Evaluation of the comparative efficacy and safety of artemether-lumefantrine, artesunate-amodiaquine and artesunate-amodiaquine-chlorpheniramine (Artemoclo™) for the treatment of acute uncomplicated malaria in Nigerian children.

OBJECTIVE: To evaluate the comparative efficacy and safety of artemether-lumefantrine (AL), artesunate-amodiaquine (ASAQ) and artesunate-amodiaquine-chlorpheniramine (AQC) for the treatment of acute uncomplicated malaria among Southwest Nigerian children. SUBJECTS AND METHODS: One hundred and sixty children aged 6 months to 14 years with acute uncomplicated malaria were randomized to AL (n = 53), ASAQ (n = 53), or AQC (n = 54). Enrollees were seen daily on days 0-3 and then on days 7, 14, 21, 28 and 42 for clinical and parasitological evaluations. Paired samples of genomic DNA at enrolment and at the time of recurrent parasitaemia were genotyped using nested PCR to distinguish between reinfection and recrudescence. Detailed haematological and biochemical evaluations were carried out in a subset of enrollees on days 0, 7 and 28 as part of a safety evaluation. RESULTS: Of the 160 children, 144 (90%) completed the study. The mean fever clearance times and parasite clearance times for AL, ASAQ and AQC were comparable (p = 0.94 and p = 0.122, respectively). On day 14, the adequate clinical and parasitological response (ACPR) for AL and AQC was 100% and for ASAQ it was 90% (p = 0.39). The PCR-uncorrected results on days 28 and 42 and the ACPR-corrected results on day 42 were similar for all drugs (p = 0.62 and p = 0.56, respectively). AQC resulted in the best parasite clearance and haematological recovery on day 2 (p = 0.022 and p = 0.018, respectively). Biochemical parameters were not adversely affected by the three artemisinin-based combination therapies (ACTs) and these were well tolerated. CONCLUSION: The three ACTs were efficacious and safe, but AQC resulted in a better haematological recovery on day 2 and higher cure rates throughout the study period.

Cryptosporidium hominis subtypes and Enterocytozoon bieneusi genotypes in HIV-infected persons in Ibadan, Nigeria.

Cryptosporidium and Enterocytozoon are common opportunistic pathogens in HIV+ patients in developing countries, especially those do not have access to antiretroviral therapy. To determine the distribution of genotypes/subtypes of Cryptosporidium and Enterocytozoon bieneusi, faecal specimens were collected from 132 HIV+ persons attending a tertiary hospital in Ibadan, Nigeria. By polymerase chain reaction, eight and ten patients were identified as positive for Cryptosporidium spp. and E. bieneusi, respectively. Seven of the Cryptosporidium specimens were identified as C. hominis, while the remaining one as the new species C. viatorum recently identified in the United Kingdom. DNA sequencing of the 60-kDa glycoprotein gene showed that the C. hominis belonged to three common subtype families: Ia (in three patients), Ib (in one patient) and Ie (in one patient). In contrast, DNA sequencing of the E. bieneusi internal transcribed spacer products showed the occurrence of genotypes associated with both humans (Peru 8 in one patient, Nig2 in two patients and a new genotype in one patient) and animals (D in one patient and Type IV in five patients). Low CD4+ cell count was identified as a risk factor for both cryptosporidiosis and microsporidiosis.

PATTERN OF OROFACIAL BACTERIAL INFECTIONS IN A TERTIARY HOSPITAL IN SOUTHWEST, NIGERIA.

