Metagenomic sequencing at the epicenter of the Nigeria 2018 Lassa fever outbreak.

The 2018 Nigerian Lassa fever season saw the largest ever recorded upsurge of cases, raising concerns over the emergence of a strain with increased transmission rate. To understand the molecular epidemiology of this upsurge, we performed, for the first time at the epicenter of an unfolding outbreak, metagenomic nanopore sequencing directly from patient samples, an approach dictated by the highly variable genome of the target pathogen. Genomic data and phylogenetic reconstructions were communicated immediately to Nigerian authorities and the World Health Organization to inform the public health response. Real-time analysis of 36 genomes and subsequent confirmation using all 120 samples sequenced in the country of origin revealed extensive diversity and phylogenetic intermingling with strains from previous years, suggesting independent zoonotic transmission events and thus allaying concerns of an emergent strain or extensive human-to-human transmission.

Factors influencing hemodialysis and outcome in severe acute renal failure from Ilorin, Nigeria.

The epidemiology of acute renal failure (ARF) varies between nations and even within the same country because of differences in diagnostic criteria, causes, mode of presentation, and cost of therapy. To determine the factors influencing hemodialysis and outcome of severe ARF in Ilorin, Nigeria, we studied ARF patients on hemodialysis in our center between January 1989 and December 2009. There were 138 (58 males and 80 females) patients with age range between 18 and 69 years and a mean of 29.4 ± 11.9 years. Major etiologies of ARF included septicemia, acute glomerulonephritis, septic abortion, herbal remedies, post-partum bleeding, and gastroenteritis. The mean duration of illness and waiting time before dialysis was 11.7 ± 8.14 days and 3.28 ± 1.86 days, respectively. The mean number of dialysis was 2.24 ± 1.13 sessions and 89% of the patients received a maximum of three sessions before recovery. Hypotension, twitching of muscles, and back pains were common intradialysis complications. The factors that influenced hemodialysis and outcome were late presentation, severity of ARF, and financial constraints. The etiological agents are preventable and treatable conditions. The short duration of hospital stay, waiting time before dialysis, and total duration of illness influenced the outcome positively. We strongly recommend early referral of patients with severe ARF to nephrologists for proper management in a bid to reduce mortality from this disease.