Global trend of Methicillin-resistant Staphlococcus aureus and emerging challenges for control

Background: Following its first recognition in early 1960s, the increasing incidence of nosocomial and community-acquired methicillin resistant Staphylococcus aureus (MRSA) infections has become a global problem. The emergence of multiple-drug resistant MRSA strains and dissemination of epidemic antibiotic clones including presence of wide spectrum of virulence and predisposing risk factors complicate diagnosis, chemotherapy and control causing significant morbidity and mortality. Detection of MRSA strains in domestic animals and protozoan has widened the epidemiologic characters of the organism and may influence infection control policies. Objectives: To review the emergence and epidemiologic spread of resistant strains of MRSA, molecular/genetic basis of resistance in the organism and challenges facing control strategies worldwide. It also aims to suggest intervention strategies so as to checkmate the spread of MRSA infections.Methods: By reviewing local and international literatures on MRSA infections coupled with practical experience in the field of this endeavour. Result/Conclusion: MRSA has shown increasing endemic and epidemic spread in the last four decades causing serious medical and socio-economic difficulties. Routine and regular surveillance (uncommon in poor-resourced developing areas of especially sub-Saharan Africa), good hospital practices and personal hygiene, public enlightenment, development of effective therapeutic agents and rational administration of antibiotics based on reliable test results will limit the spread of MRSA infections.Key words: MRSA, incidence, morbidity, mortality, surveillance, control

Emerging and re-emerging infectious agents of nosocomial diseases – The need for review of hospital policy and control strategies

Nosocomial infections (NIs, now referred to as Healthcare-associated infections, HCAIs) are diseases that essentially originate from the hospital and may be disseminated via biologic or inanimate agents in the healthcare center. They occur globally and constitute major hazards inhealthcare institutions resulting in significant morbidity, mortality and increased hospital stay, and high socio-economic cost. Between 3 and 21 percent (average range, 5 – 9%) of all hospitalized patients are affected by HCAIs each year in various communities worldwide; while critically ill,trauma or immunocompromised patients (e.g. those requiring multiple life – saving invasive procedures or immunosuppressive therapy) are hardest hit. The increasing involvement of multiple drug-resistant strains of a large spectrum of emerging and re-emerging infectious agents of NIscomplicate morbidity, management and impose serious burden on the patients and relations. Hospital workers, patients, materials or equipments and hospital procedures constitute major factors of transmission mechanism of HCAIs. However, the incidence and socioeconomic impact ofNIs (though estimated to be high) are rarely investigated in sub-Saharan Africa (including Nigeria) due to poor healthcare facility and low capacity. There is need for increased awareness on HCAIs and adoption of enduring hospital policy and effective control measures that will take cognizanceof emerging trends of nosocomial agents and transmission mechanism to reduce morbidity, mortality and socio-economic impact associated with HCAIs.Keywords: Healthcare – associated infections, hazards, morbidity, mortality, control measures

Review of Lassa fever, an emerging old world haemorrhagic viral disease in sub-Saharan Africa

Lassa fever is an acute immunosuppressive illness of increasing public health concern causing severe morbidity and significant mortality (Case fatality rate (CFR) ≥ 50%) especially in epidemic cases. Although Lassa fever has emerged (following its first detection (1969) in Lassa town, Nigeria) as one of the most prevalent and debilitating viral haemorrhagic fevers endemic in West Africa region (Nigeria inclusive), yet, the control/prevention of the regular outbreak of the disease has become an herculean task in the areas affected; there is inadequate healthcare facility (including Laboratory/diagnostic and care centres), poor socioeconomic environment, lack of awareness among the populace and presence of favourable ecologic niche for the survival and propagation of the natural host and reservoir mouse (Mastomys natalensis) of Lassa virus . Lassa fever is mainly transmitted by contact with excretions and secretions of infected rats via foods and water as well as exposure to other contaminated items. Lassa virus is a member of an Old World Arenariruses, of family Arenaviridae. It is an enveloped, single-stranded (SS) bisegmented RNA virus with ability to replicate very rapidly. It consists of 4 lineages; 3 members are identified as ancenstral strains found in Nigeria, while the fourth is domiciled in other West Africa Countries. Lassa virus infects almost every tissue in human body resulting in multisystemic dysfunction. The incubation period is generally between 6 to 21 days resulting in 3 stages of clinical manifestation viz: Acute phase characterized by flu-like, non-specific illness; haemorrhagic phase accompanied with gastrointestinal symptoms and cardiovascular/neurologic complications. Currently, there is no clinically certified Lassa fever vaccine thus complicating deterrent or preventive measures. Hence, there is need for intensification of educational programs for the populace on the useful control measures against Lassa fever. The stakeholders need to prioritize intervention and support program and also speed up the processes leading to the production of effective vaccine to limit the menace of Lassa fever outbreak and associated morbidity, fatality and high socio-economic cost.Keywords: Lassa fever, endemic, epidemic, reservoir rodent, West Afric