BACKGROUND: Orofacial bacterial infections present in diverse patterns due to the anatomical complexity of the area. The likelihood of spread from the initial area of infection is also high because of the presence of contiguous spaces in the head and neck region. AIM: To determine the pattern and management outcome of orofacial bacterial infections in Southwest Nigeria. STUDY DESIGN: A prospective study. SETTING: University College Hospital, Ibadan, Nigeria. MATERIALS AND METHODS: A prospective study on 102 patients with orofacial bacterial infections seen between June and December, 2011 was carried out. The information collected with data sheet included socio- demographic data, clinical history and examination, treatment and outcome. Frequencies, means, medians and diagrams of relevant variable generated. Chi square test was used to test association between categorical variables at p<0.05. RESULTS: Male to female ratio was 1.1: 1 with age range 10 months to 83 years and mean age 33.0 (±20.3) years. The median number of days between onset of orofacial bacterial infection and presentation for treatment was 7 (range 3-90) days. Sixty seven (65.7%) patients presented to hospital within 7 days of the onset of symptoms of infection. Pain was the common symptom 100 (98.04%), followed by sleep disturbance 71 (69.6%) while the least common symptom was dyspnea 18 (17.7%). Most of the early presenters had complaint of sleep disturbance (67.6%) while most of the late presenters had dyspnea (44.4%). Positive medical history including diabetes mellitus was reported by 28 patients (27.6%). Sixty seven (65.7%) had fascial space involvement, of which the majority 38 (56.7%) had multiple space involvement. Eight (21%) of those with multiple space involvement had submental, bilateral sublingual and submandibular spaces (Ludwig's angina).The majority 12 (41.4%) of those with single space infection had it in submandibular space. The majority 35 (45%) of the patients with odontogenic infections had it in right posterior mandible. All the patients had antibiotics prescribed for them and also had one form of surgical treatment or the other which included extraction, incision and draina cge with extraction, decompression, exploration and debridement and sequestrectomy. The majority (90.5%) of the participants whose orofacial bacterial infection resulted into swelling had regression of the swelling and majority (90.0%) of those who had inadequate mouth opening had adequate mouth opening after treatment. Three mortalities were recorded in the course of the study. CONCLUSION: Odontogenic aetiology is commoner than non odontogenic. Multiple fascial space involvement occurred more than single space. Outcome was good with adequate treatment although few cases of mortalities were recorded.

Evaluation of Paracheck-Pf(TM) rapid malaria diagnostic test for the diagnosis of malaria among HIV-positive patients in Ibadan, south-western Nigeria.

Febrile illnesses occur frequently among HIV positive patients and these are often treated presumptively as malaria in endemic areas. Parasite-based diagnosis of malaria will eliminate unnecessary treatment, reduce drug-drug interactions and the chances for the emergence of drug resistant Plasmodium. We evaluated finger prick blood samples from 387 people living with HIV (PLWHIV) and suspected of having malaria by expert microscopy and Paracheck-Pf(TM) - a histidine-rich protein-II based malaria rapid diagnostic test. The study was conducted at the PEPFAR supported AIDS Prevention Initiative in Nigeria (APIN) Clinic of the University College Hospital Ibadan, southwest Nigeria. Outcome parameters were prevalence of malaria parasitemia, sensitivity and specificity of Paracheck-Pf as well as the positive and negative predictive values for Paracheck-Pf using microscopy of Giemsa-stained blood film as gold standard. Malaria parasites were detected in 19·1% (74/387) of enrollees by microscopy and 19·3% (74/383) by Paracheck-Pf. Geometric mean parasite density was 501/µl (range 39-749 202/µl). Sensitivity and specificity of Paracheck-Pf at all parasite densities were 55·4% and 89·3% while corresponding figures at parasite densities ≥200/µl were 90·9% and 90·3%. Sensitivity and specificity at parasite densities ≥500/µl was 97·6% and 90·3%. Positive and negative predictive values for parasite density ≥200/µl were 55·4% and 98·7%, respectively. Paracheck-Pf was found to be a useful malaria diagnostic tool at parasite densities ≥200/µl facilitating appropriate clinical management.

Asymptomatic bacteriuria among an obstetric population in Ibadan.

BACKGROUND: Asymptomatic bacteriuria in pregnancy is the major risk factor for symptomatic urinary tract infection during pregnancy. Screening and identification of bacteriuria during pregnancy have been recommended. OBJECTIVE: To determine the prevalence and pattern of asymptomatic bacteriuria associated with pregnancy. METHODS: The study was a descriptive, cross sectional survey of pattern of asymptomatic bacteriuria among consecutive patients presenting for the first antenatal visit at a University College Hospital, during a period of two months. Relevant information obtained from all the patients recruited for the study included age, parity, educational level, gestational age and occupation of participant. Haemoglobin electrophoresis patterns were also retrieved and recorded. Main outcome measures were prevalence of asymptomatic bacteriuria, bacterial isolates and their antibiotic sensitivities. RESULTS: There were 205 eligible participants with a mean age of 30.6 ± 4.3 years and a mean gestational age at booking of 20.9 ±7.0 weeks. The prevalence of asymptomatic bacteriuria was 22(10.7%). The isolated pathogens were predominantly coliforms (Klebsiella and E. coli) accounting for 45.5% and Staphylococcus saprophyticus (27.3%). Only gentamycin, nitrofurantoin and ofloxacin demonstrated high efficacy against these uropathogens with antibiotic sensitivity rates of 72.7%-81.8%. CONCLUSION: Prevalence of asymptomatic bacteriuria in this centre is relatively high. This underscores the need for routine screening of pregnant women for bacteriuria.

