Psychosocial health effects of Covid-19 infection on persons in treatment centers in Lagos, Nigeria

Introduction

Prior research has highlighted the psychosocial impact of infectious diseases on individuals and the community at large. However, little is known about the psychosocial implications of COVID-19. This study set out to determine the rate as well as correlates of anxiety and depressive symptoms among persons managed as in-patients for COVID-19 in Lagos, Nigeria.

Materials and methods

We conducted an online survey between April to June ending 2020 using a consecutive sampling technique of persons positive for COVID-19 and who were managed as in-patients across five (5) treatment centres in Lagos, Nigeria. The survey collected information on demographic as well as clinical data including suicidality. Anxiety and depressive symptoms were assessed using the Hospital Anxiety and Depression Scale (HADS).

Results

There were one hundred and sixty participants in total. The mean age of respondents was 36.4 (±9.7) years with a higher proportion (56.9%) being males. With regards to diagnosis, 28.1% and 27.5% of the respondents were categorised as probable cases of depression and anxiety respectively, while 3.8% respondents reported suicidal ideation. Majority of the respondents (61.9%) reported the fear of infecting their loved ones. The variables that showed association with psychiatric morbidity were a past history of an emotional concern, employment status, guilt about infecting others and boredom.

Conclusion

This study revealed a high burden of psychological/psychiatric morbidity among persons treated for COVID-19, particularly persons who have had prior emotional concerns. The findings from this study reiterate the need to pay attention to the mental health of people during disease outbreaks and to incorporate psychosocial interventions as part of the management package.

Pattern of anxiety psychopathology experienced among postgraduate medical trainees

Objectives: Postgraduate medical training is characteristically intensive and stressful. Given that anxiety disorders are often linked with stress-related scenarios; awareness of the burden of anxiety disorders among postgraduate medical trainees and their determinants is essential for informed intervention. This study was set to investigate the pattern of anxiety psychopathology, and to determine its correlates among doctors in a Nigerian postgraduate medical training facility.Methods: The participants, made up of 204 resident doctors were administered questionnaire to elicit their socio-demographic and work related variables. Subsequently, 12- item General Health Questionnaire (GHQ-12) was used to ascertain the presence of emotional distress, and the Structured Clinical Interview for Diagnostic & Statistical Manual for Mental Disorders- fourth edition [DSM-IV] Axis-1 Disorders, Non-patient edition (SCID-1/NP) was administered to characterize anxiety related psychopathology in the participants.Results: The mean age of participants was 33.44 (±4.50). In all, 120 (58.8%) respondents reported various difficulties with their examinations, 14(8.3%) reported having physical disorder and 59(28.9%) respondents were emotionally distressed. The prevalence of anxiety psychopathology based on DSM-IV criteria was 13.2% and the pattern elicited based on recognised categories include generalized anxiety disorder (4.9%), obsessive-compulsive disorder (3.4%), specific phobia (2.4%), social phobia (1.5%) and substance induced anxiety disorders (1.0%). Having additional qualification to the medical degree seems protective against anxiety psychopathology (?2= 3.91; df=1; p<0.05), while those with emotional distress (?2=17.54; df=1; p<0.001) were more likely to experience anxiety.Conclusion: Comprehensive and need-based mental health services with psychosocial support for trainee doctors are implied. Future research focusing on modifiable predictors of mental health challenges among resident doctors and their linkage with specific aspects of training is indicated.Bangladesh Journal of Medical Science Vol.15(1) 2016 p.25-32

Characterization of Clostridium Species from Food Commodities and Faecal Specimens in Lagos State, Nigeria

BACKGROUND

Food-borne pathogens are a major public health challenge worldwide. These organisms' cause illnesses leading to time loss in the work place and reduced productivity.Clostridium species cause infections through the production of powerful toxins which are responsible for diarrhoea and cramping. Diarrhoeal diseases due to Clostridia are one of the commonest worldwide but have hardly been reported in Nigeria.

OBJECTIVE

This study characterized Clostridium species from food commodities and human faeces in Lagos State MATERIALS AND METHODS: Four hundred and twenty samples comprising food (220) and faecal (200) specimens in Lagos state were included in this study. Isolates obtained were identified using API 20-A and confirmed by Polymerase Chain Reaction assay and 16S rRNA sequencing. The food samples included meat and meat products, ready to drink traditionally prepared milk products, fresh vegetables, canned foods and local honey.

RESULTS

Seventy (16.7%) Clostridium species were identified, 50 from food and 20 from faeces. Majority of the isolates were obtained from vegetables (56%) and meat products (34%). Of the 70 Clostridial species, 38 (54.3%) were C. perfringens, 5 (7.1%) were C. difficile and 2 (2.9%) were C. botulinum. All 38 (100%) strains of C. perfringens possessed alpha (cpa) toxin gene.

CONCLUSION

Clostridium species are present in our environment and contaminate food products posing potential risks to consumers. There is therefore a need for these traditionally made street vended foods to be monitored because they are potential sources of food borne pathogens.

Arcobacter, an emerging opportunistic food borne pathogen--A review

BACKGROUND

Arcobacters, emerging aetiologic agents of food-borne diarrhoeal illness in humans and animals are more frequently isolated in meat, especially poultry meat, pork and beef. Though human infection may exist, it has not been documented in Nigeria.

AIM

This review presents an update of scientific information in Nigeria on arcobacters as an emerging food-borne pathogen of public health significance in Nigeria.

METHODS

A comprehensive reviews of literatures was adopted to give an update on scientific findings on the disease in Nigeria.

RESULTS AND CONCLUSIONS

The review revealed scientific evidences attributing the cause of human and animal illness to Arcobacter spp. It also highlights efforts towards the development of animal models where in virulence and pathogenicity of primarily A. butzleri and A. cryaerophilus isolated from human diarrhoeal stool samples were tested. This in turn elucidated the public health significance of this emerging food-borne pathogen. The review canvases for more investigation as to the role of arcobacters in food contamination and unrecognised food-borne disease in Nigeria.

