The Growing Resistance of Klebsiella pneumonia; the Need to Expand Our Antibiogram: Case Report and Review of the Literature

Carbapenemases are being increasingly reported in Enterobacteriaceae including Klebsiella pneumoniae causing considerable increases in morbidity and mortality with limited therapeutic options. Issues related to difficulties associated with pathogen identification and infection control have been identified as major obstacles to the control of these multi-drug resistant organisms. Identification of this enzyme in organisms not previously found to harbor them has added to the already existing challenge in the control of this growing problem. The case of a 60 year-old Saudi lady with diabetes, hypertension, pituitary adenoma, hypothyroidism, and obstructive sleep apnea who was admitted in our intensive care unit following a cardiac arrest is hereby presented. During the course of her treatment she acquired various infections that led to her exposure to antimicrobials from almost all classes at various times; including bacteremia due to a pan-drug resistant Klebsiella pneumoniae and multi-drug resistant Acinetobacter baumannii. She was successfully treated with a combination of colistin and amikacin. This case highlights the resurgence of colistin in clinical practice and also calls for the need to expand our antibiogram to include antibiotics not conventionally reported, especially in areas where drug resistance is a growing problem. Improving susceptibility detection methods for Klebsiella pneumoniae and hand hygiene could prove effective in reducing nosocomial infections. Involvement of clinical pharmacists in antimicrobial stewardship could reduce the development of antimicrobial drug resistance.Key words: Klebsiella pneumoniae, pan-drug resistance, infection, intensive care unit

Sputum smear positivity among patients presenting to the dots clinic with chronic cough

Cough is one of the cardinal features of Pulmonary Tuberculosis (PTB). However, even in communities with high prevalence of TB, lung diseases other than TB appear to account for this symptom. Objective: To estimate the prevalence of sputum smear positivity among patients with TB who presented with complaints of chronic cough to the Directly Observed Therapy Short Course (DOTS) clinic at the University of Maiduguri Teaching Hospital, North Eastern Nigeria. Methodology: A cross sectional study was conducted at the University of Maiduguri Teaching Hospital (UMTH) Borno state, Northeastern Nigeria between September 2014 and January 2017. All patients (new or previously treated) who presented to the DOTS clinic of the UMTH with complaints of chronic cough and had screening for pulmonary TB using sputum smear microscopy were reviewed. The minimum and the maximum ages were 1 year and 85 years, respectively, and the mean age was 36.0 (SD=14.0) years. The mean age did not differ among the male and female patients (i.e.37.3 ± 14.4 vs 34.1 ± 13.2, p=0.78). The overall prevalence of sputum smear positivity for TB was 26.5%. Although majority of patients who were sputum smear positive for TB fell within the age groups 30-39 and 20-29 thus accounting for 42.6% and 28.7% respectively, however, there was no significant association between age of those with chronic cough and sputum smear positivity TB (p=0.80). Among those who were sputum smear positive, 24.3% were new cases and 2.2% were previously treated. Conclusions: Data were entered into a computer database and analyzed with SPSS version 20.0 statistical software. Results: This study showed a high prevalence of sputum smear positivity among suspected TB patients with complaints of chronic cough This could be explained by the fact that the DOTS strategy has improved the case detection of PTB in this community. All patients with chronic cough should be evaluated for PTB

A comparative study of clinical presentation and risk factors for adverse outcome in patients hospitalised with acute respiratory disease due to MERS coronavirus or other causes

Middle East Respiratory syndrome (MERS) first emerged in Saudi Arabia in 2012 and remains a global health concern. The objective of this study was to compare the clinical features and risk factors for adverse outcome in patients with RT-PCR confirmed MERS and in those with acute respiratory disease who were MERS-CoV negative, presenting to the King Fahad Medical City (KFMC) in Riyadh between October 2012 and May 2014. The demographics, clinical and laboratory characteristics and clinical outcomes of patients with RT-PCR confirmed MERS-CoV infection was compared with those testing negative MERS-CoV PCR. Health care workers (HCW) with MERS were compared with MERS patients who were not health care workers. One hundred and fifty nine patients were eligible for inclusion. Forty eight tested positive for MERS CoV, 44 (92%) being hospital acquired infections and 23 were HCW. There were 111 MERS-CoV negative patients with acute respiratory illnesses included in this study as 'negative controls'. Patient with confirmed MERS-CoV infection were not clinically distinguishable from those with negative MERS-CoV RT-PCR results although diarrhoea was commoner in MERS patients. A high level of suspicion in initiating laboratory tests for MERS-CoV is therefore indicated. Variables associated with adverse outcome were older age and diabetes as a co-morbid illness. Interestingly, co-morbid illnesses other than diabetes were not significantly associated with poor outcome. Health care workers with MERS had a markedly better clinical outcome compared to non HCW MERS patients.published_or_final_versio

Seroprevalence of IgG anti- T. Gondii antibody among HIV-infected patients in Maiduguri, north eastern Nigeria.