The microbiological diagnosis of tuberculosis in a resource - limited setting: is Acid-fast bacilli microscopy alone sufficient?

The objective of this study is to audit the processes for the microbiological diagnosis of tuberculosis (TB) in our resource-limited setting. A total of 694 specimens were received from 333 patients. 129 (38.7%) of these patients were positive for TB. 78 (60.5%) were positive on AFB microscopy alone, 13 (10.0%) on culture alone and 38 (29.5%) on both culture and AFB microscopy. Fifty-one (51) cases were positive on culture, 38 of these (74.5%) had growth on Lowensen-Jensen culture medium alone, 11 (19.6%) on Pyruvic Acid Enhanced Medium (PAEM) and 3 (5.9%) on both culture media. AFB microscopy showed a diagnostic specificity of 71.6% and a sensitivity of 74.5%. M. Bovis appears to be prevalent and we suggest the need for speciation. If AFB microscopy is to be routinely used alone, without confirmation by culture, then the overriding need is for quality to be fully assured in its use.

Asymptomatic bacteriuria in pregnancy: evaluation of reagent strips in comparison to microbiological culture.

Screening for asymptomatic bacteriuria during pregnancy, the major risk factor for symptomatic urinary tract infection during pregnancy have been recommended. This cross sectional study was conducted to determine prevalence of asymptomatic bacteriuria in Ibadan and evaluate the diagnostic accuracy and relative cost effectiveness of dipstick tests for nitrite and leucocyte esterase in comparison to laboratory culture. Two hundred and five patients, presenting for their first antenatal visit at the University College Hospital, Ibadan, participated in the study. Urine samples obtained from the participants were subjected to two tests; reagent dipstick test for nitrite and leucocyte esterase and routine laboratory culture, which is the gold standard for diagnosis. Main outcome measures were sensitivity, specificity, positive and negative predictive values of the reagent dipstick tests as well as likelihood ratios. The prevalence of asymptomatic bacteriuria in pregnancy with routine laboratory culture and using combined leucocyte esterase and nitrite strip tests were 10.7% and 11.7% respectively. Compared with laboratory culture, combined strip tests had sensitivity, specificity and negative predictive values of 50%, 92.9% and 93.9% respectively, indicating a statistically significant lower level of accuracy (P < 0.05). The corresponding likelihood ratios for positive and negative strip tests (LR+ and LR-) were 7 and 0.5 respectively. The study concludes that combined Leucocyte esterase-nitrite dipstick test is not sufficiently sensitive and specific to be used for routine screening of bacteriuria in pregnancy in place of laboratory culture, though may be more cost effective in low resource settings.

Predictors of asymptomatic bacteriuria among obstetric population in Ibadan.

BACKGROUND: Asymptomatic bacteriuria in pregnancy is the major risk factor for symptomatic urinary tract infection during pregnancy. Screening and identification of bacteriuria during pregnancy have been recommended. The general objective of the study was to determine the pattern as well as possible predictors of asymptomatic bacteriuria at the University College Hospital, Ibadan. METHODS: The study was a descriptive, cross sectional, exploratory survey of the pattern of asymptomatic bacteriuria among all consecutive patients presenting for the first antenatal visit at the University College Hospital, Ibadan during the study period. RESULTS: The prevalence of asymptomatic bacteriuria was 10.7%. Although no statistically significant association was found, the prevalence was higher among women aged between 26 - 35 years (11.5%) and those with only secondary education (14.6%). Other demographic parameters characterized by high rates of bacteriuria were Christian women (12.7% compared to 4.3% among Muslims) and genotypes AS and AC (16.4% and 16.7% respectively). Low parity (para 1-2), 2nd and 3rd trimesters of pregnancy were the identified possible obstetric predictors of bacteriuria in pregnancy. Staphylococcus species constitute the predominant isolates in 3rd trimester and among Muslim pregnant women. CONCLUSION: Since no statistically significant predictors for bacteriuria in pregnancy were found, routine screening of all our pregnant women for this condition in 2nd trimester is recommended.