Burnout among doctors in residency training in a tertiary hospital

The mental health of doctors is an issue of growing concern all over the world as it frequently interplays with their professional trainings and responsibilities. This study was done to determine the pattern and correlates of burnout among 204 doctors undergoing residency training. Eligible participants were interviewed using designed questionnaire, General Health Questionnaire (GHQ-12) and Maslach Burnout Inventory (MBI). The mean age of participants was 33.44±4.50. Ninety-three (45.6%) respondents reported burnout in the dimension of emotional exhaustion (EE), 118 (57.8%) in the dimension of depersonalization (D), and 126 (61.8%) in the dimension of reduced personal accomplishment (RPA). Factors that were significantly associated with all the dimensions of burnout were perceived heavy workload and presence of emotional distress (based on GHQ score of ≥3). The perception of call duty as being not stressful was negatively predictive of burnout in the emotional exhaustion subscale (odds ratio [OR]=0.52; 95%confidence interval [CI]=0.29-0.97; p=0.03), while emotional distress was a positive predictor (OR=6.97; 95%CI=3.28-14.81; p<0.001]. Absence of doctor-to-doctor conflict negatively predicted burnout in the depersonalization subscale (OR=0.36; 95%CI=0.17-0.76); p<0.01), while older age (OR=0.66; 95%CI=0.47-0.95; p=0.03) and adequate support from the management (OR=0.45; 95%CI=0.22-0.90; p=0.02) constituted negative predictors of burnout in the reduced personal accomplishment subscale. Burnout is highly prevalent among resident doctors. Evolvement of comprehensive mental health services, training supports, conflict de-escalation/resolution mechanisms, and periodic assessment are indicated to mitigate work related distress with burn out among resident doctors, while improving their productivity.

Serum biochemistry and heamatological changes associated with graded doses of experimental Arcobacter infection in rats

BACKGROUND; Arcobacters have unusually wide range of habitats, and some species can be human and animal pathogens

OBJECTIVE

This study was designed to assess the haematological and biochemical changes associated with experimental Arcobacter infection in adult albino rat.

METHODS

The pathogenicity of Arcobacterbutzleri and A.cryerophilus, isolated from the caecal content of healthy chicken and confirmed by multiplex PCR was tested in albino rats (Rattusnovegicus). Seventy-five healthy adult male rats, subdivided into 5 rats per group, challenged orally with a single dose of 10⁻³ - 10⁻⁹ cfu/ml of bacterial strains and another group of five uninfected rats served as control.

RESULTS

Experimental infection resulted in diarrhoea,electrolyte imbalance and alteration of heamatological values. The packed cell volume (PCV), platelets, neutrophils and lymphocytes of the experimentally infected albino rats were significantly higher than those of the control group.

CONCLUSION

This study showed that Arcobacter could be a potential pathogen in albino rats while the selected haematological and electrolyte parameters may be good diagnostic indicators of the animal response to the bacterial infections.

A study on job satisfaction among clinical and non-clinical hospital staff in a teaching hospital in Lagos, Nigeria

OBJECTIVES

Previous studies had demonstrated that continuous and effective productivity of hospital staff are linked to job satisfaction and only those who are satisfied with their job can be maximally effective and productive. This cross-sectional descriptive survey was designed to determine the levels of job satisfaction among various groups of health care professionals working in a teaching hospital in Lagos, Nigeria.

METHODS

Two hundred clinical and non-clinical hospital staff were invited to take part in the study. They completed a sociodemographic questionnaire and the Job Descriptive Index (JDI).

RESULTS

The results indicated that majority clinical and non-clinical staff were satisfied with their jobs as regards the parameters of the JDI compared with those not satisfied with their jobs.

CONCLUSION

The government and health policy makers should continue to pay attention to boost job morale and satisfaction of medical health workers to continue to make them to be satisfied with their job.

Delayed diagnosis of intersex state: surgical outcome of cases seen and review of current concepts

BACKGROUND

Sexual ambiguity is said to occur when the gender of the baby cannot be determined at birth. The gender of an individual is in question because the genitals do not appear clearly as that of male or female. It is traumatizing to the family. It also causes confusion and problems in determining the sex, in which a child would be reared. The abnormality is relatively uncommon. Disorders of sexual differentiation can arise from abnormalities in chromosomes, gonadal development or hormonal production or activity. The orderly development process may also be affected by various environmental factors. Some of these factors may ultimately lead to the development of ambiguous external genitalia.

CASE PRESENTATIONS AND MANAGEMENT

Three of such patients with ambiguous genitalia are presented, in which the initial diagnosis proved to be incorrect. The various investigations that were carried out and surgical management are discussed.

CONCLUSION

Arguments which led to the ultimate choice of the sex of a child ranged from strict medical, to psychosocial and even cultural considerations. Expert examination shortly after birth would allow an early and definite decision, avoiding more serious problems with sexual ambiguity in later life.

Isolation and molecular identification of Fusobacterium nucleatum from Nigerian patients with oro-facial infections

BACKGROUND

Fusobacterium nucleatum is one of the most common anaerobic bacteria present in the oral cavity and is often isolated from infections involving other body sites.

OBJECTIVE

To characterise F. nucleatum strains from patients attending a teaching hospital in Nigeria in order to provide information on the methods for accurate identification of anaerobes in clinical specimen.

METHODS

Fusobacterium nucleatum specie from 50 patients presenting with oro-facial infections were studied by culture on Fusobacterium selective agar and fastidious anaerobe agar. The isolates were characterised based on colonial morphology, microscopy, lipase production, susceptibility to kanamycin and colistin and resistance to vancomycin. Biochemical tests were performed using a commercial test kit. The identity of the isolates was confirmed based on molecular characterization performed using polymerase chain reaction (PCR) analysis.

RESULTS

Forty-eight (96%) F. nucleatum isolates were obtained from the 50 patients by culture and all the isolates were identified by colonial appearance and microscopy based on their unique spindle shape with tapered ends. Only 26 (54.2%) of the 48 isolates were identified by commercial API 20A test kit while PCR confirmed the identity of all the isolates.

CONCLUSION

Anaerobes are involved in human infections and their study is quite cumbersome due to tedious nature and high cost of the techniques involved. Cultural method is reliable in the isolation and identification of F. nucleatum species. PCR is a rapid and simple method that can complement the phenotypic identification of anaerobes and would assist in their full identification.

