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Mmerem JI, Umenzekwe CC, Johnson SM, Onukak AE, Chika-Igwenyi NM, Chukwu SK, Onyeaghala CA, Ozougwu JJ, Alasia D, Ehiakhamen O, Nwankwo HM, Ezejiofor OI, Unigwe US, Iroezindu MO. Mpox and Chickenpox Coinfection: Case Series From Southern Nigeria. J Infect Dis 2024; 229:S260-S264. [PMID: 38058122 DOI: 10.1093/infdis/jiad556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 11/25/2023] [Accepted: 12/04/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND We describe clinicoepidemiologic characteristics of mpox-chickenpox coinfection in Nigeria. METHODS A retrospective cohort analysis was performed of confirmed mpox cases in Nigeria from January 2022 to March 2023. Mpox and chickenpox were confirmed by real-time polymerase chain reaction (RT-PCR). RESULTS Of 94 (60.0%) suspected cases, 56 had confirmed mpox, of whom 16 (28.6%) had chickenpox coinfection. The median age of confirmed mpox cases was 29 years (interquartile range, 20-37 years), 24 were men (60.7%), 6 (10.7%) were bisexual, and 5 (8.9%) died. Mpox-chickenpox-coinfected patients had more complications than mpox-monoinfected cases (56.3% vs 22.5%, P = .015). CONCLUSIONS The high frequency of mpox-chickenpox coinfection argues for accelerated access to mpox and chickenpox vaccines in Africa.
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Affiliation(s)
- Juliet I Mmerem
- Department of Medicine, University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu, Enugu State, Nigeria
| | - Chukwudi C Umenzekwe
- Department of Internal Medicine, Nnamdi Azikwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
| | - Simon M Johnson
- Department of Internal Medicine, Federal University Teaching Hospital, Owerri, Imo State, Nigeria
| | - Asukwo E Onukak
- Department of Internal Medicine, University of Uyo Teaching Hospital, Uyo, Akwa Ibom State, Nigeria
| | - Nneka M Chika-Igwenyi
- Department of Internal Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria
| | - Sunday K Chukwu
- Department of Internal Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria
| | - Chizaram A Onyeaghala
- Department of Internal Medicine, University of Port-Harcourt Teaching Hospital, Port-Harcourt, Rivers State, Nigeria
| | - Jideofor J Ozougwu
- Department of Medicine, University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu, Enugu State, Nigeria
- Department of Internal Medicine, Federal University Teaching Hospital, Owerri, Imo State, Nigeria
| | - Datonye Alasia
- Department of Internal Medicine, University of Port-Harcourt Teaching Hospital, Port-Harcourt, Rivers State, Nigeria
| | - Odianosen Ehiakhamen
- National Mpox Emergency Operating Centre, National Centre for Disease Control, Abuja, Nigeria
| | - Henry M Nwankwo
- Department of Internal Medicine, Nnamdi Azikwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
| | - Ogochukwu I Ezejiofor
- Department of Internal Medicine, Nnamdi Azikwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
| | - Uche S Unigwe
- Department of Medicine, University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu, Enugu State, Nigeria
- Department of Internal Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria
| | - Michael O Iroezindu
- Department of Medicine, University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu, Enugu State, Nigeria
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2
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Chika-Igwenyi NM, Unigwe US, Ajayi NA, Onwe OE, Ewa RL, Ojide CK, Una AF, Igwenyi C, Chukwu KS, Okorie GM, Nnadozie UU, Ifebunandu NA, Ugwu CN, Emeka S, Ibemesi D, Nnaji TO, Primus NO, Odianosen E. Atypical Mpox in a Nigerian Tertiary Health Facility. J Infect Dis 2024; 229:S181-S187. [PMID: 38157416 DOI: 10.1093/infdis/jiad607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 12/22/2023] [Accepted: 12/26/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND We describe diverse clinical characteristics and course of confirmed mpox cases managed in a Nigerian tertiary health facility. METHODS Clinical and epidemiologic data were analyzed, highlighting the unusual presentations of polymerase chain reaction (PCR)-confirmed mpox cases observed during the 2022 outbreak. RESULTS Out of 17 suspected cases, 13 (76.4%) were PCR confirmed for mpox. The mean ± SD age for the participants was 28.62 ± 10.29 years (range, 2-55), of which 9 (64.3%) were male. Of the 13 PCR-confirmed cases, 5 (38.5%) had varicella zoster virus coinfection, 2 (15.4%) had HIV coinfection, and 1 (7.7%) had diabetes mellitus comorbidity. All patients experienced rash, with 6 (46.2%) having significant genital lesions and 1 (7.7%) having a severe perianal lesion. A lack of prodromal symptoms was reported in 3 (23.1%), and a prolonged prodrome (>1 week) occurred in 5 (38.5%). Skin lesions were polymorphic in 6 (46.2%), and solitary skin lesions occurred in 3 (23.1%), which persisted for >120 days in 7.7%. CONCLUSIONS Clinical recognition, diagnosis, and prevention remain a concern in resource-limited settings. Our findings highlight the need to further evaluate unusual skin lesions and to include mpox screening for genital skin lesions that are presumed to be sexually transmitted infections. Revision of clinical case definition and enhanced surveillance are key to early recognition and prevention of spread.
