Acute bronchiolitis in tropical Africa: a hospital-based perspective in Ibadan, Nigeria.

In a 30-month prospective study of severe acute lower respiratory infections in hospitalized pre-school Nigerian children, acute bronchiolitis was diagnosed in 67 cases; 19 (28.4%) and 2 (3.0%) of these had concomitant pneumonia or croup, respectively. The peak prevalence was in the wet (rainy) season (May-October). The male/female (M:F) ratio in infants < or = 6 months was 2.9:1, differing significantly from the 1.1:1 in older subjects (P = 0.04). None of the subjects had severe malnutrition. Neither a high fever (> or = 39 degrees C), nor tachypnea on admission was significantly correlated with co-existing pneumonia. Of the 29 subjects in whom it was possible to explore viral immunofluorescence studies and/or serodiagnosis, we identified 26 viral identifications in 18 (62.1%) cases; 6 (20.7%) had > or = 2 viruses. Respiratory syncytial virus was identified in 11 (38.0%) of the 29 cases, and parainfluenza virus (PIV) types 1, 2, and 3 in 10 (34.5%). PIV type 3 accounted for 7 cases, including 3 with bacteremia. Bacterial isolates were made in 9 (21.4%) of 42 blood cultures and in the only lung aspirate; Staphylococcus epidermidis and Staphylococcus aureus accounted for 4 and 3 cases, respectively. Although bacteremia was 2.9 times more common in cases with co-existing pneumonia or croup, the respective frequency of virus-positive cases and that of bacteremia was not significantly different between cases with bronchiolitis alone and those with associated pneumonia or croup. No deaths were recorded, but subjects aged > 6 months had a significantly shorter hospital stay than those < 6 months old (P = 0.02). Despite the limited sample size, our findings reflect the etiological importance of the paramyxoviruses and the seasonal pattern of bronchiolitis in tropical Africa.

Staphylococcal lower respiratory infection in children.

A prospective study of staphylococcal lower respiratory infection in 31 children aged 1-48 months has shown that radiologically, patchy consolidation was the single most common lesion, followed by pleural effusion with or without pneumothorax. Although the mean respiratory rate was 65/minute, it was below 50/minute in 8 cases. Complications include heart failure in 9 cases and severe anaemia necessitating blood transfusion in 9 others, seven (78%) of whom had pleural effusion. Finally diagnoses were bronchopneumonia alone in 16 (52%) cases, pyopneumothorax alone in 6 (19%), pyopneumothorax plus pneumonia in 5 (16%), pleural effusion in 2 (6%) cases and one case each of lobar pneumonia alone and a combination of lobar and bronchopneumonia. Staphylococcus aureus was isolated from the blood in 8 (62%) of 13 children with pleural effusion, indicating a need to consider parenteral antibiotic administration in the initial management of children with staphylococcal pleural effusion. Three (9.7%) patients died; they were all malnourished children who did not receive antibiotics prior to presentation; they all had bronchopneumonia, positive blood cultures and respiratory rates of 60/minute.

Evaluation of the Rosco system for the identification of Listeria species.

The Rosco system was used to identify previously confirmed isolates of the seven currently recognised species of Listeria. These included reference cultures and recent isolates from clinical material, food products and environmental sources. The system identified all correctly. Results were obtained after 4 h if heavy inocula, as suggested by the manufacturers, were used. The method may be used to aid identification of isolates of Listeria from clinical and non-clinical specimens and would be of particular value in laboratories examining small numbers of isolates relatively infrequently. Essential tests not included in the system are beta-haemolysis on sheep-blood agar and the CAMP test.

Rapid screening of colonies from Listeria selective agar.

A rapid method ('Liststrip', Lab M) of screening aesculin-positive colonies from Oxford selective agar was evaluated. This method relies on the ability of all Listeria spp. to hydrolyse aesculin and to have a rapid phosphatase but neither a pyroglutamic acid beta-naphthylamide amidase nor produce indole. Of 198 Listeria spp., all gave identical results (as above) in 10 min (except four isolates of L. murrayi), whereas of 112 aesculin-positive colonies from Oxford agar that were not Listeria only one gave a similar result. The method was compared with Gram stain and oxidase as a screening procedure. This strip test method is simple enough to be used by relatively unskilled staff and provides a rapid and reliable method to screen colonies from Oxford selective agar.