Detection of Arcobacter in feces of healthy chickens in Osogbo, Nigeria

Isolation of arcobacters in foods, with the highest prevalence reported in poultry, has underscored its importance as a potential food safety problem in recent years. To estimate its prevalence in live birds, fresh stool samples from healthy chickens were screened by enrichment and plating on Arcobacter selective medium containing cefoperazone, amphotericin B, and teicoplanin. Of 150 fecal samples, only 2 (1.3%) yielded Arcobacter. Species were identified with fluorescence resonance energy transfer PCR. Isolate no. 21 from a local flock shared 99% identity with the complete genome of A. butzleri RM4018 (CP000361.1). Isolate no. 4 from a layer hen shared 100% identity with a partial 16S rRNA gene sequence of A. cryaerophilus (EF064151.1). The low prevalence of Arcobacter in the fecal samples of healthy chickens concurs with earlier studies suggesting that Arcobacter appears to be a transient colonizer of poultry intestines and therefore might not be the major source of chicken carcass contamination.

Antibiotic susceptibility patterns in Helicobacter pylori strains from patients with upper gastrointestinal pathology in western Nigeria

A total of 186 Helicobacter pylori isolates and 532 gastric biopsies recovered from 532 patients with varying degrees of gastroduodenal pathology are subjected to in vitro antibiotic susceptibility testing using the disc-diffusion method, Etest (MIC breakpoints) and molecular testing using the polymerase chain reaction (PCR). In the isolates studied, antibiotic resistance was as follows: piperacillin (72%), amoxicillin (66%), erythromycin (78%), tetracycline (100%) and metronidazole (95%). All isolates were sensitive to ofloxacin, ciprofloxacin and norfloxacin. None of the 245 amplicons (positive for H. pylori) from the biopsies were digested with the Bbs1 and Bsal restriction enzyme used in the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) technique, showing sensitivity to clarithromycin. However, a 238 bp fragment from H. pylori chromosomal DNA (corresponding to the quinolone resistance determining region [QRDR]) of the gyrA gene was amplified successfully. Twelve (4.9%) of the 245 strains studied had the described mutation at position 91, from asparagine (Asn) to glycine (Gly). The study showed that all the H. pylori strains were sensitive to clarithromycin and ciprofloxacin. It also highlighted PCR as a potential tool for faster diagnosis and determination of antibiotic susceptibility (within 24 h) of H. pylori from biopsies and/or isolates recovered from peptic ulcer and gastritis patients.

Susceptibility of cariogenic Streptococcus mutans to extracts of Garcinia kola, Hibiscus sabdariffa, and Solanum americanum

BACKGROUND

The elimination of cariogenic bacteria from the oral cavity using antibacterial agents is one of the primary strategies for the prevention of dental caries. Avariety of plants with potent activity are known to be used in indigenous communities for dental hygiene worldwide.

OBJECTIVE

To determine if Hibiscus sabdariffa, Solanum americanum and Garcinia kola can inhibit the growth of cariogenic bacteria in the mouth.

METHODS

Methanol and aqueous extracts obtained from three plants, Hibiscus sabdariffa, Solanum americanum and Garcinia kola were studied for their antibacterial activity against cariogenic Streptococcus mutans obtained from patients with clinically identified carious lesions, using the agar dilution method. The sources of extracts for Garcinia, Hibiscus and Solanum were respectively fruits and leaves for the latter two.

RESULTS

The extracts (both methanol and aqueous) from Garcinia kola showed the most intensive activity and completely inhibited the growth of the primary cariogenic Streptococcus mutans at 1.25 mg/ml. Hibiscus sabdariffa was also active at a minimum inhibitory concentration (MIC) of 2.5mg/ml while Solanum americanum did not show any direct effect on S. mutans.

CONCLUSION

The result of this study showed that G. kola and H. sabdariffa have direct antibacterial effect on Streptococcus mutans.

Bacteriological and clinical evaluation of twelve cases of post-surgical sepsis of odontogenic tumours at a referral centre

OBJECTIVE

To determine the bacterial aetiology of sepsis occurring following surgery of odontogenic tumours and assess the effect of prompt and proper antibiotic usage.

DESIGN

A prospective study.

SETTING

A tertiary referral centre in Lagos, Nigeria.

SUBJECTS

Twelve patients with odontogenic tumours that developed sepsis postoperatively. Eight of the patients were referred from private hospitals, the remaining were in-patients who sought for alternative medical attention following interruption of health care services at the referral centre.

INTERVENTION

Adequate review of patient's medical history, bacteriological investigations and antibiotic therapy.

MAIN OUTCOME MEASURES

Bacteriological and clinical cure following antibiotic therapy based on susceptibility test results.

RESULTS

Two categories of patients were identified; those who completed the course of antibiotics prescribed post-surgery and patients who failed to conform to antibiotic prescription. Sepsis developed in the non-compliance group much earlier than in the group that complied (p<0.001). Infections were polybacterial with aerobes accounting for 77.4% (alpha-haemolytic streptococci 29.0%, Streptococcus pyogenes 16.1%, Staphylococcus aureus 16.1%, diphtheroids 9.7%, Klebsiella pneumoniae 6.5%) and anaerobes 22.6% (Porphyromonas gingivalis 9.7%, Peptostreptococcus spp. 6.5%, Prevotella melaninogenica 3.2%, Clostridium perfringens 3.2%). Mixed aerobic and anaerobic aetiology occurred more in osteosarcoma and fibrosarcoma. Clostridium perfringens was isolated from a case of osteosarcoma with necrotic tissues. The anaerobic bacteria were 100% sensitive to metronidazole, ciprofloxacin and augmentin, 65-85% sensitivity to ampicloxacillin, amoxicillin and erythromycin. Over 92% of the streptococci were sensitive to the beta-Lactams contrast low susceptibility with S. aureus and K. pneumoniae.

CONCLUSION

Interruption of healthcare service was the sole factor identified in the development of sepsis as the patients could not be monitored to ensure compliance to prescription.

Campylobacter enteritis in Ilorin, Nigeria

BACKGROUND

Campylobacterje junilcoli is one of the most commonly identified bacterial causes of acute gastroenteritis worldwide. In Nigeria, it has been reported in the northern part of the country, extensive work has also been done in the south-west leaving behind the middle-belt of the country.

OBJECTIVE

To determine the role of Campylobacter jejunilcoli as an agent of diarrhoea in the middle-belt of Nigeria.

DESIGN

A prospective case control study.

