Healing Potentials of Nigerian Bee Propolis on Meticillin- Resistant Staphylococcus Aureus Infected Skin Wound of Wistar Rats

This study evaluated the effects of Nigerian Bee Propolis extract on Methicillin Resistance Staphylococcus Aureus (MRSA) infected skin wounds of albino rats. Two full thickness circular wounds were created each on the dorsum of eighteen (18) healthy adult male albino rats with mean body weight of 126±7.09g. Each wound was contaminated with 108 colony forming unit of MRSA. The rats were then randomized into three (3) treatment groups (n=6) with topical application of Propolis extract (PE Group), Silver sulphadiazine (SS Group) and untreated Control (UT Group). Gross wound healing indices (exudation, edema, hyperemia, wound contraction), histopathologic (granulation, angiogenesis, fibroplasia, epithelialization) and immunologic healing indices were evaluated using standard methods. Bacteria clearance was through culture and quantification. The wound surface exudation and edge edema and hyperemia were prominent in all the groups from day 0 to 6 but persisted in the untreated group till day 12. Wound contraction was gradual in all the groups from day 0-18, it was higher between days 0 and 3 in the PE and SS than the UT group (P<0.05). Complete wound closure occurred on SS (day 15), and PE (day 16). The histopathological changes observed showed neutrophils regressed on day 6 to 18 in all groups and was faster in PE and SS groups (P<0.05). Platelets reduction was ` gradual from days 3 to 18 in all groups and was absent from days 6 to 18 in the PE group. Nigerian Bee propolis has a profound bacteria clearance and healing effect on wound infected with methicillin resistant staphylococcus aureus (MRSA) comparable to silver sulphadiazine and therefore recommended for infected wound treatment.

A community-based surveillance of gastrointestinal helminthiasis among pregnant women in Ibadan, South West Nigeria.

BACKGROUND: : Intestinal helminthiasis is a major public health problem in Africa. Helminthic infection in pregnant women causes loss of appetite, poor nutrient absorption, gastrointestinal impairment, iron deficiency, and iron deficiency anemia resulting in low birth weights and preterm births. The main aim of this study is to assess the prevalence of helminthic infections in pregnant women in rural and peri-urban communities of Ibadan. MATERIALS AND METHODS: : A cross-sectional descriptive study was carried out at the antenatal clinics of 12 selected primary health centers and mission homes in Ibadan, Nigeria. Open- and closed-answer questionnaires were administered to 604 consenting pregnant women, who provided fresh stool samples for microscopy. Helminthic quantification was carried out by the Kato-Katz technique. Proportions were compared using Chi-squared with IBM® SPSS® Statistics 21 for analysis. Statistical significance was set at P < 0.05. RESULTS: : Eighty-nine stool samples (14.7%) were positive for helminthiasis. Most had roundworms (13.6%); 13 (2.2%) had hookworms. The mean arithmetic eggs per gram of feces were 2,124 and 248, respectively. No participant had a heavy intensity infection; nearly all were of low intensity. Participants (P = 0.005) and their husbands (P = 0.005) who had higher education were less likely to have helminthiasis. CONCLUSION: These communities are classified as Category III, having a low prevalence and low intensity infection. Therefore, prophylactic anti-helminthic treatment in pregnancy is not recommended. The inverse relationship with education may be a function of better living conditions. Better hygiene should be advocated.

PATTERN OF MULTIDRUG RESISTANT BACTERIA ASSOCIATED WITH INTENSIVE CARE UNIT INFECTIONS IN IBADAN, NIGERIA.

