children in whom clinical and bacteriological features of resistance to chloramphenicol were identified. One of the cases had concomitant resistance to ampicillin (multiple-drug resistance). Significant anaemia was an associated feature in two cases, one of whom had a recent measles infection. All three cases were malnourished. The possible mechanisms of antimicrobial resistance in H. influenzae infections are highlighted while the need for periodic surveillance of antibiotic resistance profiles in resource-poor countries is emphasized. The potential value of prophylactic measures like H. influenzae type b conjugate immunization is discussed.

Perioperative infections in Nigerians: a seven-year prospective study.

The introduction of simple, measures in addition to usual aseptic and antiseptic measures at the University of Ilorin Teaching Hospital theatre in Ilorin, Nigeria, led to a significant decrease in perioperative infection rate in a pilot study. These measures were applied to 440 operative procedures in a unit over a 7-year period in an old as well as new theatre. Sterility tests on sterilizing packs, nasal and throat swabs and bacteria-carrying particle samplings were done to document and limit the sources of wound contamination. Mortality and infection rates were significantly higher among patients undergoing thoracic than extrathoracic surgical operation (P less than 0.05; p less than 0.005) including post-tube thoracostomy empyema. Clean and clean-contaminated cases survived operations significantly more frequently and were significantly less infected than the contaminated and dirty cases (less than 0.001; p less than 0.005). Although there was significantly higher mortality (p less than 0.05) in patients older than 31 years, there was no significantly higher infection rate. Neither the mortality rate nor infection rate was significantly affected by seasonal and patients' sex. Overall infection rate was 7.5% (32 out of 428 fully evaluated patients) while wound and non-wound infection rate in this study is an improvement over those previously reported in this country.

Pediatric gonorrhea: is it receiving adequate attention?

During a 1-year period, 28 cases of gonococcal infections were confirmed in children whose ages were below 13 years. Of 22 gonococcal isolates from these children, 18 (81.8%) were beta-lactamase positive. It is remarkable that sexual exposure was established as the mode of transmission of gonorrhea in nine cases. Health education, sex education in schools, and satisfactory microbiology investigations are essential to effective contact tracing and control of gonorrhea.

Review of group B streptococci and their infections.

This review article discusses the stages in the development of research on group B streptococcus (GBS), otherwise called Streptococcus agalactiae. Emphasis was placed on the bacteriology, clinical spectrum of disease, immunity to GBS infections and antibiotic susceptibility of the causative organism. The organism, first recognized by Billroth in 1873, is classified into order Eubacteriales, family Lactobacillceae, class Schizomycetes and genus Streptococcus on the basis of its biochemical and physiological characteristics. It is subdivided into types Ia, Ib, Ic, II, III, X and R on the basis of carbohydrate and protein antigens present on its cell wall. Bovine strains of GBS are found in the bovine teat while human strains are present in the female vagina, the oro-pharynx, anorectum and the external auditory canal of newborns. It could be transmitted vertically from mother to child in-utero and during parturition. Cross infection by the nursery staff could also occur during the immediate post partum period. Two types of diseases are caused in the newborn: the early disease occurring within a week of birth; and the late disease presenting during the late neonatal period. The former usually presents in the form of septicaemia while the latter presents as meningitis. Adult infections include puerperal sepsis, pyelonephritis and a wide range of other infections. Usually they are associated with other underlying clinical conditions such as malignancy, diabetes mellitus and sickle cell disease. The organism is sensitive to penicillin which is the drug choice in treating established infections by GBS. Control measures are based on treatment of cases, eradication of vaginal colonization and chemoprophylaxis of infants at risk. An effective vaccine may become available in the near future.

Multiple staphylococcal pneumatoceles in an adult.

A 33-year-old male with staphylococcal pneumonia who presented radiographically with multiple thin-walled pulmonary cavities (pneumatoceles) is reported. The cavities rapidly altered following treatment with antibiotics and the patient clinically improved.

Epidemiology of group B streptococcal carriage among pregnant women and their neonates: an African experience.

A prospective study of group B streptococcal vaginal carriage among 225 Nigerian pregnant women in labour at UCH, Ibadan during a 3 month period in 1980 revealed a vaginal carriage rate of 19.5%; 8.9% of the 224 infants of the 218 infant-mother pair studied were colonized at birth. A significant proportion of the colonized mothers were primigravidas but no significant association was found between vaginal colonization and premature onset of labour, prolonged rupture of membranes, prolonged labour, stillbirth rate or puerperal infection. None of the twenty colonized infants developed "early" or "late" group B streptococcal disease on 3 months follow up. These results suggest the incidence of group B streptococcal disease in the newborn in Nigeria may be low despite high vaginal carriage rate.