Asymptomatic bacteriuria in patients with diabetes mellitus in Ile-Ife, South-West, Nigeria.

OBJECTIVES: To investigate the prevalence and associates of asymptomatic bacteriuria (ASB) in a sample of Nigerian diabetic patients. DESIGN: Cross-sectional descriptive and analytic study. SETTING: The Wesley Guild Hospital and Ife State Hospital, both units of Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria. SUBJECTS: One hundred and thirty five diabetic patients and 57 non-diabetic patients as controls. MAIN OUTCOME MEASURES: Demographic parameters of participants were recorded. Significant bacteriuria was determined for each of the mid-stream urine specimen obtained from all the subjects. Organisms isolated were identified and evaluated for antibiotic susceptibility patterns. RESULTS: There was a significant difference in the prevalence of ASB in the two groups. Prevalence of ASB was 16% and 3.5% in the diabetic patients and control respectively (p=0.03). Demographic parameters except age were not related to the presence of ASB. ASB was found in 54.4% of diabetic patients with poor glycaemia control compared with 2.9% in diabetics with good glycaemia control (p = 0.006). Organisms associated with ASB were Staphylococcus aureus, Klebsiella sp, Escherichia coli and Enterococcus faecalis, however the most predominant was Staphylococcus aureus. These organisms were largely resistant to the common antibiotics tested such as cotrimoxazole and gentamicin but susceptible to nitrofurantoin. CONCLUSIONS: The prevalence of ASB is high in diabetic patients and poor glucose control can be considered a predisposing factor.

Determination of baseline antibody titre to S. typhi/paratyphi in Ile-Ife, Nigeria.

The aim of the study is to determine the baseline antibody titres to Salmonella typhi/paratyphi in healthy individuals with a view to establishing the significant titre for Widal agglutination test in Ile-Ife, Western Nigeria. Three hundred and ten healthy volunteers were admitted into the study and forty-eight clinically diagnosed and culture positive cases of Enteric fever were used as purposeful controls. Widal test was performed on each serum. Slide agglutination test was first done, then positive samples were further subjected to tube agglutination for quantitative titration. Of the 310 healthy volunteers, 274 (97.2%) had reciprocal antibody titre of < or = 80 to O antigen and 265 (95.0%) had reciprocal antibody titre of < or = 80 to H. antigen of S. typhi. On the other hand, in 48 control cases, 43 (89.6%) had reciprocal antibody titre of > or = 160 to O antigen and 38 (78.2%) had reciprocal titre of > or = 160 to H. antigen. The sensitivity and specificity of the test were 89.9% and 94.2% for O antibody, and 79.2% and 92.3% for H. antibody respectively. The baseline titre to S. typhi/paratyphi for both O & H antibody is 1:80 whilst the significant titre for O & H antibodies is 1:160 and above in Ile-Ife, Nigeria.

Role of Campylobacter jejuni/coli in diarrhoea in Ile-Ife, Nigeria.

BACKGROUND: Campylobacter jejuni/coli are well established causative agents of diarrhoea. In Nigeria, gastroenteritis due to C. jejuni was first reported in northern part of the country in 1981 and the South-Western part in Ile-Ife in 1983. OBJECTIVE: To re-examine the role of C. jejuni as an agent of diarrhoea after more than a decade at Ile-Ife, Nigeria and to determine the biological characteristics of local strains. DESIGN: A prospective case control study. SETTING: Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC) Ile-Ife, Nigeria. SUBJECTS: Three hundred and three children with diarrhoea and 100 children with other medical conditions other than diarrhoea were randomly selected. MAIN OUTCOME MEASURES: Isolation of C. jejuni/coli from stool samples collected from the patients and controls. Biological characteristics of the isolates. RESULTS: Fifty eight (19.1%) and 6% of the patients and controls, had the organism respectively. Campylobacter coli accounts for 53.3% of isolates. All the isolates were susceptible to erythromycin and there was no evidence of beta-lactamase production. CONCLUSION: Campylobacter jejuni is an important diarrhoea agent in our environment and should be considered strongly in children with diarrhoea. Complete characterization of local, strains is necessary.