BACKGROUND: Patients admitted into the intensive care unit (ICU) usually have impaired immunity and are therefore at high risk of acquiring hospital associated infections. Infections caused by multidrug resistant organisms now constitute a major problem, limiting the choice of antimicrobial therapy. OBJECTIVES: This study was aimed at determining the antimicrobial resistance pattern of pathogens causing ICU infections in University College Hospital (UCH), Ibadan, Nigeria. The aetiological agents, prevalence and types ICU infections were also determined. METHODS: One year hospital associated infections surveillance was conducted in the ICU of UCH, Ibadan. Blood, urine, tracheal aspirate and wound biopsies specimens were collected under strict asepsis and sent to the Medical Microbiology laboratory of the same institution for immediate processing. All pathogens were isolated and identified by standard microbiological methods. Disk diffusion antibiotic susceptibility testing was performed and interpreted according to Clinical and Laboratory Standards Institute (CLSI) guidelines. RESULTS: The overall prevalence of ICU infections was 30.9% out of which 12.9% were bloodstream infections, 31.5% urinary tract infections, 38.9% pneumonia, and 16.7% skin and soft tissue infections. Klebsiella species andEscherichia coli were the predominant pathogens. Multidrug resistant organisms constituted 59.3% of the pathogens, MDR Klebsiella spp and MDR E. coli were 70.8% and 71.4% respectively. Resistance to Cefuroxime was the highest (92.9%) while Meropenem had the least resistance (21.4%). CONCLUSION: There is a high prevalence of multidrug resistant bacteria causing ICU infections. Application of more stringent infection control procedures and institution of functional antimicrobial stewardship are recommended to combat this problem.

Drug resistance profiles of new- and previously treated patients with pulmonary tuberculosis in Ibadan, Nigeria.

BACKGROUND: Information on TB drug resistance profiles and its' associated risk factors are scarce in Nigeria despite the large burden of disease in the country. The study was designed to report drug resistance profiles of new- and previously treated patients with pulmonary tuberculosis (TB) in Ibadan, Nigeria. METHOD: Sputum from consenting pulmonary TB patients were collected and cultured for Mycobacterium tuberculosis (Mtb) at the TB laboratory of the University College Hospital, Ibadan, Nigeria using standard method. Mtb were stored and sent for drug susceptibility testing against first and second-line anti-TB drugs at the MRC Unit, The Gambia and at the Institute of Tropical Medicine, Antwerp, Belgium using BACTEC MGIT 960 and proportion method on solid medium respectively. RESULTS: Of 238 Mtb collected, 124 (52.1%) were viable, 102 (59.65%) non-viable while 12 (7.02%) were contaminated. About half (58.87%) of the Mtb were from previously treated patients, 40 (32.26%) were from new patients while treatment history of 1.1 (8.87%) were unknown. Forty-seven (37.90%) of the 124 Mtb. tested were multidrug resistant (MDR) out of which, 40 (85.10%) were from previously treated patients.. HIV prevalence was 8.69%. Of the 17 MDR-TB from previously treated cases tested for second-line drugs, four (23.53%) were resistant to fluoroquinolones or injectable agents, 13 (76.47%) were susceptible while none was resistant to both of these classes of drugs. CONCLUSION: MDR-TB in Ibadan already demonstrates resistance to second line anti-TB drugs hence management of MDR-TB patients should be strengthened to prevent emergence of extensively drug-resistant TB (XDR-TB).

Anti-tuberculosis activities of the crude methanolic extract and purified fractions of the bulb of Crinum jagus.

