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Candiduria among HIV- Infected Patients Attending a Tertiary Hospital in Benin City

NO Esebelahie, IB Enweani, FO Newton-Esebelahie, R Omoregie

 

Abstract

Background: Candiduria is a common finding. However, in  immunocompromised patients like HIV-infected individuals, it has high risk of morbidity and mortality as it could be a pointer to systemic candidiasis. Unfortunately, there are no clear criteria for differentiating between colonization and infection or between upper or lower urinary tract infections.

Objective: This study focused on determining the spectrum of Candida species implicated in candiduria among HIV-infected individuals and their
susceptibility to fluconazole and voriconazole in a tertiary hospital.

Methods: A total of 300 subjects comprising of 200 HIV patients and 100 non-HIV individuals were used for this study. Clean catch midstream were collected from each individual and processed using standard  microbiological techniques. Emergent Candida isolates were identified with CHROMagar Candida and sugar fermentation tests.

Results: The overall prevalence of candiduria among HIV patients was 13.5%. HAART-naive patients had a significantly higher prevalence  (OR=4.165, 95%CI=1.602, 10.828; P=0.0038) than their counterpart on highly active antiretroviral therapy (HAART). Female gender was a  significant risk factor for acquiring candiduria. Age had no significant effect on the prevalence of candiduria in this study. A CD4+ count <200 cells/µl was a significant risk factor for acquiring candiduria only among  HAART-naive patients (OR=11.711; 95%CI=3.943, 34.780; P= 0.0001). The three species of Candida recovered from this study were C. albicans, C. krusei and C.parapsilosis. C. albicans (64.52%, 83.36%) and C. krusei (66.67%, 100.00%) were resistant to fluconazole and voriconazole  respectively.

Conclusion: There is a significant relationship between  antiretroviral therapy, CD4+ counts, and the prevalence of candiduria among the study population.

Keywords:HAART, HAART-naive, candiduria, CD4+ counts, Candida,  prevalence.

 

Contexte: La candidurie est un problème commun de sante publique. Cependant, chez les patients immunodéprimés comme les individus infectés par le VIH, elle présente un risque élevé de morbidité puisqu’elle peut évoluer vers la candidose systémique. Malheureusement, il n’existe pas de critères clairs permettant de distinguer la colonisation et l’infection de même que les infections des voies urinaires supérieures et inférieures.

Objectif: Cette étude a porté sur la détermination du spectre d’espèces de Candida impliqués dans la candidurie chez les personnes infectées par le VIH et leur sensibilité au fluconazole et voriconazole dans un hôpital tertiaire.

Methodes : Un total de 300 sujets comprenant 200 patients atteints du VIH et 100 personnes non -VIH ont été utilisés dans cette étude. Les echantillons d’urine ont été collectées auprès de chaque personne par la methode de ‘‘Clean catch midstream’’et traitées en utilisant des techniques microbiologiques standard. Les isolats émergents de Candida ont été identifiés avec CHROMagar Candida et les tests de fermentation de sucre.

Résultats : La prévalence globale du VIH chez les patients atteints de candidurie était de 13,5%. Les patients en naïfs de la multithérapie HAARTavaient une prévalence significativement plus élevée (OR = 4,165, IC à 95% =1,602, 10,828, p = 0,0038 ) par rapport a leurs homologues sous traitement antiretroviral hautement actif (HAART ) . Le sexe feminin etait un facteur de risque important d’acquisition de candidurie. L’age n’avait pas d’effet significat nif sur la prevalence de candidurie dans cette etude. Un compte de CD4 + < 200 cellules / µl ete un facteur de risque important pour l’acquisition de candidurie que chez les patients en multitherapie naifs (OR = 11,711 ; IC a 95% = 3, 943, 34, 780, p = 0,0001). Les trois especes de Candida recuperes de cette etude etaient C. albicans, C. krusei et C.parapsilosis. C. albicans(64,52%, 83,36 %) et C. krusei (66,67%, 100,00 %) etaient resistants respectivement au  fluconazole et voriconazole.

Conclusion: Il existe une relation significative entre le traitement  antiretroviral, CD4 +, et la prevalence de candidurie parmi la population de l’etude..