Pattern of intestinal parasites among hosptial patients at Ile-Ife.

Intestinal and extraintestinal parasitic diseases continue to constitute important public health problems in many developing African countries. While malaria continues to ravage the continent, the silent onslaught of intestinal helminthiases and protozoal infection seem not to relent. The objectives of this study was therefore to determine the prevalence of intestinal helminthic and protozoan infections and to determine the trends in intestinal parasitic infections. Results of laboratory investigations for parasitic infections during a three-year period in two succeeding decades (1988-90 and 1996-98) were analysed. During the two periods 4233 (65.1%) of 6504 and 2297 (63.1%) of 3641 clinical specimens were respectively, positive for intestinal parasites. These results are very significant as determinants of the level of environmental and domiciliary hygiene. It is concluded that the findings should be of great concern to the local Authority Health Departments which should spur the government to concerted effort aimed at ameliorating the deplorable situation brought about by indiscriminate faecal disposal.

Sero-prevalence of HIV antibodies in tuberculosis patients in Ile-Ife, Nigeria.

BACKGROUND: The acquired immunodeficiency syndrome (AIDS) is of major public health concern worldwide more so in sub-Saharan Africa where there is an upsurge in the incidence of the disease. Reports from developed countries have shown that a close link exists between the human immunodeficiency virus (HIV) and pulmonary tuberculosis. No such study has ever been carried out in Ile-Ife, Nigeria. OBJECTIVE: The study was designed to determine the prevalence of HIV infection among randomly selected tuberculosis patients seen in a Nigerian chest clinic using third generation ELISA kits that detect HIV-1 and HIV-2 strains. RESULTS: Of the 79 subjects with confirmed active tuberculosis, 12.7% tested positive for HIV antibodies compared with 2.0% of subjects without tuberculosis designated as the control group--a value that is statistically significant (p < 0.05). Farmers, artisans and students contributed a large proportion of the seropositive sera. Although the seroprevalence rate of 12.7% is low compared with the rates from eastern and southern African countries, this value was threefold higher than 5.2% value reported in metropolitan Lagos--suggesting concern about the spread of HIV in a semi-urban centre such as Ile-Ife. CONCLUSION: This study suggests that a close link exists between active tuberculosis and HIV infection in Ile-Ife, Nigeria which underscores the urgent need to monitor tuberculosis patients as the increase in the rate of new cases may indicate the spread of HIV infection. The study also recommends that an aggressive public awareness programme be undertaken to enlighten communities about the risk of TB/HIV infection.

Aflatoxins in autopsy kidney specimens from children in Nigeria.

Autopsy kidney specimens from 24 children with kwashiorkor and 21 with other miscellaneous diseases, at the Obafemi Awolowo Teaching Hospital Complex, Ile-Ife, Nigeria, were analyzed for the presence of aflatoxins using high-performance liquid chromatography. Aflatoxins were detected in 14 children who died of kwashiorkor and in 13 of those who died from miscellaneous diseases. Aflatoxicol was detected in 10 specimens, 7 of which had severe gastroenteritis. Seven kidney specimens demonstrated the presence of more than one type of aflatoxin; four of these were kidneys of patients with kwashiorkor and the remaining three died from renal failure. No difference was found between the frequency of detection, type of aflatoxin detected, or mean concentrations of total aflatoxins in the kidney specimens of the kwashiorkor children when compared to the kidney specimens of children who died from miscellaneous diseases. These findings demonstrate that aflatoxins can be detected in the kidneys of children exposed to aflatoxins.

Aflatoxins in the lungs of children with kwashiorkor and children with miscellaneous diseases in Nigeria.

Autopsy lung specimens from 20 children with kwashiorkor and 20 with other miscellaneous diseases, at the Obafemi Awolowo Teaching Hospital complex, Ile-Ife, Nigeria, were analyzed for the presence of aflatoxin using high-performance liquid chromatography. Aflatoxins were detected in 18 children who died from kwashiorkor but only in 13 of those who died from miscellaneous diseases. Of the 10 children, 5 in each group, who died with pneumonia, all had detectable levels of aflatoxins in their lungs. The two children with congestive cardiac failure, one secondary to pneumonia and the other secondary to tuberculous pericarditis, had more than two detectable aflatoxins in their lungs. These findings demonstrate that Nigerian children are exposed to aflatoxins and that high levels can accumulate in lung tissue.