Tuberculosis (TB) is of great public health burden globally especially in developing countries of Africa and Asia . Current TB regimen involves multiple therapies and of long duration leading to poor patient adherence. There is also the challenge of multidrug resistant TB. Hence, there is a need for discovery of new anti- TB drugs. This study was designed to investigate the in -vitro activity of the crude methanolic extract and chromatographic fractions of the bulb of Crinum jagus against Mycobacterium tuberculosis isolates. The extracts were screened for anti- TB activity against three different M. tuberculosis isolates and a drug susceptible reference strain H37Rv using Lowenstein Jensen (L-J) medium and Middlebrook 7H10agar. The crude extract was prepared using soxhlet extraction apparatus while the purified fractions were obtained by column chromatography. The two media were inoculated with M. tuberculosis strains, after which the crude and purified extracts were added. After 4-6 weeks incubation, colony forming units were counted and percentage inhibition calculated. The crude extract and the purified fractions showed inhibitory activity on all the isolates tested including the reference strain. Fraction 3 showed the highest inhibitory percentage (86%) among the extracts. At a concentration of 1.0mg/ml, the percentage inhibition of fraction 3, rifampicin and isoniazid against M. tuberculosis strain 3 were 83%, 95% and 86% in L-J medium respectively while 86%, 96% and 89% were obtained respectively in Middle brook medium. Results showed that the crude methanolic extract and the purified fractions of the bulb of Crinum jagus exhibited anti-mycobacterial activity which is an indication of promising potential of this plant for the development of anti-tuberculosis agent.

Molecular diagnosis of MDR-TB using GenoType MTBDRplus 96 assay in Ibadan, Nigeria.

Multidrug resistant Mycobacterium tuberculosis (MDR-TB) is of great public health importance worldwide. This three month laboratory- based study (1st September-30th November, 2011) was carried out at the TB laboratories of the University College Hospital, Ibadan, Nigeria to determine the magnitude of MDR-TB using molecular based GenoType MTBDRplus 96 assay. Two sputum samples were collected from each subject. These were processed using Ziehl -Neelsen (ZN) reagents. The sputa were cultured on Loewenstein-Jensen egg -based medium and incubated at 370C for eight weeks. Mycobacterium tuberculosis complex (MTBC) was confirmed by colonial morphology and repeat ZN staining. All the Acid-fast bacill (AFB) positive smears and culture positive isolates were tested for genetic identification and drug susceptibility testing (DST) using PCR- based GenoType MTBDRplus 96 assay (HAINs Lifesciences, GmbH, Nehren, Germany) according to manufacturers' instructions. Of the 68 samples processed, 11 (16.2%) were AFB positive while six (8.8%) were positive for culture. Eleven (64.7%) out of the 17 samples tested for genetic identification were MTBC while six were Non Tuberculosis Mycobacteria (NTM). All NTM were from AFB positive sputum while none was from culture positive isolates. Of the six culture isolates tested for DST, three (33.3%) were susceptible to isoniazid and rifampicin; one (16.7%) showed mono-resistance to isoniazid while two (30.0%) were resistant to the two drugs. This study shows that MDR-TB is present in Ibadan. There is a need to make DST diagnostic facilities more available and accessible in Nigeria.

Pulmonary tuberculosis among health care workers at two designated DOTS Centers in urban city of Ibadan, Nigeria.

BACKGROUND & OBJECTIVES: Tuberculosis (TB) infection control interventions are not routinely implemented in many Sub-Saharan African countries including Nigeria. This study was carried out to ascertain the magnitude of occupationally-acquired pulmonary TB (PTB) among health care workers (HCWs) at two designated DOTS centers in Ibadan, Nigeria. METHODS: One year descriptive study (January-December 2008) was carried out at the University College Hospital and Jericho Chest Hospital, both located in Ibadan, Nigeria. A pre-tested questionnaire was used to obtain socio-demographic data and other relevant information from the subjects. Three sputum samples were collected from each subject. This was processed using Zeihl-Neelsen (Z-N) stains. One of the sputum was cultured on modified Ogawa egg medium incubated at 37 ° C for six weeks. Mycobacterium tuberculosis was confirmed by repeat Z-N staining and biochemical tests. RESULTS: A total of 271 subjects, 117 (43.2%) males and 154 (56.8%) females were studied. Nine (3.3%) had their sputum positive for acid fast bacilli (AFB) while six (2.2%) were positive for culture. The culture contamination rate was 1.8 per cent. Significantly, all the six culture positive samples were from males while none was obtained from their female counterparts. About half of the AFB positive samples were from subjects who have spent five years in their working units. Eight AFB positive cases were from 21-50 yr age group while students accounted for seven AFB positive cases. INTERPRETATION & CONCLUSIONS: The study shows that occupationally-acquired PTB is real in Ibadan. Further studies are needed to ascertain and address the magnitude of the problem.