Mots-cles: multitherapie HAART , naifs , candidurie , CD4 + , Candida , prevalence

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Candiduria among HIV- Infected Patients Attending a Tertiary Hospital in Benin City

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Serological Screening for Ante-Natal Toxoplasmosis in Maiduguri Municipal Council, Borno State, Nigeria

SO Oyinloye, M Igila-Atsibee, B Ajayi, MA Lawan

 

Abstract

Toxoplasma gondii infection causes devastating defects including,  blindness, neurological impairment and mental retardation in congenitally infected children. Congenital infection occurs when a woman becomes infected during pregnancy; and the severity of the illness is related to the trimester period. This research was designed to evaluate the  seroprevalence of toxoplasmosis amongst pregnant women (n=90) using enzyme linked immunosorbent assay (ELISA) kit (Cortez Diagnostics Inc. USA). A structured questionnaire was used to collect socio-demographic data. A significant (x2 Cal 233.0/ x2 tab 124.1, p=0.01) overall prevalence of 22.2% (20/90) was obtained. Pregnant women within 25-29years had the highest prevalence of 33.3% (3/9); this was significant (x2 Cal 35.85/ x2 tab 9.21, p=0.01). An association between high levels of toxoplasma IgG and miscarriage was established in four of twenty five women who had suffered miscarriage (t cal 5.3/t tab 2.81, p=0.01). The results presented indicate that toxoplasmosis is a significant public health burden in the area of study, which requires drastic remedial measures.

Key words: Toxoplasmosis, pregnant women, miscarriage, Nigeria

 

L’infection de Toxoplasma gondii provoque des malformations dévastatrices, y compris, la cécité, des troubles neurologiques et un retard mental chez les enfants infectés congénitalement. L’infection congénitale se produit quand une femme est infectée au cours de la grossesse, et la gravité de la maladie est liée à la période de trimestre. Cette recherche a été conçue pour évaluer la séroprévalence de la toxoplasmose chez les femmes enceintes (n = 90) à l’aide de dosage immunoenzymatique (ELISA) (Cortez Diagnostics Inc. USA). Un questionnaire structuré a été utilisé pour
recueillir des données socio- démographiques. Une prévalence importante globale de 22,2 % (20/ 90) a été obtenu (p =0,01). Les femmes  enceintes dans les tranche d’âge25- 29 ans ont eu la plus forte prévalence de 33,3 % (3/9)qui était significative (p = 0,01). Une association entre des niveaux élevés de Toxoplasme IgG et fausse couche a été établie dans quatre des vingt-cinq femmes qui avaient subi une fausse couche (p = 0,01). Les résultats présentés indiquent que la toxoplasmose est un problème de santé publique dans cette localité, ce qui nécessite des mesures correctives drastiques.

Mots clés: Toxoplasmose, femmes enceintes, fausses couches, Nigeria

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Serological Screening for Ante-Natal Toxoplasmosis in Maiduguri Municipal Council, Borno State, Nigeria

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Toxoplasma Gondii Infection in HIV/AIDS: Prevalence and Risk Factors

O Okwuzu, NN Odunukwe, OC Ezechi, TA Gbajabiamila, AZ Musa, PM Ezeobi, BA Oke, T Somefun, RN Okoye, CC Onyeitu, MA Adetunji, AO Otubanjo

 

Abstract

BACKGROUND: Toxoplasmosis is an infection caused by the protozoan Toxoplasma gondii. It is common in severely immunecompromised
persons.
OBJECTIVE: To determine the seroprevalence of T. gondii infection and the risk factors associated with the infection and to investigate the association between T. gondii infection and CD4 cell count.
METHODS: Sera collected from 242 HIV positive HAART- naive patients were tested for T. gondii specific immunoglobulin G antibodies. Information was obtained using a structured questionnaire. Baseline CD4 cell counts were obtained from patients case files. Data was managed using SPSS version 20 software and Microsoft Excel worksheet.
RESULTS: One hundred and sixty eight (69.4%) subjects were females while 74(30.6%) were males. One hundred (41.3%) of study participants were Toxoplasma IgG antibody positive. Thirty two(32) HIV positive pregnant women were among this group studied with 12( 37.5%) being Toxo IgG antibody positive. Toxoplasma seropositivity was higher in females (42.8%) than in males (39.2%), P= 0.60. CD4 cell count level of < 200 was negatively associated with Toxoplasma seropositivity than CD4 count . 200 by logistic regression (OR= 0.6; 95% CI 0.3- 1.0). Living in proximity with cat was positively associated with T. gondii infection (P= 0.01).
CONCLUSION: T. gondii infection is common in pregnant women indicating greater probability of congenital transmission of T. gondii. This could form a basis for recommending intensifying health education and prophylactic treatment for all HIV positive pregnant women. Measures should be taken to prevent stray cats from entering homes.

