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Prematurity as a secondary immunodeficiency disorder with increased risk of infections: A mini-review

*1Ibraheem, R. M., and 2Issa, A.

1Department of Paediatrics and Child Health, University of Ilorin and University of Ilorin Teaching Hospital, PMB 1515, Ilorin, Nigeria

2Department of Paediatrics, Children Specialist Hospital, Ilorin, Nigeria

*Correspondence to: ibraheem.rm@unilorin.edu.ng;

rasheedahbidmus@yahoo.com +2348033704168; ORCID: 0000-0002-3960-9740

Abstract:
Prematurity significantly increases neonatal mortality in sub-Saharan Africa. Underdeveloped immune systems and prolonged hospitalization elevate the risk of secondary immunodeficiency leading to heightened vulnerability to healthcare-associated infections, including neonatal sepsis from various sources like intrauterine, intrapartum, and postnatal agents. This review explores the impact of prematurity on infection susceptibility and the role of immature immunity. A literature search using PubMed and Google Scholar identified relevant articles published between January 1980 and December 2022, focusing on terms such as “preterm,” “prematurity,” “neonatal sepsis,” and “secondary immunodeficiency.” Despite neonatal susceptibility to sepsis, accurate incidence estimates are lacking in many countries, and preterm infants face higher morbidity and mortality risks compared to full-term babies. Early-onset infections usually manifest within the first 72 hours post-delivery, while late-onset neonatal sepsis occurs after this period. Immaturity affects various immune system components, with gestational age influencing functionality. The compromised innate immune response in preterm infants involves factors such as fragile skin, reduced tear/mucus production, and low antimicrobial peptide levels. Complement deficiencies and impaired neutrophil function increase susceptibility to infections. Macrophages, dendritic cells, and natural killer cells exhibit reduced activity, impacting viral clearance. Preterm infants also have lower immunoglobulin (Ig) G levels, contributing to a weakened adaptive immune response. Hypogammaglobulinaemia heightens susceptibility to infections relying on antibody-mediated protection, while low secretory IgA production and delayed antibody response predispose to gastrointestinal and respiratory infections. The combined effect of immature immunity and medical interventions heightens preterm infants’ susceptibility to pathogens. Recommendations for mitigating infection risks include antimicrobial stewardship, prompt initiation of exclusive breastfeeding, and timely administration of routine vaccinations. Continue reading “Prematurity as a secondary immunodeficiency disorder with increased risk of infections: A mini-review”

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Microbial menace to kidney health: A review of the role of infections in acute kidney injury

Medugu, N., and *Adegboro, B.

Department of Medical Microbiology and Immunology, Nile University of Nigeria, Abuja, Nigeria

*Correspondence to: boazadegboro@gmail.com; boaz.adegboro@nileuniversity.edu.ng; +234 80 33812348

Abstract:

Acute kidney injury (AKI) of infectious aetiology is a complex condition that requires a comprehensive microbiological evaluation. This includes sepsis workup, evaluation of urinary tract infection (UTI), assessment for viral, fungal, and bacterial infections, consideration of the patient’s microbiome, and vigilance towards antibiotic toxicity. Advanced molecular diagnostic tools such as metagenomic sequencing and rapid point-of-caretesting, may offer future advances in accurate and timely identification of infectious aetiologies in AKI. Continue reading “Microbial menace to kidney health: A review of the role of infections in acute kidney injury”

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In vitro antibiotic susceptibility of bacterial pathogens and risk factors associated with culture positive neonatal sepsis  in two hospitals, Katsina metropolis, Nigeria

[1]Obaro, H. K., 1Abdulkadir, B., and 2Abdullahi, S.

1Department of Microbiology, Umaru Musa Yar’adua University, Katsina, Katsina State, Nigeria

2Department of Pharmacology, Umaru Musa Yar’adua University, Katsina, Katsina State, Nigeria

*Correspondence to: obarohasan@yahoo.com; +2348136436916

Abstract:

Background: Neonatal sepsis is one of the most important causes of morbidity and mortality among neonates, particularly in developing countries. This study aimed to determine the risk factors and in vitro antibiotic susceptibility patterns of bacterial pathogens associated with neonatal sepsis in Federal Medical Centre (FMC) and Turai Umaru Yar’adua Maternal and Children Hospital (TUYMCH), Katsina, Nigeria.

Methodology: A total of 60 hospitalized neonates evaluated for neonatal sepsis at the special care baby units (SCBU) of the two healthcare facilities whose parents gave informed consent were enrolled for the study between July and December 2020. Blood samples were aseptically collected from the neonates and cultured on BacT/Alert automated platform (BioMérieux, Mercy-Etoile, France) machine. Bacteria were identified from all positive cultures and in vitro susceptibility test was performed on the isolates to determine their minimum inhibitory concentrations (MICs) to eight selected antibiotics using the Vitek-2 compact system. Data were analyzed by SPSS version 22.0.  Continue reading “In vitro antibiotic susceptibility of bacterial pathogens and risk factors associated with culture positive neonatal sepsis  in two hospitals, Katsina metropolis, Nigeria”

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Evaluation of procalcitonin as a biomarker of bacterial sepsis in adult population in a tertiary healthcare facility in Lagos, Nigeria

*1,2Idakari, C. N., *2,3Efunshile, A. M., 4Akase, I. E., 1Osuagwu, C. S., 1Oshun, P.,
and 1Oduyebo, O. O.