Risk factors for pulmonary tuberculosis among health-care workers in Ibadan, Nigeria.

Data on TB infection control programs is limited in many of the TB high burden countries. We carried out a one-year cross sectional epidemiological study (January-December, 2008) to determine the prevalence of occupationally-acquired pulmonary tuberculosis (PTB) among Health- Care Workers (HCWs) in Ibadan, Nigeria. This information is important for planning preventive strategies. All consenting HCWs at two TB centres in Ibadan--the University College Hospital (UCH) and Jericho Chest Hospital were enrolled into the study. A well structured questionnaire was used to obtain information on socio-demographic characteristics of the subjects including their medical and social data. Three sputum samples collected from each subject were processed for acid-fast bacilli (AFB) and culture on selective medium. Isolates were confirmed as M. tuberculosis by standard biochemical tests. Of the 271 subjects recruited, nine (3.3%) had their sputum positive for AFB while six (2.2%) were positive for culture. Subjects aged 20 years and above, female gender and unskilled professionals had higher risk for occupationally-acquired PTB than those who were 20 years and below, male gender and skilled professionals (Odd Ratio OR = 1.9, 95% Confidence Interval, 95% CI = 0.23-16.3, Fisher's exact P = 0.37; OR = 1.1, 95% CI = 0.28-4.0, p = 0.01; OR = 1.05, 95% CI = 1.02-1.08, p = 3.43) respectively. Multivariate logistic regression analysis showed that subjects who received BCG vaccination were less likely to have occupationally-acquired PTB than those without vaccination (OR = 0.86, 95% CI = 0.20-3.6, p = 0.83 for microscopy; OR = 0.76, 95% CI = 0.13- 0.44, p = 0.76 for culture). Even though the risk for occupationally-acquired PTB was lower in subjects who had not spent up to two years in their units, the association was not statistically significant (OR = 0.84, 95% CI = 0.20-3.5, p = 0.82 for microscopy and OR = 1.21, 95% CI = 0.22-0.65, p = 0.82 for culture). There is a need to develop and implement affordable and cost-effective TB infection control strategies in Nigeria in order to reduce the burden of occupationally-acquired PTB in the country.

Epidemiology of clinical isolates of Mycobacterium tuberculosis at Ibadan, Nigeria.

Despite the huge burden of tuberculosis (TB) in Nigeria, case detection rate of infectious cases still remain low, thus constituting obstacle to eradication of the disease in the community. We carried out a 15 month (1st January 2008 to 30th March 2009) retrospective review of epidemiology of clinical isolates of M. tuberculosis isolated at TB regional reference laboratory at the department of Medical Microbiology and Parasitology, University College Hospital, Ibadan, Nigeria. Fifty isolates were recovered from 720 specimens during the period of study with a recovery rate of 6.9%. Sixty- two (8.6%) of the specimens were contaminated. Thirty eight (76.0%) isolates were from the specimens of male subjects and 12 (24.0%) from female subjects giving a male to female ratio of 3.2: 1.0 Majority (62.0%) of the isolates were from subjects aged 20 years and above with an isolation rate of 7.3% while only two clinical isolates (4.0%) were recovered from specimens from children. A high yield of 20.8% was recovered from specimen collected from Hausa ethnic group who predominantly domiciled in a particular part of the metropolis. In terms of socio-economic status, clinical isolates recovered from specimens from unskilled workers (76.0%) was more than thrice from that obtained from the professionals (24.0%). Seven (14.0%) of the total isolates were recovered from extra-pulmonary lesions while the majority 43 (86.0%) were for pulmonary TB. The isolation rate from children and extra-pulmonary sites are low. This suggests a need to pay more attention to diagnosis of childhood and extra-pulmonary TB in Ibadan, Nigeria.