Keywords: Toxoplasma gondii , IgG, Seroprevalence, HIV positive, CD4 cells.

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Toxoplasma Gondii Infection in HIV AIDS Prevalence and Risk Factors

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Prevalence of Acid-Alcohol-Fast Bacilli among Patients with Suspected Cases of Pulmonary Tuberculosis in Jos, Nigeria

EI Bigwan, MC Ohaeri, HI Okonkwo, IS Udosen, GC Markus, Z Sheyin

 

Abstract

Mycobacterium tuberculosis is a major public health problem in globally due to its high tendency of person-person transmission, morbidity, and  mortality. This study aimed at determining the prevalence of AAFB within the study area. Sputum samples were collected from three hundred and three (303) patients with suspected cases of pulmonary tuberculosis attending Plateau State Specialist Hospital and Faith Alive Foundation. The samples were examined using Ziehl Neelsen method. Structured  questionnaires were administered to obtain some demographic data from patients that consented. Results were tested statistically for significance at p < 0.05 using Chi-square test. Out of the samples examined,29(9.57.0%) were positive for AAFB .The study showed that the prevalence of smear-positive increased with age between 15 and 45 and then decreased from age groups 46 and above. The study also revealed that males had a higher prevalence with 19(12.34%)than females who had 10(6.71%  ).Marital status showed that divorced individuals had the highest  prevalence of 2(12.50%) followed by married ,singles and the widowed with 18(11.76%),8(6.34%),and 1(5.90%) respectively. Statistically the study reveals that age groups, sex, hospital (location) does not have any effects on the prevalence (p > 0.05) while marital status showed a significant  effect on the prevalence (p < 0.05).There is need for a more collaborative efforts and political will by the government and non-governmental agencies in order to fast track prevention and control measures aimed at eliminating the infection in the nearest future.

Key words: AFB, Tuberculosis, Jos, Nigeria.

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Case-Detection Rate of Direct Sputum Smear Microscopy for Diagnosis of Pulmonary Tuberculosis in Abia State, Nigeria

EO Ekundayo, SD Abbey, O Okorie

 

Abstract

The accuracy of sputum smear microscopy, the tuberculosis case-finding method in the Abia State TB Control Programme has never been assessed due to lack of culture facilities. To assess the accuracy of sputum smear microscopy in routine control programme conditions in Abia State, sputum samples from patients undergoing investigation for tuberculosis were analyzed using Ziehl-Neelsen staining technique for sputum smear  microscopy and culture on Löwenstein-Jensen medium as reference standard. Out of 150 participants tested, 51 were smear –positive for acid fast bacilli (positivity rate, 34.0 %, 51/150) while 79 were culture positive for Mycobacterium tuberculosis complex and 12 for non-tuberculous mycobacteria (NTM). Thirty-seven of the 79 culture positive for M. tuberculosis were smear positive giving a ratio of smear to culture positivity of 46.84%. Forty-two (42.4%) of the 99 smear negative cases were culture positive for M. tuberculosis. The sensitivity of smear microscopy was 50.0%
(95%CI=39.0-61.0) and specificity was 92.3% (95% CI=86.4-98.2). The prevalence of HIV/TB coinfection among the study participants was 48% (12/25). Although the case- detection rate of smear microscopy was moderate in this study, the large proportion of TB patients missed by smear microscopy is a cause for concern and requires concerted effort to improve the sensitivity of smear microscopy. Introduction of more sensitive diagnostic methods like culture also need to be considered.

