Changing susceptibility pattern of Neisseria Gonorrhoeae: A threat to management of sexually transmitted infections - Case series.

Gonorrhoea is a sexually transmitted infection (STI) that increases the risk of infection with human immunodeficiency virus (HIV) and causes infertility and urethral stricture. We describe three cases of sexually active men, otherwise stable, who presented with a history of painful micturition and creamy white, urethral discharge. A clinical diagnosis of gonococcal urethritis was made and confirmed by microscopy, culture and 16SrRNA. Antimicrobial susceptibility revealed resistance to all the antimicrobial agents tested including ceftriaxone. A dual therapy was initiated using ceftriaxone and azithromycin, but at a higher dose for the patient with multi-drug resistant (MDR) Neisseria gonorrhoeae. Patients did well and were followed up for 5 months. Contact tracing was done for their sexual partners. While it is also important for healthcare workers to familiarize themselves with current treatment guidelines for gonococcal urethritis, the place of clinical laboratory in the management of STIs, with molecular techniques and the need for surveillance for MDR Neisseria gonorrhoeae cannot be overemphasized.

Haematological and Immunological Parameters in Patients with Chronic Hepatitis B Infection in Zaria, Nigeria.

Hepatitis B virus (HBV) is one of the major causes of morbidity and mortality worldwide. The aim of this study was to determine the haematological and immunological parameters in patients with chronic HBV infection in Zaria, Nigeria. Twenty individuals with confirmed chronic HBV (CHB) infection constituted the subjects while 20 non-HBV-infected individuals were monitored as controls. The subjects were enrolled purposively from the Gastroenterology Clinic of the Ahmadu Bello University Teaching Hospital Shika, Zaria Nigeria. Four millilitres of blood samples were collected from each study participants. Full blood count was conducted using the Swelab Alfa Haematology Analyzer, while CD4+ T-Cell enumeration was performed using the Sysmex Partec CyFlow® Counter IVD flow cytometer according to the manufacturers' instruction. The mean (and standard deviation) age of the 20 participants with CHB was 32.7 (±10.1) years while that of the 20 HBV negative control participants was 30.0 (±7.8) years. Mann-Whitney test showed no significant difference between the two groups in their total WBC (p=0.6634) and granulocytes (p=0.2386). There was a significant increase in the monocytes count (p=0.0151) and a significant decrease in the lymphocytes count (p=0.0006) of patients with CHB compared to the healthy control. There was no significant difference in the mean CD4+ T-lymphocytes count between subjects and controls (p=0.0633). Unpaired Student t-test showed no significant difference between the two groups in the other haematological parameters. This study showed a significant increase in monocytes and decrease in lymphocytes, a phenomenon that characterize the sustenance of infection by immune evasion mechanism.

Seroprevalence of poliovirus antibodies amongst children in Zaria, Northern Nigeria.

BACKGROUND: Poliomyelitis is endemic in Northern Nigeria where there is continuous transmission of wild poliovirus 1 and 3 (WPV1 and 3) and circulating vaccine derived poliovirus 2 (cVDPV2) resulting in a high number of cases of children with acute flaccid paralysis. The seroprevalence of antibodies to polio serotypes which can be used to assess the immune status of children and the effectiveness of the vaccine against poliomyelitis is unknown, despite its endemicity in this part of the world. OBJECTIVE: This study aimed to determine the seroprevalence of poliovirus antibodies in children aged 1-10 years in Zaria, Northern Nigeria. METHODS: A descriptive, cross sectional, community based study was undertaken in Zaria, North Western Nigeria between 2008 and 2009. Two hundred and sixty-four (264) children aged 1-10 years were enrolled from two local government in Zaria by multistage random sampling method. Demographic data and polio immunisation history were retrieved from parents and caregivers by an interviewer administered questionnaire. Neutralising antibody titres to polioserotypes 1, 2 and 3 were assayed according to the WHO Manual for the virological investigation of polio. Antibody titres ≥ 1:8 were considered positive. RESULTS: The mean age of the 264 children studied was 6.25 years. Fifty-five percent of the children were protected against the three polioserotypes, while 86.4%, 76.1% and 77.3% of children had neutralising antibodies to P1, P2 and P3 polioserotypes respectively. 5 (1.9%) of the children had no antibodies to all the three polioserotypes. Polio antibody seropositivity was significantly associated with higher socioeconomic status and immunisation was the single most important determinant of seropositivity to poliovirus serotypes. CONCLUSION: Seroprevalence to poliovirus serotypes, though higher than values found in previous studies done in Nigeria, was lower compared to findings in the developed world. The use of more immunogenic vaccines and the balanced use of OPV formulations in SIAs, with further improvements in programme quality could provide the necessary immune booster to make polio eradication in Nigeria a reality.