SETTING

University of Ilorin Teaching Hospital (UITH), private hospitals and primary health centers all in Ilorin, Nigeria.

SUBJECTS

Three hundred and six children with diarrhoea and 100 without diarrhoea were randomly selected.

MAIN OUTCOME MEASURES

Isolation of Campylobacter jejuni/coli from stool samples. Biological characteristics of the isolates.

RESULTS

Twenty five (8.2%) of the patients and none of the controls had the organism. Campylobacter jejuni and C. coli were 56% and 44% respectively. All the isolates were susceptible to erythromycin and ciprofloxacin. None of the isolates harboured plasmids.

CONCLUSION

C. jejunil coli is an important diarrhoea agent in our geographic environment, further characterisation is desired of these local strains.

Multidrug resistance in Salmonella enterica serovar typhi isolated from patients with typhoid fever complications in Lagos, Nigeria

OBJECTIVE

The aim of this study was to determine the prevalence of Salmonella enterica serovar typhi in patients with pyrexia of unknown origin (PUO), and antimicrobial resistance in strains isolated from patients with S. typhi in Lagos, Nigeria.

STUDY DESIGN

In total, 103 patients were included in this study, subdivided into two categories. Category A comprised 74 patients presenting with PUO, and Category B comprised 29 patients harbouring S. typhi who did not respond to initial treatment.

METHODS

Blood samples were cultured for bacterial isolates and identified by standard procedures. Susceptibility testing was performed according to the National Committee for Clinical Laboratory Standards. Plasmid DNA extraction was performed using the alkaline lysis method with Escherichia coli v517 used as the standard. Conjugation and transformation experiments were performed using standard methods. For the latter, E. coli K12 HB 101 (ara-14, galK2, hsd 520, lacyl, leu, mtl-1, Pro A2, rec A13, rps L20, sup E44, thii xyl-5) was used as the recipient and plasmid PBR 322 was used as the positive control.

RESULTS

The prevalence of S. typhi in PUO was 16.2% (12/74). In all, 25 of 41 (61.0%) cases were multidrug resistant (MDR) with phenotypic-resistant patterns: ACoCT, ACTCeS, ACTCoCe and ACTS were commonly encountered among the strains. Interestingly, four of the strains harbouring similar plasmid DNA were isolated from patients with hepatosplenomegaly, and a strain harbouring a large transferable plasmid of 81.2MDa was isolated from a psychosis patient.

CONCLUSIONS

Our study confirmed the circulation of MDR S. typhi in Lagos, Nigeria. Periodic review of antibiotics used in hospitals is essential as the efficacies of chloramphenicol, ampicillin and cotrimoxazole are now doubtful. Ciprofloxacin and ofloxacin are effective drugs for treatment of typhoid fever, but with current trends of drug abuse in Nigeria, resistance is likely to develop. These results, therefore, provide an early warning signal for the prudent use of fluoroquinolone antimicrobials to preserve their usefulness.

Screening of some medicinal plants used in south-west Nigerian traditional medicine for anti-Salmonella typhi activity

Ten Nigerian medicinal plants used traditionally for the treatment of several ailments of both microbial and non-microbial origins were tested on multi-drug resistant S. typhi (MDR) strains of which six of them were active. The results revealed that both the aqueous and ethanol extracts of Terminalia avicennioides, Momordica balsamina, Combretum paniculatum and Trema guineensis were effective on the MDR-S. typhi strains with minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) values ranging from 9.60 to 14 mcg/ml and 24 to 33 mcg/ml, respectively. Whereas, only the aqueous extracts of Morinda lucida and Ocimum gratissimum were found to be active against this pathogen with MIC and MBC values of 9.60 and 24 mcg/ml for M. lucida, 40 and 55 mcg/ml for O. gratissimum, respectively. There was no statistical significant difference (P > 0.05) between the activity of each plant extract and the decoctions prepared from them. All the six active plants showed positive reactions to alkaloids, tannins, flavonoids and anthraquinones but in variable degrees. All but M. balsamina, indicated the presence of saponin.

Genotyping and genetic diversity of Arcobacter butzleri by amplified fragment length polymorphism (AFLP) analysis

AIMS

To investigate the potential of amplified fragment length polymorphism (AFLP) profiling for genotyping Arcobacter butzleri and to obtain further data on the genetic diversity of this organism.

METHODS AND RESULTS

Seventy-three isolates of Danish, British, Turkish, Swedish, Nigerian and North American origin from human infections, chickens, turkeys, ducks, sheep and poultry abbatoir effluent were studied by use of a protocol that involved stringent PCR amplification of fragments derived from digestion of genomic DNA with restriction enzymes BglII and Csp6I. The mean similarity value of duplicate profiles of 10 isolates was 91.15%, indicating the method to be reproducible. Numerical analysis of all 73 isolates distinguished 51 subtypes at the 91% similarity level, of which 39 comprised single strains. The remaining 34 isolates were distributed among 12 subtypes, each of which contained strains homogeneous with respect to their respective source of isolation. However, contemporaneous strains from the same source could also be distinguished.

CONCLUSIONS

AFLP profiling is an effective method for typing the genetically diverse organism A. butzleri.

SIGNIFICANCE AND IMPACT OF THE STUDY

The study represents a comprehensive analysis of the genetic diversity of A. butzleri by use of isolates from six countries spanning three continents and also shows that several distinct A. butzleri genotypes may be found in a given environment. AFLP profiling appears to have considerable potential for molecular epidemiological studies of this ubiquitous emerging pathogen that is implicated as a causative agent of both human and animal disease.

Arcobacter butzleri strains from poultry abattoir effluent in Nigeria [corrected]

OBJECTIVE

To investigate the prevalence, species distribution and genetic diversity of zoonotic Arcobacter species.

DESIGN

Prospective study.

SETTING

Drainage system of a cosmopolitan chicken abattoir in Lagos, Nigeria.

METHODS

One hundred and fifty drainage water samples were enriched in a minimal antibiotics-containing medium at room temperature and bacteria then isolated by use of a membrane filtration method.

RESULTS

Twenty six (14%) of samples were positive for Arcobacter spp. Of these, 20 were examined by a comprehensive probabilistic identification scheme for Epsilobacteria and all strains identified as A. butzleri. AFLP analysis of these strains revealed considerable genetic diversity among the strains, with 12 genotypes defined at the 90% similarity level.