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Affiliation(s)
- Nneka M Chika-Igwenyi
- Department of Internal Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki
| | - Uche S Unigwe
- Department of Internal Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki
- Department of Medicine, University of Nigeria Teaching Hospital, Ituku/Ozalla
| | - Nnennaya A Ajayi
- Department of Internal Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki
| | - Ogah E Onwe
- Department of Internal Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki
- Department of Paediatrics, Alex Ekwueme Federal University Teaching Hospital Abakaliki
| | - Richard L Ewa
- Department of Anaesthesia, Alex Ekwueme FederalUniversity Teaching Hospital Abakliki
| | - Chiedozie K Ojide
- Department of Medical Microbiology, Alex Ekwueme Federal University Teaching Hospital Abakaliki
| | - Alfred F Una
- Department of Community Medicine, University of Nigeria Teaching Hospital, Ituku/Ozalla
| | - Chikaodiri Igwenyi
- Department of Internal Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki
| | - Kyrian S Chukwu
- Department of Internal Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki
| | - Gabriel M Okorie
- Department of Plastic Surgery, Alex Ekwueme Federal University Teaching Hospital Abakaliki
| | - Ugochukwu U Nnadozie
- Department of Plastic Surgery, Alex Ekwueme Federal University Teaching Hospital Abakaliki
| | - Ngozi A Ifebunandu
- Department of Internal Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki
| | - Collins N Ugwu
- Department of Internal Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki
| | | | - Desi Ibemesi
- Department of Community Medicine, University of Nigeria Teaching Hospital, Ituku/Ozalla
| | - Thomas O Nnaji
- Department of Internal Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki
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Savelkoel J, Oladele RO, Ojide CK, Peters RF, Notermans DW, Makinwa JO, de Vries MC, Sunter MA, Matamoros S, Abdullahi N, Unigwe US, Akanmu AS, Wiersinga WJ, Birnie E. Presence of Burkholderia pseudomallei in Soil, Nigeria, 2019. Emerg Infect Dis 2023; 29:1073-1075. [PMID: 37081606 PMCID: PMC10124662 DOI: 10.3201/eid2905.221138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023] Open
Abstract
Melioidosis, caused by the soil-dwelling bacterium Burkholderia pseudomallei, is predicted to be endemic in Nigeria but is only occasionally reported. This report documents the systematic identification of the presence of B. pseudomallei and B. thailandensis in the soil across multiple states in Nigeria.
