Prevalence and Speciation of Non-albican Vulvovaginal Candidiasis in Zaria

Candida species are versatile microorganisms which live normally in the skin, mouth, gastrointestinal tract, and genitourinary tract. In healthy people, Candida species usually live as benign commensals and produce no disease. However, they are the most common cause of fungal infections in immunosuppressed individuals, leading to a range of non-life threatening mucocutaneous diseases to threatening invasive systemic diseases. Among Candida spp, the more important pathogenic species are Candida albicans, C. glabrata, C. tropicalis, C. parapsilosis and C.krusei. The research set out to determine the prevalence of non albicans vulvovaginal candidiasis and pattern of distribution of the different Candida species in Zaria.A cross sectional study of female genital swabs collected from 400 women with features suggestive of vulvovaginal candidiasis attending Gynaecology clinics in four selected hospitals in Zaria. The swabs collected between a period of February 2012 to March 2013 were analysed by microscopy and culture in the Medical Microbiology laboratory, Ahmadu Bello University, Zaria.  Data on demographic details were also obtained; using structured questionnaires. Of the 400 patient samples examined 163(40.8%) were culture positive for Candida spp. Of these 163 isolates, 84 were germ-tube negative giving a prevalence of 21% for non albicans candida (NAC). Of the 84 isolates of NAC, 51(60.7%) were Candida parapsilosis, 18 (21.4%) were Candida tropicalis, while 15 (17.9%) were Candida glabrata. Vulvovaginal candidiasis was found to be more prevalent among the age group 21-30 years in general. Vulvovaginal candidiasis is a prevalent infection among women. More than half of the infections are due to non-albicans Candida.  NAC is becoming increasingly relevant in the aetiology of Vulvovaginal candidiasis and health providers need to be aware of this as the treatment options differ. Keywords: Non albicans Candida, Vulvovaginal candidiasis, Vulvovaginiti

ABSENCE OF mecA GENE IN METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS ISOLATES

Methicillin-resistant Staphylococcus aureus has emerged as a serious threat to public health, causing both hospital and community-associated infections. The gold standard for MRSA detection is the amplification of the mecA gene that codes for the production of the altered penicillin-binding protein (PBP2a) responsible for classical methicillin resistance. This work determined the nature of methicillin-resistance observed in staphylococcal isolates. Staphylococcus aureus isolates with phenotypic resistance to methicillin (oxacillin) were tested for the carriage of the mecA gene by multiplex PCR to detect and type the SCCmec. The isolates were tested for the production of the altered PBP2a by latex agglutination test and β-lactamase production/hyper production by microplate Nitrocefin assay. None of the isolates hybridized with any of the 16 sets of primers representing the five major SCCmec types, nor contained the mecA gene; and none was positive for the gene product PBP2a determined by the MRSA screen latex agglutination test. Majority of the isolates 72.2 % (26/36) tested positive for β-lactamase production while 11/26 (42.3%) were β-lactamase hyper producers. The MRSA phenotype observed in the isolates was not the classical mecA-mediated resistance, but most probably due to hyper-production of β-lactamase. Reports of loss of the mecA gene (believed to be stable) during storage and the fact that all PCR detection of mecA gene reported in Nigeria were done outside the country calls for attention on building local capacity for prospective molecular screening for MRSA in clinical and environmental isolates to adequately document their prevalence and monitor the increase. Appropriate guidelines should also be drawn up for the proper screening and reporting of MRSA isolates with the establishment of regional Reference Laboratories

Factors associated with delayed presentation to healthcare facilities for Lassa fever cases, Nigeria 2019: a retrospective cohort study.

BACKGROUND: Large outbreaks of Lassa fever (LF) occur annually in Nigeria. The case fatality rate among hospitalised cases is ~ 20%. The antiviral drug ribavirin along with supportive care and rehydration are the recommended treatments but must be administered early (within 6 days of symptom onset) for optimal results. We aimed to identify factors associated with late presentation of LF cases to a healthcare facility to inform interventions. METHODS: We undertook a retrospective cohort study of all laboratory confirmed LF cases reported in Nigeria from December 2018 to April 2019. We performed descriptive epidemiology and a univariate Cox proportional-hazards regression analysis to investigate the effect of clinical (symptom severity), epidemiological (age, sex, education, occupation, residential State) and exposure (travel, attendance at funeral, exposure to rodents or confirmed case) factors on time to presentation. RESULTS: Of 389 cases, median presentation time was 6 days (IQR 4-10 days), with 53% attending within 6 days. There were no differences in presentation times by sex but differences were noted by age-group; 60+ year-olds had the longest delays while 13-17 year-olds had the shortest. By sex and age, there were differences seen among the younger ages, with 0-4-year-old females presenting earlier than males (4 days and 73% vs. 10 days and 30%). For 5-12 and 13-17 year-olds, males presented sooner than females (males: 5 days, 65% and 3 days, 85% vs. females: 6 days, 50% and 5 days, 61%, respectively). Presentation times differed across occupations 4.5-9 days and 20-60%, transporters (people who drive informal public transport vehicles) had the longest delays. Other data were limited (41-95% missing). However, the Cox regression showed no factors were statistically associated with longer presentation time. CONCLUSIONS: Whilst we observed important differences in presentation delays across factors, our sample size was insufficient to show any statistically significant differences that might exist. However, almost half of cases presented after 6 days of onset, highlighting the need for more accurate and complete surveillance data to determine if there is a systemic or specific cause for delays, so to inform, monitor and evaluate public health strategies and improve outcomes

