Microbiological profile of chronic suppurative otits media among HIV infected children in South Eastern Nigeria

Background: Immune compromised HIV/AIDS infected children have consistently shown a higher prevalence of chronic suppurative otitis media than their immune competent counterparts.This study aimed to compare the microbial isolates from ear discharges in HIV infected and non infected childrenMethod: This was a Hospital based prospective cohort study designed to determine the relative prevalence of the common organisms present in chronically discharging ears of HIV infected children and their antimicrobial sensitivities and compare that of age and sex matched non HIV infected children. Fifty HIV infected children being followed up at the paediatric HIV clinic of a tertiary health facility, had ear swabs obtained for culture and antimicrobial sensitivity.The same was done for another cohort of fifty age and sex matched non HIV infected children.Results: The mean age of the study population and controls were 6years 11months (SD 0.96) and 7years 11 months (SD 1.00) respectively.Male to female ratio for each group was 1:1.Ear discharge was bilateral in 27(54%) HIV infected children and in 35(70%) of the controls.The most prevalent bacterial isolate in both groups was Pseudomonas aeruginosa though it was more prevalent in HIV infected children(P=0.005). Fungal isolates were commoner in non HIV infected children(P=0.001).Ninety percent sensitivity to the 4 Quinolones was recorded by isolates in HIV infected children while sensitivity to the Aminoglycosides was greater in non HIV infected childrenConclusion: Pseudomonas aeruginosa is the predominant organism isolated from HIV infected children with chronic otitis media.Fungal isolates are less frequently encountered in ear discharges of HIV infected children. The 4 Quinolones are the drugs of choice in treatment of Chronic suppurative otitis media in HIV infected children.Keywords: Chronic suppurative otitis media;Bacteriology;HIV infection;Childre

Folate levels in children with sickle cell anaemia on folic acid supplementation in steady state and crises at a tertiary hospital in Enugu, Nigeria: a prospective, comparative study

IntroductionFolic acid supplementation is an integral aspect of the management of children with sickle cell anaemia (SCA) especially in Africa. In spite of this, there have been concerns about lower folate levels, especially during crisis. AimTo determine red cell folate levels of children with sickle cell anaemia in steady state and during crisis and compare with those with haemoglobin AA genotype. MethodThis study was prospective, hospital based, and comparative. Fifty children with sickle cell anaemia were recruited during crises and followed up until they met the criteria for attaining steady state. The controls were fifty children matched with those with SCA for age and gender and had haemoglobin AA genotype. Red cell folate estimation was done with the Electrochemiluminescence Immunoassay (ECLIA) method using the automated Roche Cobas e411 equipment. ResultsThe median (IQR) red cell folate level in children during sickle cell crisis was 265.95 (134.50) ng/ml, which was significantly lower than the median (IQR) of 376.30 (206.85) ng/ml obtained during steady state. Most children with SCA (41 out of 50) had significantly higher folate levels during steady state (T=1081, Z-score= -4.660, p < 0.001). Median level of red cell folate was lower during anaemic crisis compared to vaso-occlusive crisis, though not significantly so (N(50), U = 214.00, Z-score= -1.077, p = 0.305). The median red cell folate level of normal controls was 343.55 (92.90) ng/ml, which was significantly lower than the 376.30 (206.85) ng/ml obtained during steady state (N(50), U= 209.00, Z-score= -7.177, p <0.001). Conclusion Median red cell folate levels of the study participants were within normal limits, though most children with SCA had significantly higher levels during steady state compared to crisis. Normal controls had significantly lower red cell folate levels than the children with SCA during steady state

Assessment of Physical Growth in Male Children Infected with Human Immunodeficiency Virus on Highly Active Antiretroviral Therapy in Abakaliki

Background: Human immunodeficiency virus (HIV) infection causes a derangement in growth. Antiretrovirals promote immune function restoration and improvement in the quality of life. Variables such as poor adherence to drugs and unsuppressed viral load may negatively influence growth in HIV-infected children. The study aimed at determining the growth in HIV-infected males aged 8–17 years in Abakaliki who were on antiretrovirals. Methods: Acase–control hospital-based study, involving 80 HIV-infected males aged 8–17 years who were matched for age and socioeconomic class with 80 HIV‑uninfected controls. Growth parameters including the heights, weights, and body mass index (BMI) of subjects and controls were measured, and Z scores for age derived for height, weight, and BMI. Results: The mean height of subjects (1.420 ± 0.18 m) was significantly lower than that of controls (1.515 ± 0.17 m). The mean weight of subjects (35.09 ± 12.48 kg) was significantly low compared to controls (42.21 ± 12.95 kg). A significant difference was documented in the mean BMI for age among subjects (16.78 ± 2.12 kg/m2 ) and controls (17.93 ± 2.27 kg/m2 ). There was a significant relationship between CD4 count and growth (BMI) (P = 0.006) and between duration on highly active antiretroviral therapy and growth (P = 0.024). Conclusion: HIV‑infected males had significantly impaired growth despite the use of antiretroviral drugs. Keywords: Children, human immunodeficiency virus antiretroviral drugs, males, physical growt

