Species distribution and antifungal susceptibility pattern of candida isolates from pregnant women in a tertiary hospital in Nigeria

Introduction: Information regarding the resistance pattern of Candida species in developing countries  is limited. Most sensitivity studies were performed on few isolates and/or few antifungal agents using  the disc diffusion method because of limited resources.Methods and Material: We evaluated six antifungal agents against Candida isolates recovered from  the vagina of apparently healthy pregnant women using the E-test method.Results: One hundred and seventy Candida isolates recovered from 500 participants were identified and subjected to an antifungal susceptibility test. Candida albicans(53.5%) was the most common specie  identified, followed by Candida glabrata(14.1%). C. albicans was mostly resistant to itraconazole (31.9%), with MIC 50 and 90 of 0.038 mg/L and 6 mg/L, respectively. Resistance to 5-fluorocytosine, fluconazole, and voriconazole was not observed for C. albicans. Caspofungin resistance was observed in 3 C.  albicansand 1 C. glabrata isolates. Resistance to amphotericin B (50%) and itraconazole (100%) were the highest for C. glabrata. Flucytosine and voriconazole resistance was not observed in this study.Conclusion: The observed species diversity and the presence of C. albicans resistance to 3 of the 6  antifungal agents tested justify the need for a regular surveillance of the sensitivity pattern to antifungal  drugs in Nigeria

Perception of the efficacy of artemisinin-based combination therapy (ACT) and chloroquine prescription pattern and among nurses in South-West Nigeria

Background-Malaria remains a threat to millions of children despite the recent advances recorded in the fight against the disease which remain the 3rd largest killer of children below the age of 5 years in endemic regions. Drug resistant plasmodium species continues to limit the fight against malaria, while the spread of fake and substandard antimalarial drugs has been recognized as a major problem across Africa because of its association with drug resistant parasite. We aim to find out the prescription pattern of chloroquine among nurses in South-West Nigeria and perception of artemisinin-based combination therapy (ACT).Design and methods-About 180 pre-tested questionnaires were administered to randomly selected nurses out of which 155 were sufficiently completed and suitable for analysis. Results-Majority (56.1%) still have confidence in the efficacy of CQ which was still being prescribed by 45.2% of the respondents. CQ was mostly prescribed by those who had previous ACT treatment failure experience (54.3%) with their patients, P=0.03; as well as those who believe that ACT resistance malaria is now in circulation (44.3%). Fifty (32.3%) of our respondents claimed that they had come across fake and substandard ACT, from which 40.0% now prescribe CQ.Discussion-The high rate of CQ prescription in this study showed that many of the health workers were still resistant to the change in antimalarial treatment policy, which is related to unsatisfactory experience with ACT. Additional measures are urgently required to verify this experience so as to win the confidence of healthcare workers away from chloroquine.Keywords: Artemisinin-based combination therapy (ACT), chloroquine, substandard antimalaria

Antimalarial use and the associated factors in rural nigeria following implementation of affordable medicines facility-malaria (amfm) price subsidy

Purpose: This study was set out to find out the pattern of antimalarial drug use in a Nigerian rural community following the aggressive price subsidy of Artemisinin Combination Therapy(ACT) recently embarked upon by Roll Back Malaria partners through Affordable Medicines Facility-malaria (AMFm).Methods: Questioners were administered to 310 adult members of the community with the most recent malaria episodes so as to find out about the drugs used and some of the factors associated with the choice of the drug.Result: Although the overall use of ACT (13.55%) in this community was about 4 times higher than what it used to be, Chloroquine 123(39.62%) and sulphadozine/pyrimathamine 120(38.71%) were the mostly used antimalarial agents. Choice of drug used was significantly associated with perception of efficacy and price among other factors. Respondents liked the price of ACT (33.3%) most, CQ was the drug most liked in terms of efficacy (44.2%) while SP was the drug most liked in terms of lack of side effect (38.9%), taste (61.6%) and convenience (35.7%).( P= 0.001)Conclusion: In addition to sustaining the current price control, there is a need to continuously monitor and effectively regulate the quality of the ACTs in circulation so as to gain the confidence of both the prescribers and the end users regarding efficacy and adherence to ACTs. This will help to safeguard the huge investment in ACT subsidy by the Roll Back Malaria partners.Key words: ACT, Subsidy, Affordable Medicines Facility-malari

Intestinal Helminthiasis among School Children in Ilie, Osun State, Southwest, Nigeria

A cross sectional study of intestinal helminthiasis among school pupils was undertaken in three primary schools in Ilie in Olorunda Local Government Area of Osun state in order to determine the prevalence and intensity of helminthic infections. The relationship between intestinal helminths and anthropometric indices and the factors that could favour the infection were also studied. Faecal samples from three hundred and four (304) randomly selected out of the four hundred and seven (407) school children in the study area were collected and analysed with the semi-quantitative Kato Katz technique and concentrated method. The intensity of infection was classified into light, moderate or high according to World Health Organisation (WHO) thresholds. The overall prevalence rate was 52.0% while five species of intestinal helminths were identified. Ascaris lumbricoides (36.2%) was the most common, followed by Hookworm (10.5%), Schistosoma mansoni (4%), Strongyloides stercoralis (0.7%) and Hymenolepis nana (0.7%). Multiple helminthic infection were recorded with Ascaris –Hookworm (6.58%) having the highest prevalence among the children. Female (56.6%) were more infected than male (46.4%) and the difference was statistically significant (P=0.0019). Seventeen percent (17%) of the children were below the third percentile for weight (wasted) while fourteen percent (14%) were below the third percentile for height (stunted). There was a relationship between intensity of infection and wasting since there were fewer underweight pupils (13%) with normal stool than those moderately infected (35%) (

