Full autopsy in a confirmed COVID-19 patient in Lagos, Nigeria - A case report.

OBJECTIVES: To report the postmortem findings of a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positive individual who died in Lagos (Nigeria) in June 2020 and to investigate the cause, pathogenesis as well as pathological changes noticed during the examination. METHODS: Complete postmortem examination was performed according to standard procedures in a regular autopsy suite using personal protective equipment including N95 masks, goggles and disposable gowns. The diagnosis of coronavirus disease 2019 (COVID-19) was confirmed by real-time reverse transcription polymerase chain reaction (RT-PCR) testing on postmortem nasopharyngeal swabs. RESULTS: A 47-year-old man with a medical history of well controlled hypertension and dyslipidaemia died after long hours of transportation for medical care in a hospital in Lagos. He tested positive for SARS-CoV-2 on ante- and postmortem nasopharyngeal swabs. Autopsy revealed pneumonia with diffuse alveolar damage, disseminated intravascular coagulopathy and hypovolaemic shock. CONCLUSIONS: Autopsy can be performed on decedents who died from or with SARS-CoV-2 infection in a low resource environment such as ours. A standard autopsy room was used while deploying recommended infection prevention control and regular decontamination. The clinical details, autopsy findings such as diffuse alveolar damage and airway inflammation were consistent with a COVID-19 related pathology. While the decedent had 'controlled' co-morbidity, he succumbed to multi-organ failure occasioned by shock and disseminated intravascular coagulopathy.

A prospective randomized comparative study of targeted versus empirical prophylactic antibiotics in the prevention of infective complications following transrectal ultrasound-guided prostate biopsy.

Background: It is established that antibiotic prophylaxis prevents infection following transrectal ultrasound-guided prostate biopsy. This study compares the infective complications in transrectal prostate biopsy (TRPB) in empirical versus targeted prophylactic antibiotics. Patients and Methods: Urine and rectal swabs were obtained prior to TRPB. They were randomized into targeted antibiotic (TA) and empirical antibiotic (EA) groups. TA had prophylactic antibiotics according to rectal swab culture, whereas EA had the standard parenteral ciprofloxacin. They were followed up weekly for 4 weeks. Chi-square or Fisher's exact tests were used to compare categorical variables, Student's "t"-test was used to compare means of numerical variables, and P < 0.05 was considered statistically significant. Results: One hundred patients were studied, fifty in each group. The mean age was 66 years, with men aged 60-69 years accounting for 50% of the study population. Providencia stuartii, Escherichia coli, and Citrobacter freundii were the most predominant bacteria identified in the prebiopsy rectal swab culture, with resistance to ciprofloxacin (57%) being much more common than that to levofloxacin (21%). Postbiopsy infection occurred in one (2%) patient in the TA group and five (10%) patients in the EA group. Difference in the infection rate between the two groups was statistically significant (P = 0.042). Three of the patients with postbiopsy infection in the EA group had urosepsis and required hospitalization. Fluoroquinolone-resistant bacteria were responsible for infection in all the six patients. TA reduced the risk of postbiopsy infection by 5.6 folds. Conclusion: TA was associated with a decreased risk of infection in TRPB.

