ABSTRACT
COVID-19 is a global pandemic, with attendant high morbidity and mortality. There is no previous documentation of its coinfection with Mycobacterium tuberculosis; the single most common cause of death from an infectious disease. Management and survival from this "cruel duel" in a low resource country will be daunting. We report the case of a middle-aged man who survived and the lessons learned from a COVID-19 treatment centre in the north-central of Nigeria. The patient presented with symptoms and clinical features of COVID-19 and Mycobacterium tuberculosis was confirmed with laboratory investigation. The patient commenced anti-tuberculous medications, received nutritional support and other supportive treatment for COVID-19 infection. He was discharged home to continue follow up at the medical outpatient and the DOTS clinic. Early recognition and prompt treatment are critical for a favourable clinical outcome.
Subject(s)
COVID-19 Drug Treatment , Coinfection , Mycobacterium tuberculosis , Aged , Coinfection/diagnosis , Humans , Male , Middle Aged , Nigeria , SARS-CoV-2ABSTRACT
OBJECTIVES: The objective of this study was to assess the prevalence of maternal recto-vaginal extended-spectrum ß-lactamase producing Enterobacteriacea (ESBL-E) colonization, identify risk factors for maternal and neonatal ESBL-E colonization, and subsequent impact on neonatal mortality. METHODS: A prospective, cross-sectional study was conducted at the University of Abuja Teaching Hospital from April 2016 to May 2017. Maternal-neonatal pairs were screened for ESBL-E exposure at time of delivery. Neonatal mortality was assessed at 28 days. RESULTS: A total of 1161 singleton deliveries were evaluated. In total, 9.7% (113/1161) of mothers and 4.3% (50/1161) of infants had ESBL-E-positive cultures at delivery. Maternal antibiotic exposure was associated with ESBL-E recto-vaginal colonization (18.6% (21/113) vs. 8.4% (88/1048), p < 0.001)). Maternal ESBL-E colonization (adjusted odds ratio (AOR) 14.85; 95% CI 7.83-28.15) and vaginal delivery (AOR 6.35; 95% CI 2.63-17.1) were identified as a risk factor for positive ESBL-E neonatal surface cultures. Neonatal positive ESBL-E surface cultures were a risk factor for neonatal mortality (stillbirths included, AOR 4.84; 95% CI 1.44-16.31). The finding that maternal ESBL-E recto-vaginal colonization appeared protective in regards to neonatal mortality (AOR 0.22; 95% CI .06-0.75) requires further evaluation. CONCLUSIONS: Maternal ESBL-E recto-vaginal colonization is an independent risk factor for neonatal ESBL-E colonization and neonates with positive ESBL-E surface cultures were identified as having increased risk of neonatal mortality.