Background: Toxoplasma gondii infection is one of the commonest opportunistic infections in HIV-infected patients, with the fatal consequences of toxoplasmic encephalitis particularly in advanced disease. However, data regarding T.gondii infection in the setting of HIV/AIDS are scant in Nigeria. Objective: To determine the seroprevalence of T.gondii amongst HIV-infected patients as well as to determine the correlation between anti-T.gondii IgG titre and the CD4+ cell count/HIV-1 RNA viral load. Method: A cross sectional study in which a total of 190 subjects were involved i.e. 110 newly diagnosed HAART naïve HIV-positive patients and 80 apparently healthy HIV-negative age- and-sex matched controls that were selected by simple random sampling method. Results: The age range of the study population was 20-64 years. The mean ages of male subjects for both HIV-positives and controls were 37.52 ±8.20 years and 35.79 ±12.31years, respectively, (p= 0.462). On the other hand, the mean ages of female subjects for both HIV-positives and controls were 29.90 ±6.98 years and 32.30 ±10.29 years, respectively, (p=0.149). Twenty one subjects (19.1%) among HIV-positives and 1 (1.25%) HIV-negative tested positive for anti-T.gondii IgG, respectively, (p= 0.000). The prevalence rate ration of anti-T. gondii IgG of HIV positives compared to HIVnegatives was 15.28. Significant proportion of anti-T.gondii positive subjects presented with AIDS defining illnesses compared with their anti-T.gondii negative counterparts. Conclusion:The study has shown that anti-T.gondii IgG is about 15 times more prevalent among HIV positive patients compared to controls. Routine screening for T.gondii IgG anti-body is therefore recommended for all HIV-infected subjects at the facility as well as commencement of chemoprophylaxis against Toxoplasmic encephalitis in HIV-infected patients with CD4+ cell count of <100 cells/ml

Molecular Epidemiology of Hospital Outbreak of Middle East Respiratory Syndrome, Riyadh, Saudi Arabia, 2014

We investigated an outbreak of Middle East respiratory syndrome (MERS) at King Fahad Medical City (KFMC), Riyadh, Saudi Arabia, during March 29–May 21, 2014. This outbreak involved 45 patients: 8 infected outside KFMC, 13 long-term patients at KFMC, 23 health care workers, and 1 who had an indeterminate source of infection. Sequences of full-length MERS coronavirus (MERS-CoV) from 10 patients and a partial sequence of MERS-CoV from another patient, when compared with other MERS-CoV sequences, demonstrated that this outbreak was part of a larger outbreak that affected multiple health care facilities in Riyadh and possibly arose from a single zoonotic transmission event that occurred in December 2013 (95% highest posterior density interval November 8, 2013–February 10, 2014). This finding suggested continued health care–associated transmission for 5 months. Molecular epidemiology documented multiple external introductions in a seemingly contiguous outbreak and helped support or refute transmission pathways suspected through epidemiologic investigation.link_to_OA_fulltex

Beta-HPV 5 and 8 E6 Promote p300 Degradation by Blocking AKT/p300 Association

The E6 oncoprotein from high-risk genus alpha human papillomaviruses (α-HPVs), such as HPV 16, has been well characterized with respect to the host-cell proteins it interacts with and corresponding signaling pathways that are disrupted due to these interactions. Less is known regarding the interacting partners of E6 from the genus beta papillomaviruses (β-HPVs); however, it is generally thought that β-HPV E6 proteins do not interact with many of the proteins known to bind to α-HPV E6. Here we identify p300 as a protein that interacts directly with E6 from both α- and β-HPV types. Importantly, this association appears much stronger with β-HPV types 5 and 8-E6 than with α-HPV type 16-E6 or β-HPV type 38-E6. We demonstrate that the enhanced association between 5/8-E6 and p300 leads to p300 degradation in a proteasomal-dependent but E6AP-independent manner. Rather, 5/8-E6 inhibit the association of AKT with p300, an event necessary to ensure p300 stability within the cell. Finally, we demonstrate that the decreased p300 protein levels concomitantly affect downstream signaling events, such as the expression of differentiation markers K1, K10 and Involucrin. Together, these results demonstrate a unique way in which β-HPV E6 proteins are able to affect host-cell signaling in a manner distinct from that of the α-HPVs

The burden of non-communicable diseases in Nigeria; in the context of globalization

