Detection of CTX-M and SHV Genes in Extended Spectrum Beta-Lactamase Producing Klebsiella Pneumoniae and Pseudomonas Aeruginosa in a Tertiary Hospital in North-central Nigeria.

Background: Antimicrobial resistance (AMR) is an emerging threat to global health security. Globally, an estimated 700,000 deaths are attributed to AMR annually. Annual deaths due to AMR are projected to reach 10 million by 2050 if current trends persist. Extended Spectrum ß-Lactamases (ESBLs) have the ability to hydrolyse penicillins, cephalosporins up to the third generation, and monobactams, but not ß-lactamase inhibitors such as clavulanic acid. ESBLs undergo continuous mutation, leading to the development of new enzymes with over 400 different ESBL variants described. This study aimed to detect selected CTX-M genes, SHV,and TEM genes in Extended Spectrum Beta-Lactamase producing Klebsiella pneumoniae and Pseudomonas aeruginosa in Jos, Nigeria. Methodology: A total of 110, non-replicated isolates of Klebsiella pneumonia and 125 isolates of Pseudomonas aeruginosa were identified phenotypically from clinical specimens of patients at a tertiary hospital in Jos, North-central Nigeria. The isolates were screened for ESBL production using the disk diffusion method of the Clinical Laboratory Standard Institute (CLSI) breakpoints. Phenotypic confirmation of ESBL production was done using the double-disc synergy test. Multiplex PCR was used to detect ESBL genes. Results: Fifty (45.5%) of the 110 isolates of Klebsiella pneumoniae and 9(7.2%) of the 125 isolates of Pseudomonas aeruginosa were ESBL-positive. Typing of 20 representative ESBL isolates (17 Klebsiella and 3 Pseudomonas spp) showed the presence ofblaCTX-M1, blaCTX-M9, and blaSHV genes in these isolates. All 20 (100%) isolates had the blaCTX-M1 gene. The blaSHV gene was detected in 16(80%) while CTX-M9 was detected in 6(30%) of the isolates studied. Conclusion: The study showed that there is a high prevalence of ESBL genes among isolates ofKlebsiella pneumoniae and Pseudomonas aeruginosa in North-central Nigeria. This emphasizes the need for continuous surveillance and coordinated infection prevention and control to curtail its spread.

Hand hygiene knowledge, training and practice: A cross-sectional study in a tertiary health institution, North-central Nigeria.

BACKGROUND: Hand hygiene (HH) is the single most important means of preventing hospital-acquired infections. We set out to determine the knowledge, training gaps, and practice of HH in a tertiary health institution in a resource constrained setting. METHODS: This cross-sectional study was conducted among health care workers in a 600-bed capacity tertiary health centre. The study was conducted between April and November 2013. A multi-stage randomized sampling method was used to self-administer 322 WHO HH knowledge questionnaires. Information on HH training in the past 3 years, knowledge and practice of HH were obtained, and data were analysed using Epi-Info version 3.5.1. RESULTS: A response rate of 98.5% was obtained for the HH knowledge assessment. Mean age of the study population was 39 ± 9.8. About 64% were females. Of all the respondents, only 16% had good knowledge of HH, 52% had moderate knowledge while 32% had poor knowledge. About 24% had formal training on HH. In terms of practice, only about 22% of the respondents self-reported routine practice of HH. CONCLUSIONS: The findings in this study suggest that there is sub-optimal HH knowledge, practice and training. It is imperative to improve the HH training and retraining of health care workers with a focus on attendants. Administrative controls and bold signage in healthcare institutions are also recommended.

Lassa fever outbreak in adolescents in North Central Nigeria: report of cases.