Emergence of ebola virus disease and its devastating impact in poor-resourced areas of sub-Saharan Africa

Ebola virus disease (EVD) is an unusual infection, and one of the most virulent emerging viral diseases known causing severe morbidity and significant mortality. In recent epidemic outbreak of EVD in West African countries of Guinea, Sierra Leone and Liberia (the 3 nations epi-centre of the epidemic), the disease has affected over 25,000 people resulting in more than 10,000 deaths, (Case Fatality Rate, CFR>40%; i.e. from December, 2013-March, 2015). Following the first outbreak of EVD in Sudan and Democratic Republic of Congo (DRC) in 1976, several epidemics (>20 outbreaks) of the disease have been recorded particularly in poor-resourced areas of the East, Central and West-Africa resulting in significant mortality. CFR of EVD is 25-90 percent. Ebola virus is transmitted to humans by wild animals (mainly non-human primates) and spreads in human population via close contact with blood, body fluids and secretions of infected patients. EVD can also be acquired through direct contact with infected corpses. It is characterized (at initial stage) by non-specific flu-like symptoms including headache, fever, myalgia and malaise following incubation period of 2-21 days. This may terminate into severe systemic manifestations including diffuse internal and external bleeding, shock and death if untreated early. Non recognition of the specific natural host of Ebola virus and rapid progression of infection including slow mounting of acquired immunity against EVD by infected host complicate control measures. The socio-economic cost of EVD epidemic outbreak is colossal. Despite notable advances in healthcare-related technology enhancing the diagnosis, treatment / management and prevention / control of infectious or viral diseases, the response of the stakeholders over the years geared toward controlling the spread of the disease left much to be desired. No clinically certified drugs or vaccines against EVD are yet available. There is the urgent need by stakeholders to device appropriate preventive / control measures including development of effective drugs and vaccines to checkmate the spread of EVD and associated severe morbidity, high mortality and devastating socio-economic impact.Key Words: Ebola virus disease, severe morbidity, mortality, socio-economic impact, checkmate

Aetiological agents of surgical site infection in a specialist hospital in Kano, north-western Nigeria

Despite the advances made in asepsis, antimicrobial drugs, sterilization and operative techniques, surgical site infections (SSI) continue to be a major problem in all branches of surgery in the hospitals. The objective of this study was to establish the incidence of SSI, the type and frequency of various pathogens and their antibiotic susceptibility pattern in Murtala Mohammed Specialist Hospital (MMSH), Kano, Nigeria. A total of 2,920 consecutive patients who underwent different surgical procedures between January 2009 and December 2010 at Murtala Mohammed Specialist Hospital were enrolled in this study. Samples of pus were collected from infected cases and screened for bacterial and fungal pathogens by standard microbiological methods. Antibiotic susceptibility tests were done by disc diffusion technique. A total 878 patients were found to be clinically infected and 919 isolates were obtained in all. This gave an incidence of 30.1% infection rate. While 783(89.2%) cultures yielded single organism, 77(9.8%) yielded mixed growth and 18(8.1%) cultures yielded no growth. The most frequently isolated organism was E. coli (25.5%) followed by Staphylococcus aureus 20.6%. The incidence of Methicillin resistant Staphylococcus aureus was 35.7%. Ceftriaxone, ceftazidime and ofloxacin showed good results against most isolates while ampicillin and cotrimoxazole which are commonly used drugs were ineffective. An understanding of the various types of pathogen involved in SSI and their antibiotic susceptibility pattern will reduce indiscriminate prescription of antibiotics and help in infection control

Seroprevalence and risk factors of Hepatitis C Virus in patients and blood donors in Kano, Nigeria

Hepatitis C virus (HCV) is a major cause of chronic liver disease resulting in cirrhosis and hepatocarcinoma. It is believed to be widespread in Africa but its epidemiology is incomplete and is yet to be determined in many areas of the sub-saharan Africa including Nigeria. Using third generation enzyme immuno-assay (EIA-3) and recombinant immunoblot assay (RIBA) technique as confirmatory test, we examined the prevalence of HCV antibodies in 226 blood donors and 226 patients attending Aminu Kano Teaching Hospital (AKTH) in Kano, Nigeria and evaluated the risk factors of HCV transmission in this environment. HCV antibodies were detected in 0.4% and 2.2% blood donors and patients respectively. The overall HCV seroprevalence was 1.3%. There was increased infection acquisition with increasing age; one (16.7%) HCV infection occurred in 25-34 years age group and 5 or 83.3% in subjects > 45 years in age which was significant (P< 0.05). The ratio of infection in male to female was 1:5. Evidence of previous exposure via transfusion was common in HCV seropositive subjects and could be a major risk factor of acquisition in this environment. Adequate screening of blood products in sub- Saharan Africa (Nigeria inclusive) may minimize the risk of HCV transmission and associated health complications.Key words: Hepatitis C virus, seroprevalence, patients, blood donors, risk factors