1Department of Medical Microbiology and Parasitology, College of Medicine, University of Lagos/Lagos University
Teaching Hospital, Idi-Araba, Lagos, Nigeria

2Department of Medical Microbiology, Alex-Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria

3Department of Medical Microbiology, Ebonyi State University, Abakaliki, Nigeria

4Department of Internal Medicine, College of Medicine, University of Lagos/Lagos University
Teaching Hospital, Idi-Araba, Lagos, Nigeria
*Correspondence to: idakarichinedu@gmail.com and drefunshile@yahoo.com

Abstract:
Background: Prompt antibiotic treatment of sepsis improves the outcome, but dependence on clinical diagnosis for empiric therapy leads to overuse of antibiotics which in turn promotes the emergence of antibiotic resistance. Blood culture takes time and molecular diagnosis may not be available or affordable. The use of procalcitonin (PCT) as a biomarker to guide antibiotic therapy in adults is less established compared to children. This study was therefore designed to evaluate the usefulness of PCT as a biomarker to aid early commencement of antibiotics among adult patients with sepsis in a tertiary healthcare facility in Lagos, Nigeria.

Methodology: Three hundred patients with clinical diagnosis of sepsis made by the managing physicians were recruited for the study. Criteria used for clinical diagnosis of sepsis include tachycardia, tachypnea, fever or
hypothermia and presence of leukocytosis, bandemia or leucopenia. The patients were selected using systematic consecutive sampling methods. A sepsis work-up including quick sequential organ failure assessment (qSOFA),
white blood cell count (WCC), aerobic blood culture and estimation of serum PCT levels were done for all the participants. Data were analysed using the Statistical Package for Social Sciences (SPSS) for windows version 25.0.
Sensitivity, specificity, positive, and negative predictive values, accuracy and likelihood ratio of PCT against blood culture, WCC and qSOFA score were determined. Association between variables was measured using Fisher exact
test (with Odds ratio and 95% confidence interval). P-value ˂0.05 was considered statistically significant. Continue reading “Evaluation of procalcitonin as a biomarker of bacterial sepsis in adult population in a tertiary healthcare facility in Lagos, Nigeria”

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Recent advances in the pathophysiology and management of sepsis: a review

*1Adegboro, B. A., 1Imran, J., 2Abayomi, S. A., 3Sanni, E. O., and 4Biliaminu, S. A.

Departments of 1Medical Microbiology and Immunology, 2Department of Medical Microbiology, LAUTECH Teaching Hospital, Ogbomoso, Nigeria  3Haematology, and 4Chemical Pathology, Nile University of Nigeria, Abuja, Nigeria

*Correspondence to: boazadegboro@gmail.com

Abstract:

Sepsis is a syndrome consisting of physiological, pathological and biochemical anomalies caused by infectious agents. It causes clinical organ dysfunction, which is identified by an acute increase in the Sequential (sepsis-related) Organ Failure Assessment (SOFA) score of two or more points. SOFA score is a score of three components that can be easily used at the bedside to track the clinical status of a patient while on admission, and these are altered respiratory rate of ≥ 22 breaths/minute, altered mental status, and systolic blood pressure of ≤ 100 mmHg. A patient with SOFA score of ≥ 2 has an attributable 2 – 25-fold increased risk of mortality compared to a patient with SOFA score of ˂ 2. This present review provides information on the new definition of sepsis and septic shock, aetiology, pathophysiology, biochemical, pathological and haematological changes, morbidity and mortality parameters, management, and prognostic factors in patients with sepsis. Continue reading “Recent advances in the pathophysiology and management of sepsis: a review”

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Profile of septic work up among patients admitted into the intensive care unit in University of Abuja teaching hospital Gwagwalada, Abuja

T. Yunusa, A.M. Adeoye, O.A. Akitoye

 

Abstract

Background: Several infectious agents are responsible for sepsis in all age groups presenting with fever which can have devastating consequences if not adequately treated. Sepsis may arise from bacteria, fungi and viral origin but are localized in particular organ or system with systemic affectation. Febrile illness is a leading reason for admission to the intensive care unit of hospitals in the tropics and these patients comes mostly from inpatients rather than from outpatients. Diagnostic apparatus needed for sepsis work up are usually not available in most cases and the data regarding septic work up are very scanty. Therefore, this research set out to determine the pattern of isolates from septic work-up among patients admitted to the intensive care unit in Abuja.
Methodology: This was a descriptive cross-sectional study. Sixty-four consecutive patients admitted to the intensive care unit with symptoms such as fever were involved in the study in a view to determine the septic state of the patients. Samples were collected. Blood culturing was performed using the BACTEC 9050® system and biochemical analytical profile index were used for identification and confirmation of bacterial isolates.
Results: The mean age of the patients admitted to ICU was 40.9±3.2 with the highest proportion within the age range of 31-40 years accounting for 31.7% of the patients enrolled and the lowest proportion being 10-20 years group accounting for 5.0%.Out of the 64 patients investigated in the ICU 60 patients had clinical and positive cultures with an overall positive and negative infection rate of 93.8% and 6.3% respectively. From the positive cultures yields 86.7% were bacteremia and 13.3% were fungaemia. Multiple infections were observed among the male patients, Multi-drug resistance bacteria were observed among Klebsiella pneumonia, E. coli and P. aeroginosa isolates.
Conclusion: Bacterial and fungal isolates were found in this study but increased rate of polymicrobial isolation and nosocomial infections calls for concern.

Key words: Profile of infectious agents, sepsis, fever, septic work up, Abuja

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Profile of septic work up among patients admitted into the intensive care unit in University of Abuja teaching hospital Gwagwalada, Abuja