Risk factors for pulmonary tuberculosis among health-care workers in Ibadan, Nigeria

Data on TB infection control programs is limited in many of the TB high burden countries. We carried out a one-year cross sectional epidemiological study (January-December, 2008) to determine the prevalence of occupationally-acquired pulmonary tuberculosis (PTB) among Health- Care Workers (HCWs) in Ibadan, Nigeria. This information is important for planning preventive strategies. All consenting HCWs at two TB centres in Ibadan--the University College Hospital (UCH) and Jericho Chest Hospital were enrolled into the study. A well structured questionnaire was used to obtain information on socio-demographic characteristics of the subjects including their medical and social data. Three sputum samples collected from each subject were processed for acid-fast bacilli (AFB) and culture on selective medium. Isolates were confirmed as M. tuberculosis by standard biochemical tests. Of the 271 subjects recruited, nine (3.3%) had their sputum positive for AFB while six (2.2%) were positive for culture. Subjects aged 20 years and above, female gender and unskilled professionals had higher risk for occupationally-acquired PTB than those who were 20 years and below, male gender and skilled professionals (Odd Ratio OR = 1.9, 95% Confidence Interval, 95% CI = 0.23-16.3, Fisher's exact P = 0.37; OR = 1.1, 95% CI = 0.28-4.0, p = 0.01; OR = 1.05, 95% CI = 1.02-1.08, p = 3.43) respectively. Multivariate logistic regression analysis showed that subjects who received BCG vaccination were less likely to have occupationally-acquired PTB than those without vaccination (OR = 0.86, 95% CI = 0.20-3.6, p = 0.83 for microscopy; OR = 0.76, 95% CI = 0.13- 0.44, p = 0.76 for culture). Even though the risk for occupationally-acquired PTB was lower in subjects who had not spent up to two years in their units, the association was not statistically significant (OR = 0.84, 95% CI = 0.20-3.5, p = 0.82 for microscopy and OR = 1.21, 95% CI = 0.22-0.65, p = 0.82 for culture). There is a need to develop and implement affordable and cost-effective TB infection control strategies in Nigeria in order to reduce the burden of occupationally-acquired PTB in the country

Upper lid skin bacterial count of surgical eye patients in Ibadan, Nigeria.

Infective endophthalmitis can follow contamination from eyelid of surgical eye patients. Information about peri-ocular skin bacterial isolates and their determinants would help in planning appropriate interventions. This study aimed to determine the upper lid skin bacterial count and factors related to high counts if any, among surgical eye patients. A cross section of consenting new surgical eye patients seen at the Eye clinic of the University College Hospital Ibadan between May and July 2006 was studied. They were interviewed with a standard questionnaire, and swab of the upper eyelid skin taken. Specimens were Gram-stained, bacterial counts and culture were carried out using standard techniques. A total of 80 subjects were studied, age range 13 to 87 years (mean 57.8 +/- 15.8) years. Females were 42 (52.5%) while males were 38 (47.5%). Bacterial culture was obtained from 76 (95.0%) of those studied, with 24 (30.0%) having Staphylococcus aureus sensitive to gentamycin and amoxicillin + clavulanic acid combination while 52 (65.0%) had coagulase negative Staphylococcus. The mean bacterial count was 218 +/- 321 colony forming units (CFUs) per ml. Higher bacterial counts (> 50 CFUs per ml) were found amongst non-literates, patients older than 60 years of age, and male gender. Older age and male gender remained significantly associated with a high bacterial count using the logistic regression model (OR = 4.9, P = 0.03 and OR = 8.06, P = 0.005 respectively). The conclusion reached was that risk of having positive bacterial culture from the upper lid skin increases with older patient age and male sex of eye surgery patients. Adequate care should be taken to ensure proper skin preparation of elderly and male patients to prevent contamination of operation site.