 

La précision des frottis, la méthode la recherche de cas de tuberculose  dans le programme de lutte contre la tuberculose dans l’Etat d’Abia n’a jamais été évalué en raison du manque d’installations de culture. Pour évaluer la précision des frottis dans les conditions du programme de  contrôle de routine dans cet Etat , les expectorations de patients subissant une enquête de la tuberculose ont été analysées à l’aide de technique de coloration de Ziehl-Neelsen pour la microscopie des frottis de crachats et
de la culture sur milieu de Löwenstein- Jensen en tant que norme de  référence . Sur les 150 participants testés, 51 étaient à frottis positif pour les bacilles acido rapide (taux de positivité, 34,0%, 51/150), tandis que 79 étaient positifs à la culture pour complexe Mycobacterium tuberculosis et 12 pour les mycobactéries non tuberculeuses (NTM). Trente-sept de la culture 79 positive pour M.tuberculosis étaient à frottis positif donnant un ratio de frottis de positivité de la culture de 46,84 %. Quarante-deux  (42,4%) des 99 cas à frottis négatifs étaient positifs à la culture pour M. tuberculosis. La sensibilité de la microscopie des frottis était de 50,0 % (IC à 95% = 39,0 à 61,0) et la spécificité était de 92,3 % (IC à 95% = 86,4 à 98,2). La prévalence du VIH / TB coïnfection parmi les participants à l’étude était de 48% (12 /25). Bien que le taux de microscopique des  frottis de dépistage des cas ait été modéré dans cette étude, la forte proportion de patients atteints de tuberculose manqués par examen microscopique des frottis est un sujet préoccupant et exige un effort concerté pour améliorer la sensibilité de la microscopie des frottis. La présentation des méthodes de diagnostic plus sensibles comme la culture doivent aussi être pris en considération.

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Case-Detection Rate of Direct Sputum Smear Microscopy for Diagnosis of Pulmonary Tuberculosis in Abia State, Nigeria

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Diverse genetic subtypes of HIV-1 among female sex workers in Ibadan, Nigeria

SA Fayemiwo, GN Odaibo, JL Sankale, AA Oni, RA Bakare, OD Olaleye, P Kanki

 

Abstract

Genetic diversity is the hallmark of HIV-1 infection. It differs among geographical regions throughout the world. This study was undertaken to identify the predominant HIV-1 subtypes among infected female sex workers (FSWs) in Nigeria. Methods: Two hundred and fifty FSWs from brothels in Ibadan Nigeria were screened for HIV antibody using ELISA. All reactive samples were further tested by the Western Blot Techniques. Peripheral Blood Mononuclear Cells (PBMCs) were separated from the blood samples of each subject. Fragments of HIV Proviral DNA was amplified and genetic subtypes of HIV-1 was determined by direct sequencing of the env and gag genes of the viral genome followed by phylogenetic analysis . Results: The age of the FSWs ranged from 15 to 55 years old (Mean = 25.8years, SD =3.74). Majority were Nigerians while others (1.6 %) were from neighboring West Africa countries. Four ( 1.6% ) of the FSWs were active for less than one year as sex workers, and the mean length of sex work was 2.80 years ( Range = 1.0 – 15.0 years ). Sixty-four (25.6%) of the 250 CSWs were positive for HIV-1 while 7 (2-8%) had dual infections to HIV-1 / HIV-2. Among the 34 HIV-1 strains  characterized by sequencing, 19 (55-9%) were subtype G, 9 (26.5%) CRF02_A/G, 3 (8.8%) CRF06_cpx while 1 (2.9%) each were identified as subtype C, CRF01_A/E and CRF09_cpx respectively. Nineteen (55.9%) of the FSWs with subtype G had been active in the sex work for between one to five years. The youngest of the HIV -1 infected FSWs with sexual activity of less than a year had subtype G strain. There is a significant probability that infection with this subtype occurred with a short incubation period (p< 0.05). Conclusion: This study showed a wide range of HIV- 1 subtypes among FSWs in Nigeria. The situation poses serious challenge for the design of HIV vaccine candidate for use in Nigeria.

Keywords: Diverse, HIV, subtypes, Female Sex workers and Vaccine

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Diverse genetic subtypes of HIV-1 among female sex workers in Ibadan, Nigeria

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Molluscum contagiosum virus infection amongst plwha in ibadan, Nigeria

SA Fayemiwo, OA Adesina, JO Akinyemi, GN Odaibo, TO Omikunle, IF Adewole

 

Abstract

Background: Molluscum contagiosum (MC) infection is caused by a pox virus and the virus is probably passed on by direct skinto- skin contact which may affect any part of the body. There is anecdotal evidence associating facial lesions with HIV-related immunodeficiency. This study was aimed to determine the prevalence and associated risk factors of Molluscum contagiosum infection among PLWHAs attending ART clinic at the University College Hospital, Ibadan, Nigeria.

