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STUDIES ON DIABETIC FOOT ULCERS IN PATIENTS AT JOS UNIVERSITY TEACHING HOSPITAL, NIGERIA

E.I. Ikeh, F. Peupet, C. Nwadiaro

 

Abstract

An epidemiologcal and microbiological studies of diabetic foot ulcers were carried out in our hospital, with a view to reducing the amputation and mortality rate associated with the disease. Wound swabs from 38 Diabetes Mellitus (DM) foot ulcer patients were investigated using culture methods for both strict aerobes and anaerobes. The bacterial isolates were subjected to antibiotic susceptibility tests using the disc diffusion method. Baseline biochemical and haematological analysis were also carried out. The prevalence of the disease was stratified in relation to some clinical and laboratory parameters, gender, age, educational and occupational status of the patients. The prevalence of the disease was 24.7%, with amputation and mortality rates of 18.4% and 15.8% respectively. Only 13% had DM for less than 1 year, while 53% for more than 10 years. 28.9% have regular shoe-wearing habits. Duration of healing ranged from 2 weeks to 24 weeks (mean = 2.7months). 31% of the patients with marked periosteal reaction had lower extremity amputation or died before amputation could be done. Staphylococus aureus (31%), Proteus spp (16%), Pseudomonas aeruginosa (10%), Klebsiella spp (6%), Peptococcus spp (6%), Bacteroides fragilis (3%), Streptococcus pyogenes (3%), Escherichia coli (3%), Candida albicans (3%), Streptococcus viridans (1%), Flavobacterium spp (1.5%) and Bacteroides melaninogenicus (1%) were isolated. Most of the bacteria isolates were sensitive to pefloxacin. Our results demonstrate a very high rate of diabetic foot ulcer with the corresponding high rate of amputation and mortality. A multi-disciplinary approach to the management of DM foot ulcers is advocated. Efforts should be made to carry out cultures of samples from refractory ulcers to rule out yeast colonization, which if not treated will delay wound healing.

Key words: Diabetic foot ulcers, Microbial and antimicrobial surveillance, Refractory ulcers.

(Af J Clinical & Exp Microbiology: 2003 4(2): 52-61)

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AETIOLOGIC AGENTS OF DIARRHOEA IN CHILDREN UNDER FIVE YEARS OF AGE IN OSOGBO, OSUN STATE

O.A. Olowe, A.B. Olayemi, K.I.T. Eniola, O.A. Adeyeba

 

Abstract

A survey of the aetiological agents of diarrhoea in children under 5 years of age was carried out in Osogbo, Osun State. A total of 135 patients visiting the outpatient and children emergency units of LAUTECH Teaching Hospital were examined. Strains of Shigella isolated were tested for antibiotic sensitivity. Consideration of the distribution showed that Escherichia coli was more prevalent in children aged between 3 to 5 years (57%) and was the most encountered of the organisms isolated (present in 77.8% of all samples) while Shigella spp was found in 16.3% of samples, Vibrio cholerae 0.7% and other coliforms 5.2%. Statistical analysis showed that E. coli was significantly associated with diarrhoea in the patients aged 3-5 years (P< 0.05). Shigella spp was shown to show some resistance to tetracycline and high sensitivity to ofloxacin.

(Af J Clinical & Exp Microbiology: 2003 4(2): 62-66)

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PHAGE AMPLIFICATION TECHNOLOGY AND ANTI-TUBERCULOUS DRUG SUSCEPTIBILITY TESTING IN NIGERIA

E.J. Otive-Igbuzor

 

Abstract

The emergence of multi-drug resistant tuberculosis (MDR-TB) defined as combined resistance to the two most effective anti-tuberculosis drugs, rifampicin and isoniazid, threatens to create a public health hazard of unprecedented proportion. The fact that MDR-TR is more difficult and expensive to cure creates the need for prompt diagnosis. Conventionally, the proportion method on Lowenstein Jensen (L J) medium is used in most developing countries as the ‘gold standard’ in the drug susceptibility testing of Mycobacterium tuberculosis (MTB) and it takes 3-4 weeks to give results from an MTB culture. The use of phage as a diagnostic is fast gaining ground today. It involves targeting viable MTB cells from culture with a specific mycobacteriophage. After a one-hour incubation, it is treated with an antivirus to destroy the phages that are not protected with the bacilli. Upon addition of cells of growing, non-pathogenic Mycobacterium smegmatis (sensor cells), progeny phage from the MTB cells infect the sensor cells, thus amplifying the effect of the phage. When plated in an agar medium overnight, plaques occur in the cell lawn indicating the presence of viable MTB in an original sample. A comparison is made between the number of plaques produced in a drug-free control and a sample incubated in the presence of the drug. While the presence of plaques beyond a cut-of point indicates drug resistance, the absence of plaques indicates that the drug destroyed MTB cells. Overall accuracy from several trials so far conducted is put at 97-98% compared with the ‘gold standard’. With the phage amplification method, antituberculosis drug susceptibility results are obtained from MTB culture within 48 hours as opposed to the L J proportion method, which gives resulted in 3 to 4 weeks. Also, phage, as a diagnostic, is much more applicable in Nigeria laboratories than newer, rapid methods which requires specially dedicated instrumentation and are therefore very expensive. Phage amplification technology requires no special equipment and the results can be read visually.