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Mmerem JI, Unigwe US, Iroezindu MO, Chukwu KS, Ezenwosu IL, Okorie GO, Chika-Igwenyi NM, Nwatu CB, Onodugo OD. Demographic characteristics, clinical presentation and in-hospital outcome among patients with Covid-19 in a Nigerian tertiary hospital. Malawi Med J 2023; 35:43-57. [PMID: 38124701 PMCID: PMC10645895 DOI: 10.4314/mmj.v35i1.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Abstract
Background We described the demographic/clinical characteristics and in-hospital outcome of patients with COVID-19 at the University of Nigeria Teaching Hospital (UNTH) during the first wave to inform evidence-based responses during subsequent waves in Africa. Methodology We conducted retrospective cohort analyses of adult patients ≥18 years with PCR or GeneXpert-confirmed SARS-CoV-2 infection. Data was extracted from patients' medical records from 1st May to 30th September 2020. Based on disease severity, patients were either hospitalized (82) or managed at home (90). Logistic regression and cox-proportional hazard models were used to determine predictors of severe COVID-19 disease and in-hospital mortality, respectively. Results Of 172 cases, 113 (65.7%) were males, and the mean age was 45 ± 19 years. The majority were urban dwellers (72.1%), 19.8% had a positive history of contact with a confirmed/suspected case, 15.7% were healthcare workers while 68 (39.5%) had co-morbidities. Symptomatic patients comprised 73.3% of cases. Fever (p=0.02) and breathlessness (p=0.03) were commoner in males while diarrhoea (p<0.01) was predominant in females. On multivariate analysis, severe COVID-19 was predicted by the presence of co-morbidity (AOR= 14.44, 95% C.I= 4.79- 43.58, p <0.001)and prior antibiotic/antimalarial use (AOR= 6.35, 95% C.I= 2.24- 18.05, p =0.001) while being a non-healthcare worker (AOR= 0.18, 95% C.I= 0.04-0.78, p=0.02) was protective. However, none of the variables assessed predicted in-hospital mortality. Conclusion Our findings underscore the contributions of demographic variables in COVID-19 transmission and gender differences in clinical presentation. Underlying comorbidity likewise prior antimicrobial use increased the likelihood of severe COVID-19. The absence of mortality predictors in our study may be related to the relatively small number of deaths. Further studies are recommended to unravel the predominance of severe disease in healthcare workers.
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Affiliation(s)
- Juliet I Mmerem
- Department of Medicine, University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu, Enugu State, Nigeria
- Department of Internal Medicine, Federal Medical Centre, Owerri, Imo State, Nigeria
| | - Uche S Unigwe
- Department of Medicine, University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu, Enugu State, Nigeria
- Department of Internal Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria
| | - Michael O Iroezindu
- Department of Medicine, University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu, Enugu State, Nigeria
| | - Kyrian S Chukwu
- Department of Medicine, University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu, Enugu State, Nigeria
- Department of Internal Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria
| | - Ifeyinwa L Ezenwosu
- Department of Community Medicine, University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu, Enugu State, Nigeria
| | - Geofrey O Okorie
- Department of Medicine, University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu, Enugu State, Nigeria
- Department of Internal Medicine, Enugu State University Teaching Hospital, Parklane, Enugu, Enugu State, Nigeria
| | - Nneka M Chika-Igwenyi
- Department of Medicine, University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu, Enugu State, Nigeria
- Department of Internal Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria
| | - Chidinma B Nwatu
- Department of Medicine, University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu, Enugu State, Nigeria
| | - Obinna D Onodugo
- Department of Medicine, University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu, Enugu State, Nigeria
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5
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Chika-Igwenyi NM, Harrison RE, Psarra C, Gil-Cuesta J, Gulamhusein M, Onwe EO, Onoh RC, Unigwe US, Ajayi NA, Nnadozie UU, Ojide CK, Nwidi DU, Ezeanosike O, Sampson E, Adeke AS, Ugwu CN, Anebonam U, Tshiang JK, Maikere J, Reid A. Early onset of neurological features differentiates two outbreaks of Lassa fever in Ebonyi state, Nigeria during 2017-2018. PLoS Negl Trop Dis 2021; 15:e0009169. [PMID: 33684118 PMCID: PMC7984835 DOI: 10.1371/journal.pntd.0009169] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 03/22/2021] [Accepted: 01/22/2021] [Indexed: 01/15/2023] Open
Abstract
Lassa fever (LF) is an acute viral haemorrhagic illness with various non-specific clinical manifestations. Neurological symptoms are rare at the early stage of the disease, but may be seen in late stages, in severely ill patients.The aim of this study was to describe the epidemiological evolution, socio-demographic profiles, clinical characteristics, and outcomes of patients seen during two Lassa fever outbreaks in Ebonyi State, between December 2017 and December 2018. Routinely collected clinical data from all patients admitted to the Virology Centre of the hospital during the period were analysed retrospectively. Out of a total of 83 cases, 70(84.3%) were RT-PCR confirmed while 13 (15.7%) were probable cases. Sixty-nine (83.1%) patients were seen in outbreak 1 of whom 53.6% were urban residents, while 19%, 15%, and 10% were farmers, students and health workers respectively. There were 14 (16.8%) patients, seen in second outbreak with 92.9% rural residents. There were differences in clinical symptoms, signs and laboratory findings between the two outbreaks. The case fatality rates were 29.9% in outbreak 1 and 85.7% for outbreak 2. Neurological features and abnormal laboratory test results were associated with higher mortality rate, seen in outbreak 2. This study revealed significant differences between the two outbreaks. Of particular concern was the higher case fatality during the outbreak 2 which may be from a more virulent strain of the Lassa virus. This has important public health implications and further molecular studies are needed to better define its characteristics.