Methods: This is a descriptive cross-sectional survey of 5,207 patients (3519 female and 1688 males) attending ART clinic between January 2006 and December 2007. Physicians performed complete physical and pelvic examinations. Diagnosis of Molluscum Contagiosum infection was based on the clinical findings of typical lesions on the external genitalia, perianal, trunk, abdominal and facial regions.

Results: The mean age of the patients was 34.67 yrs. ± 9.16). About 10% (542) had various sexually transmitted infections (STIs). The male to female ratio was 1: 4.2. One hundred and twenty seven subjects (23.4%) had no formal or primary education with 247 (45.6 %) beingtreatment naïve while 295 (54.4 %) were treatment experienced. Of the 542 PLWHAs with STIs, 3.3 % had undetectable viral load (< 200 copies/ ml) while 272 (50.1 %) had low CD4 count (< 200 cells / mm3.) and The Mean log10 viral load was 5.02 + 0.94. Molluscum Contagiosum infection was diagnosed in 13 patients (0.024%; 8 females and 5 males). Vaginal Candidiasis was the commonest genital infection diagnosed in 223 (41.1%) of the patients with STIs. MC patients had higher viral load, lower CD4 count and more likely to be treatment experienced”.

Conclusions: Molluscum Contagiosum infection is not uncommon among the HIV-infected patients, but underreported. Awareness of this cutaneous manifestation should be known to Physicians in AIDS care.

Key Words: Molluscum contagiosum, HIV, Sexually Transmitted Infection

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Molluscum contagiosum virus infection amongst plwha in ibadan, Nigeria

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Seroprevalence of parvovirus BI9 antibody in blood donors and sickle cell disease patients at Lagos university teaching hospital (LUTH): a comparative study

MC Iheanacho, SA Akanmu, B Nwogoh

 

Abstract

Introduction: Parvovirus B19 (PVB19) is a DNA virus transmissible by blood transfusion. It is a major cause of aplastic crisis especially in chronic haemolytic anaemic patients such as sickle cell disease patients.
Objective: The study was aimed to determine the seroprevalence of PVB19 in blood donors and sickle cell anaemia (SCA) patients and to evaluate its association with blood transfusion in SCA patients.
Methods: This is a cross sectional study conducted at the Lagos University Teaching Hospital, Lagos Nigeria. Three hundred participants, consisting of 150 voluntary blood donors and 150 sickle cell anaemia subjects were enrolled into the study. Seroprevalence of parvovirus was determined using ELISA kits for IgG and IgM anti-PVB19 antibodies by Immuno-Biological Laboratories, (IBL) inc. Minneapolis, USA. Results was analyzed with SPSS 11 software and presented in tables. Fishers Exact test, Chi-square and student T-test were used as appropriate to compare variables between both groups. P-values <0.05 were considered significant.
Results: Ninety nine (66%) blood donors were positive for anti-PVB19 IgG antibody while ninety two (61.3%) sickle cell patients were positive. Two (1.3%) blood donors were positive anti-PVB19 IgM antibodies while 8 (5.3%) SCD patients were positive for anti-PVB19 IgM antibodies. There was no significant difference in the seroprevalence of IgG and IgM antiPVB19 virus in both groups. There was no association of parvovirus seroprevalence with blood transfusion.
Conclusion: The study has shown a high seroprevalence of IgG anti-PVB19 antibodies in both blood donors and SCA patients. Therefore routine screening for parvovirus infection for donor blood is not justified. However seronegative SCA patients who require blood transfusion should have the blood screened for parvovirus to reduce the risk of associated aplastic crisis.