Predisposing factors to neonatal septicaemia at ahmadu bello university teaching hospital, zaria Nigeria.

OBJECTIVES: The study aimed at identifying the risk factors for neonatal septicaemia in Zaria. PATIENTS AND METHODS: Consecutive newborns admitted into the Special Care Baby Unit of Ahmadu Bello University Teaching Hospital, Zaria with the presumptive test diagnosis of neonatal septicaemia between 25 May, 2004 and 31 May, 2005 were studied. History of events in the antenatal and neonatal periods was obtained and physical examination was done. Blood, urine, cerebrospinal fluid and swabs of body discharges were taken for culture and sensitivity studies. The data were analysed using Epi Info version 6 software. Associations were tested using Chi square, with Yates correction, or Fisher's exact tests where appropriate, while statistical significance was set at p < 0.05. RESULTS: A total of 211 neonates, consisting of 69 in-born and 142 out-born infants were studied. There were 122 (57.8%) males and 89 (42.2%) females; giving a male: female ratio of 1.4:1. Seventy-five (35.5%) of the newborns had bacteriologically proven septicaemia consisting of 54 (38.0%) of the outborn and 21 (30.4%) of the inborn babies (p = 0.3535); 42 males and 33 females (p = 0.8011). The male: female ratio of newborns with culture-proven septicaemia was 1.2:1. The predisposing factors that were associated with culture-proven septicaemia were lack of antenatal care (p = 0.0234), prolonged rupture of membranes (p = 0.0085), prolonged labour (p = 0.0032), preterm delivery (p = 0.0125) and perinatal asphyxia (p = 0.0078). CONCLUSION: The risk factors in neonates with septicaemia in this study emphasise the need for timely improvement in the implementation of existing public health strategies.

Production of extended spectrum beta-lactamases of urinary isolates of Escherichia coli and Klesiella pneumoniae in Ahmadu Bello University Teaching Hospital; Zaria; Nigeria

Multidrug resistant strains of Klebsiella pneumoniae and Escherichia coli constitute a problem in many hospitals. The antibiotic susceptibility profile and the Production of Extended Spetrum Beta-Lactamase (ESBL) of the strains of Klebsiella pneumoniae and Escherichia coli were assessed by the Kirby-Bauer technique and the modified disc diffusion technique respectively. Out of a total of 65 urinary specimens submitted to the Medical Microbiology laboratory at the Ahmadu Bello University Teaching Hospital; Shika-Zaria; Nigeria; 50 isolates consisting of 33 (66) Escherichia coli and 17 (34) strains of Klebsiella pneumoniae were recovered from patients suspected to have Urinary Tract Infections (UTIs). Of these 50 isolates; 15(30) were ESBL producers; made up of 6/17 (35.3) ESBL-positive Klebsiella pneumoniae isolates and 9/33 (27.3) ESBL-positive E. coli isolates. The susceptibility of the ESBL-positive Klebsiella pneumoniae isolates to ciprofloxacin; ofloxacin and amikacin were 64.7; 82.4 and 82.4 respectively; while the susceptibility of the ESBL-positive E. coli isolates were: ciprofloxacin (57.6); ofloxacin (48.5) and amikacin (84.8). All (100) of the ESBL-positive E. coli isolates and 3/6 (50) of the ESBL-positive Klebsiella pneumoniae isolates had Multiple Antibiotic Resistance (MAR) index of greater than 0.3 which is an indication that they originated from an environment where antibiotics are frequently used. It is important to determine the prevalence and antibiotic susceptibility of ESBL-producing clinical isolates as a guide to clinicians for the chemotherapy and there should be effective infection control policies to curb their spread in the hospital setting

Adherence of Staphylococcus aureus isolated from urine to medical prostheses and glass.

The physicochemical surface property of two Staphylococcus aureus isolates obtained from urine (isolates B and C) and a standard strain ATCC 13709 (isolate A) were compared. Isolate B was the most hydrophobic while isolate A was least hydrophobic as determined by bacterial adherence to hydrocarbon (BATH). Isolate A was most adherent to silicone urinary catheter and least adherent to both glass and intravenous catheter placement unit. Isolate B was most adherent to glass while isolate C was most adherent to the intravenous catheter. The clinical isolates B and C were generally more adherent and more hydrophobic than the standard strain ATCC 13709. There was no direct correlation between hydrophobicity of isolates and their adherence to biomedical materials and glass in this work.