Background Tuberculosis is one of the infections targeted for eradication and is still under surveillance. Hospital workers in Nigeria take little or no precautions against tuberculosis while attending to patients. Objectives This research aimed to study the prevalence of the reactivity of positive Tuberculin Skin Tests among healthcare workers in a Nigerian University Teaching Hospital. Methods Ethical approval and informed consent were obtained from the participants. Two hundred and ten consented participants were recruited for this study, while 185 contributed till the end. The Tuberculin Skin Test was conducted following the standard operating procedures. The chi-square test was used to compare the variable at a significant level of P < 0.05. Of those who received a BGC vaccine < 3 years, 4.8% were excluded from the analyses. Results Mean ± SD of participants’ age was approximately 30 ± 8 years. Participants comprised 87 (47%) males and 98 (53%) females. The modal age group was 21-25 years. Most participants were clinical medical students, 93(50.3%), while doctors, 7 (3.8%), were second to least. The prevalence of positive reactivity to the Tuberculin Skin Test was 29.9%. There was no significant difference observed regarding sexes and positive reactivity. A significant difference was found in reactivity ≥ 10 mm between those who didn’t receive BCG and those who received BCG vaccine ≥ 10 years before the study. Conclusion Healthcare workers can be potential active TB patients and reservoirs. We recommend highly sensitive and specific periodic TB screening, prophylactic treatment, and re-vaccination of Health Care Workers in Nigeria.
Introduction/Background The steadily increasing bacterial resistance to existing antimicrobial drugs is a significant issue, hence, it is imperative to look out for new approaches to bacterial therapy Occasionally, effective inhibitory action is not produced when antibiotics are used alone. To overcome this problem, a combination of drugs is often used. One approach to treat infectious diseases is the use of a combination of antibiotics together with plant extracts or phytochemicals. For patients with serious infections caused by pathogens resistant to drugs, combination therapy is beneficial and useful. Materials and Methods Seven antibiotics were obtained from a local pharmacy (gentamicin, ceftazidime, ciprofloxacin, doxycycline, amoxicillin, ceftriaxone, and azithromycin). Minimum inhibitory concentrations (MIC) were determined by broth micro-dilution method, and different antimicrobial combinations were studied on 20 Multidrug-resistant (MDR) clinical isolates (10 S. aureus and 10 P. aeruginosa ). Moreover, the antibacterial activity of some volatile oils (limonene, rosemary, salvia, thymus, and black pepper), plant extracts (moringa seed, curcumin, and capsicum), and phytochemicals (thymol, and chitosan) was detected against S. aureus and P. aeruginosa isolates using broth micro-dilution method. Results According to our findings, ceftriaxone and ciprofloxacin or gentamicin together exhibited a substantial synergistic effect against S. aureus . Moreover, the combination of amoxicillin with ceftazidime was synergistic to reduce MIC by five to six times. Regarding MDR clinical isolates of P. aeruginosa, the combination of azithromycin with doxycycline exhibited a decrease of MIC of azithromycin by about five to sixfold. The combination of gentamicin with ceftriaxone was significant. For natural compounds, thymol, rosemary oil, curcumin, capsicum, and moringa seed extract exhibited the highest synergistic activity with the tested antibiotics against S. aureus and P. aeruginosa . Conclusion In conclusion, the lack of new antibiotics necessitates the improvement of existing ones. Our study shows that antibiotic combinations and antibiotic-natural plant combinations are very promising strategies for combating complex bacterial resistance.