Key words: Seroprevalence, parvovirus B19, blood donors, sickle cell anaemia

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Seroprevalence of parvovirus BI9 antibody in blood donors and sickle cell disease patients at Lagos university teaching hospital LUTH a comparative study

 

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Sero-prevalence of human parvovirus B19 among patients attending some hospitals in Kano metropolis, Nigeria

A Jegede, M Aminu, EE Ella

 

Abstract

Background: Human Parvovirus B19 (HPVB19) belongs to the family Parvoviridae, causes Erythema infectiosum, aplastic crises in persons with blood disorder and prolonged anaemia in immuno-compromised persons. During pregnancy the virus may be transmitted to the foetus which can result in hydrops foetalis, spontaneous abortion or intrauterine foetal death. The study determined the sero-prevalence of IgG antibodies to HPVB19 among patients in Kano metropolis in order to provide information on their immune status and the possible risk factors for acquiring the virus.
Method: The study population comprised 460 patients seen at the outpatient department of two hospitals in Kano whose mean age was 28.8 (range 0 –70) years. Questionnaire was used to obtain data on socio-demography and risk factors. Blood sample was collected from each patient, serum was obtained and analysed for IgG antibodies to HPVB19 by ELISA according to manufacturer’s instruction.
Result/Discussions: Sero-prevalence of 41.5% (191/460) was obtained for HPVB19 and seropositivity increased significantly with age with the highest prevalence (51%) recorded among patients ≥51 years old while the lowest prevalence was among those < 1 year old (χ2=13.130, df=6, P=0.04). Seropositivity was higher in female (42.6%: 98/230) than male patients (40.4%: 93/230) (p>0.05). Highest seropositivity was observed among farmers (64.2%:18/28) while the lowest was among retired persons (27.2%:3/11). There was significant association between HPVB19 and level of formal education attained (χ2 =10.363, df=4, P=0.03) and number of persons living in a house (χ2 =14.30, df=1, P=0.00). There was no  association between HPVB19 and marital status (P=0.3) and type of residence (P=0.5). Blood transfusion (OR=2.0:1; P=0.08) and sickle cell anaemia (OR=1.7:1; P=0.08) were important risk factors for HPVB19 transmission in this study. Having blood transfusion showed a 2.0 fold risk while having sickle cell showed a 1.7 fold risk of acquiring HPVB19 infection. During the study, 48.2% of women of child bearing age had antibodies to HPVB19 IgG antibodies leaving about 52% still susceptible to the virus.
Conclusion: Seroprevalence to B19 among patients was low leaving a large proportion of the population especially women in Kano still susceptible to B19 infection.

Keywords: Sero-prevalence, Human Parvovirus B19, Patients, Hospitals, Kano, Nigeria

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Sero-prevalence of human parvovirus B19 among patients attending some hospitals in Kano metropolis, Nigeria

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Current antibiotic susceptibility profile of the bacteria associated with Surgical wound infections in the Buea health district in Cameroon

JN Palle, N Bassah, HLF Kamga, G Nkwelang, JF Akoachere, E Mbianda, UG Nwarie, AL Njunda, NJC Assob, GH Ekane, M Ngowe Ngowe

 

Abstract

Background: Most surgical wounds seen in clinical practice in the Buea Health District, Cameroon are infected prior to arrival or while they are in the hospital. Sometimes the infection necessitates a combination of local wound site measures and systemic antibiotherapy to properly manage the patient.
Objective: To identify the current antibiotic susceptibility profile of the common germs that cause surgical wound infections in the Buea Health District of Cameroon.
Methods: A total of 2120 specimens comprising swabs from burns, ulcers, open or post-operative wounds were collected from hospitalized patients attending health institutions in Buea. The samples were collected from different anatomic sites of the patients. Cultures were effected from the specimens and bacteria isolated from infected wounds using standard microbiological techniques. Antibiotic susceptibility of the different isolates was determined.
Results: Majority (79.8%) of the wounds were infected with pathogenic bacteria. The germs globally showed multi resistant patterns to commonly used antibiotics in the study area, especially to co-trimoxazol, doxycycline, chloramphemicol, ampicilline and aztreonam. However appreciable sensitivity was noted to ofloxacillin, perflacin, and ceftriazone.
Conclusion: This study has revealed ofloxacin as the only antibiotic to which all the isolated bacteria from infected wounds were sensitive in the study area.

Keywords: Wound infection, Antibiotic susceptibility profile, Buea Health District, Cameroon

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Current antibiotic susceptibility profile of the bacteria associated with Surgical wound infections in the Buea health district in Cameroon