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Affiliation(s)
- Nneka M. Chika-Igwenyi
- Department of Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Abakaliki, Ebonyi, Nigeria
| | | | - Christina Psarra
- Médecins sans Frontières Operational Research Unit (LuxOR), Operational Centre Brussels, Belgium
| | - Julita Gil-Cuesta
- Médecins sans Frontières Operational Research Unit (LuxOR), Operational Centre Brussels, Belgium
| | - Maria Gulamhusein
- Médecins sans Frontières Operational Research Unit (LuxOR), Operational Centre Brussels, Belgium
| | - Emeka O. Onwe
- Department of Paediatrics, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Abakaliki, Ebonyi, Nigeria
| | - Robinson C. Onoh
- Department of Obstetrics and Gynaecology, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Abakaliki, Ebonyi, Nigeria
| | - Uche S. Unigwe
- Department of Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Abakaliki, Ebonyi, Nigeria
- University of Nigeria Teaching Hospital, Ituku Ozalla Enugu, Nigeria
| | - Nnennaya A. Ajayi
- Department of Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Abakaliki, Ebonyi, Nigeria
| | - Ugochukwu U. Nnadozie
- Division of Plastic Surgery, Department of Surgery, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Abakaliki, Ebonyi, Nigeria
| | - Chiedozie K. Ojide
- Department of Medical Microbiology, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Abakaliki, Ebonyi, Nigeria
- Virology Laboratory, Virology Centre,AlexEkwueme Federal University Teaching Hospital Abakaliki, Abakaliki, Ebonyi, Nigeria
| | - Damian U. Nwidi
- Department of Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Abakaliki, Ebonyi, Nigeria
| | - Obumneme Ezeanosike
- Department of Paediatrics, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Abakaliki, Ebonyi, Nigeria
| | - Emeka Sampson
- Ebonyi State Ministry of Health, Abakaliki, Ebonyi, Nigeria
| | - Azuka S. Adeke
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital Abakiliki, Abakaliki, Ebonyi, Nigeria
| | - Collins N. Ugwu
- Department of Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Abakaliki, Ebonyi, Nigeria
| | | | | | | | - Anthony Reid
- Médecins sans Frontières Operational Research Unit (LuxOR), Operational Centre Brussels, Belgium
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6
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Iloanusi NI, Unigwe US, Uche EO, Iroezindu MO, Okafor OC. Pott's disease with extensive bilateral psoas abscesses in a Nigerian woman: an unusual case. Malawi Med J 2021; 32:168-172. [PMID: 33488989 PMCID: PMC7812151 DOI: 10.4314/mmj.v32i3.10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Bilateral psoas abscesses are uncommon in Pott's disease. We describe a 28-year-old Nigerian woman with a 2-year history of constitutional symptoms and a 1-year history of bilateral paravertebral masses. She had received anti-tuberculosis (TB) treatment in an interrupted manner. A computed tomography (CT) scan revealed T10-T12 spondylitis, wedge collapse and extensive bilateral psoas abscesses. Histology of the abscess wall was definitively diagnosed as soft tissue TB, and special staining for acid-fast bacilli was positive. She was successfully treated with anti-TB therapy and ultrasound-guided surgical drainage of 6 L of abscess fluid. Complicated cases of Pott's disease may require multi-disciplinary interventions for optimal outcome.