Aims: The aim of our study was to provide a synthesis of successful policies applied in the fight against malaria in African countries at different stages of intervention; Burkina Faso and Senegal. Background: Malaria is a global public health problem with many cases each year in the world (241 million cases with 247,000 deaths; 67% were under five children) in 2020. Most malaria cases occur in Sub-Saharan African countries (93%). Objective: The objective of our study was to present policies implemented against malaria (with the best results) in these two African countries (Burkina Faso and Senegal) which are at different stages of intervention. These could serve as an example to others malaria endemics countries. To achieve our purpose, we used DHS survey data and information from a literature synthesis. Methods: Data used for analysis are from Demographics and Health Surveys (DHS) 2017-2018 for Burkina Faso and DHS 2017 for Senegal. We added information from a synthesis of the literature. Linear regression models were performed with an estimation of the mean number of persons using insecticide-treated nets among groups (urban or rural areas, wealth level, highest education level in the household and age of household head) in each country. We evaluated the importance of co-factors in the relationship between the number of ITNs in a household and the number of household members by calculating the R-squared. A criteria grid used for this synthesis of literature included eight important sub-groups: funding sources, entomological monitoring, use of ITNs, use of insecticide, malaria case management, health system organization, communication and surveillance. Results: Senegal and Burkina Faso have the same proportion (51%) of households in which all children under 5 sleep under ITNs. We found R-squared (R2=0.007 in Burkina Faso and R2=0.16 in Senegal) for the relationship between the number of ITNs in a household and household size. When wealth level, age of head of household, area of residence (rural or urban), education level in the household and number of bedrooms in the household were controlled for, we found R2=0.106 for Burkina Faso and R2=0.167 for Senegal. We found that Senegal’s National Malaria Program is decentralized with entomological monitoring in all districts, which is normal considering the intervention stage in the fight against malaria. In Burkina Faso, we found centralization of routine data. Conclusion: Our study synthesized the health policies applied in African countries which are at different stages of intervention in the fight against malaria and which have succeeded in maintaining low malaria prevalence (in Senegal) or in rapidly decreasing the prevalence of the disease (in Burkina Faso). Being close to elimination, Senegal required more active malaria surveillance than passive surveillance. Burkina Faso did not require a lot of active surveillance being not close to malaria elimination. These results encourage a review in the context of each African country.
Aim: The aim of the study was to reduce morbidity and mortality associated with COVID-19 in pregnant women. Background: Since the detection of the first case of COVID-19 on March 6, 2020, in Togo, pregnant women have received special attention due to their usual vulnerability to infection. Objective: The objective of this study was to evaluate the influence of pregnancy on the prognosis of COVID-19 in patients hospitalized in Lomé. Methods: This was an analytical cross-sectional study of women of childbearing age (15-49 years) admitted between March 22, 2020, and December 31, 2021, to the Lomé Commune Regional Hospital, a national referral center for COVID-19 patients. Results: We registered 438 women of childbearing age, including 31 pregnant women (7.1%). Pregnant women were younger (28.8 years vs. 34.2 years, p = 0.001). Asthenia was more common in pregnant women (38.7% vs. 20.6%, p = 0.025), and SpO2 was lower (88.6% vs. 94%, p= 0.016%). Pregnancy was not associated with the occurrence of severe forms nor with prolonged hospitalization. Independent risk factors for mortality were 3rd trimester of pregnancy, mean age > 34 years, diabetes, HIV, and obesity. Conclusion: Most symptoms were similar to those observed in the general population. However, in addition to comorbidities, complications in the third trimester of pregnancy have worsened the prognosis for COVID-19. These results corroborate the observations made in the subregion. However, it is important to assess the effect of COVID-19 on pregnancy outcomes.
Monkeypox virus, a member of orthopoxviruses, has recently started to emerge in non-endemic countries worldwide, ringing the false alarms of a possible new epidemic as the world is already fighting the COVID-19 pandemic. However, there are some key differences in the nature of these two infections that require understanding by public health authorities in order to keep the masses safe from another psychological trauma, which has been previously associated with the COVID-19 pandemic. SARS-CoV-2 primarily affects the respiratory tract, whereas the monkeypox virus is mainly associated with skin lesions. Similarly, from symptoms to pathogenesis and from incubation period to treatment, both infections are not alike in many aspects. Monkeypox virus infection is self-limiting and can be treated without new vaccine interventions. Its case fatality ratio is also very low as compared to that of COVID-19. Though monkeypox virus infections can be treated easily, it can cause serious complications in immunocompromised individuals. Therefore, avoiding physical contact with infected individuals is recommended, and care must be taken in this regard.