Carbapenem resistance expressed by Gram-negative bacilli isolated from a cohort of Libyan patients

Background and objectives: Carbapenem-resistant Enterobacteriaceae (CRE) and other Gram-negative bacteria are among the most common pathogens responsible for both community and hospital acquired infection. The global spread of cephalosporinases in Enterobacteriaceae has led to the increased use of carbapenems resulting in the emergence and rapid spread of CRE. This has become an alarming public health concern, yet the condition in Libya remains unclear. The aim of this study was to obtain a better understanding of CRE strains prevalent in Libyan patients by investigating their phenotypic characteristics and antibiograms. Methods: Gram-negative bacterial species were collected from Misrata Central Hospital, Misrata Cancer Centre and Privet Pathology Laboratories. Clinical samples and swabs were obtained from hospitalised and non-hospitalised patients and from mechanical ventilation and suction machines. Patients who had received antibiotic therapy for at least three days prior to the study were excluded. The identification and characterization of the isolated species were achieved using the growth characteristics on MacConkey and blood agar, spot tests and API 20E or API 20NE biochemical testing systems. Screening for carbapenem resistance was performed using the disk diffusion method with carbapenem 10 μg and cephalosporin 30 μg disks and minimum inhibitory concentrations (MIC) determined using the Sensititre Gram-negative Xtra plate format (GNX2F). All strains demonstrating resistance or reduced susceptibility to one of the four carbapenems were subjected to carbapenememase activity detection using the RAPIDEC CARBA NP test, Modified Hodge test and carbapenem inactivation methods. Results: A total of one hundred and forty isolates representing fourteen bacterial species were isolated from 140 non-duplicated specimens. Clinical specimens included urine samples (96/140, 68.57%), sputum (15/140, 10.71%), surgical wound swabs (18/140, 12.85%), foot swabs from diabetes mellitus (DM) patients (6/140, 4.29%), ear swabs (3/140, 2.14%) and wound swabs (2/140, 1.43%). Thirty-four (24.29%) isolates demonstrated resistance to at least one of the four carbapenems with Klebsiella pneumoniae representing 73.53% (25 isolates) of all carbapenem resistant species, followed by 8.82% for Pseudomonas aeruginosa (3 isolates), 5.88% for both Proteus mirabilis (2 isolates) and Escherichia coli (2 isolates) and 2.94% for both Citrobacter koseri (1 isolate) and Rahnella aquatilis (1 isolate). The other isolates were either susceptible or cephalosporinase producers. Conclusion: This study has revealed the high rate of carbapenem resistance amongst Libyan patients and emphasizes the crucial need for accurate screening, identification and susceptibility testing to prevent further spread of nosocomial and community acquired resistance. This may be achieved through the establishment of antibiotic stewardship programmes along with firm infection control practices.National Research Foundation of South Africa; Libyan GovernmentWeb of Scienc

Public Health Implications of Cryptococcal Infection among HIV Patients on Antiretroviral Therapy in Hospital in Shika, Nigeria

Cryptococcal meningitis is a leading cause of death in AIDS patients and contributes substantially to the high early mortality in antiretroviral treatment (ART) programs in low-resource settings. A hospital-based seroprevalence of cryptococcal antigen among HIV patients on ART program was determined using the Alpha cryptococccal Antigen EIA KIT. The prevalence was low in the study area probably because the ART monitoring program used helped in reducing the incidence of cryptococccal infection. Routine screening of HIV patients is needed for early detection of the infection before unset of complicating clinical signs

Evaluation of the Measles Case-Based Surveillance System in Kaduna State (2010-2012)

Despite the high investment on Measles surveillance activities, frequent measles outbreaks still occur in Kaduna State. We evaluated the surveillance system to adentify gaps in its operations.We adapted the updated CDC guidelines on surveillance evaluation to assess the systems usefulness, representativeness, simplicity, timeliness, stability and acceptability. Our findings showed that the surveillance system is still useful however there were marked deficiencies in the timeliness and completeness of weekly reporting

Evaluation of the Measles Case-Based Surveillance System in Kaduna State (2010-2012)