In-vitro Antimicrobial Efficacy of Carex Powerful Antiseptic Liquid

The Paterson Zochonis Industries in Lagos, Nigeria recently produced Carex Powerful Antiseptic Liquid, which was investigated for antimicrobial activities against common human skin pathogenic bacteria, yeasts and a dermatophyte including Staphylococcus aureus, Pseudomonas aeruginosa, Malassezia furfur, Candida albicans and Trichophyton mentagrophytes. The microbes were challenged in-vitro with 0.7% and undiluted Carex antiseptic liquids for a period between 30 seconds and 120 seconds and the microbial cell reduction rates were determined at every 30 seconds contact by time kill test. Both diluted and undiluted Carex antiseptic liquids produced 100% reduction in all the microbial cells tested except Pseudomonas aeruginosa in which 62% and 100% cell reductions were observed for diluted and undiluted Carex antiseptic liquids respectively within 30 seconds of contact time. It is concluded that Carex Powerful Antiseptic liquid made by the PZ Industries has antimicrobial activities but its non-toxicity to human skin should be proven by subjecting the preparation to clinical trial. Keywords: Carex Antiseptic Liquid, Time Kill Test. Nigerian Journal of Health and Biomedical Sciences Vol. 7 (2) 2008: pp. 44-5

Persistence of chloroquine-resistant haplotypes of Plasmodium falciparum in children with uncomplicated Malaria in Lagos, Nigeria, four years after change of chloroquine as first-line antimalarial medicine.

BACKGROUND: In Nigeria, despite the change in National malaria drug policy to artemisinin combination therapy (ACT) in 2005 due to widespread chloroquine resistance, chloroquine (CQ) is still widely used in the treatment of malaria because it is cheap, affordable and accessible. The use of ACT for the management of uncomplicated malaria is currently being promoted. The employment of genetic markers to track circulating chloroquine-resistant parasites are useful in elucidating likely poor efficacy of chloroquine, especially in settings where it is not recommended for the treatment of uncomplicated falciparum malaria. This study determined the prevalence of pfcrt haplotypes and point mutations in pfmdr1 genes four years after the change in antimalarial treatment policy from CQ to the ACTs in Lagos, a commercial city in South-West, Nigeria. METHODS: This was a cross sectional study on uncomplicated malaria in children less than 12 years that presented with fever and other symptoms suggestive of malaria. Parasite DNA was extracted from 119 patients out of 251 children who were positive for Plasmodium falciparum by microscopy and amplified. The occurrence of haplotypes was investigated in pfcrt gene using probe-based qPCR and single nucleotide polymorphisms in pfmdr1 gene using nested PCR. RESULTS: One hundred and nine (109) of the 119 children with P falciparum infection (91.6%) harbourd parasites with the mutant pfcrt haplotype (CVIET). Out of this, 4.2% comprised a mixture of genotypes encoding CVMNK and CVIET, while 4.2% had the wild type (CVMNK). Furthermore, the frequency of point mutations in pfmdr1 was 62.2% and 69.0% for codons Y86 and F184 respectively. There were no mutations at codons 1034, 1042 and 1246 of the Pfmdr1 genes. CONCLUSION: The high frequency of the CQ-resistant haplotypes (CVIET) and mutations in Pfmdr1 associated with CQ resistance in P. falciparum among these children suggest that CQ-resistant parasites are still in circulation. Continuous use of chloroquine may continue to increase the level of mutations in pfcrt and pfmdr1genes. There is need to strengthen current case management efforts at promoting ACT use as well as urgently restricting access to chloroquine by the National drug regulatory agency, National Agency for Food Drug Administration and Control (NAFDAC). VIRTUAL SLIDES: The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/2069472010142303

Toxoplasmosis - Awareness and knowledge among medical doctors in Nigeria

Toxoplasma gondii is a zoonotic parasite causing high disease burden worldwide. A One Health approach is needed to understand, prevent, and control toxoplasmosis, while knowledge gaps in the One Health aspects have been identified among medical professionals in earlier studies. As a One Health collaboration between veterinary and medical fields, we surveyed the knowledge on toxoplasmosis among medical doctors in Nigeria. The knowledge questions, which the participants answered without consulting literature and colleagues, covered epidemiological One Health aspects as well as clinical interspecialty aspects of T. gondii infections. Altogether 522 medical doctors from four tertiary hospitals completed the questionnaire. The mean number of correct answers in the knowledge questions was 7.5, and 8.4% of the participants selected at least 12 of the 17 correct answers. The proportion of medical doctors scoring such a high score was significantly higher among those who reported having seen a case of clinical toxoplasmosis than in those who did not. While 62% of the medical doctors participating in our study knew that cats can shed T. gondii in their feces, 36% incorrectly suggested that humans could do that too. That T. gondii infection can be meatborne was known by 69%, but that it can be also waterborne only by 28% of the medical doctors participating in our study. Most of the medical doctors, 78%, knew that clinical toxoplasmosis may involve the central nervous system, while only 37% answered that it can involve the eyes. Our results suggested knowledge gaps, which need to be addressed in Continuous Medical Education. The identified gaps included both intersectoral One Health aspects and interspecialty aspects: For prevention and management of toxoplasmosis, knowing the main transmission routes and that the parasite can affect several organs is relevant.Peer reviewe