The prevalence liver function and immunologic status of children with HIV and hepatitis Bvirus coinfection in Enugu, Nigeria

Background: Hepatitis B Virus (HBV) co-infection is prevalent among HIV infected individuals because of shared routes and mechanisms of transmission. The multidimensional immunosuppression from HIV infection causes impaired spontaneous recovery from an acute HBV infection, predisposing to chronic infection which is worsened by younger age at infection. Co-infection increases the risk of HBV replication, hepatotoxicity and liver related deaths from Highly Active Antiretroviral Therapy (HAART). The study was undertaken to highlight the burden of co-infection among HIV positive children in Enugu, determine the associated risk factors and compare the effect of co-infection between co-infected and non-co-infected children using liver enzyme and CD4 counts.Materials and Methods: A cross sectional study was carried out among HIV positive children attending the Paediatric ARV clinic of the University of Nigeria Teaching Hospital, Ituku-Ozalla. A total of 140 HIV infected children aged 18 months to 15 years were recruited. An interviewer questionnaire was administered. Hepatitis B surface antigen (HBsAg) was determined using Determine test Kit. Baseline and recent CD4 counts/CD4% were retrieved from the patients’ folders.Results: Fourteen (10%) were positive for HBsAg. The highest prevalence of HBsAg was observed among children aged 11- 15 years. The higher the socioeconomic class the less likely the HBsAg positivity. Seven (50%) of the co-infected children had elevated baseline ALT compared with 57 (45.2%) of non-co-infected children though the difference was not statistically significant (t = 0.6, P = 0.56). After the initiation of HAART, 10 (76.9%) of the co-infected and 18 (15.1%) of the non-co-infected children had elevated ALT. The baseline median CD4 count among children ≥ 6 years was 230 cells/mm3 and 360 cells/mm3 respectively among the co-infected and nonco-infected, (P = 0.67). However, in children ≤ 5 years, it was 25% and 15 % respectively (P = 0.06).Conclusion: HBV co-infection among HIV infected children is common in our environment, and co-infection is associated with impaired immunity and probably liver enzyme derangement.Keywords: HIV infection, Children, HBV co-infection, Liver function, Immunologic statu

Generalized lymphadenopathy: an unusual presentation of burkitt lymphoma in a Nigerian child: a case report

Intoduction: Burkitt Lymphoma is the fastest growing tumor in human and the commonest of the childhood malignancies. Generalized lymphadenopathy is a common feature of immunodeficiency associated Burkitt lymphoma but an uncommon presentation of the endemic type in Human Immunodeficiency Virus (HIV) negative children. Case presentation: The authors report a 6 year old HIV negative boy who presented with generalized lymphadenopathy, cough, weight loss, fever and drenching night sweat and had received native medication as well as treatment in private hospitals. His examination revealed hepatosplenomegaly, bull neck with generalized significant massive lymphadenopathy. Diagnosis was missed initially until a lymphnode biopsy for histology confirmed Burkitt lymphoma. He was managed on combination chemotherapy with complete resolution and now on follow up. Conclusion: To the best of our knowledge, this is the first documented report of its kind of endemic Burkitt lymphoma involving lymphnodes generally as the primary site. High index of suspicion and early biopsy are the key in this uncommon presentation

THE PREVALENCE LIVER FUNCTION AND IMMUNOLOGIC STATUS OF CHILDREN WITH HIV AND HEPATITIS B VIRUS COINFECTION IN ENUGU, NIGERIA

Background: Hepatitis B Virus (HBV) co-infection is prevalent among HIV infected individuals because of shared routes and mechanisms of transmission. The multidimensional immunosuppression from HIV infection causes impaired spontaneous recovery from an acute HBV infection, predisposing to chronic infection which is worsened by younger age at infection. Co-infection increases the risk of HBV replication, hepatotoxicity and liver related deaths from Highly Active Antiretroviral Therapy (HAART). The study was undertaken to highlight the burden of co-infection among HIV positive children in Enugu, determine the associated risk factors and compare the effect of co-infection between co-infected and non-co-infected children using liver enzyme and CD4 counts. Materials and Methods: A cross sectional study was carried out among HIV positive children attending the Paediatric ARV clinic of the University of Nigeria Teaching Hospital, Ituku-Ozalla. A total of 140 HIV infected children aged 18 months to 15 years were recruited. An interviewer questionnaire was administered. Hepatitis B surface antigen (HBsAg) was determined using Determine test Kit. Baseline and recent CD4 counts/CD4% were retrieved from the patients’ folders. Results: Fourteen (10%) were positive for HBsAg. The highest prevalence of HBsAg was observed among children aged 11- 15 years. The higher the socioeconomic class the less likely the HBsAg positivity. Seven (50%) of the co-infected children had elevated baseline ALT compared with 57 (45.2%) of non-co-infected children though the difference was not statistically significant (t = 0.6, P = 0.56). After the initiation of HAART, 10 (76.9%) of the co-infected and 18 (15.1%) of the non-co-infected children had elevated ALT. The baseline median CD4 count among children ≥ 6 years was 230 cells/mm3 and 360 cells/mm3 respectively among the co-infected and nonco- infected, (P = 0.67). However, in children ≤ 5 years, it was 25% and 15 % respectively (P = 0.06). Conclusion: HBV co-infection among HIV infected children is common in our environment, and co-infection is associated with impaired immunity and probably liver enzyme derangement