BACKGROUND: Lassa fever (LF) is a viral haemorrhagic fever endemic to West Africa. The clinical presentation and course is variable, making diagnosis difficult. AIM: To report the outbreak and identify the common clinical presentations of LF in paediatric patients in Jos, Plateau State, North Central, Nigeria. METHODS: This was a retrospective review of patients managed for LF during the June-August 2017 outbreak. LF was suspected in cases with: fever of less than 3 weeks' duration that had not responded to antimalarials or antibiotics, myalgia, abdominal pain, prostration and history of contact with any person diagnosed with LF. LF was confirmed by a positive reverse transcriptase polymerase chain reaction test (RT-PCR). RESULTS: Ten adolescents were studied. The common presenting complaints were fever (100%), prostration (90%) and headache (70%) while the commonest clinical signs were pyrexia (temperature >38.0oC; 90%), prostration (80%) and abdominal tenderness (80%). Leukocytes were present in urine in 60%. Eight individuals recovered fully, one adolescent died and one developed intestinal perforation necessitating laparotomy. CONCLUSION: In settings such as North Central Nigeria, LF should be suspected in any patient with fever that is unresponsive to antimalarials and antibiotics, especially in the presence of prostration, tachypnoea, tachycardia or abdominal tenderness. Early diagnosis and treatment is needed to reduce mortality from the disease and protect against transmission to health personnel.

DECLINING PREVALENCE OF HIV AND OTHER SEXUALLY TRANSMITTED INFECTIONS AMONG FEMALE SEX WORKERS IN JOS, NORTH-CENTRAL NIGERIA.

BACKGROUND: Female Sex Workers (FSWs) are key reservoirs of human immunodeficiency virus (HIV) and other sexually transmitted infections (STIs) from which transmission to the general population fuels epidemics. STIs amplify HIV infectiousness and susceptibility. We determined the status of HIV and STIs among brothel-based FSWs in Jos as part of an ongoing prevention intervention. METHOD: Between January and May 2012, consenting consecutive brothel-based FSWs were recruited from previously designated brothels across Jos. HIV counseling and testing as well as screening for gonorrhoea, syphilis, trichomonasis, candidasis and Bacteria vaginosis (BV) were performed. Positive cases were provided free treatment and follow-up at Solat Women Hospital, Jos. Ethical clearance was obtained from Jos University Teaching Hospital (JUTH) ethical committee. RESULT: Two hundred FSWs aged 27.6 ± 4.6 years (range 15-55 years) were recruited and of these, 47 (23.5%) were HIV Positive, 20 (10.0%) had syphilis, 9 (4.5%) had Neisseria gonorrhea, 3 (1.5%) had Trichomonas vaginalis and 86 (43.0%) had BV. The association between HIV and bacterial vaginosis was statistically significant (OR of 2.2, 95% CI of 1.1-4.2, P-value=0.02). In comparison to similar prevalence in 2006, the current findings represent 51.5% decline in HIV prevalence, 40.8% decline for syphilis and over 83.3% decline in prevalence for Trichomonas vaginalis. There was no significant change in the prevalence of Neisseria gonorrhoea and BV. CONCLUSION: The prevalence of HIV and STIs among brothel-based FSWs in Jos remain unacceptably high, although, there is a declining trend. A comprehensive HIV prevention program targeting these women is required to block transmission to the general population.

An audit of diagnosis and treatment of sepsis in north-central Nigeria.

BACKGROUND: We audited the diagnosis and antibiotic therapy of patients admitted with sepsis in a resource-limited Nigerian hospital setting in order to improve the quality of sepsis care. METHOD: We conducted a retrospective analysis of the records of medical patients admitted for sepsis at the Jos University Teaching Hospital between September 2011 and August 2012. Data analysis included age, sex, appropriateness of sepsis diagnosis/severity, comorbidities, utility/yield of sample cultures, antibiotic therapy, duration of hospital stay and treatment outcome. RESULT: Only 94 out of 142 cases (66.2%) were judged to meet the diagnostic criteria for sepsis. Out of the 94 patients, 77 (82%) were appropriately classified for sepsis severity. Nineteen patients (20%) met criteria for severe sepsis/septic shock. The commonest comorbidity was HIV/AIDS (57.3%). All the patients received empirical antibiotic therapy but in 23 cases (24.5%), the empirical prescriptions were judged inappropriate and none was administered within one hour of diagnosis. Blood cultures were available to guide definitive antibiotic therapy in only 12.5% of cases. The median (range) duration of hospital stay was 12 (1-70) days while the in-hospital mortality rate was 53%. CONCLUSION: The management of sepsis was suboptimal in our setting and mortality was high. We recommend adoption of standard sepsis guidelines to ensure optimal management and improved outcome.

Integrating syndromic case management of sexually transmitted diseases into primary healthcare services in Nigeria.

