Cytomegalovirus in Immunosuppressed Patients: A Silent and Potential Killer.

Cytomegalovirus (CMV) is a recognized cause of morbidity and mortality among immunocompromised individuals. This review will concentrate on understanding the pathogenesis, clinical manifestations and laboratory diagnostic options for CMV infection.Keywords: Review, Cytomegalovirus, Immunosuppresse

Re-emergence of monkeypox in Nigeria: a cause for concern and public enlightenment

Monkey pox infection is a zoonotic infection transmitted by direct or indirect contact with blood, body fluids and lesions of an infected animal. Human to human spread of Monkey pox has been described and infection is usually self-limiting, with an incubation period of 6-16 days. In Nigeria, the last case of monkey pox infection was recorded over 46 years ago. The recent emergence in Nigeria occurred in the year 2017 and was reported to have spread to 24 states with 228 suspected individuals affected. Laboratory diagnosis, as well as management and prevention of monkey pox infection in Nigeria, remain challenging as Nigeria is a resource-poor country with limited infrastructure, technical skill and training which is required in making a diagnosis. The ability of the monkey pox virus to evolve, its potential bioterrorism potential, as well as its recent emergence in Nigeria further justifies the need for improving the understanding of the presentation and prevention of monkey pox infection.Keywords: monkey pox, emerging virus, Nigeria, rash, zoonosis, orthopo

Lassa Fever: Another Infectious Menace

Nigeria is presently suffering from another Lassa fever epidemic. This was confirmed in the statement of the Minister of Health of the Federation in which he said, “There has been an upsurge in the reported cases of Lassa fever since the beginning of this year, especially in the Federal Capital Territory and its environs. Within two weeks, 12 cases with five deaths due to the disease were recorded. 25 contacts are confirmed by laboratoryinvestigations to have been infected, including 4 health staff working in the National Hospital, Abuja.”1 Lassa fever is an acute viral haemorrhagic fever first described in 1969 in the town of Lassa in Borno state, Nigeria.2 It isendemic in West African countries, and causes 300,000 cases annually with 5000 deaths.3 Lassa fever epidemics occur in Nigeria, Liberia, Sierra Leone, Guinea and the Central African Republic.4 Lassa virus, the agent of the disease is a member of the Arenaviridae family. The virus is pleomorphic with single-stranded and bisegmented RNA genome.3 Its primary host is Natal Multimammate Mouse (Mastomys natalensis). Transmission to man occurs via exposure to the rat excrement through respiratory or gastrointestinal tracts5, exposure of broken skin or mucus membrane to infected material, direct contact, sexually and transplacentally. The prevalence of antibodies to the virus is 8-22%9 in Sierra Leone, 4-55% in Guinea,12 and 21% in Nigeria.13 Thedisease is mild or asymptomatic in 80% of infected people, but 20% have a severe multisystemic disease. Clinical features are difficult to differentiate from that of other viral haemorrhagic fevers  and common febrile illness such as Malaria, Typhoid fever and so on. Definitive diagnosis is by viral isolation, Antigen and Antibody detection and ReverseTranscriptase PCR. Treatment is with Ribavirin, an antiviral agent. No vaccine is currently available. Prevention is by keeping rats away from homes

High seropositivity of IgG and IgM antibodies against cytomegalovirus (CMV) among HIV-1 seropositive patients in Ilorin, Nigeria

Background: Human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) is a major public health problem in sub-saharan Africa. Cytomegalovirus (CMV) has been reported to enhance HIV replication and accelerate the progression of HIV infection to AIDS.Objective: This study reports on the high seropositivity of immunoglobulin (Ig) G and M antibodies against CMV and the risk factors for CMV infection among HIV/AIDS patients in Ilorin, Nigeria.Method: A total of 180 consented HIV-1 seropositive patients (age-range 16-56 years; 108 females and 72 males) were consecutively recruited. Socio-demographic/behavioral data and 5 ml blood samples were collected from each patient. Plasma of each sample was assayed for anti-CMV IgG/IgM using a CMV IgG and IgM Enzyme Linked ImmunoSorbent Assay (ELISA) kit.Results: Twenty (11.1%) of the 180 HIV-1 seropositive subjects were positive for anti-CMV IgM antibody while 169(93.9%) were positive for anti-CMV IgG antibody. Age, marital status, number of sexual partners, CD4 cells counts and previous history of blood transfusion were the main correlates of CMV seropositivity among these patients. However, occupation, sex, highly active antiretroviral therapy (HAART) were not statistically associated with CMV seropositivity in this study.Conclusion: This study has shown that greater percentages of HIV-1 seropositive patients had active CMV infection. It has further shown that CMV is hyperendemic in HIV-1 seropositive patients in Ilorin, Nigeria.Keywords: CD4, CMV, HIV/AIDS, IgG, IgM, Risk factors, HAAR

A Rare Case of Salmonella typhi Meningitis in an Eleven Month Old Infant: A Case Report

Non-typhoidal Salmonella are infrequent causes of childhood meningitis. Most reports of Salmonella typhi meningeal infections are confined to neonates. A rare instance of S. typhi in an otherwise healthy eleven month old infant is being reported.Keywords: Salmonella typhi, meningitis, infant

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

Hepatitis B virus infection among pregnant women on antenatal visits: rapid tests or ELISA?