Prevalence and Predictors of Tuberculosis Coinfection among HIV-Seropositive Patients Attending the Aminu Kano Teaching Hospital, Northern Nigeria

Background: The HIV/AIDS epidemic has been accompanied by a severe epidemic of tuberculosis (TB), although the prevalence of coinfection is largely unknown, especially in developing countries, including Nigeria. The aim of this study was to determine the prevalence and predictors of TB coinfection among HIV-seropositive Nigerians. Methods: The case files of HIV/AIDS patients attending Aminu Kano Teaching Hospital, Nigeria from January to December 2006 were reviewed. Results: A total of 1320 HIV/AIDS patients had complete records and were reviewed, among which 138 (10.5%) were coinfected with TB (95% CI, 8.9% to 12.2%). Pulmonary TB was diagnosed in 103 (74.6%) patients, among whom only 18 (17.5%) were sputum-positive. Fifty (36.2%) coinfected patients had some type of extrapulmonary TB (EPTB); 15 had both pulmonary TB and EPTB. Among the 35 patients with EPTB only, 20 (57.1%) had abdominal TB, 5 (14.3%) had TB adenitis, 5 (14.3%) had spinal TB, 3 (8.6%) were being monitored for tuberculous meningitis, and 1 (2.9%) each had renal TB and tuberculous adrenalitis. The highest prevalence of TB, 13.7% (n = 28), was seen among patients aged 41–50 years. TB coinfection was significantly associated with marital status, WHO clinical stage, and CD4 count. Marital status (OR, 2.1; 95% CI, 1.28–3.59; P = 0.04), WHO clinical stage at presentation (4.81; 1.42–8.34; P = 0.001), and baseline CD4 count (2.71; 1.51–6.21; P = 0.02) remained significant predictors after adjustment for confounding. Conclusions: The moderately high prevalence of TB among HIV-seropositive patients underscores the urgent need for strategies that lead to rapid identification and treatment of coinfection with active or latent TB

The trend of HIV infection in Kano, Nigeria-A-Seven-Year study of Adult attendees of Aminu Kanu Teaching Hospital

No Abstract Nigerian Journal of Medicine Vol. 16 (4) 2007: pp. 344-34

Distribution and antibiotic susceptibility pattern of methicillin-resistant Staphylococcus aureus isolates in a university Teaching hospital in Nigeria.

Background: The rise of methicillin resistant Staphylococcus aureus (MRSA) infection has become a serious health issue. The emergence of mutidrug – resistant MRSA strains compounds chemotherapy and has raised public health concern. In this preliminary study, the distribution and antimicrobial susceptibility profile of MRSA to 10 commonly used antimicrobial agents at the University of Calabar Teaching Hospital (UCTH), Nigeria were determined between June 2005 and May 2006. Methods: S. aureus were cultured from various clinical samples using standard bacteriologic technique. Methicillin disc diffusion method for the detection of methicillin resistance and Kirby – Bauer NCCLS modified disc diffusion for antibiotic susceptibility tests were used. Results: The MRSA prevalence rate was 37.5% (33/88) of all S. aureus isolates. Majority of the MRSA strains (15/33) were recovered from blood samples followed by isolates from wound exudates (11/33) and were statistically significant (p 50 years (60%) and were statistically significant (r = - 0.083). The MRSA isolates were resistant to penicillin and ampicillin (97.0%), tetracycline (93.9%), Cotrimoxazole (90.9%), Chloramphenicol (78.8%), Cefuroxime (66.7%), Erthromycin (60.6%) and Gentamycin (54.5%). Amoxycillin clavunanic acid and ciprofloxacin were most active with MRSA isolates showing 97% and 93.9% susceptibility to the two drugs respectively. Eighteen (54.5%) MRSA isolates showed resistance to more than four antibiotic groups. One strain was resistant to all of the antimicrobial agents used. Conclusion: The study affirms the increasing prevalence of multidrug resistant MRSA in Nigeria. There is need for rational chemotherapy, routine detection and regular surveillance of MRSA to limit its spread. Keywords:incidence, MRSA, multidrug, resistance, chemotherapy; surveillanceSahel Medical Journal Vol. 11 (4) 2008: pp. 142-14

HIV Infection Rate Among Newly Recruited Senior Cadres In A Nigerian Security Agency

Objective: To determine the rate of HIV infection among newly recruited personnel in a Nigerian Security Agency. Materials and Methods: Four hundred and thirty-one security officers were screened for HIV antibodies. Double ELISA technique and Immunocomb II, HIV I and II (Orgenics Isreal) were employed for the test. Results: HIV infection rate of 1.8% was obtained. The ratio of infected men to women is approximately 2:1. the largest HIV seropositive cases were found among officers in age group 25-28 years. Conclusion: The overall HIV infection rate of 1.86% obtained appear low compared to general national average of 5.4% and 33% for commercial sex workers. Key words: HIV/AIDS, Pandemic, Prevalence Rate, Epidemic. Highland Medical Research Journal Vol.1(3) 2003: 35-3