BACKGROUND: Sexually transmitted diseases (STDs) are a huge public health problem; both the aetiological and clinical approaches to management have limitations. WHO has therefore developed an alternative strategy--the syndromic case management approach. This paper reports a training of healthcare providers at the Primary Health Centers aimed at integrating STD care into other services in the PHCs to improve management at the community level. METHODS: Sixteen nurses, from eight PHCs were trained on this new strategy. The training included: identification of STDs, use of flow charts, patient education and counseling, clinic management issues and record keeping and reporting. RESULTS: Over a period of eight weeks post training, about 731 clients were attended to, 451 (61.7%) had signs and symptoms of various STDs (genital discharge, genital ulcer, genital warts and lower abdominal pains). They were treated using the syndromic case approach. About 18.6% (84/451) were males and 81.4% (367/451) were Females. Singles (never married) constituted 32.8% (148/451) while 28.6% were married. About 26.6% and 12.0% were divorced and separated respectively. Age group 20-35 years was at highest risk of infection CONCLUSION: Syndromic case management of STDs can be conveniently integrated into the primary health care delivery system in Nigeria.

Evaluation of commercial HIV test kits used in Nigeria.

BACKGROUND: Accurate and reliable diagnosis of HIV plays a central role in any effective HIV intervention. We decided to evaluate 4 commercial HIV test kits to determine their reliability for use in developing countries. METHODS: Serum samples obtained from clients accessing tertiary health services at the STI clinic, Jos University Teaching Hospital were used to evaluate Sdbioline, Diaspot, Determine and DIALAB Elisa kits. A Western blot was used as the reference kit. RESULTS: DETERMINE kit gave 34 positive and 58 negative reactions and the positive sera were all confirmed by Western blot while DIASPOT kit gave 27 false negative results, which was at variance with the reference kit result. Other kits were SDBIOLINE with 5 false positive and DIALAB Elisa kit, which gave one false positive, and one false negative result. CONCLUSION: We conclude that Determine, SDbioline and DIALAB Elisa kits are reliable for HIV antibody testing in Nigeria and other developing countries.

Distribution of Male Urethral Discharge among the Patients in Primary Health Care Centres of Jos North L.G.A.; Jos; Nigeria

Objectives: The study was to determine the distribution of male urethral discharge among the patients seen in primary health care centres of Jos North Local Government Area. Methods: Male patients with urethral discharge were recruited during their clinic days; from September 2004 to May 2006. A structured questionnaire was administered to the patients who gave their consent. Pre-treatment and post-treatment urethral samples were collected and processed according to standard laboratory procedures. Results: One hundred and seventy-six out of 200 patients completed the study. The age range and mean age of the patients were 11-60 years and 30.7 years respectively. The age decade 21-30 years constituted 100 (56.8) of 176 patients; commercial motorcyclists contributed 80 (45); the single marital status recorded 106 (60.2) while primary and secondary education status had 141 (80). Conclusion: Commercial motorcyclists recorded the highest risk of male urethral discharge; and the peak was among young adults of age decade 21-30 years; especially among the single and less educated

Hepatitis B surface antigen, hepatitis C and HIV antibodies in a low-risk blood donor group, Nigeria.

We investigated the seroprevalence of human immunodeficiency virus (HIV), hepatitis B virus (HBV) and hepatitis C virus (HCV) infection among 258 clergymen-in-training (age range 18-39 years) who represented a donor population that fulfilled the criteria for safe blood transfusion. In all, 15.1% of the men were positive for HBsAg, 4.3% were positive for anti-HCV and 2.7% were HIV-positive; 22.1% were infected with at least one of these viruses. Co-infection with HIV and HBV was found in 0.4% of the subjects, HBV and HCV in 0.4%, and HIV and HCV in 0%. This underscores the importance of routine screening of blood before transfusion, regardless of the donor background.

Intestinal parasitism, potable water availability and methods of sewage disposal in three communities in Benue State, Nigeria: a survey.