The menace of beta-lactamase production on antibiotic prescription in community acquired-infections in Nigeria.

Antibiotic resistance is a major clinical problem in the management of infectious diseases. The production of beta-lactamases by pathogens of all grades which has spread extensively during the last decade has further narrowed down the choice of antibiotics. Those antibiotics that are efficacious are costly and not readily available. The purposes of this study therefore were: To evaluate the incidence of beta-lactamase producing organisms responsible for common community-acquired infections. To evaluate the incidence of bacterial resistance to commonly prescribed antibiotics in the general practice. Nitrocefin strip was used to test each isolate for beta-lactamase production. All isolates were tested against five commonly prescribed antibiotics and a new oral cephalosporin. A nationwide survey revealed that 78% of community-acquired pathogens produced beta-lactamases while more than 50% of most community isolated showed in-vitro resistance to most commonly prescribed antibiotics. We conclude that treatment of bacterial infections are becoming more difficult and more costly. There is need therefore to continually review the susceptibility profiles of community-acquired pathogens.

Clinical trial of sulbactam/ampicillin in the treatment of typhoid fever, and in-vitro sensitivity of isolates to sulbactam/ampicillin and chloramphenicol.

A trial of Sulbactam/Ampicillin in treatment of typhoid fever was carried out while in-vitro sensitivity of the drug was compared with chloramphenicol. Sulbactam/Ampicillin was found to be effective in 11 out of 12 patients who received the drug. The 1 patient who failed to respond had intestinal perforation with peritonitis. No side effects were encountered. The in-vitro study showed that 91.7% of the isolates were sensitive to sulbactam/ampicillin compared to 75% sensitivity to chloramphenicol. The difference was however not statistically significant (P < 0.05). It is concluded that sulbactam/ampicillin is effective and safe in the treatment of typhoid infection.

The role of the laboratory in a Chlamydia control programme in a developing country.

The laboratory components of a Chlamydia trachomatis disease control programme for a developing country are reviewed. Early diagnosis of chlamydial infections is the most cost effective means of preventing the long term sequelae of trachoma, pelvic inflammatory disease, ectopic pregnancy and infertility, which are now a major public health burden to the health care system in developing countries. Public health strategies are required to establish both a co-ordinated limited system of laboratory services, and to promote the diagnosis and treatment of disease syndromes in the absence of laboratory support. Laboratory tests for the specific diagnoses of chlamydial infections requiring different levels of expertise and equipment can be instituted within settings appropriate to the resources and technical expertise available. Emphasis is given to appropriate cost effective utilization of laboratory testing.

PIP: Current methods used for the laboratory diagnosis of a Chlamydia trachomatis disease control program for a developing country are reviewed to guide clinical microbiology laboratories to develop criteria for testing. Human chlamydia infections are a major public health problem in both developed and developing countries. Worldwide an estimated 360 million persons are infected by the ocular serovars of Chlamydia trachomatis and 6.4 million are blind from the scarring, sequelae. The genital strains of Chlamydia trachomatis cause cervical, endometrial or tubal infections in women, resulting in pelvic inflammatory disease (PID) or ectopic pregnancy, and infertility. Over 50% of chlamydia infections in women are asymptomatic and progress to silent PID and infertility. In industrialized countries chlamydia infections are the major cause of sexually transmitted disease-related infertility. Infants born to infected mothers are at risk for chlamydia pneumonia and ophthalmia neonatorum. More tentative associations of chlamydia infections exist with Reiter's Syndrome. Early diagnosis of chlamydia infections is the most cost effective means of preventing the longterm sequelae of trachoma, pelvic inflammatory disease, ectopic pregnancy and infertility, which are a major public health liability in developing countries. In many developed and developing countries, public health decision maker are not aware of the extent of chlamydia infections in the community. One of the priorities of the disease control program is to provide accurate epidemiologic data through seroprevalence studies. This includes estimates of persons infected, the severity of complications and sequelae. Public health strategies are required to establish laboratory services and to diagnose and treat the disease. The diagnostic methods for C. trachomatis include specimen collection, cytologic methods, serologic methods, cell culture method, antigen detection methods, and nucleic acid hybridization tests that should be available at the national reference laboratory.