Bacteriology of non-surgical wound infections in Ibadan, Nigeria.

Previous studies done on wound infections in this environment had been mostly on the surgical variety rather than the non-surgical. However,few studies available on the non-surgical type have indicated that changes do occur in the pattern and antibiogram of the bacterial isolates of these non-surgical wound infections. This study was therefore designed to investigate the bacteriology of non-surgical wound infections in this environment. A retrospective review of seven hundred and fifty four cases of non-surgical wound infections was conducted between September 2002 and February 2005 at the University College Hospital, Ibadan, Nigeria. A total number of 871 bacterial, and seven fungal isolates were obtained from these wound cultures. In 477 (70.3%) cases, cultures were monomicrobial and 202 (29.8%) polymicrobial. Staphylococcus aureus (38%) was the predominant pathogen, followed by Pseudomonas aeruginosa (18.7%), Klebsiella species (17%), Escherichia coli (10.6%), Proteus species (7.4%), Staphylococcus epidermidis (4.4%), Streptococcus species (1.6%), Enterococcus faecalis (1.4%), and Candida albicans (0.8%). High rates of antibiotic resistance were recorded among these isolates. 53.4% of them were sensitive to ceftriaxone, 42.5% to gentamycin and 39.3% to ofloxacin. This high antibiotic resistance gives credence to the value of determining the antibiogram of these pathogens in their management. Continuous interaction between the wound care practitioners and microbiology department is also advocated.

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.

Case report: extra pulmonary tuberculosis in sickle cell disease.

In apparently healthy individuals, tuberculosis (TB) affects mainly the lungs however, worsening immune status tend to predispose to an increased tendency for extra-pulmonary tuberculosis (EPTB). We report the case of a 22 year old known sickle cell anaemia (HBS) female student with three-month history of bilateral hip pain, weight loss and swelling of the left hip with multiple discharging sinuses, paraplegia and recurrent fever. There was no preceding history of trauma. Full Blood Count (FBC) revealed leukocytosis with neutrophilia, monocytosis, thrombocytosis and Packed Cell Volume (PCV) of 23%. Erythrocyte sedimentation rate (ESR) was 120mm/Hr (Western Green) and retroviral screening was negative. Bacteriologic culture of the discharging sinuses grew Escherichia coli and Staphylococcus aureus, both sensitive to sparfloxacin. Smear microscopy for acid-fast-bacilli (AFB) was negative. Chest X-Ray was reported normal but X-Ray of the pelvis showed loss of L4/L5 disc space and appearances suggestive of avascular necrosis of the femoral heads. Clinical and haematological profile of the patient started to improve by the second month on therapeutic trial of anti-TB regimen. She had nine-month course of therapy and later discharged to physiotherapy clinic. Management of EPTB requires a high index of clinical suspicion and well-equipped laboratory to support the diagnosis. Therefore, this case report highlights the need to upgrade TB-diagnostic facilities in this environment.

STI/HIV co-infections in UCH, Ibadan, Nigeria.

Sexually transmitted infections (STIs) are poorly recognised and inadequately treated in Nigeria in spite of the fact that it constitutes a major risk for HIV transmission. This study was carried out to ascertain STI/HIV co-infection rate and to obtain relevant socio-demographic and reproductive health data associated with STIs. This information is urgently needed for designing STI/HIV control strategies. All consenting patients with history suggestive of STI, who attended STI clinic at the University College Hospital, Ibadan, between March and November 2001 were enrolled in the study. Of the 210 patients seen, 98 (46.7%) were males while 112 (53.3%) were females (p > 0.05). One hundred and fifty six (74.3%) of them were aged 20-39 years while only 10 (5.1%) were adolescents. Twenty (9.5%) had laboratory diagnosis of STIs, out of which 6 (30%) were also HIV positive. Among those with STIs, 8 (40%) had gonorrhoea, 8 (40%) had candidiasis, while 4 (25%) were positive for Trichomonas vaginalis. None of the patients' sera was positive for Treponema palladium antibody HIV prevalence rate in the study was 21.9%. Highest rate was found in patients aged 20-29 years while no adolescent and no one over 50 years old was HIV positive. Five (62.5%) of the patients with gonorrhoea were also HIV positive, a lower percentage (25%) of those with trichomoniasis were positive for HIV, while none of those infected with candidiasis was HIV positive. STI/HIV co-infection rate was 30%. This study reveals a high STI/HIV co-infection rate, indicating that there is a need for proper management of STIs as a way of reducing the spread of HIV infection in Nigeria.