Introduction: The aim was to assess weight gain during tuberculosis treatment in patients co-infected with tuberculosis and HIV. Methods: Tuberculosis patients co-infected with HIV and undergoing tuberculosis treatment in the pneumophtisiology and infectious and tropical diseases departments of the CHU in Conakry were included. Results: 562 patients were included, with a mean age of 35.6±11.3 years, and 52.5% were women. The average Body Mass Index [BMI] at baseline was 17.8 3.3 kg/m2. 71.5% of patients had a favorable result and 28.5% had an unfavorable result [death, abandonment]. Healed and lost patients gained an average of 2.6 kg and 0.1 kg respectively. Deceased patients lost an average of 3.6 kg. The weight variations of the cured patients were different from those of the deceased [p < 0.001]. A weight gain of 5% after 6 months of treatment was associated with the treatment site [OR=3.81; 95% CI 1.08 to 13.45], alcohol consumption [OR=10.33; 95% CI 1.20 to 89.16], malnutrition before treatment [OR=2.72; 95% CI 1.43 to 5.17] and the form of tuberculosis [OR=3.27; 95% CI 1.15 to 9.33]. Conclusion: Newly diagnosed patients co-infected with TB-HIV at Conakry's CHU are often malnourished. Weight gain during treatment seems to be a reliable indicator of the overall response to treatment.
Objective: A meta-analysis was performed to explore the relative effects of clarithromycin and amoxicillin (with or without clavulanate potassium) in the treatment of acute maxillary sinusitis. Methods: Six studies were identified in the peer-reviewed literature. All were randomized single-blind (investigator-blind) or open-label trials in outpatients diagnosed with acute maxillary sinusitis. A total of 1580 patients were enrolled, of whom 1194 were clinically evaluable. The total daily dose of clarithromycin was 1000 mg; the total daily dose of amoxicillin (with or without clavulanate potassium) was either 1500 or 2000 mg. The duration of study drug treatment varied from 8 to 14 days. Endpoints comprised clinical and radiological success within 48 h of the end of study drug treatment plus bacteriologic cure and eradication. Success and cure rate differences were analyzed using fixed- and random-effect models. The absence of between-study heterogeneity was tested using Cochran’s Q-test. Results: Clinical success rates varied between 85.8% and 97.9% for clarithromycin and between 84.2% and 96.8% for amoxicillin. The combined rate difference in clinical success rates between clarithromycin and amoxicillin was +1.9% (P=0.14). Radiological success rates (four studies) varied from 78.2% to 94.0% for clarithromycin and 79.7% to 95.0% for amoxicillin, with a combined rate difference of zero (P=1.00). Bacteriologic cure rates (four studies) were 87.1–94.6% for clarithromycin, compared with 89.8–98.1% for amoxicillin, with a combined difference in cure rates of –3.2% (P=0.16). Overall bacterial eradication rates were comparable between the two treatments (clarithromycin, 89.3%; amoxicillin, 92.1%). Conclusion: These data, with their limitations properly acknowledged, identify clarithromycin as a valid and viable alternative to amoxicillin for the treatment of acute maxillary sinusitis in adults.
The possibility of using ivermectin in the treatment of COVID-19 as an immunomodulating agent, has been discussed, which may prevent life-threatening virally driven cytokine storm syndrome.
Background: Brucellosis is associated with people living in close proximity to their animals, where conditions for disease onset and spread exist. An epidemic of brucellosis in Bosnia and Herzegovina (B&H) has persisted since 2004. Zenica-Doboj Canton is one of the most affected areas. Objective: To investigate the epidemiological characteristics of human brucellosis from the year 2008 to2018. Methods: Data collected from paper-based patients/cases reported to the Epidemiology Department were analyzed. Results: After 2008, the annual number of patients diagnosed with brucellosis was decreasing, except in 2017 and 2018 with 20 and 35 cases, respectively. Within the 2008-2018 period, a total of 263 human brucellosis cases were recorded, decreasing from 102 (incidence of 44.7/100,000) cases in 2008 to three cases in 2012, but increased to 35 cases in 2018. Males were predominant, with a total of 205 (77.9%) cases. The mean age of the affected patients was 39.2 years; but the most affected age group was the 25-49 years age group with 117 (44.5%) cases. Most cases (151 cases, 66%) were reported during the period of March-July, and 242 (92%) cases were from the rural areas. Conclusion: With the implementation of the small ruminant vaccination program in 2009, the number of infected humans had declined, while brucellosis still remains.
Background and Aim Nosocomial infections are one of the major causes of morbidity in the Neonatal Intensive Care Unit (NICU). Known risk factors include birth weight, gestational age, severity of illness and its related length of stay, and instrumentation. Objective: The purpose of this article is to determine the occurrence of Nosocomial Infections (NIs), including infection rates, main infection sites, and common microorganisms. Methods: A retrospective study was conducted between June 2015 and December 2016. Results: The incidence of nosocomial infection was 16%. The primary reasons for admission were intauterin growth retardation (52.5%). Klebsiella Pneumoniae was the most commonly identified agent in the blood cultures and in the hospital unit (43.6%). The mortality rate from nosocomial infection was 52.6%. The proportion of infected newborns with a lower than normal birth weight was predominant (58.13%). Conclusion: Thus, prevention of bacterial infection is crucial in these settings of unique patients. In this view, improving neonatal management is a key step, and this includes promotion of breast-feeding and hygiene measures.