CONCLUSION

The prevalence of A. butzleri in Nigerian poultry abattoir effluent indicates this species may constitute a public health problem in this country. AFLP profiling could be a useful tool for molecular epidemiological and population genetic studies of this organism. This is the first known report of A. butzleri in Nigeria, and first application of AFLP analysis for genotyping the species.

Fingerprinting of Nigerian Helicobacter pylori isolates by plasmid profile and PCR

Plasmid profiling and digestion of amplified PCR product of ureA genes were used to determine genomic variation in 56 strains of Helicobacter pylori isolated from patients with peptic ulcers and subjects with gastritis recruited in Lagos and Ife, Nigeria. Twenty-five (45%) of the strains were found to harbour plasmids ranging in size from 0.9 kb to > 10 kb. The plasmid profile was able to detect differences between the strains, and also to distinguish between different strains isolated from the same patient. The expected amplified ureA gene PCR product was detected in all strains and digestion with the restriction enzyme DdeI did not produce discrimination amongst the strains, however, digestion with MluI produced little discrimination amongst strains. In conclusion, plasmid profiling produced better discrimination amongst H. pylori strains than ureA PCR gene profiling.

Role of Campylobacter jejuni/coli in diarrhoea in Ile-Ife, Nigeria

BACKGROUND

Campylobacter jejuni/coli are well established causative agents of diarrhoea. In Nigeria, gastroenteritis due to C. jejuni was first reported in northern part of the country in 1981 and the South-Western part in Ile-Ife in 1983.

OBJECTIVE

To re-examine the role of C. jejuni as an agent of diarrhoea after more than a decade at Ile-Ife, Nigeria and to determine the biological characteristics of local strains.

DESIGN

A prospective case control study.

SETTING

Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC) Ile-Ife, Nigeria.

SUBJECTS

Three hundred and three children with diarrhoea and 100 children with other medical conditions other than diarrhoea were randomly selected.

MAIN OUTCOME MEASURES

Isolation of C. jejuni/coli from stool samples collected from the patients and controls. Biological characteristics of the isolates.

RESULTS

Fifty eight (19.1%) and 6% of the patients and controls, had the organism respectively. Campylobacter coli accounts for 53.3% of isolates. All the isolates were susceptible to erythromycin and there was no evidence of beta-lactamase production.

CONCLUSION

Campylobacter jejuni is an important diarrhoea agent in our environment and should be considered strongly in children with diarrhoea. Complete characterization of local, strains is necessary.

Acute normovolaemic haemodilution in colorectal surgery

AIMS

Blood transfusions are often given to surgical patients. This study was designed to assess whether acute normovolaemic haemodilution (ANH) reduces exposure to allogeneic blood, affects clinical outcome and hospital stay, and is feasible in colorectal surgery.

METHODS

All ASA 1 and 11 patients undergoing colectomies performed between 1997 and 1999 were identified retrospectively from our colorectal cancer database to ascertain our current peri and postoperative transfusion practice. Twenty-six selected patients subsequently underwent ANH during colectomy surgery. The number of patients and units transfused were identified.

RESULTS

One hundred and twenty-three of 317 (39%) patients identified from our colorectal cancer database were transfused a total of 328 units (median 2, range 1-7). Of the 26 patients undergoing ANH, 4 (15%) were transfused a total of 13 units (median 3, range 2-5). The reduction in number of patients transfused was statistically significant (P=0.017). ANH increased anaesthetic time by a median of 19 min. There were no complications associated with ANH and the median hospital stay was 9 days (range 6-13).

CONCLUSIONS

In this pilot study of selected patients, ANH is a feasible and effective method of reducing allogeneic blood exposure in major colorectal surgery. A prospective randomised controlled trial is now urgently required.

Use of direct Gram stain of stomach biopsy as a rapid screening method for detection of Helicobacter pylori from peptic ulcer and gastritis patients

Four hundred and thirty five stomach mucosal biopsies were taken from 145 consecutive patients (3 from each patient) during investigations for dyspepsia in three hospitals in Western Nigeria. The aim was to determine the best suited rapid screening method to aid fast diagnosis of ulcer/gastritis in this environment, using Gram stain, CLO test kit (urease production test) and culture methods. Eighty-nine (61.4%) biopsies were positive using Gram stain, 61 (42.1%) using CLO test kit and only 28 (19.3%) using culture. Based on the various limitations of CLO test kits and culture methods, Gram stain was adjudged the best suited rapid method. The clinical implication of this finding is discussed.

Use of direct Gram stain of stomach biopsy as a rapid screening method for detection of Helicobacter pylori from peptic ulcer and gastritis patients

Four hundred and thirty five stomach mucosal biopsies were taken from 145 consecutive patients (3 from each patient) during investigations for dyspepsia in three hospitals in Western Nigeria. The aim was to determine the best suited rapid screening method to aid fast diagnosis of ulcer/gastritis in this environment, using Gram stain, CLO test kit (urease production test) and culture methods. Eighty-nine (61.4%) biopsies were positive using Gram stain, 61 (42.1%) using CLO test kit and only 28 (19.3%) using culture. Based on the various limitations of CLO test kits and culture methods, Gram stain was adjudged the best suited rapid method. The clinical implication of this finding is discussed.

Evaluation of a locally-made urease test for detecting Helicobacter pylori infection

We studied the efficacy of a home-made urease test (HUT) in the detection of Helicobacter pylori (HP) infection in patients undergoing upper gastrointestinal endoscopy. In the first phase of the study, two antral biopsies each were obtained from 43 patients for urease tests using the CLOtest and a home-made buffered 2% urea solution with phenol red as indicator at pH 6.8 (2% HUT). Twenty-six patients (60.5%) were HP positive, both by the 2% HUT and CLOtest with 100% concordance. In the second phase of the study three antral biopsies each and blood were obtained from 42 patients for the determination of HP status using a 10% HUT and a combination of culture and serology. Twenty-three patients (54.8%) were HP positive using the 10% HUT, while 32 patients (76.2%) were positive using the combination of 2 tests. Compared to this the sensitivity and specificity of the 10% HUT were 72% and 100% respectively. The CLOtest produced a colour change in a shorter time than the 2% and 10% HUT (median 1 hour versus 10 hours versus 16 hours p < 0.0001). In the third phase of the study, we observed that by doubling the biopsy size, the time required to obtain a colour change was significantly reduced (median 4.5 hours versus 10 hours p < 0.05). The HUT is easy to prepare, cheap, sufficiently sensitive and it is reliable enough to start treatment when positive. With 100% concordance and 1% the cost per test when compared to the commercially available CLOtest; the 10% HUT is hereby recommended for the detection of UP infection in our region.