Despite the high investment on Measles surveillance activities, frequent measles outbreaks still occur in Kaduna State. We evaluated the surveillance system to adentify gaps in its operations.We adapted the updated CDC guidelines on surveillance evaluation to assess the systems usefulness, representativeness, simplicity, timeliness, stability and acceptability. Our findings showed that the surveillance system is still useful however there were marked deficiencies in the timeliness and completeness of weekly reporting

Seroprevalence of brucellosis among women with miscarriage at Ahmadu Bello University Teaching Hospital, Zaria

Background: Brucellosis in animals has been identified as a common cause of miscarriage. It is the most common zoonotic disease that leads to considerable morbidity in humans. It is rarely diagnosed in hospitals in Nigeria, and debate exists as to whether it is a more common cause of miscarriage in humans compared to other infective agents, especially with the finding of antibrucella activity in human amniotic fluid. Brucellosis in humans is a treatable disease and risk factors for transmission are prevalent in Zaria. Objective: The objective of this study was to determine the seroprevalence of brucellosis among women with miscarriage. Materials and Methods: This was a descriptive cross-sectional study involving 121 women aged between 15 and 49 years with miscarriage who presented to Ahmadu Bello University Teaching Hospital (ABUTH), Zaria from August 2014 to May 2015. Information on socio-demographic characteristics, reproductive profile, and risk factors for contracting Brucella infection were obtained using a questionnaire. Blood samples were obtained and analysed for Brucella IgG and IgM using indirect enzyme-linked immunosorbent assay kits. The data was analysed with SPSS, version 20.0. Results: The mean age of the participating women was 29.07 years [standard deviation (SD) ±6.74]. The seroprevalence of brucellosis was 19.0%; 17.4% of the women had a recent infection, and 1.7% had a chronic infection. Age, history of previous miscarriage, consumption of milk products and consumption of roasted meat/barbecue had positive relationships with recent Brucella infection (χ2 = 9.706, P = 0.046; χ2 = 7.300, P = 0.026; χ2 = 3.169, P = 0.049; χ2 = 3.012, P = 0.050, respectively). Chronic Brucella infection had a positive relationship with number of pregnancies (χ2 = 8.036, P = 0.018). Regression analyses showed that age, history of previous miscarriage and history of recent miscarriage in animals reared were positively correlated with Brucella seropositivity and miscarriage (χ2 = 13.200, P = 0.022; χ2 = 9.795, P = 0.007; χ2 = 7.890, P = 0.005, respectively). Conclusion: There is a high prevalence of brucellosis among women with miscarriage in Zaria. The burden of the disease should be appreciated and routinely tested to prevent reoccurrence

Evaluation of the Measles Surveillance System in Kaduna State, Nigeria (2010-2012)

ObjectiveTo evaluate the case-based Measles surveillance system in Kaduna State of Nigeria and identify gaps in its operation.Introduction In Africa, approximately 13 million cases of measles and 650,000 deaths occur annually, with sub-Saharan Africa having the highest morbidity and mortality (1). Measles infection is endemic in Nigeria and has been documented to occur all year round despite high measles routine and supplemental immunisation coverage (2,3). The frequent outbreaks of Measles in Kaduna State prompted the need for the evaluation of the Measles case-based surveillance system.Methods We interviewed stake holders and  adapted the updated 2001 CDC guidelines on surveillance evaluation to assess the systems usefulness, representativeness, timeliness, stability and acceptability. A retrospective record review of the measles case-based surveillance data from 2010– 2012 was carried out to assess data quality and representativeness. We calculated the annualized detection rate of measles and non-measles febrile rash, proportion of available results, proportion of Districts (LGAs) that investigated at least one case with blood, proportion of cases that were IgM positive and the incidence of measles. We compared the results with WHO (2004) recommended performance indicators to determine the quality and effectiveness of measles surveillance system. Results According to the Stake holders, the case-based surveillance system is useful and acceptable. Median interval between specimen collection and release of result was 38  days (Range: 16 – 109) in 2011, 11 days (Range: 1 – 105) in 2012. The best median turnaround time of 7days (1 – 25) was recorded in 2010. The annualized detection rate of measles rash in 2011 was 1.0 (target: ≥2), in 2012 it was 1.4 (target: ≥2). The annualized detection rate of non-measles febrile rash in 2011 was 0.6 (target: ≥2) while it was 0.8 (target: ≥2) in 2012. Case definitions are simple and understood by all the operators. We found a progressive decline in  timeliness and data quality in the years under review.ConclusionThis evaluation showed that the surveillance system was still useful. Also, the efficiency and effectiveness of the laboratory component as captured by the “median interval between specimen collection and the release of results improved in 2010 and 2012 compared to 2011. However, there was a progressive decline in the timeliness and completeness of weekly reports in the years under review.Keywords:  Measles; Case-based; Surveillance; Evaluation; Nigeri