BACKGROUND: To assess the level of parasite burden in a village community and the predisposing factors. METHODS: Two hundred subjects each were recruited from three communities- Tyogbenda, Jato-Aka and Adikpo during an episode of free medical outreach. A simple random sampling method was adopted and a questionnaire was interviewer administered on relevant aspects of basic hygiene such as- sources of water supply, methods of domestic sewage disposal and frequency of hand washing. Stool samples were collected and tested and findings analysed using appropriate statistical methods, p values < 0.05 were considered significant. RESULTS: The prevalence of intestinal parasites in Tyogbenda, Jato-Aka and Adikpo communities was found to be 71.5%, 65.5% and 40.5% respectively. Ascaris lumbricoides was the commonest parasite in the three centres (34.5%, 28.5% and 19.0% respectively for Tyogbenda, Jato-Aka and Adikpo communities). Other parasites identified were- Entamoeba histolytica, Entamoeba coli, Hookworm. Enterobius vermicularis, Strongyloides stercoralis, Schistosoma mansoni and Trichuris trichura. Multiple parasitic infestation was common in the communities where quality of water supply and methods of sewage disposal facilities were below standard. CONCLUSION: The prevalence of intestinal parasitism is still high in Nigerian rural communities. The present resolve by the federal ministry of water resources to supply potable water to all Nigerian rural communities should be sustained. Furthermore, a health education program should be properly constituted and integrated into the present primary health care policy for the country.

Parasitic contamination of vegetables in Jos, Nigeria.

BACKGROUND: Intestinal parasites are very common in developing countries including Nigeria. There are diverse ways of their transmission; the study attempts to determine the level of intestinal parasitic contamination on vegetables sold in Jos. METHODS: Sample of 200 each of Tomatoes (Lycopersium sativus), Letus (Loctus satival) Carrot (Davcus carota L) Cabbage (Brassica Denceal) and Green leafy vegetables were analyzed using standardized Centrifugal-floatation technique methods. RESULTS: Of the 1250 samples of vegetables examined, 450 (36.0%) were positive for intestinal parasites, cabbage recorded the highest prevalence of 64% while tomatoes had the least prevalence of 20%. CONCLUSION: Vegetables in Jos are heavily contaminated with intestinal parasites and there is need for public enlightenment campaign on the danger of consuming inadequately washed and prepared vegetables.

Hepatitis B surface antigen, hepatitis C and HIV antibodies in a low-risk blood donor group, Nigeria

We investigated the seroprevalence of human immunodeficiency virus [HIV], hepatitis B virus [HBV] and hepatitis C virus [HCV] infection among 258 clergymen-in-training [age range 18-39 years] who represented a donor population that fulfilled the criteria for safe blood transfusion. In all, 15.1% of the men were positive for HBsAg, 4.3% were positive for anti-HCV and 2.7% were HIV- positive; 22.1% were infected with at least one of these viruses. Co-infection with HIV and HBV was found in 0.4% of the subjects, HBV and HCV in 0.4%, and HIV and HCV in 0%. This underscores the importance of routine screening of blood before transfusion, regardless of the donor background

Nosocomial and community acquired urinary tract infections at a teaching hospital in north central Nigeria: findings from a study of 12,458 urine samples.

BACKGROUND: Urinary tract infection (UTI) is still a problem not infrequently encountered in the course of clinical practice. This study was designed to ascertain its prevalence among both the in and out-patients and the antibiotic susceptibility pattern of the isolates. METHOD: A retrospective analysis of data from all the urine samples processed at Jos university teaching hospital microbiology laboratory was undertaken for a period of 36 months (January 2000-December 2002). Samples had been collected, stored and processed by standard laboratory procedures. Results obtained were analysed using SPSS 11 statistical software and P values < 0.05 were considered significant. RESULTS: Of the 12,458 urine samples studied comprising 43% males and 57% females: the overall prevalence of UTI was found to be 22%; 7.4% among males and a higher figure of 14.6% among females, this was statistically significant (p < 0.05). The rate of nosocomial UTI was significantly higher than the community acquired type: 12.3% and 9.3% respectively (p < 0.05). The commonest nosocomial isolate was Klebsiella spp while Escherichia coli were for community acquired group. Staphylococcus aureus, Coagulase negative Staphylococcus, Proteus spp and Pseudomonas aeruginosa were also common isolates. The most effective antibiotics were Ofloxacin, Ciprofloxacin and Cefuroxime. CONCLUSION: In-patients especially should be encouraged to drink adequate water daily and practice "double urination" to reduce incidence of UTL. Ofloxacin, Ciprofloxacin and Cefuroxime should be considered first in the treatment of UTI in the absence of a susceptibility test.