This paper highlights the tenets of globalization and how its elements have spread to sub-Saharan Africa, and Nigeria in particular. It assesses the growing burden of non-communicable diseases (NCDs) in Nigeria and its relationship with globalization. It further describes the conceptual framework on which to view the impact of globalization on NCDs in Nigeria. It assesses the Nigerian dimension of the relationship between the risk factors of NCDs and globalization. Appropriate recommendations on tackling the burden of NCDs in Nigeria based on cost-effective, culturally sensitive, and  evidence-based interventions are highlighted.Keywords: Globalization, Nigeria, non-communicable disease

An observational study of the prevalence of anaemia in clinical AIDS, immunological AIDS And HIV infection in Maiduguri, north eastern Nigeria

Aim: To deterime the prevalence of anaemia in patients with clinical AIDS. Methodology: A retrospective small observational study of the prevalence of anaemia in 114 patients with confirmed HIV/AIDS seen at the department of medicine of the university of Maiduguri Teaching Hospital between January, 2002 and June, 2004 are reported. Results: One hundred and three (90.4%) patients had anaemia and only 11 (9.6%) did not have anaemia. Forty one (36%) patients had immunological AIDS and anaemia was seen in 39 (95.1%) of them with median haematocrit of 31 %± 4.7SD. Thirty-four (29.8%) had clinical AIDS and anaemia was seen in 31 (91.2%) of them with median haematocrit of 32.5% ± 6.1SD. Thirty-nine (34.2%) had HIV infection and anaemia seen in 33(84.6%) of them with median haematocrit of 35% ± 7.4SD. Regression of anaemia and opportunistic infection showed a positive correlation (p-value = 0.003). Conclusion: The study shows that anaemia is a common finding in patients with HIV/AIDS with opportunistic infection being the most likely contributing factor in our environment. A large collaborative observational cohort study design and a prospective follow up design is necessary to address questions regarding causal relationship of anaemia and survival and whether HAART may have a positive impact on reducing the prevalence of anaemia in HIV/AIDS patients. Keywords: prevalence, anaemia, HIV/AIDS Sahel Medical Journal Vol. 8(1) 2005: 12-1

Evaluation of glutaraldehyde test in the diagnosis of pulmonary tuberculosis in Nigeria

In the developing world with scarcity of diagnostic facilities, the diagnosis of pulmonary tuberculosis (PTB) could often be difficult. Previous methods have proved inadequate, especially where TB is endemic. Serologic tests for the diagnosis of TB require advanced technology which is not readily available. The study therefore proposed to evaluate the usefulness (or otherwise) of the glutaraldehyde test (GT) in the diagnosis of PTB in this environment. Two hundred and ten consecutive consenting adults 18 years and above with newly diagnosed sputum smear positive PTB attending 4 government hospitals in the Lagos area were studied over one year. Age and sex matched controls from LUTH who had no symptoms or signs of TB were also studied. All cases had sputum smear examination (by the Ziehl-Neelsen method) and the glutaraldehyde test. Considering the normal gelification time o

Association between preoperative statin therapy and postoperative infectious complications in patients undergoing cardiac surgery: a systematic review and meta-analysis.

Infectious complications of cardiac surgery are often severe and life threatening. Statins having both immunomodulatory and anti-inflammatory effects were intuitively thought to influence the development of postsurgical infections. We sought to systematically examine whether any association exists between statin use and risk of infectious complications in patients undergoing cardiac surgery. We searched Ovid MEDLINE, Ovid EMBASE, Thomson Scientific Web of Science, and Elsevier Scopus from inception through February 2011 for comparative studies examining the association between statin use and risk of postoperative infections in patients undergoing cardiac surgery. We contacted a study's author for missing information. We conducted a random-effects meta-analysis of individual studies' odds ratios (adjusted for potential confounders). We identified 6 cohort studies for inclusion, 3 of which were conducted in Canada and 3 of which were conducted in the United States. Four were single-center studies, and 2 were population based. Exposure ascertainment was based on a review of admission medication list or prescription databases. Infectious outcomes were heterogeneous and included surgical site infections within 30 days, serious infections (sepsis), or any other postoperative infection. Statin use in the preoperative period was associated with a trend toward reduction in the incidence of postoperative infections in patients who underwent cardiac surgery (odds ratio, 0.81 [95% confidence interval, 0.64–1.01]; P = .06; I2 = 75%). Heterogeneity was explained by country effect. Studies performed in Canada showed weaker associations than studies performed in the United States. This difference could not be attributed to study quality alone. We did not find good evidence to support an association between statin use and postoperative infectious complications. However, the trend toward statistical significance for this association indicates that further investigation is warranted