Lactobacilli in human dental caries and saliva

Samples (98 plaque and 72 saliva) from 93 patients with dental caries were investigated for Lactobacillus species which comprised 65 (62.5%) of 104 isolates. Yeasts (20.1%), Streptococcus spp. (8.7%), Staphylococcus spp. (2.9%) and a few unidentified species (5.8%), were also found. The Lactobacillus isolates were L. brevis (24.6%) L. fermentum (18.5%) L. casei (16.9%), L. delbrueckii (15.4%), L. plantarum (9.23%), L. acidophilus (7.69%), L. jensenii (4.62%), L. salivarius (1.54%) and L. gasseri (1.54%). The most common species was L. brevis (24.6%). The strains tested for beta-lactamase production showed 75.4% positive. All the Lactobacillus strains were tested for bacteriocin production against Escherichia coli, Salmonella spp., Shigella dysenteriae, S. sonnei, Klebsiella spp. and Campylobacter sp. All the lactobacilli except L. jensenii produced bacteriocin against at least one of the indicator organisms. The involvement of Lactobacillus in dental caries was established, although its role and mechanism is not well understood. The ability of Lactobacillus spp. to protect their host against certain diseases by inhibiting the growth of potential pathogens was evident.

Gastric antral juxtamucosal pH in helicobacter pylori positive and negative dyspeptic patients

Maintenance of gastric juxtamucosal pH at a stable near neutral value may be the cumulative effect of the various components of the mucosal defense system. In order to assess the effect of helicobacter pylori (HP) infection on mucosal defense, we measured the gastric antral juxtamucosal pH in 40 dyspeptic patients by using a flexible glass pH microelectrode which can be passed down the instrument channel of standard gastroscopes. HP status was determined using serology, culture, histology and urease test. We also investigated the relationship between juxtamucosal pH and the severity of antral HP infection. The mean antral juxtamucosal pH in 26 (65%) HP positive patients was 6.49 +/- 0.20 compared to 6.19 +/- 0.21 in 14 (35%) HP negative patients (p < 0.00001). Other factors like age, sex, duodenogastric reflux or presence of chronic duodenal ulcer did not significantly affect juxtamucosal pH (p > 0.05). Subset analysis of data on HP positive patients (n = 26) revealed no significant correlations between antral chronic gastritis anti-HP IgG titre and antral juxtamucosal pH (p > 0.05). This study shows that HP increases gastric antral juxtamucosal pH. This finding supports the suggested role of HP in producing hypergastrinaemia and gastric acid hypersecretion.

Gastric acid secretion in Helicobacter pylori positive and negative dyspeptic Nigerians

The pathological role of Helicobacter pylori is largely unproven in our region of high incidence of infection but very low incidence of serious gastroduodenal lesions. The aim of this study was to investigate the effect of H. pylori infection on gastric acid secretion. One week after gastroduodenoscopy, basal and pentagastrin (8 micrograms/kg) stimulated gastric acid secretion were measured in 39 dyspeptic Nigerians. H. pylori status was determined using urease test, culture, histology and serology, while gastritis was assessed using the Sydney system criteria. The median maximal acid output (MAO) and peak acid output (PAO) in mmol/h were significantly higher in H. pylori positive (29.3, range 7.4-81.6 and 34.4, range 7.6-144.0) than in H. pylori negative (16.6, range 4.2-44.1 and 22.4, range 5.6-48.6) patients, p = 0.019 and p = 0.029, respectively. Stimulated gastric acid secretion was significantly higher in patients with duodenal ulcer (n = 8) than in H. pylori negative (n = 11) patients, but was similar in non-ulcer dyspeptics (n = 20) and H. pylori negative patients. The median basal acid output was not significantly different between the groups of patients. Our patients (median age 32 years) had normal mucosa (12.1%), pangastritis with corpus predominance (12.1%), antrum-only gastritis (24.3%) and pangastritis with antral predominance (51.5%). In the subset of H. pylori positive patients (n = 28, 71.8%), there were no significant correlations between grade of antral chronic inflammation, gastritis index score, anti-H. pylori IgG titre and gastric acid secretion, p > 0.05. H. pylori infection increases MAO and PAO in our relatively young patients with antral predominant chronic gastritis.

Genotyping of clinical and chicken isolates of Campylobacter jejuni and Campylobacter coli

Genomic DNA from 58 strains of Campylobacter made up of 48 Campylobacter jejuni and ten Campylobacter coli were digested with Sma I and analysed by pulsed-field gel electrophoresis (PFGE). The cleavage of DNA by Sma I gave 22 distinct hybridization patterns. The two Campylobacter species were subtyped by PFGE. The average genomic size for C. jejuni by Sma I digestion was 1.73 Mb, while that of C. coli gave 1.7 Mb. Results from this study indicate that PFGE analysis by Sma I digested genomic DNA provides a reliable means of differentiating between and within species of Campylobacter and provides a practical approach to epidemiological studies of Campylobacter.

Prevalence of EHEC O157:H7 in patients with diarrhoea in Lagos, Nigeria

The prevalence of sorbitol-nonfermenting Escherichia coli O157:H7 (EHEC) was assessed in 100 patients with diarrhoea by stool culture on sorbitol MacConkey agar. The cytotoxicity of the EHEC strains was analysed by Vero cell assay and the antimicrobial susceptibility pattern of the isolates was determined. Detection rate of EHEC O157:H7 was 6%. Five of the six patients were males. Three of the isolates were from children and one was from a teenager. All strains induced cytotoxic effects in the Vero cell assay. All isolates were susceptible to most of the antimicrobials tested. The results showed that diarrhoea caused by EHEC O157:H7, a potentially life-threatening pathogen, has remained common particularly among the child population of Lagos during the past 10 years (5). There must therefore be adequate meat and food inspection to improve the general hygiene of local fast food restaurants, so-called 'bukkas', which are regarded as likely sources of infection.