RésuméContexte: Il est établi que la prophylaxie antibiotique prévient l'infection après une biopsie transrectale guidée par une échographie de la prostate (TRPB). Cette étude compare les complications infectieuses liées au TRPB entre antibiotiques prophylactiques empiriques et ciblés. Patients et méthodes: Des écouvillons urinaires et rectaux ont été obtenus avant le TRPB. Ils ont été randomisés en groupes d'antibiotiques ciblés (TA) et d'antibiotiques empiriques (EA). TA avait des antibiotiques prophylactiques selon la culture sur écouvillon rectal, alors que EA avait la ciprofloxacine parentérale standard. Ils ont été suivis chaque semaine pendant quatre semaines. Les tests exacts du chi carré ou de Fischer ont été utilisés pour comparer les variables qualitatives, le test de l'étudiant a été utilisé pour comparer la moyenne des variables numériques et P <-0,05 a été considéré comme statistiquement significatif. Résultats: Cent patients ont été étudiés; 50 dans chaque groupe. L'âge moyen était de 66 ans, les hommes de 60 à 69 ans représentant 50% de la population étudiée. Providencia Stuartii, Escherichia Coli et Citrobacter Freundii étaient les bactéries les plus prédominantes identifiées dans la culture du prélèvement rectal avant biopsie, la résistance à la ciprofloxacine (57%) étant beaucoup plus commune qu'à la lévofloxacine (21%). Une infection après la biopsie s'est produite chez 1 patient (2%) du groupe TA et 5 patients (10%) du groupe EA. La différence de taux d'infection entre les deux groupes était statistiquement significative (p = 0,042). Trois des patients présentant une infection post-biopsie dans le groupe EA présentaient une urosepsie et devaient être hospitalisés. Des bactéries résistantes à la fluoroquinolone étaient responsables de l'infection chez les six patients. L'AT réduit le risque d'infection après la biopsie de 5,6 fois. Conclusion: L'AT était associée à une diminution du risque d'infection dans le TRPB.

A prospective randomized comparative study of targeted versus empirical prophylactic antibiotics in the prevention of infective complications following transrectal ultrasound-guided prostate biopsy

Background: It is established that antibiotic prophylaxis prevents infection following transrectal ultrasound-guided prostate biopsy. This study compares the infective complications in transrectal prostate biopsy (TRPB) in empirical versus targeted prophylactic antibiotics. Patients and Methods: Urine and rectal swabs were obtained prior to TRPB. They were randomized into targeted antibiotic (TA) and empirical antibiotic (EA) groups. TA had prophylactic antibiotics according to rectal swab culture, whereas EA had the standard parenteral ciprofloxacin. They were followed up weekly for 4 weeks. Chi-square or Fisher's exact tests were used to compare categorical variables, Student's "t"-test was used to compare means of numerical variables, and P < 0.05 was considered statistically significant. Results: One hundred patients were studied, fifty in each group. The mean age was 66 years, with men aged 60­69 years accounting for 50% of the study population. Providencia stuartii, Escherichia coli, and Citrobacter freundii were the most predominant bacteria identified in the prebiopsy rectal swab culture, with resistance to ciprofloxacin (57%) being much more common than that to levofloxacin (21%). Postbiopsy infection occurred in one (2%) patient in the TA group and five (10%) patients in the EA group. Difference in the infection rate between the two groups was statistically significant (P = 0.042). Three of the patients with postbiopsy infection in the EA group had urosepsis and required hospitalization. Fluoroquinolone-resistant bacteria were responsible for infection in all the six patients. TA reduced the risk of postbiopsy infection by 5.6 folds. Conclusion: TA was associated with a decreased risk of infection in TRPB

Typhoid Fever: Tracking the Trend in Nigeria.

Typhoid fever continues to pose a serious health challenge in developing countries. A reliable database on positive blood cultures is essential for prompt interventions. To generate reliable data on Salmonella enterica serovar Typhi (S. Typhi)-positive blood culture trends in typhoidal Salmonella in Nigeria alongside changing contextual factors and antimicrobial resistance patterns, a retrospective cohort study was conducted in two hospitals in Lagos between 1993 and 2015. Medical records of typhoid patients were reviewed for positive culture and antibiogram, using standard procedures and analyzed. Additional data were retrieved from a previous study in seven facilities in Abuja and three hospitals in Kano from 2008 to 2017 and 2013 to 2017, respectively. A declining trend in percent positivity of S. Typhi was observed in Abuja with more erratic trends in Lagos and Kano. In Lagos, more than 80% of the isolates from the entire study period exhibited multiple drug resistance with a generally increasing trend. Of the chosen contextual factors, improvements were recorded in female literacy, access to improved water supply, diarrheal mortality in children younger than 5 years, gross domestic product, and poverty while access to improved sanitation facilities decreased over time nationally. Typhoid fever still poses a serious health challenge in Nigeria and in antibiotic resistance, and is a major health security issue. A combined approach that includes the use of typhoid vaccines, improvements in sanitation, and safe water supply is essential.