Human immunodeficiency virus infection in a rural community of plateau state: effective control measures still a nightmare?

BACKGROUND: This study was designed to find out the prevalence of human immunodeficiency virus (HIV) infection in Zawan village as well as their socio-cultural practices that promote its spread. METHODS: Three hundred subjects were recruited into the study comprising 193 males and 107 females by a simple random sampling method. A structured questionnaire was administered to each respondent and 5mls of blood collected and assayed for anit-HIV antibodies. The results were analysed using statistical software Epi-Info version 6, P < 0.05 was considered significant. RESULTS: The prevalence of HIV in Zawan village was found to be 8.3% (25 out of 300) and the significant risk factors noted were--use of sharp objects, trading and the divorce/separated group, (P < 0.05). Other factors such as tattooing, male circumcision by traditional method and tonsillectomy were not found to be statistically associated with HIV infection in this community, (P > 0.05). CONCLUSION: HIV is still causing serious devastation in our rural communities. Hence government should supply affordable antiretroviral drugs to our rural dwellers, step up public enlightenment campaign and pursue with vigour the present micro-economic revival policies to alleviate abject poverty in our rural communities.

Bacteriology of urinary tract infection among patients with acquired immunodeficiency syndrome in Jos, Nigeria.

BACKGROUND: The study was set to find out the bacterial agents causing urinary tract infection (UTI) in acquired immunodeficiency syndrome (AIDS) patients. METHODS: Two hundred patients with AIDS on admission at the Jos University Teaching Hospital (JUTH) were recruited into this study. Urine sample was collected from each patient and processed. Other information was obtained with protocol questionnaire. The results were analyzed using Epi Info 6. RESULTS: The prevalence of UTI in AIDS patients was found to be 24% and control 10.6%. Escherichia coli were the commonest Gram-negative isolate followed by Klebsiella species. Enterococcus species was the commonest Gram-positive organism. CONCLUSION: There should be extreme caution whenever the need arises to catheterize AIDS patients.

Hepatitis B virus infection in a rural settlement of northern Nigeria.

BACKGROUND: Hepatitis B virus (HBV) infection has been present in our communities for quite sometime now. However, majority of the people especially in rual areas are not aware of its devastating effects as adjudged by their socio-cultural practices. METHODS: Three hundred randomly selected residents of Zawan community (comprising 193 males and 107 females) were screened for hepatitis B surface antigen (HBsAg) presence in their sera. Other information was obtained with the aid of a structured questionnaire and results analysed using Epi Info 6 statistical software. RESULTS: The prevalence of HBV in Zawan village was found to be 12.6% (9% among males and 3.6% among females). The risk factors associated with HBV transmission were tonsillectomy, tattooing, use of sharp objects as well as trading. Marital status was also found to be a significant risk factor as there was a high prevalence of HBV infection among the widowed/divorced/separated group. CONCLUSION: HBV infection is endemic in our rural communities just as it is in the urban areas and efforts should be made to step up its health education campaign as well as the interventional mechanisms including immunization.

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

Multiple drug resistant strains of Shigella isolated in Jos, central Nigeria.

The objective of this study is to highlight the alarming rise in antimicrobial resistance among Shigella species in Jos, Plateau State. Stool samples of eight hundred and ten patients who presented at the Jos University Teaching Hospital with diarrhoea/dysentery were analysed using standard bacteriological techniques. The antimicrobial susceptibility of the isolates were determined. 25 Shigella species were isolated representing 3.1% isolation rate. The male to female ratio is 1.3:1, children aged 0-10 years constituted 16(64%) of the cases. Shigella flexneri (48%) was the most common sero-group. This was followed by S. boydii (24%), then S. sonnei (20%), and S. dysenteriae (8%). Most strains of shigella species were resistant to Ampicillin (96.0%). Chloramphenicol (96.0%), Cotrimoxazole (88%), Nalidixic acid (84%) and Tetracycline (75%). All strains were found to be sensitive to Ciprofloxacin. The drugs of choice in the treatment of Shigella infection in this environment should be Ciprofloxacin and Ofloxacin. Gentamicin was the third drug of choice its use is limited since the infection is not systemic. To avoid continuous abuse of antibiotics in our country there should be an effective legislation by the government to control the indiscriminate purchase of antibiotics.

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.