Cross-sectional survey of knowledge and attitudes of healthcare workers and community members toward the Ebola virus disease and antimicrobial resistance pathogens outbreaks in Nigeria

Introduction: the 2014 Ebola virus disease (EVD) outbreak in Nigeria has further raised the awareness of health-care workers (HCWs) and community members (MCs) on the threat posed by infectious diseases and the need for improvement on infection control practices. However, awareness of dangers of increasing incidences of antimicrobial resistance (AMR) in hospitals and communities remained low. Methods: a cross-sectional survey of awareness of 195 HCWs and 265 MCs toward EVD and AMR was conducted through a structured questionnaire. Results: majority of HCWs (95.4%) and MCs (82.8%) still have knowledge of EVD´s danger and give reasons like its unique way of killing and unavailability of drugs for their awareness. Only 17.2% of MCs are aware of AMR as a problem, and only 3.4% of MCs and 10.3% of HCWs agreed that AMR is more dangerous than EVD. On the contrary, 76.4% of doctors, 95.1% nurses, 67.9% laboratory scientists, 66.7% pharmacists, 77.4% students and 100% of civil servants, drivers and religious leaders believed that EVD is more horrific and spread faster. They both attributed the rapid awareness of EVD in Nigeria, despite being new at the time of the outbreak, to the seriousness with which stakeholders and the media fought EVD, the gesture AMR is yet to receive. Though both HCWs and MCs agreed that prevention, not treatment is the best option to tackle Ebola like-diseases, but surprisingly, about 37% and 65% of HCWs and MCs respectively, still believe that traditional medicines can be used to treat Ebola related illnesses. Conclusion: AMR awareness remains low among MCs and some HCWs when compared with EVD. It is recommended that efforts put in place during EVD outbreak by all stakeholders and the media need to be doubled to increase the knowledge of both HCWs and MCs toward AMR

Fungal contamination of indoor public swimming pools and their dominant physical and chemical properties

Introduction: Considering to the existence of both parasitic and fungal pathogens in the indoor public swimming pools and non-utilization of suitable filtration and disinfection systems in these places, this research aimed to determine the relationship between the indoor public swimming pools and possible pollution with parasitic and fungal agents, as well as physical and chemical characteristics of these pools and compare the results with national standards. Methods: In this study, 11 active indoor swimming pools of Zahedan city were sampled, using plastic pumps techniques, at the middle of winter to the late summer season. A total of 88 water samples (eight water samples from each pool) were examined to determine the residual chlorine, contamination with parasitic and fungal agents, using culture media and slide culture techniques. Results were analyzed with SPSS software (V16) and, Microsoft Excel (V2010). Results: The findings revealed parasitic fungal contamination with Cladosporium, Penicillium, Aspergillus flavus and Aspergillus fumigatus, etc. and the physicochemical factors comply with the minimum standards had which indicates the need for continuous monitoring and control of water filtration and disinfection of water is swimming. Conclusion: The results show reasonable derangement of physicochemical and microbial factors of the evaluated pools. Efforts shall be made by the concerned authorities to provide health education to users, quality water at the pools and to maintain the safety and quality of the water through proper and adequate chlorination

Proven pulmonary aspergillosis in a COVID-19 patient: A case report

Background and Purpose: Coronavirus disease 2019 (COVID-19) has become a significant clinical challenge in healthcare settings all over the world. Critically ill COVID-19 patients with acute respiratory distress syndrome may be at increased risk of co-infection with pulmonary aspergillosis. This study aimed to describe a clinical case of proven pulmonary aspergillosis caused by Aspergillus tubingensis in a 59-year-old man with a history of hospitalization due to COVID-19 infection.Case report: The Covid-19 infection was confirmed by positive nasopharyngeal polymerase chain reaction. He had a cavitary lesion measured 20 mm in diameter with intracavitary soft tissue density in the left lung in the first chest computerized tomography scan. After 25 days, he showed two cavitary lesions in both lungs which raised suspicion of fungal infection; hence, the patient underwent a trans-thoracic biopsy of the cavitary lesion. The direct examination and culture of the biopsy material revealed Aspergillus species. To confirm the Aspergillus species identification, the beta-tubulin region was sequenced. The patient was treated with oral voriconazole.Conclusion: This report underlined the importance of early diagnosis and management of invasive fungal infections in severe COVID-19 patient