Risk factors for HIV infection among special treatment clinic attendees in Ibadan, Nigeria.

Control of sexually transmitted infections (STIs) is an important factor in the prevention of sexual transmission of HIV infection. Despite a close link between the two disease entities, not enough data are however available on risk factors for HIV infection among STI clinic patients in Nigeria. This information is important for planning preventive measures. All consenting patients that attended special treatment clinic (STC), University College Hospital (UCH), Ibadan from March to November 2001 were enrolled into the study. Using a structured interview assisted questionnaire, information on socio-demographic characteristics, sexual and reproductive history and other potential risk factors for HIV infection were obtained. Urethral swab, endocervical swab and high vaginal swab were also obtained and processed by standard laboratory methods. HIV tests were carried out by double ELISA tests. Of the 210 subjects, 180 (85.7%) were diagnosed as having STI while 46 (21.9%) screened positive for HIV. Co-infection was found in 41(19.5%) of all subjects. The risk of HIV was higher in subjects with STIs. Multivariate logistic regression analysis indicated that subjects who were not infected with gonorrhoea (OR = 0.685, 95% CI = 0.47- 0.99, p = 0.045) and those with negative history of blood transfusion (OR= 0.1,95% CI = 0.02-0.5, p=0.009) were less at risk of HIV infection while those with lower occupation had a higher risk (OR = 1.126,95% CI = 0.32-3.9, p = 0.085). The results of this study emphasize the need for adequate management of STIs and the importance of upgrading blood transfusion services in order to curtail the spread of HIV infection.

Acute phase proteins, trace elements in asymptomatic human immunodeficiency virus infection in Nigerians.

The natural history of Human Immunodeficiency Virus (HIV) infection is incompletely understood. Factors other than HIV infection alone may be required for the development of the profound immunosuppression that characterizes advanced HIV disease. Nutritional status plays an important role in maintaining normal immunity and thus may be one of these factors. The plasma concentrations of C-reactive protein, transferrin, selected trace elements (Mg, Zn, Fe, Cu, Cd, Se and Cr,), total protein and albumin were determined in 25 asymptomatic HIV-infected Nigerian subjects and 30 age matched HIV-seronegative controls using single radial immunodiffusion and spectrophotometric methods. The mean values of Cu (73.2 + 23.9 microg/dl), Mg (9.83 + 5.5 mg/dl), Fe (126 + 21 microg/L), Cd (24.6 + 7.2 microg/L), Se (22.0 + 12.2 microg/dl) and Cr (19.0 + 5.2 microg/L) were low in asymptomatic HIV-positive subjects when compared with the controls (Cu = 119.3 + 30.8 microg/dl; Mg = 14.5 + 4.6 mg/L; Fe = 155 + 8.8 microg/ dl; Cd = 33. 1 + 8.3 microg/L; Se = 30.9 + 8.3 microg/dl; Cr = 32.1 + 7.8 microg/ L). The level of Zn was similar in asymptomatic HIV-positive subjects (5.1 + 1.9 mg/dl) and the controls (4.6 + 1.7mg/dl). The value of albumin in asymptomatic HIV-positive subjects (3.43 + 0.7 g/dl) was significantly low when compared with the controls (4.04 + 0.52 g/dl). Significant correlation existed between albumin and Mg in asymptomatic HIV subjects (r = + 0.758, p < 0.001). The mean value of C-reactive protein was significantly higher in HIV-infected subjects compared with the controls while the level of transferrin in HIV-infected subjects (92.86 + 26.3 mg/dl) did not show any significant difference when compared with the controls (84.36 + 16.9 mg/dl). This study revealed the deficiencies of trace elements in asymptomatic HIV infection and therefore suggests dietary supplementation of these trace elements in the infected subjects.