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Affiliation(s)
- Nneka I Iloanusi
- Department of Radiation Medicine, Faculty of Medical Sciences, University of Nigeria, Ituku/Ozalla Campus, Enugu, Nigeria
| | - Uche S Unigwe
- Department of Medicine, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
| | - Enoch O Uche
- Department of Surgery, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
| | - Michael O Iroezindu
- Department of Medicine, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
| | - Okechukwu C Okafor
- Department of Morbid Anatomy, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
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7
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Pemba CM, Kurosaki Y, Yoshikawa R, Oloniniyi OK, Urata S, Sueyoshi M, Zadeh VR, Nwafor I, Iroezindu MO, Ajayi NA, Chukwubike CM, Chika-Igwenyi NM, Ndu AC, Nwidi DU, Maehira Y, Unigwe US, Ojide CK, Onwe EO, Yasuda J. Development of an RT-LAMP assay for the detection of Lassa viruses in southeast and south-central Nigeria. J Virol Methods 2019; 269:30-37. [PMID: 30974179 DOI: 10.1016/j.jviromet.2019.04.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 03/30/2019] [Accepted: 04/07/2019] [Indexed: 10/27/2022]
Abstract
Lassa virus (LASV) causes Lassa fever (LF), a viral hemorrhagic fever endemic in West Africa. LASV strains are clustered into six lineages according to their geographic location. To confirm a diagnosis of LF, a laboratory test is required. Here, a reverse transcription loop-mediated isothermal amplification (RT-LAMP) assay using a portable device for the detection of LASV in southeast and south-central Nigeria using three primer sets specific for strains clustered in lineage II was developed. The assay detected in vitro transcribed LASV RNAs within 23 min and was further evaluated for detection in 73 plasma collected from suspected LF patients admitted into two health settings in southern Nigeria. The clinical evaluation using the conventional RT-PCR as the reference test revealed a sensitivity of 50% in general with 100% for samples with a viral titer of 9500 genome equivalent copies (geq)/mL and higher. The detection limit was estimated to be 4214 geq/mL. The assay showed 98% specificity with no cross-reactivity to other viruses which cause similar symptoms. These results suggest that this RT-LAMP assay is a useful molecular diagnostic test for LF during the acute phase, contributing to early patient management, while using a convenient device for field deployment and in resource-poor settings.
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Affiliation(s)
- Christelle M Pemba
- Department of Emerging Infectious Diseases, Institute of Tropical Medicine (NEKKEN), Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan; Graduate School of Biomedical Sciences and Program for Nurturing Global Leaders in Tropical and Emerging Communicable Diseases, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan
| | - Yohei Kurosaki
- Department of Emerging Infectious Diseases, Institute of Tropical Medicine (NEKKEN), Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan
| | - Rokusuke Yoshikawa
- Department of Emerging Infectious Diseases, Institute of Tropical Medicine (NEKKEN), Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan; National Research Center for the Control and Prevention of Infectious Diseases (CCPID), Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan
| | - Olamide K Oloniniyi
- Department of Emerging Infectious Diseases, Institute of Tropical Medicine (NEKKEN), Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan; Graduate School of Biomedical Sciences and Program for Nurturing Global Leaders in Tropical and Emerging Communicable Diseases, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan
| | - Shuzo Urata
- Department of Emerging Infectious Diseases, Institute of Tropical Medicine (NEKKEN), Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan; National Research Center for the Control and Prevention of Infectious Diseases (CCPID), Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan
| | - Maki Sueyoshi
- Department of Emerging Infectious Diseases, Institute of Tropical Medicine (NEKKEN), Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan
| | - Vahid R Zadeh
- Department of Emerging Infectious Diseases, Institute of Tropical Medicine (NEKKEN), Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan; Graduate School of Biomedical Sciences and Program for Nurturing Global Leaders in Tropical and Emerging Communicable Diseases, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan
| | - Ifeanyi Nwafor
- Department of Medical Microbiology, Federal Teaching Hospital Abakaliki, P.M.B. 102, Abakaliki, Nigeria
| | - Michael O Iroezindu
- Department of Medicine, College of Medicine, University of Nigeria, Ituku-Ozalla, P.M.B. 01129, Enugu, Nigeria
| | - Nnenna A Ajayi
- Department of Medicine, University of Nigeria Teaching Hospital, Ituku-Ozalla, P.M.B. 01129, Enugu, Nigeria
| | - Chinedu M Chukwubike
- Department of Microbiology, University of Nigeria Teaching Hospital, Ituku-Ozalla, P.M.B. 01129, Enugu, Nigeria
| | - Nneka M Chika-Igwenyi
- Department of Medicine, University of Nigeria Teaching Hospital, Ituku-Ozalla, P.M.B. 01129, Enugu, Nigeria
| | - Anne C Ndu
- Department of Community Medicine, College of Medicine, University of Nigeria, Ituku-Ozalla, P.M.B. 01129, Enugu, Nigeria
| | - Damian U Nwidi
- Department of Medical Microbiology, Federal Teaching Hospital Abakaliki, P.M.B. 102, Abakaliki, Nigeria
| | - Yuki Maehira
- Department of Emerging Infectious Diseases, Institute of Tropical Medicine (NEKKEN), Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan; St Luke's International University, Graduate School of Public Health, 3-6-2, Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Uche S Unigwe
- Department of Medical Microbiology, Federal Teaching Hospital Abakaliki, P.M.B. 102, Abakaliki, Nigeria; Department of Medicine, Federal Teaching Hospital Abakaliki, P.M.B. 102, Abakaliki, Nigeria
| | - Chiedozie K Ojide
- Department of Medical Microbiology, Federal Teaching Hospital Abakaliki, P.M.B. 102, Abakaliki, Nigeria
| | - Emeka O Onwe
- Department of Medicine, Federal Teaching Hospital Abakaliki, P.M.B. 102, Abakaliki, Nigeria; Pediatrics Department, Federal Teaching Hospital Abakaliki, P.M.B. 102, Abakaliki, Nigeria
| | - Jiro Yasuda
- Department of Emerging Infectious Diseases, Institute of Tropical Medicine (NEKKEN), Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan; Graduate School of Biomedical Sciences and Program for Nurturing Global Leaders in Tropical and Emerging Communicable Diseases, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan; National Research Center for the Control and Prevention of Infectious Diseases (CCPID), Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan.