Deoxyribonucleic acid restriction digest patterns in Campylobacter species: a comparison with Penner serotype

Diversity, based on restriction fragment length polymorphism (RFLP) analysis, was studied in 48 strains of Campylobacter, comprising 27 chicken and 21 human strains of C. jejuni and C. coli, using genomic Southern hybridisation. Restriction digests of chromosomal DNA were prepared by treating with HaeIII and probed using a C. jejuni DNA probe. Nineteen distinct hybridisation patterns were identified, and differences in hybridisation pattern between members of the two species, and in individual strains of the same species, were seen. The method described proved more discriminatory than the Penner serotype, as strains from the same serotype were distinguished. The relative simplicity of the patterns obtained, together with the apparent diversity identified among individual strains and species, suggests that DNA fingerprinting using the C. jejuni DNA probe could be a useful identification method in epidemiological studies of Campylobacter infection in Nigeria.

Zoonotic infections in Nigeria: overview from a medical perspective

Infections of domestic and wild animals that are transmitted directly or by an arthropod vector to humans are a major cause of morbidity and mortality worldwide and particularly in Nigeria. With a population of over 100 million and the need for improved health care delivery, Nigerians are at considerable risk considering the seriousness of these infections. Zoonotic infections that are endemic in Nigeria include tuberculosis, trypanosomiasis, toxoplasmosis, taeniasis, rabies, lassa fever and yellow fever. Zoonotic food-borne infections (caused by Campylobacter, Salmonella and Escherichia coli O157:H7) and cryptosporidiosis are emerging. Sporadic cases such as strongyloidiasis, ascariasis, leptospirosis, scabies, pentastomiasis and African histoplasmosis have been reported. There is a need to determine the prevalence of tick-borne zoonoses. Prevention and control of zoonoses in humans is by vaccination, treatment and health education. As a first measure to improve control, the link between veterinary and medical officers, which is presently very weak, needs to be strengthened. Furthermore, regional multidisciplinary approaches to the control of zoonotic infections should be adopted in West Africa, which take into consideration the huge inter-border traffic.

Prevalence of multi-drug resistant Salmonella typhi among clinically diagnosed typhoid fever patients in Lagos, Nigeria

A total of 635 clinically diagnosed typhoid fever patients were bled from three different health institutions in the metropolis of Lagos, Nigeria over a period of 15 months, May 1997 to July 1998. Out of the total blood cultured, 101 (15.9%) isolates of Salmonella species were isolated of which 68 (67.3%) were S. typhi, 17 (16.8%) and 16 (15.8%) were S. paratyphi A. and S. arizonae respectively. The overall isolation rate of S. typhi among patients is 10.7%, with most isolates 45.9% found among the severely-ill young adults, age group 16-30 years. All isolates were subjected to anti-microbial susceptibility testing using 12 different antibiotics: chloramphenicol, ampicillin, cotrimoxazole, gentamicin, colistin sulfate, nalidixic acid, nitrofurantoin, cefotaxime, tetracycline, streptomycin, ofloxacin and ciprofloxacin. All the S. typhi and S. paratyphi A isolates showed resistance to two or more of the 10 of 12 antibiotics tested particularly the 3-first-line antibiotics commonly used (chloramphenicol, ampicillin and cotrimoxazole) in the treatment of typhoid fever in Nigeria. No isolate showed resistance to ofloxacin and ciprofloxacin, however, nalidixic acid and gentamicin showed a moderate and appreciable inhibition to most of our isolates.

An experimental mouse model to study the pathogenicity of Prevotella bivia and investigations of possible virulence

Induction of subcutaneous abscesses in mice was used to study the pathogenicity of Prevotella bivia both in mono-infection and in mixed cultures with Escherichia coli and Peptostreptococcus spp. Virulence factors such as coaggregation and aggregate formation of cells, haemagglutination activity and tolerance to serum bactericidal activity were investigated for their possible role in P bivia pathogenicity. Monocultures of P bivia, E coli and Peptostreptococcus spp did not induce subcutaneous abscess at concentrations as high as 10(9) colony forming units/millilitre (cfu/ml). Only E coli persisted at the infection site for up to 7 days post infection but with a marked decline in cell count (8.0 x 10(2) cfu/ml). The anaerobic organisms did not persist at the infection sites beyond the fifth day. In contrast, mixed cultures of P bivia and E coli or all three organisms potentiated for infective abscess two weeks after infection. Viable cells were recovered from abscesses in greater numbers as the infection progressed. Prevotella bivia was the predominant organism in chronic abscesses while E coli predominated in abscesses in the acute stage of the infection. Prevotella bivia lacked haemagglutination activity against human and sheep erythrocytes and showed marked susceptibility to 50 per cent human serum. These may limit its haematogenous spread. Its ability to form aggregates in molar salt solutions and coaggregate with facultative organisms may account for its persistence in pathological sites.

Specific psychiatric morbidity among diabetics at a Nigerian General Hospital

BACKGROUND

In Nigeria, with a rising incidence of diabetes mellitus (DM), there are no controlled studies of specific psychiatric morbidity among sufferers.

OBJECTIVE

To assess the prevalence of specific psychiatric disorders and general cognitive impairment in patients with diabetes mellitus.

METHOD

Using Wing's Present State Examination and the Mini-Mental State Examination, we assessed the prevalence of specific psychiatric disorders and cognitive impairment among 100 DM patients attending an out-patient clinic, in comparison with a matched non-clinic sample; and examined the relationship between psychiatric morbidity and clinical variables.

RESULTS

They were predominantly males (66%), mean age 43.0 years, mean duration of illness, 7.7 years and in low level occupations. Only 11 of the patients had sexual dysfunction (11%) and psychiatric symptoms (31%). Psychiatric diagnosis (ICD-10) were, generalised anxiety (6%) and mild depressive disorder (4%). Two had subjective memory disturbance. Insulin-dependent patients had significantly more widespread psychiatric symptoms than the non-insulin dependent. Psychiatric symptomatology was significantly associated with low occupational status, duration of illness and sexual dysfunction.

CONCLUSION

Health education, subsidizing the cost of treatment, and physicians' sensitivity to the emotional condition of patients, will help to relieve psychic distress and make for more adequate management.