Key words: Tuberculosis, drug susceptibility, phage, treatment, FASTPlaque-TB, rifampicin

(Af J Clinical & Exp Microbiology: 2003 4(2): 67-78)

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METHICILLIN RESISTANCE IN STAPHYLOCOCCAL ISOLATES FROM CLINICAL AND ASYMPTOMATIC BACTERIURIA SPECIMENS: IMPLICATIONS FOR INFECTION CONTROL

B.O. Olayinka, A.T. Olayinka

 

Abstract

The study assessed the importance of Staphylococcus aureus as a urinary pathogen and the incidence of multidrug resistant (MDR), methicillin-resistant Staphylococcus aureus (MRSA). A total of 86 staphylococcal isolates made up of 50 clinical isolates from urine samples submitted to the Medical Microbiology Laboratory of Ahmadu Bello University Teaching Hospital and 36 asymptomatic bacteriuria isolates from urine samples of ‘healthy’ volunteers within the university community were tested for their susceptibility to various antibiotics and production of b-lactamase enzyme. A total of 27 isolates (31.4%) were methicillin resistant, with 12(44.4%) being methicillin resistant coagulase-negative staphylococci (MRCNS). Majority of the isolates tested were resistant to the cheap, readily available broad-spectrum antibiotics; ampicillin, amoxicillin, chloramphenicol, tetracycline and penicillin G. All the isolates were resistant to three or more of the antimicrobial agents tested. A total of 14/50 (28%) of the clinical isolates and 17/36 (47.2%) of the ‘community’ isolates from healthy volunteers were resistant to 7 or more of the antimicrobial agents tested. Analysis of the multiple antibiotic resistance (MAR) index of isolates and the production of b-lactamase enzyme showed that 56 isolates representing 65.1% of the total number tested had an MAR index of 0.5 and above indicating that they probably originated from an environment where antibiotics are frequently used. The implication of these findings for instituting effective control measures aimed at reducing the pool of antibiotic-resistant organisms is discussed.

Key words: Methicillin-resistant, staphylococcus aureus, asymptomatic bacteriuria, infection control
(Af J Clinical & Exp Microbiology: 2003 4(2): 79-90)

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BACTERIOLOGY OF CHRONIC SINUSITIS IN ILORIN, NIGERIA

F.E. Ologe, C. Nwabuisi

 

Abstract

A prospective study of the bacteriology of 120 patients with chronic sinusitis and 55 control subjects seen between January 1995 and December 1998 in the Ear, Nose and Throat (ENT) Diseases Clinic of University of Ilorin Teaching Hospital, Ilorin, Nigeria was made. Whereas all cultures from the control group yielded only Staphylococcus (63.6% Coagulase positive and 36.4% Coagulase negative), cultures of patients with chronic sinusitis yielded Staphylococcus aureus (48.1%), Escherichia coli (20.4%), Klebsiella spp. (20.4%), Streptococci (7.4%) and Streptococcus pneumoniae (3.7%). The isolates were 100% sensitive to Ofloxacin, while penicillin was the least effective antimicrobial agent across board. It was concluded that because of the difficulty in differentiating pathogenic organisms from commensals, the result of nasal swabs should be interpreted with caution. However, non-otolaryngologists involved in the management of the vast majority of patients with chronic sinusitis should request a carefully obtained posterior nasal mucosal swab.