Antibiotic susceptibility pattern of urinary tract pathogens in Ibadan, Nigeria.

Urinary tract infections (UTI) affect all age groups and occur in both hospitalized and non-hospitalized individuals and have serious impact on the socioeconomic life of the individual and the society, and also account for a large proportion of antibacterial drug consumption. Treatment failure has been attributed to increasing resistance to common antibiotics, but there is paucity of data from this part of Nigeria. This prospective study was carried out to determine the prevalence and antibiotic susceptibility pattern of uropathogens in Ibadan using standard microbiological diagnostic methods. Statistical analysis was by simple percentages among related variables. Four hundred and nine urinary isolates, 239 (58.4%) and 170 (41.6%) from hospitalized and non-hospitalized patients respectively were studied. Frequency of occurrence of urinary pathogens were Klebsiella spp 171 (41.8%), Pseudomonas species (including Pseudomonas aeruginosa) 81 (19.8%), Escherichia coli 78 (19.1%), Staphylococcus aureus 31 (7.6%) and Proteus mirabilis 31 (7.6%). Resistance to commonly used antibiotics such as ampicillin 97%, tetracycline 93%, cotrimoxazole 98%, and amoxycillin 89% was observed among most uropathogens. Seventy-five to 100% Pseudomonas spp. were resistant to the common antibiotics and also 87.1% and 82.4% were resistant to nalidixic acid and cefuroxime respectively. However, appreciable susceptibility by all uropathogens was found with amikacin 75%, ciprofloxacin 72.2%, ceftriaxone 68.4%, and pefloxacin 64.9%. Isolates from the community showed more susceptibility to tested drugs. In conclusion, widespread resistance to most antibiotics including cephalosporins and quinolones was found among all uropathogens.

Strongyloidiasis: prevalence, risk factors, clinical and laboratory features among diarrhea patients in Ibadan Nigeria.

Strongyloidiasis is a parasitic infection caused by Strongyloides stercoralis. The infection is usually mild or asymptomatic in normal immunocompetent individuals, but could be very severe or even fatal due to hyper infection in individuals who are immunosuppressed. This study aimed at determining the prevalence, risk factors and features of strongyloidiasis among diarrhea patients in Ibadan. This is a descriptive cross-sectional study of diarrhea patients from a teaching hospital, three major government hospitals and one mission hospital in Ibadan. Self administered questionnaire, clinical assessment and laboratory investigations were used to confirm health status and presence of S. stercoralis. Diagnosis was made by microscopic examination of stool in saline preparation and formol-ether concentration. One thousand and ninety patients, (562 (51.6%) males and 528 (48.4%) females) consisting 380 (34.9%) children and 710 (65.1%) adults who had diarrhea were studied. The prevalence rate for the parasite among diarrhea patients was 3.0%. While the risk factor for infection remains contact with contaminated soil, malnutrition, steroid therapy, HIV/AIDS, lymphomas, tuberculosis, and chronic renal failure. Others are maleness, institutionalism and alcoholism. Predominant clinical presentations are abdominal pain, chronic diarrhea, and bloating and weight loss, Strongyloides stercoralis should be considered in diarrhea patients who are either malnourished or immunosuppressed.

Malaria prevention practices among mothers delivering in an urban hospital in southwest Nigeria.

BACKGROUND & OBJECTIVES: The pregnant woman is more prone to malaria than her non-pregnant counterpart with grave consequences for both mother and baby. This study aims at determining the malaria prevention practices among pregnant women in an area hyper-endemic for malaria. METHODS: For the study 983 parturient mothers were enrolled in Ibadan, southwest Nigeria. Information was collected on sociodemographic characteristics, use of malaria chemoprophylaxis, use of anti-vector measures, and malaria parasitaemia. RESULTS: Most mothers [956/972 (98.4%)] reported the use of anti-vector measures for malaria prevention. These include, window screens (78.9%), insecticides spray (69.9%), mosquito coils (25.3%), untreated bednets (2.5%), and insecticide-treated nets (1.1%). Most mothers used anti-vector measures either singly or in combination. About 86% (840/972) of the mothers used drugs for chemoprophylaxis. Thirteen (1.3%) mothers used chemoprophylaxis alone (CP), 135 (13.9%) used anti-vector measures alone (AV) while 820 (84.4%) used chemoprophylaxis plus anti-vector (CPAV). Weekly dose of pyrimethamine [214 (25%)] and intermittent preventive treatment with sulphadoxine-pyrimethamine [598 (71.2%)] were the widely used chemoprophylactic drugs. The prevalence of patent parasitaemia at delivery was 7.7% (1/13), 12.1% (99/820) and 16.3% (22/135) among CP, CPAV and AV groups respectively. Geometric mean parasite densities among the respective groups were 7840/microl, 1228/microl and 8936/microl. CONCLUSION: Window screens and insecticide sprays were widely used for malaria prevention while the use of ITN was very low among enrolled mothers. There is a need to pay concerted efforts to improve ITN usage rate in Nigeria.