Frequency of quinolone resistance genes among extended-spectrum β-lactamase (ESBL)-producing Escherichia coli strains isolated from urinary tract infections

Abstract Background As an opportunistic pathogen, Escherichia coli (E. coli) is widely recognized as the main cause of nosocomial infections as well as some disorders especially those associated with urinary tract infections (UTIs). This study, therefore, sets out to determine the extent of antibiotic resistance to quinolones and to measure the frequency of qnr genes (A, B, and S) within extended-spectrum beta-lactamase (ESBL) and non-ESBL-producing strains of E. coli isolated from UTI-diagnosed patients as well as to investigate their antimicrobial susceptibility patterns for some selected antibiotics in southwest Iran. Methods Two hundred E. coli strains were isolated from UTI-diagnosed patients, hospitalized in nine different wards of Ahvaz Golestan Hospital between November 2015 and March 2016. The isolates were confirmed through well-practiced phenotypical methods. Moreover, the antimicrobial susceptibility test was successfully performed using a disk diffusion method. ESBL production among the isolates was screened by double disk synergism test (DDST), and the qnr genes were identified using a multiplex PCR. Results Out of the 200 samples collected, 167 isolates were confirmed to be E. coli strains. Maximum and minimum resistance were reported against nalidixic acid and chloramphenicol with 65.3% and 17.4%, respectively. Most of the isolates were resistant to all three types of quinolones studied in this research. Using multiplex PCR, the qnr genes were found in 100 (59.88%) strains (qnrA = 10, qnrB = 21, qnrS = 41, qnrB-S = 21, qnrB-A = 1, qnrA-S = 3, qnrA-B-S = 3), 58% of which was found among ESBL-producing isolates. Conclusions Resistance to quinolones antibiotics was highest among ESBL-producing isolates harboring, especially qnrS among other determinants of the qnr gene. There is a need for sensitive antibiotic stewardship especially in hospitals of Ahvaz, Khuzestan province. Further research is needed to ascertain the gravity of quinolones resistance in Iran and to quickly act against its spread among other nosocomial pathogens

Investigation of bio-air contamination in some hospitals of Kermanshah, Iran

Background: Microorganism transmission is an important route for the outbreak of microbial pathogens in outdoor and indoor environments. Objectives: In this study, we performed air sampling and analysis of various bio-aerosol particles (bacteria and fungi) by a passive method in order to measure the level of contaminant particles. Materials and Methods: Air sampling was done in five hospitals in Iran, which included Imam Ali Hospital (IAH), Taleghani Hospital (TH), Imam Khomeini Hospital (IKH), Farabi Hospital (FH) and Imam Reza Hospital (IRH). In each hospital, units such as surgery, intensive care unit, angiography, emergency, oncology, nursing station, pathology laboratory, microbiological laboratory, operating room, isolation room (infectious section), delivery room and outdoor environment were investigated. Results: The total counts for viable bacteria and fungi in the sampled air from the hospitals were as follows: IAH (bacteria 0–>100 colony-forming unit [CFU]/m3;fungi 0–14 CFU/m3), FH (bacteria 1–18 CFU/m3; fungi 0–7 CFU/m3), IRH (bacteria 0–14 CFU/m3; fungi 4–>100 CFU/m3), TH (bacteria 4–>250 CFU/m3; fungi 0–43 CFU/m3) and IKH (bacteria 11–1766 CFU/m3; fungi 0–25 CFU/m3). Conclusions: Results showed that microbial counts following the air sampling are strongly dependent on the environment. However, a low number of air microorganisms do not mean a clean and healthy environment

Prevalence and Risk Factors of Elevated Blood Lead in Children in Gold Ore Processing Communities, Zamfara, Nigeria, 2012