In vitro activities of polyene and imidazole antifungal agents against unusual opportunistic fungal pathogens.

Guidelines for the treatment of infections caused by unusual opportunistic fungi are limited and available in vitro data are scanty. In vitro susceptibility tests, employing an agar dilution procedure, were performed with amphotericin B (AMB), natamycin (NTC), itraconazole (ICZ), and ketoconazole (KTZ). Two media were used: Kimmig's agar (KA) and Yeast Morphology Agar (YMA). Fungi tested included isolates (n) of Acremonium spp. (10), Cunninghamella spp. (6), Fusarium spp. (18), Pseudallescheria boydii (14), and Trichosporon beigelii (5). All Acremonium and Cunninghamella isolates were susceptible to NTC (MIC less than or equal to 4 micrograms/ml) but many appeared to be resistant to AMB, (MIC greater than or equal to 32 micrograms/ml), KTZ and ICZ (MIC greater than or equal to 128 micrograms/ml). Most isolates of Fusarium spp. were susceptible to both AMB and NTC (MIC90 = 4 micrograms/ml); one isolate was cross-resistant to both polyenes (MIC greater than 32 micrograms/ml). Only two of 18 Fusarium isolates appeared susceptible to the imidazoles (MIC less than or equal to 4 micrograms/ml); the remaining isolates exhibited high MICs (greater than or equal to 64 micrograms/ml). All 14 isolates of P. boydii were susceptible to NTC (MIC less than or equal to 4 micrograms/ml) but four appeared to be resistant to AMB (MIC greater than or equal to 32 micrograms/ml). Most isolates of P. boydii were susceptible to both KTZ (MIC less than or equal to 4 micrograms/ml) and ICZ (MIC less than or equal to 16 micrograms/ml) but two isolates appeared to be resistant (MIC greater than or equal to 16 micrograms/ml).(ABSTRACT TRUNCATED AT 250 WORDS)

Evaluation of the Mast ID and API 50CH systems for identification of Listeria spp.

A multipoint inoculation technique (Mast ID) for the identification and species determination of Listeria monocytogenes (sensu strictu) and six other species of the genus Listeria was evaluated. This was compared with the commercially available API 50CH system. Both methods successfully identified all 123 strains tested. The Mast ID system is inexpensive and utilizing a multipoint inoculation technique permits the screening of up to 21 isolates per 9-cm petri dish. The API 50CH system was more expensive and time consuming and is therefore suitable only for the examination of smaller numbers of strains.

The use of mail reminders in STD contact tracing in Ibadan, Nigeria.

Contact tracing has become the most important tool in the control of sexually transmitted diseases (STDs) world-wide, and different strategies have been introduced into it in recent years to improve its effectiveness. Of all these strategy components, index patient counselling and co-operation to do their own contact tracing by themselves has been identified as the most important one. In Ibadan, it is the only component of the contact tracing strategies that has proven worthwhile. This study has assessed the contribution of supplementary mail reminders to defaulting index patients and their defaulting contacts to our control efforts in the first two years of its usage. It demonstrates that, like the other components of the contact tracing strategies, it is not successful in improving the contact or defaulting index patient attendance, thus only contributing to success in 7 of 141 patients. The intensification of efforts towards encouraging the index patient in contact tracing must therefore be ever more strongly emphasised as the top priority in STD control in Nigeria and similar developing countries for the success of this strategy.