Prevalence of malaria at booking among antenatal clients in a secondary health care facility in Ibadan, Nigeria.

The prevalence of malaria parasitemia at booking was studied in 1,848 pregnant women in a secondary hospital in Ibadan, Nigeria. Main outcome variables were patent parasitemia and fever. 8.4% hadpatent malaria parasitaemia. Most clients (89%) with parasitemia were asymptomatic. Febrile subjects booked at an earlier gestational age [22.7 versus 24.2 weeks] than afebrile patients (p = 0.0052). Anemia was more prevalent among patients with patent parasitemia than those without (58.1% versus 22.6%, p < 0.0001). Malaria parasitaemia was higher among nulliparous women than other parity groups (p < 0.0001). Symptomatic malaria was associated with early booking for antenatal care and malaria parasitemia was a significant determinant of anemia. The prevalence of malaria parasitaemia in this study is much lower than in previous reports.

Prevalence of malaria at booking among antenatal clients in a secondary health care facility in Ibadan, Nigeria

The prevalence of malaria parasitemia at booking was studied in 1,848 pregnant women in a secondary hospital in Ibadan, Nigeria. Main outcome variables were patent parasitemia and fever. 8.4% had patent malaria parasitaemia. Most clients (89%) with parasitemia were asymptomatic. Febrile subjects booked at an earlier gestational age [22.7 versus 24.2 weeks] than afebrile patients (p = 0.0052). Anemia was more prevalent among patients with patent parasitemia than those without (58.1% versus 22.6%, p<0.0001). Malaria parasitaemia was higher among nulliparous women than other parity groups (p<0.0001). Symptomatic malaria was associated with early booking for antenatal care and malaria parasitemia was a significant determinant of anemia. The prevalence of malaria parasitaemia in this study is much lower than in previous reports. (Afr J Reprod Health 2008; 12[2]:141-152)

Pulmonary tuberculosis in Ibadan: a ten-year review of laboratory reports (1996-2005).

Tuberculosis (TB) control programme is a balance between accurate diagnosis of the disease and effective treatment of cases to eliminate the disease in the community. We carried out a retrospective review of the specimens processed in the TB laboratory of the Department of Medical Microbiology, University College Hospital, Ibadan between 1996 and 2005. Majority of the specimens processed were sputum (75.2%) while cerebrospinal fluid and aspirates from other sources accounted for 4.3% and 20.5% respectively. Of the sputum processed, 2,738 (62.4%) were from male patients while 1,650(37.6%) were from female patients giving a male to female ratio of 1.66:1.00. Only 380 (9.5%) were reported smear positive while 477 (10.9%) were positive for culture. Three hundred and four (6.9%) were smear negative but culture positive while 207 (4.7%) were smear positive but negative for culture. Those sputum that were missed by smear microscopy (6.9%) were only confirmed by culture after six to eight weeks incubation. This culture method is only available in few reference centers in Nigeria. Thus, undiagnosed cases resulting from inadequate diagnostic facilities contribute an impediment to TB control efforts in the community. Hence there is an urgent need to have more accurate, affordable tools that would be available for use at the all levels of health care to achieve total eradication of TB in the community.

Prevalence of multiple intestinal helminths among children in a rural community.