Background. In March 2010, Medecins Sans Frontieres/Doctors Without Borders detected an outbreak of acute lead poisoning in Zamfara State, northwestern Nigeria, linked to low-technology gold ore processing. The outbreak killed more than 400 children ≤5 years of age in the first half of 2010 and has left more than 2,000 children with permanent disabilities. Objectives. The aims of this study were to estimate the statewide prevalence of children ≤5 years old with elevated blood lead levels (BLLs) in gold ore processing and non-ore-processing communities, and to identify factors associated with elevated blood lead levels in children. Methods. A representative, population-based study of ore processing and non-ore-processing villages was conducted throughout Zamfara in 2012. Blood samples from children, outdoor soil samples, indoor dust samples, and survey data on ore processing activities and other lead sources were collected from 383 children ≤5 years old in 383 family compounds across 56 villages. Results. 17.2% of compounds reported that at least one member had processed ore in the preceding 12 months (95% confidence intervals (CI): 9.7, 24.7). The prevalence of BLLs ≥10 μg/dL in children ≤5 years old was 38.2% (95% CI: 26.5, 51.4) in compounds with members who processed ore and 22.3% (95% CI: 17.8, 27.7) in compounds where no one processed ore. Ore processing activities were associated with higher lead concentrations in soil, dust, and blood samples. Other factors associated with elevated BLL were a child's age and sex, breastfeeding, drinking water from a piped tap, and exposure to eye cosmetics. Conclusions. Childhood lead poisoning is widespread in Zamfara State in both ore processing and non-ore-processing settings, although it is more prevalent in ore processing areas. Although most children's BLLs were below the recommended level for chelation therapy, environmental remediation and use of safer ore processing practices are needed to prevent further exposures. Patient consent. Obtained Ethics approval. The study protocol was approved by the US Centers for Disease Control Institutional Review Board-A and the National Health Research Ethics Committee of Nigeria. Competing Interests. The authors declare no competing financial interests

Prevalence and Determinants of Childhood Lead Poisoning in Zamfara State, Nigeria

Background. Lead poisoning is a great public health concern in the Nigerian state of Zamfara due to widespread gold ore mining by artisan miners using rudimentary and unsafe processing techniques. Children aged ≤6 years are especially vulnerable to lead poisoning, which accounts for 0.6% of the global burden of disease. We undertook this study to find out the prevalence and determinants of childhood lead poisoning in Kawaye, a village located in Zamfara’s Anka local government area (LGA). Methods. We conducted a cross-sectional study in April 2013. Using simple random sampling technique, 307 eligible children aged ≤6 years were recruited. Data were collected using interviewer-administered semi-structured questionnaires. Blood specimens were collected via venous draw for blood lead level (BLL) assessment and soil at individual households was tested for presence of lead contamination using a portable X-ray fluorescence spectrometer. Statistical tests of Chi-square and multivariable logistic regression analyses were performed to evaluate factors potentially associated with elevated childhood BLL (≥5 μg/dL). Results. A total of 307 children ≤6 years old were sampled, with males constituting 51% of the total (171). Mean age of children = 38.5 months ± 18.5 SD. Parents/guardians of the studied children were predominantly farmers (37%) and miners (15%), with 53.7% having some informal education while 4.2% had no education. Processing of ore within the living compound was reported by 4% of the miners; 7.5% returned home wearing working clothes; 7.2% brought tools home. Thirty percent of parents/guardians were living below the poverty line. The prevalence of lead poisoning (BLL ≥5 μg/dL) among the children studied was 92.5%, with 34 children (11.1%) having BLL ≥45 μg/dL. Fourteen percent of the households had soil lead levels >400 mg/kg. Being age 24–35 months, having childhood anemia, using kohl eye cosmetic and the combination of father’s/guardian’s low level of education and low socioeconomic status were found to be significant risk factors associated with childhood lead poisoning in the regression analyses. Conclusions. The prevalence of childhood lead poisoning was high in Kawaye, which may be attributable to widespread unsafe mining and ore processing activities in the community. We recommended beginning treatment in all cases where severe lead poisoning was identified, and that further targeted interventions should be designed to address the identified risk factors in order to control and prevent further lead poisoning in the village and the state at large. Competing Interests. The authors declare no competing financial interests