Ureaplasma urealyticum as a cause of non-gonococcal urethritis: the Ibadan experience.

Two hundred and eighteen men with confirmed urethritis were investigated for Ureaplasma urealyticum at the Special Treatment Clinic, University College Hospital, Ibadan between 5th January and 28th December 2000. Sixty-four (29.35%) of the 218 patients had gonococcal urethritis whilst 154 (70.65%) had non-gonococcal urethritis (NGU) out of which 22 (14.3%) had U. urealyticum urethritis and 10(6.5%) had Trichomonal urethritis. The difference in the occurrence of U. urealyticum between the patients and the control group was highly statistically significant (p<0.001). The age range of peak incidence among the patients investigated was 20-29 years. There was evidence of urethritis in all the 22 U. urealyticum positive cases as shown by the presence of increase in the number of polymorphonuclear leucocytes in the specimens collected. A significant difference in the nature of the urethral discharge in men with gonorrhoeae compared with U. urealyticum positive NGU patients was also demonstrated. Treatment of those patients found to be positive for U. urealyticum with a course of oral Tetracyline was successful but then the problems posed by the asymptomatic Ureaplasma urethritis still remained unanswered.

Penicillinase producing Neisseria gonnorhoeae: the review of the present situation in Ibadan, Nigeria.

All the isolates of Neisseria gonorrhoeae from patients that attended special treatment Clinic, University College Hospital, Ibadan, Nigeria between 15th January 1997 and 15th December 1999 were studied so as to review the present prevalence rate of penicillinase producing Neisseria gonorrhoeae (PPNG) in Ibadan. Of the 214 patients that had gonococcal infections, 161 were male (75.2%) and 53 (24.8%) were female. Ninety-two (57.1%) of the male and 28(52.8%) of the female were aged between 20- 29 years while 19.9% of the male and 15.1 % of the female were in the age of 40 and above. The sex difference is not statistically significant (chi2=2.19, df=3, p=0.53). The present study revealed that PPNG strains have increased dramatically to 98.6 per cent. This has posed a great threat to the usefulness of penicillin and ampicillin as the drugs of choice in gonococcal therapy in Nigeria.

Non-gonococcal urethritis due to Chlamydia trachomatis: the Ibadan experience.

Using a qualitative amplified enzyme-linked immunoassay, two hundred and eighty-nine male patients with symptoms and signs suggestive of urethritis were investigated for Chlamydia trachomatis as a cause of non-gonococcal urethritis (NGU). Ninety-one (31.49%) of the 289 male patients investigated had gonococcal urethritis whilst 198 (68.51%) had NGU out of which 112 (56.60%) had chlamydial urethritis and 14 (7.1%) had Trichomonal urethritis. Two (6.7%) of the control subjects had C. trachomatis in their urethral swabs. The difference in the occurrence of C. trachomatis between the patients and the controls was highly statistically significant (P<0.001). The age range of peak incidence among the patients investigated was 20-29 years. Thirteen of the men treated for gonorrhoea still had watery urethral discharge and irritation and were diagnosed as having post-gonococcal urethritis (PGU), eleven (84.6%) of whom had C. trachomatis demonstrated in their urethral swabs. We were able to demonstrate a significant difference in clinical symptoms in men with gonorrhoea and NGU but only a slight difference between men with chlamydia-positive NGU and chlamydia-negative NGU.