Impairment of physical and mental development has been identified as deleterious effects of helminthic infection. As a result, there have been concerted efforts to control this group of diseases especially among children who are most vulnerable. However, knowing the prevalence of multiple infections will strengthen or otherwise justify the use of broad spectrum antihelminthics in the prophylaxis and treatment of intestinal helminthes among children. This study was carried out in a farming community with no tarred access road, electricity or pipe-borne water. The diagnosis of intestinal helminthes was by Kato-Katz thick smear examination technique. One hundred and seventy stool samples from 88 male and 82 female children were examined. The mean age of the children was 8 +/- 1.6years. One hundred and sixteen of 170 (68.2%) of the study volunteers had one intestinal helminthic infection or the other. Co-infection by more than one helminth was not uncommon and this occurred in 49.1% of the infected population while 35.4%, 11.2% and 2.6% had double, triple and quadruple infections respectively. Ascaris lumbricoides and hookworm were the most common combinations observed in the study 52.6%, followed by the combination of A. lumbricoides and T. trichiura 17.5%. The triad of A. lumbricoides, hookworm and T. trichiura accounted for 12.3% among the multiply infected population. However, quadruple infection with A. lumbricoides, hookworm, T. trichliura and E. vernlicularis had 2.6% prevalence rate among the study population. Ascaris lumbricoides is the most prevalent among all the children, with a prevalence of 81.6%, 63.3% and 52.4% among children aged 12 -17years, 6-11 years and 0-5 years respectively. In conclusion, the presence of multiple infections especially of Ascaris lumbricoides and hookworm in almost 26% of the study population and multiple infections in 49.1% of the infected population justified the use of broadspectrum antihelminthics in the management of helminthiasis among school children of the rural community. Thus treatment and mass chemotherapy directed at school children will be a step in the right direction.

Strongyloidiasis in children five years and below.

INTRODUCTION: Strongyloidiasis is one of the major human intestinal infections caused by a minute nematode, Strongyloides stercoralis. It is a soil-transmitted nematode of worldwide distribution, which resides in the small intestines of humans and is acquired by tissue penetration by the infective stage, filariform larva, of the worm. In the immunocompetent hosts, Strongyloides stercoralis infects only the mucosal of the small intestines and persists as an asymptomatic often chronic infection. In contrast, in the presence of immune suppression it has ability to multiply within the human host, known as hyperinfection. Its occurrence has been reported more commonly among adults. AIM/OBJECTIVE: This study was undertaken to find the occurrence of Strongyloides stercoralis among children 0-5years who presented with diarrhea and then relate it to their nutritional status. MATERIALS AND METHOD: Following ethical approval, two hundred and twenty seven children, 118 boys and 109 girls, with complaints of diarrhoea, were randomly selected. A structured questionnaire was completed for each child. Anthropometric measurement was taken. Clinical assessment/diagnosis by the attending physician was also recorded. Stool specimen was collected and examined by wet preparation and formol-ether concentration methods. Infected children were treated. RESULTS: Twelve (5.3 %) of all the children with diarrhoea were found to have Strongyloides stercoralis. All the infected children were malnourished while none of the normal nourished children had Strongyloides stercoralis (p=0.001). CONCLUSION: Strongyloidiasis is a possible complication of Malnutrition in children who presented with diarrhoea.

Socio-cultural factors affecting the spread of HIV/AIDS in Africa: a case study.

There is a disproportionate share of AIDS cases over the years in Africa. This has occurred in racial and ethnic minority populations, a finding likely related to social, economic and cultural factors. Certain socio-cultural and religious practices such as polygamy and giving a daughter away in marriage without considering the social life of the man are likely contributory factors to the higher prevalence of HIV/AIDS in women in this part of the world. This is illustrated with a case of Mr. M. S. who married two wives within four months interval, having lived a promiscuous life before marriage. One of the wives was a virgin at the time of marriage. Neither of wives had any symptoms suggestive of STD or HIV before marriage, however, the three of them tested positive to HIV-1 following a visit to the special treatment clinic. He had genital herpes and his two wives also had vulvovaginal candidiasis, genital herpes and condyloma accuminata (genital warts). The husband would not want his HIV status declared to the wives. There is therefore a need to enact law on pre-marriage HIV screening for intending couples. Couple Pre-and post-test counseling must be encouraged and promoted. In addition, women should be empowered to negotiate safer sex.

Gastrodiscoides hominis infection in a Nigerian-case report.

Gastrodiscoides hominis is a large fluke of pig and human and constitutes an important parasite of human in Assam, Indian, the Philippines and Southeast Asia. This parasite has not been reported in Nigeria and possibly other parts of Africa. This is a case report of a seven year old Nigerian child who presented with features of malnutrition and anaemia and was found to have Gastrodiscoides hominis and Ascaris lumbricoides. Following clearance of the worms there was tremendous improvement of the health status of the child. The detailed epidemiology of this parasite still remains to be studied in this environment.

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.