Is renal medullary carcinoma the seventh nephropathy in sickle cell disease? A multi-center Nigerian survey

Introduction: Previous studies had enlisted renal medullary carcinoma (RMC) as the seventh nephropathy in sickle cell disease (SCD). Clinical experience has contradicted this claim and this study is targeted at refuting or supporting this assumption.Objective: To estimate the prevalence of RMC and describe other renal complications in SCD.Materials and methods: 14 physicians (haematologists and urologists) in 11 tertiary institutions across the country were collated from patients’ case notes and hospital SCD registers.Results: Of the 3,596 registered sickle patients, 2 (0.056%) had been diagnosed with RMC over a ten year period, thereby giving an estimated prevalence rate of 5.6 per 100,000. The most common renal complication reported by the attending physicians was chronic kidney disease (CKD). The frequency of routine renal screening for SCD patients varied widely between centres – most were done at diagnosis, annually or bi-annually.Conclusion: The ten year prevalence of RMC in Nigerian SCD patients was determined to be 5.6 (estimated incidence of 0.56). RMC is not more common in SCD patients and therefore cannot be regarded as a “Seventh Sickle nephropathy”. Most of the managing physicians reported that the commonest nephropathy observed in their SCD patients was chronic kidney disease.Keywords: Renal medullary carcinoma, seventh nephropathy, sickle cell disease, Nigerian surve

Association between HIV infection, sociodemographic characteristics and depression in caregivers of HIV infected children in Enugu, South-East, Nigeria.

Background: In the presence of certain factors, HIV infection in children increases the burden of depression in their caregivers. This necessitated the need for this study which aimed to determine the factors that are associated with depression in the caregivers of HIVinfected children.Methods: A comparative hospital-based study of 352 study participants comprising two groups. The first group was the subjects consisting of 176 caregivers of HIV-infected children and the second was the control consisting of 176 caregivers of HIV negative children. Having met the inclusion criteria, these study participants were screened for HIV infection, their sociodemographic characteristics were obtained and depression in them was assessed using Zung self-rating depression scale (SDS). The essence was to determine the factors that were significantly associated with depression in the subjects.Results: Forty-three (24.4%) and 133 (75.6%) of the subjects were males and females respectively while 47 (26.7%) and 129 (73.3%) of the control were males and females respectively. Seventy-six (43.2%) of the subjects and 12 (6.8%) of the control group had SDS scores in the depression range and this difference was significant (2 = 62.06, df = 1, p < 0.001). The factors that were significantly associated with depression in the subjects were the age of the HIV-infected children (p = 0.023, OR = 2.28), caregiver’s sex (p = 0.003, OR = 3.25), socioeconomic status (p < 0.001, OR = 4.00), marital status (p < 0.001, OR = 2.18), type of caregivers (p = 0.028, OR = 2.78), spouse support (p = 0.019, OR = 2.08).Conclusion: There is a high burden of depression among caregivers of HIV-infected children and depression in them is significantly associated with caring for a preadolescent HIVinfected child, female caregivers, lower socioeconomic status, death of a spouse, being a biologic caregiver and lack of spouse support

Determinants of academic performance in children with sickle cell anaemia

BACKGROUND: Some factors are known to influence the academic performance of children with Sickle Cell Anaemia (SCA). Information on their effects in these children is limited in Nigeria. The factors which influence academic performance of children with SCA in Enugu, Nigeria are determined in this study. METHODS: Consecutive children with SCA aged 5–11 years were recruited at the weekly sickle cell clinic of the University of Nigeria Teaching Hospital (UNTH) Enugu, Nigeria. Their age- and sex- matched normal classmates were recruited as controls. The total number of days of school absence for 2009/2010 academic session was obtained for each pair of pupils from the class attendance register. Academic performance was assessed using the average of the overall scores in the three term examinations of same session. Intelligence ability was determined with Draw-A-Person Quotient (DAPQ) using the Draw-A-Person Test while socio-economic status was determined using the occupational status and educational attainment of each parent. RESULTS: Academic performance of children with SCA showed statistically significant association with their socio-economic status (χ2 = 9.626, p = 0.047), and significant correlation with DAPQ (r = 0.394, p = 0.000) and age (r = -0.412, p = 0.000). However, no significant relationship existed between academic performance and school absence in children with SCA (r = -0.080, p = 0.453). CONCLUSIONS: Academic performance of children with SCA is influenced by their intelligence ability, age and socio-economic status but not negatively affected by their increased school absenteeism