(Af J Clinical & Exp Microbiology: 2003 4(2): 91-97)

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CONTROL OF HEPATITIS B INFECTION

O. I. Musa

 

Abstract

Hepatitis B infection remains a public health problem word-wide because of its high endemicity in most countries of the world and the presence of the virus in many body fluids/secretions, which is responsible for several alterative modes of transmissions. Also, the fact that most of the hepatitis B virus (HBV) infections occur in infancy or early childhood where over 70% of the infections is asymptomatic and nearly over half of the primary infection results in chronic infection/ carrier, is another reason. Most of the HBV related chronic liver diseases are associated with the chronic infection, which manifestations occur in adulthood. This article examined the various measures that can be used in the control of the disease taking into consideration the epidemiological factors responsible for the occurrence and distribution of the disease.

(Af J Clinical & Exp Microbiology: 2003 4(2): 98-106)

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CONTROL OF HEPATITIS B INFECTION

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PREVALENCE OF TRICHOMONAS VAGINALIS AMONG THE SEXUAL PARTNERS OF WOMEN WITH TRICHOMONIASIS IN IBADAN, NIGERIA

R. A. Bakare

 

Abstract

This study was conducted to determine the prevalence of Trichomonas vaginalis among the sexual partners of women with Trichomoniasis. While 103 female patients were found to have T. vaginalis using both direct wet mount microscopy and culture, only 44(42.7%) male contacts reported for screening. Trichomonas vaginalis was isolated from 20(45.5%) of the 44 male contact investigated, whilst there was no laboratory evidence of the agent in 13(29.6%) of the study group. Amongst the 60 control subjects, T. vaginalis was recovered from 7(11.7%) of them. The difference in the occurrence of T. vaginalis between the patients and the control group was highly statistically significant (p<0.001). This implies that in most cases, infestation with T. vaginalis in the male is silent and might represent a carrier state. Eight (40%) of the 20 men with Trichomonas vaginalis and 43.2% of the 44 men investigated were between 20 and 29 years and this parallels that of other sexually transmitted diseases. While only 6(30%) of the men with T.vaginalis were diagnosed by direct wet mount preparation, all the 20 (100%) positive cases were diagnosed by culture. This however, indicated the general superiority of culture over fresh smears but it is desirable to use both methods in the diagnosis of Trichomoniasis since they complement each other.

Key Words: Trichomonas vaginalis, Prevalence, Sexual Partners, Trichomoniasis, Ibadan.

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BACTERIOLOGICAL AND PARASITOLOGICAL ASSESSMENT OF VAGINITIS IN PREGNANT WOMEN IN ISEYIN, OYO STATE, NIGERIA

O.A. Adeyeba, M.O. Adeoye, Y.O. Adesiji

 

Abstract

Specimens of High Vaginal Swabs (HVS) of 135 pregnant women were examined to determine the cause of vaginitis in pregnant women in lseyin, Oyo State, Nigeria between August and October 1999.  Study subjects were selected from patient attending selected antenatal clinics in public, private and mission hospitals/clinics in lseyin. Samples were collected from subject in lithotomy position using sterile cuscos bivalve speculum. Samples were analysed by using standard technique as described. A structured questionnaire was also administered in order to obtain vital epidemiological information necessary for the study as described. The data analysis was done using chi square test. Results shows that 45 (33.3%) were positive for Candida spp, 15 (11.1%) for Gardnerella vaginalis and 5 (3.7%) for Trichomonas vaginalis. Sexual activities of individual have no significant effect on prevalence of vaginitis while symptomatology was a major indicator of infection. The effect of educational attainment and religion on infection rate was discussed. Infection decreased with age of patients while infection distribution by age of pregnancy gave a confusing pattern and the factors responsible for this were discussed. Since vaginitis could be asymptomatic most time, the screening of all pregnant women with risk factors for preterm labour and premature rupture of membranes must be undertaken. Prompt treatment of cases is also recommended.

Key Words: Pregnant women, vaginitis, aetiologic agents, prevalence, Iseyin.

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THE EFFECT OF SCHISTOSOMA MANSONI CERCARIA INFECTION AND TREATMENT WITH NIRIDAZOLE ON TESTICULAR HISTOLOGY OF THE MICE

SYLVNUS JOSIAH DAFUR, PATRICIA MANKO LAR

 

Abstract

The testicular histology of mice infected with Schistosoma mansoni (S.mansoni) cercaria and treated with Niridazole was examined. The results reveal that infection of mice with Schistosoma mansoni cercariae resulted in distortion of the testicular cyto-architecture including disruption of spermatogenesis as shown by the absence of spermatozoa in the lumen of the sominiferous tubule and distruction of the inter-tubular connective tissue of the infected mice. These changes were reversed to normalcy following two-course treatment of the infected mice with Niridazole after five weeks.

(Af. J. of Clinical and Experimental Microbiology: 2003 4(1): 2-5)