Flagellin gene polymorphism analysis of Campylobacter compared with antigen serotyping

Flagellin gene sequence polymorphisms were used to discriminate amongst 53 strains of Campylobacter jejuni and C. coli. The Campylobacter strains were made up of forty-three strains of Campylobacter jejuni and 10 strains of Campylobacter coli. The results were analysed in relation to Penner serotyping. Twenty DNA PCR-RFLP patterns (genotypes) were identified by analysis of Dde I fragment length polymorphisms in flagellin gene (fla A and fla B) polymerase chain reaction (PCR) products. Flagellin gene 13 genotype was a feature of 15% of strains, followed by flagellin gene 8 (9%). Differences in fragment patterns were observed not only between members of two species, but also between individual strains of the same species. The strains that were non-typable by the Penner serotype were distributed into 6 flagellin gene types. In conclusion, Ddc I fla typing is reproducible and offers high typability. However, when the scheme is used in combination with the Penner serotype it provides improved discrimination for the characterizing and subtyping of isolates.

Antibiotic susceptibility patterns and beta-lactamase production of animal and human isolates of Campylobacter in Lagos, Nigeria

Forty-three stool samples and rectal swabs were collected from diarrhoeic and 20 non-diarrhoeic patients under 5 years of age at various general hospitals in Lagos. A total of 110 faecal samples from animals (101 from chickens and 9 from pigs) were obtained from Mitchel farm, Agege and Oshodi--Isolo Local Government farms at Ejigbo. Campylobacter species were isolated from 6 (13.9%) of 43 children with gastroenteritis and none from 20 asymptomatic subjects. Forty-nine (48.5%) isolates from the hundred and one faecal specimen were isolated from chicken, while 3 (33.33%) out of 9 were from pigs. Campylobacter jejuni was the most prevalent accounting for 79% of the total isolates and C. coli accounted for 25%. All the human strains were gentamicin sensitive, while streptomicin and cloxacillin were resistant. Erythromycin had a high activity (83.3%) on human strains and only 59.6% activity on animal strains. About ten percent (9.6%) of the strains produced beta-lactamase.

Distributional patterns of bacterial diarrhoeagenic agents and antibiograms of isolates from diarrhoeaic and non-diarrhoeaic patients in urban and rural areas of Nigeria

OBJECTIVES

To determine the prevalence of bacteria that could cause diarrhoea in stool specimens of individuals with and without diarrhoea in both urban and rural areas of Nigeria. To ascertain the antibiotic susceptibilities of the bacterial diarrhoeagenic agents isolated. To document the predominant signs and symptoms associated with the various bacterial agents of diarrhoea.

DESIGN

Prospective study.

SETTING

Patients/individuals attending government and private clinics in Lagos, Edo and Cross-River States of Nigeria.

SUBJECTS

A total of 1,200 stool samples were collected from patients with diarrhoea. Another total of 1,200 stool specimens were obtained from controls.

RESULTS

For diarrhoea cases in urban areas Campylobacter spp. were more predominant (28%) and were followed by enteropathogenic Escherichia coli (EPEC) (28%) whereas in rural areas, EPEC were the most commonly isolated bacteria (18%), closely followed by Salmonella spp. (16%). Controls had a similar distribution pattern. Higher rates of isolation of these enteric bacteria were recorded among diarrhoea cases than in controls (p < 0.05). Diarrhoea due to Vibrio, Yersinia, Aeromonas, Plesiomonas and EPEC was mainly watery whereas it mainly consisted of blood/mucus for Shigella and Salmonella. All were associated with abdominal pain and fever. Results presented also indicate that over 80% of Shigella species, Salmonella, EPEC and P. shigelloides were susceptible to nalidixic acid and nitrofurantoin. Virtually all the enteropathogens were resistant to commonly used antibiotics such ampicillin, erythromycin, tetracyclines and streptomycin.

CONCLUSION

Results show that distributional patterns of bacterial agents of diarrhoea may vary in urban and rural areas and have revealed the effectiveness of nalidixic acid, gentamicin and nitrofurantoin, in that order, against these enteropathogens.

Ribosomal RNA gene restriction fragment diversity amongst Penner serotypes of Campylobacter jejuni and Campylobacter coli

Diversity based on ribosomal RNA gene-restriction endonuclease digest patterns was detected amongst forty-seven strains of Campylobacter made up of 38 strains of Campylobacter jejuni and 9 strains of Campylobacter coli. Restriction digests of chromosomal DNA prepared by treating with Hae III were probed with an oligonucleotide specific for Campylobacter 16S ribosomal RNA genes. Seventeen distinct hybridization patterns, each indicating the presence of 2-4 copies of the 16S rRNA gene are encoded in Campylobacter DNA. Differences in fragment patterns were observed not only between members of two species, but also between individual strains of the same species. Ribopattern fragments of 8.71, 7.56, 2.81 and 1.0 kb were characteristic of the majority of C. jejuni, whereas 7.59 and 4.68 kb fragments were commonly present in C. coli. In conclusion, Hae III ribotyping was even more discriminatory than the Penner serotyping of C. jejuni and C. coli, as strains of the same serotype were distinguished.

Diagnostic potentials of the activities of lectins with whole cells of three bacterial diarrheagenic agents: Aeromonas, Plesiomonas, Campylobacter

The reactiviteisofstrains ofPlesionmona shigeloides, Campylobater jejuni, Campylobacter coli and Aeromonas species with some lectins namely Soyabean agglutinin (SBA), Ricinus communis agglutinin (RCA), Peanut agllutinin (PNA), Cancanavalin-A (Con-A), Lima bean agglutinin (LMA) and Abrin were investigated using the microtitre plate method. The results obtained show that all stains of A. hydrophila, A. caviae, A. Sobria and P. shigelloides reacted very strongly with PNA and SBA. All strains of C. jejuni studied failed to react with SBA but reacted with PNA Whereas C. coli did not show any reaction towards PNA but reacted very strongly with SBA. All strains of the different organisms were strongly agglutinated by RCA and LMA except A. Hydrophilia and A. sobria which did not react with RCA and LMA respectively. C. jejuni was not agglutinated by Con-A unlike C. coli. Only C. jejuni, C. coli and P. shigelloides reacted with abrin. This study suggests that the reactivities of lectins with the diarrheogenic bacteria studied may be used for their presumptive identifications and for epidemiological purposes.