Pattern of reactive serological tests for syphilis in different population groups attending the University College Hospital Ibadan (1976-1985).

A review of the reactive serological tests for syphilis was carried out. An overall seroreactivity of 5.1% was obtained over the 10-year period reviewed. A subtle but steady rise in the incidence of syphilitic infections was noted, from 7 to 10 new cases per 1000 population between 1970 and 1975. The predictive characteristics obtained from the screening tests show that the tests are reliable diagnostic tests when the results are carefully interpreted, and the medical personnel can be alerted of the prevalence of syphilitic infections.

PIP: Serological tests for syphilis conducted at the University College Hospital, Ibadan, Nigeria, from 1976-1985 were compared to results from 1970-1975, showing a clear increase in prevalence. The departments participating were the antenatal care, special treatment (venereal disease), outpatient, wards, and blood bank. For most of the decade, sera and verified with the TPHA (Treponema pallidum hemagglutination test) test, although data were also available from the 1st half of the period from initial screening with the RPR (Rapid Plasma Reagin) test. The overall positive rates were 5.1% with the VDRL, 7.7% with the TPHA test, and 2.8% with the RPR test. The lowest rate of reactive sera by the VDRL was the antenatal clinic, with 2.3%, and the highest were the outside-hospital clinics, with 7.6%. Using the TPHA test as a reference, the sensitivity of the VDRL was 54.7%, and its specificity was 94.7%. Considering a positive titer of 1:4 as reactive, 0.995% of the VDRL tests were positive, giving a syphilis incidence of 10/1000. This is an increase of 3 cases/1000 above the rate found in the previous decade. The results are plausible considering the rapid increase in new cases of other STDs (sexually transmitted diseases).

Enhanced susceptibility of trypsinized HeLa cells to Chlamydia trachomatis infection.

An improved cell culture method for the recovery of Chlamydia trachomatis from clinical samples was evaluated. Freshly trypsinized HeLa 229 cells were infected in suspension culture and compared to a standard monolayer culture method. Among 1085 specimens evaluated, 84 were positive by both methods, 978 were negative by both methods, 2 were positive by the monolayer method only, and 21 were positive by the suspension method only. Inclusion counts were two-fold higher in the suspension culture method than in the monolayer method (p less than .001). It is concluded that freshly trypsinized HeLa 229 cells infected in suspension culture are more susceptible to infection with Chlamydia trachomatis than standard monolayer cells.

Single dose treatment of gonococcal urethritis with augmentin in Ibadan.

Augmentin, a new orally absorbed broadspectrum antibacterial agent comprising of amoxycillin trihydrate and potassium clavulanate, was investigated in the treatment of gonococcal urethritis in Ibadan, Nigeria, where penicillinase producing Neisseria gonorrhoeae (PPNG) constitute about 80% of the circulating strains of gonococci. Two different formulations of the agent were employed in the study. The first formulation consisting of 3.0 g amoxycillin and 125 mg clavulanic acid, achieved a cure rate of 75% (i.e. eighteen out of twenty-four patients) among PPNG infections, but 100% cure rate among nine patients with non-PPNG infections. The second formulation consisting of 3.0 g amoxycillin and 250 mg clavulanic acid, had a cure rate of 86% (i.e. fifty-seven out of sixty-six patients) among PPNG infections, and 91% (i.e. ten out of eleven patients) among non-PPNG infections. Clavulanic acid appears to potentiate and enhance the activity of amoxycillin against the beta-lactamase produced by the gonococci. Augmentin seems to be a good and acceptable agent for the treatment of gonococcal infections, in this environment and further studies on its efficacy are therefore justified, such as the simultaneous administration of probenecid.