Background: Hepatitis B virus (HBV) infection is a global public health challenge with over 360 million people infected worldwide, and is one of the leading causes of death worldwide. The hepatitis B surface antigen (HBSAg) is the most important marker for HBV screening, and HBSAg rapid screening test methods are the most widely used compared with the enzyme-linked immunosorbent assay (ELISA) and nucleic acid testing methods. The objectives of this study are to evaluate the comparative efficacy of rapid test kits and ELISA for HBV screening among pregnant women on antenatal visits and to screen for other HBV serological markers among HBsAg positive patients. Methodology: This is a cross-sectional study of 172 pregnant women who were recruited consecutively on their first antenatal visit at the University College Hospital, Ibadan, Nigeria between November 2018 and February 2019. All participants were screened for HBsAg using both rapid immunochromatographic test (ICT) and ELISA techniques. HBsAg negative samples were further screened for anti-HBeAg/Ab, anti-HBcAg and anti-HBs by ELISA. Socio-demographic data of the participants were obtained using a semi-structured questionnaire, and data were analyzed using EPI INFO 7.2 statistical software. Results: The prevalence rate of HBsAg among pregnant women in this study was 10.5% (18/172). The sensitivity, specificity, accuracy, positive predictive value (PPV) and the negative predictive value (NPV) of the rapid ICT kit were 72.2%, 97.4%, 94.8%, 76.5% and 96.8% respectively. Level of education, previous history of sexually transmitted infections (STIs) and previous positive HBV results were significantly associated with HBsAg seropositivity. Majority of the pregnant women (66.9%) tested negative to all the serological markers. Conclusion: The low efficacy of rapid ICT kits compared to ELISA justifies the need to develop a safer antenatal screening strategy for HBV by combining the use of the less sensitive rapid screening techniques with the more sensitive ELISA method to limit vertical transmission of hepatitis B virus. Keywords: Hepatitis B virus; Rapid ICT kits; ELISA; pregnant women   French title: Infection par le virus de l'hépatite B chez les femmes enceintes en consultation prénatale: tests rapides ou ELISA? Contexte: L'infection par le virus de l'hépatite B (VHB) est un défi de santé publique mondial avec plus de 360 million de personnes infectées dans le monde et est l'une des principales causes de décès dans le monde. L'antigène de surface de l'hépatite B (HBSAg) est le marqueur le plus important pour le dépistage du VHB, et les méthodes de test de dépistage rapide HBSAg sont les plus largement utilisées par rapport aux méthodes de test immuno-enzymatique (ELISA) et d'acide nucléique. Les objectifs de cette étude sont d'évaluer l'efficacité comparative des kits de tests rapides et de l'ELISA pour le dépistage du VHB chez les femmes enceintes lors de consultations prénatales et de dépister d'autres marqueurs sérologiques du VHB chez les patients AgHBs positifs. Méthodologie: Il s'agit d'une étude transversale de 172 femmes enceintes qui ont été recrutées consécutivement lors de leur première visite prénatale à l'Hôpital Universitaire, Ibadan, Ibadan, Nigéria entre novembre 2018 et février 2019. Tous les participants ont été dépistés pour l'AgHBs en utilisant les deux tests immuno-chromatographiques rapides (TIC) et techniques ELISA. Les échantillons négatifs à l'AgHBs ont en outre été criblés pour l'anti-HBeAg/Ab, l'anti-HBcAg et l'anti-HBs par ELISA. Les données sociodémographiques des participants ont été obtenues à l'aide d'un questionnaire semi-structuré et les données ont été analysées à l'aide du logiciel statistique EPI INFO 7.2. Résultats: Le taux de prévalence de l'HBSAg chez les femmes enceintes dans cette étude était de 10,5% (18/172). La sensibilité, la spécificité, la précision, la valeur prédictive positive (VPP) et la valeur prédictive négative (VPN) du kit ICT rapide étaient respectivement de 72,2%, 97,4%, 94,8%, 76,5% et 96,8%. Le niveau d'éducation, les antécédents d'infections sexuellement transmissibles (IST) et les résultats positifs antérieurs pour le VHB étaient significativement associés à la séropositivité de l'AgHBs. La majorité des femmes enceintes (66,9%) ont été testées négatives pour tous les marqueurs sérologiques. Conclusion: La faible efficacité des kits TIC rapides par rapport à l'ELISA justifie la nécessité de développer une stratégie de dépistage prénatal plus sûre du VHB en combinant l'utilisation des techniques de dépistage rapide moins sensibles avec la méthode ELISA plus sensible pour limiter la transmission verticale du virus de l'hépatite B. Mots clés: virus de l'hépatite B; Kits TIC rapides; ELISA; femmes enceinte