PIP: Contact tracing has become the most important tool in the control of sexually transmitted diseases (STDs) world-wide and different strategies have been introduced in recent year to improve its effectiveness. Of all these strategy components, index patient counselling and co- operation to do their own contact tracing by themselves has been identified as the most important one. In Ibadan, it is the only component of the contact tracing strategies that has proven worthwhile. This study has assessed the contribution of supplementary mail reminders to defaulting index patients and their defaulting contacts to our control efforts in the first 2 years of its usage. It demonstrates that, like other components of the contact tracing strategies, it in not successful in improving the contact or defaulting index patient attendance, thus only contributing to success in 7 of 141 patients. Of the 141 letters sent to defaulting index patients, 38% and 19% of them were returned as untraceable addresses by the postal services in 1985 and 1986. The remaining 103 letters were assumed to have reached their correct destination. Only 7 of these 103 index patients attended the clinic on account of mail reminders, while non of the 39 contacts to whom slips were sent came for follow-up. 11 of the non-responding 96 index patients were later traced physically. 7 of these 11 were found, 6 of whom would not return to the clinic because they felt cured. Efforts must be intensified towards involving index patients in contact tracing as a top priority in STD control in Nigeria. (Author's modified).

An in-vitro study on ciprofloxacin and other anti-microbials against gram-negative bacteria isolated from patients in Ibadan, Nigeria.

The high prevalence of common clinical isolates that are resistant to multiple antibiotics calls for regular review of the anti-microbial sensitivity pattern among bacteria of clinical significance in our environment. In the present study an increasing percentage of common isolates from hospitalized patients have been found to be resistant to Gentamicin and Cefotaxime, which play an important role in the chemotherapy of infections. Of special significance is the finding that over 60% of pseudomonads are now resistant to Gentamicin. The new fluoroquinolone, Ciprofloxacin, showed strong activity against all the isolates tested, with MIC values within the range of those reported as sensitive from many overseas centres. It should prove to be a valuable agent in the management of infections due to these organisms.

Comparison of the in vitro activity of ofloxacin and gentamicin against isolates from hospitalised patients.

The in vitro activity of ofloxacin (Hoe 280) against Staphylococcus aureus, some Enterobacteriaceae and Pseudomonas spp. is compared with that of gentamicin using the agar dilution method to determine the minimal inhibitory concentration of each agent for the isolates. Ofloxacin and gentamicin were found to have similar activity against Staphylococcus aureus with an MIC50 of 0.25 mg/l and an MIC90 of 1.0 mg/l. However, ofloxacin appears to be more active against the Enterobacteriaceae than gentamicin with lower MICs for some species of that family. Ofloxacin was found to have an MIC50 value of 0.25 mg/l for the Enterobacteriaceae and an MIC90 of 1.0 mg/l while the MIC90 of gentamicin for the same isolates was 32.0 mg/l. A significant proportion of our Pseudomonas spp. were resistant to gentamicin with an MIC90 of over 16 mg/l and a range of 0.5 mg/l to greater than 128 mg/l. Ofloxacin had an MIC range of 0.25 to 4.0 mg/l for the same organisms.

Clinical trial of cefoxitin (mefoxin) in parenteral therapy of septicemia (postabortal and postpartum) in Ibadan.

Cases of post-abortal sepsis are admitted every day into the University College Hospital (UCH), Ibadan, Nigeria. This derives from the high incidence of induced (illegal) abortions in this environment. The infections are usually caused by mixed bacterial flora, often resistant to the common antibiotics because of the indiscriminate use of these drugs. Any new drug that can be effective in the treatment of these resistant cases will be welcome. The efficacy of Cefoxitin in the treatment of twenty-five cases of postabortal sepsis was therefore compared with the efficiency of other antibiotics in the management of sixty other cases. Response to Cefoxitin was prompt. Temperatures settled within 96 h and no case of pelvic abscess resulted. It was concluded that Cefoxitin could well be a safe and effective alternative antibiotic to replace the common antibiotics to which many hospital organisms have developed resistance.

Intraoral condylomata acuminata. A case report.

Condylomata acuminata occurred intraorally in a 6 year old Nigerian girl. Since she had no skin or genital lesions and no history of sexual contact, the virus was probably acquired from environmental sources. Non-sexual modes of transmission should, therefore, be considered, particularly when the lesions are extragenital.