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8
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Iroezindu MO, Unigwe US, Okwara CC, Ozoh GA, Ndu AC, Ohanu ME, Nwoko UO, Okoroafor UW, Ejimudo E, Tobin EA, Asogun DA. Lessons learnt from the management of a case of Lassa fever and follow-up of nosocomial primary contacts in Nigeria during Ebola virus disease outbreak in West Africa. Trop Med Int Health 2015; 20:1424-1430. [PMID: 26171669 DOI: 10.1111/tmi.12565] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To describe our experiences in the management of a case of Lassa fever (LF) and follow-up of nosocomial primary contacts during the 2014 Ebola outbreak in West Africa. METHODS Clinical management of the index case and infection control/surveillance activities for primary contacts are described. Laboratory confirmation was by Lassa virus-specific reverse-transcriptase PCR. RESULTS A 28-year-old man with a 10-day history of febrile illness was referred to a major tertiary hospital in south-east Nigeria from a city that previously experienced a LF outbreak and was recently affected by Ebola. On observation of haemorrhagic features, clinicians were at a crossroads. Diagnosis of LF was confirmed at a National Reference Centre. The patient died despite initiation of ribavirin therapy. Response activities identified 121 primary contacts comprising 78 (64.5%) hospital staff/interns, 19 (15.7%) medical students, 18 (14.9%) inpatients and 6 (5.0%) relatives. Their mean age was 32.8 ± 6.6 years, and 65.3% were women. Twenty (16.5%) had high-risk exposure and were offered ribavirin as post-exposure prophylaxis. No secondary case of LF occurred. Fatigue (43.8%) and dizziness (31.3%) were the commonest side effects of ribavirin. CONCLUSIONS Response activities contained nosocomial spread of LF, but challenges were experienced including lack of a purpose-built isolation facility, absence of local Lassa virus laboratory capacity, failure to use appropriate protective equipment and stigmatisation of contacts. A key lesson is that the weak health systems of Africa should be comprehensively strengthened; otherwise, we might win the Ebola battle but lose the one against less virulent infections for which effective treatment exists.
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Affiliation(s)
- Michael O Iroezindu
- Department of Medicine, University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu, Nigeria
| | - Uche S Unigwe
- Department of Medicine, University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu, Nigeria
| | - Celestine C Okwara
- Department of Medicine, University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu, Nigeria
| | - Gladys A Ozoh
- Department of Medicine, University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu, Nigeria
| | - Anne C Ndu
- Department of Community Medicine, University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu, Nigeria
| | - Martin E Ohanu
- Department of Medical Microbiology, University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu, Nigeria
| | - Ugochukwu O Nwoko
- Department of Medicine, University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu, Nigeria
| | - Uwadiegwu W Okoroafor
- Department of Medicine, University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu, Nigeria
| | - Esinulo Ejimudo
- Nigeria Centre for Disease Control and Prevention, Abuja, Nigeria
| | - Ekaete A Tobin
- Institute of Lassa Fever Research and Control, Irrua Specialist Hospital, Irrua, Edo State, Nigeria
| | - Danny A Asogun
- Institute of Lassa Fever Research and Control, Irrua Specialist Hospital, Irrua, Edo State, Nigeria
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