Recent rubella infection among childbearing women in a tertiary hospital in Nigeria: A seroepidemiological indication for vaccination need

Background: Congenital Rubella Infection can be prevented and future generation saved from  disability by protecting women of reproductive age through vaccination. The study is aimed at  determining serological evidence of recent rubella infection among women of childbearing age.Method: A cross sectional study was carried out among 285 women aged between 15 and 49 years. Enzyme immunoassay method was used to detect and quantify human IgM and IgG antibodies with avidity for Rubella virus in sera of participants. Socio-demographic characteristics of the subjects, along with recent history of fever, rash and adverse pregnancy outcome among others were obtained using a questionnaire. Statistical analysis was carried out using the program statistical package for social sciences (SPSS) version 16. Majority (78.3%) of the women recruited for the study were within 15-34 years age range. Of the 285 sera assayed for Rubella IgM antibodies, 23 (8.1%; 95% CI: 4.9%-11.3 %.) was IgM seropositive, while the remaining 262 (91.9%) were seronegative. A total of 7 (2.5%) of reproductive age women in Ilorin had a recent primary infection while 16 (5.6%) had a persistent Rubella infection or recent re-infection.In conclusion, there is need for vaccination of susceptible women of reproductive age in Ilorin as a large number of women have Rubella in their reproductive age.Keywords: Rubella, Immunoglobulin M, avidity, reproductive age, Ilorin, Nigeri

Prevalence of intestinal parasites in newly diagnosed HIV/AIDS patients in Ilorin, Nigeria

AbstractBackgroundHuman immune-deficiency virus/acquired immune-deficiency syndrome predisposes to opportunistic parasitic infestations of the gastrointestinal tract. This study aimed to determine the prevalence of intestinal parasites in newly diagnosed treatment naïve HIV/AIDS patients.MethodsThis hospital-based cross-sectional study was carried out from December 2010 to June 2011. Questionnaires were administered to 238 HIV/AIDS subjects, and 238 age and sex-matched controls. CD4+ T cell count was carried out on HIV-positive subjects. Stool samples were examined using direct microscopic and modified Ziehl-Neelsen methods. Positivity of intestinal parasites was taken as the presence of worms, oocyst, cyst, ova or larvae in the stool samples.ResultsNinety males and 148 females were studied for the HIV-positive and HIV-negative controls respectively. Intestinal parasitic infestation in HIV-positive subjects was 68.5%, and was significantly higher than in the HIV-negative controls 49.2% (P<0.05). In HIV-positive subjects, Cryptosporidium spp. was the commonest (55.0%) parasite isolated. Others were Cyclospora cayetanensis (41.2%), Isospora belli (3.0%), Entamoeba histolytica (8.4%), Giardia lamblia (3.7%), Ascaris lumbricoides (2.5%), Strongyloides stercoralis (1.7%), Trichuris trichiura (0.8%) and Schistosoma mansoni (0.4%). HIV-positive patients with CD4+ T cell count of less than 200 cells/ul were more at risk of opportunistic parasites compared to the HIV-negative controls.ConclusionThe prevalence of intestinal parasites in newly diagnosed HIV/AIDS individuals was high, and its association with CD4+ T cell count was demonstrated. Routine screening for parasitic infestations at diagnosis is indicated to reduce the burden of the disease

Internal and external quality control in the medical microbiology laboratory

Culture media play a very important role in bacteriology as they are used in the isolation, identification and antimicrobial susceptibility testing. It is essential that the quality of media be safeguarded to have a successful microbiology laboratory. Microorganisms usually show typical morphological appearance and properties on solid media. Variations in the composition of the medium may alter this appearance and properties. There is therefore a need to ensure good quality media, which is capable of giving satisfactory results by ensuring a proper quality management system. Often times, majority of laboratories prepare their media for routine diagnostics and research purposes. Therefore, it is essential that certain parameters of media are checked thoroughly before they are considered suitable for laboratory use. Control methods are discussed in details in this report