Background: Vitamin D has been associated with the pathogenesis of infectious diseases. Objective: To perform a systematic review on the association of vitamin D and outcomes of HTLV (Human T-cell lymphotropic virus) infection. Methods: We searched PubMed, LILACs, Scielo, Embase and Cochrane Library for studies addressing vitamin D and HTLV infection. We included studies published in English since 1980. Studies associated with HIV, bone metabolism and not related to HTLV- associated myelopathy/ tropical spastic paraparesis (HAM/TSP) or adult T cell leukemia/lymphoma (ATL) were excluded. Results: Twenty-three studies were selected and sixteen studies were included in the review (eight experimental studies, three case reports, three cases series, one cross-sectional study and one review). Fourteen studies were focused on ATL, and two on HAM/TSP. The available data show that in vitro exposure to 1,25(OH)2D inhibits proliferation of HTLV-infected lymphocytes in patients with ATL or HAM/TSP. It has been observed that hypercalcemia, the main cause of death in patients with ATL, is not associated with serum levels of 1,25(OH)2D or parathyroid hormone-related protein, but leukemia inhibitory factor/D factor seems to be an important factor for hypercalcemia pathogenesis. It was also demonstrated an association between the VDR ApaI gene polymorphism and a decreased risk of HAM/TSP in HTLV positive individuals. Conclusion: Despite the small number and heterogeneity of the studies, this systematic review suggests that vitamin D play a role in the pathogenesis of HTLV-associated diseases.
Background: Schistosomiasis is one of the parasitic infections that are often found in humans. More than approximately 200 million people are infected with Schistosomiasis in tropical and subtropical areas of Africa, South America and Asian countries. Literature has long been suggesting the correlation between Schistosomiasis and colorectal malignancy. There is a considerable directory supporting the etiological relation between Schistosoma japonicum infection and colorectal cancer in the Far East, however, the available data about the role of Schistosoma mansoni that can initiate the carcinogenesis of colorectal remain insignificant. Objective: As such, more studies of this disease should be conducted comprehensively for corporate social responsibility internationally. Methods: The present study reviewed the available data about the role of Schistosoma , including S. mansoni in association with the carcinogenesis of colorectal. Results: The study shows the possible evidence of epidemiology, pathology, molecules and immunopathology associated with Schistosomal infections and colorectal cancer. The infections are apparently getting little attention nor support worldwide due to the geographical barriers and some political issues because it mainly occurs in the people living in the bottom billion and happens in the endemic regions only. Conclusion: The in-depth study of this infectious disease will tailor early diagnosis, novel prescription drugs and cost-effective strategies for the treatment of infectious disease colorectal cancer, and hence eradicate the disease in the endemic regions.
Otorhinolaryngological infections are common pathologies especially in children, their clinical manifestations are varied. Knowledge of the microbial ecology of these infections in the ENT sphere may be important for the choice of probabilistic antibiotic therapy, but also for adapting and adjusting the treatment in therapeutic failure situations and complications. This is a descriptive retrospective study between January 2017 and August 2018. Including all samples taken in the ENT field in patients hospitalized in the ORL service of Med VI University Hospital of Marrakech. Of the 115 samples, bacterial confirmation was found in 87% of cases. The bacteriological profile was dominated by Gram-positive bacteria in 52% of cases. Isolated strains were mainly represented by Streptococcus (28%), followed by Staphylococcus aureus (22%). Enterobacteria accounted for 34% of isolates dominated by Klebsiella pneumoniae found in 20.5% of cases. The study of antibiotic susceptibility of isolated strains revealed a penicillin sensitivity of 98% in isolates of Streptococcus pneumoniae. A 75% sensitivity to amoxicillin was revealed in Enterococcus and all strains of Staphylococcus aureus were sensitive to meticillin. In enterobacteria, resistance to C3G was 18%, 38% to fluoroquinolones, 35% to cotrimoxazole and 29% of strains were resistant to Gentamycin. The multi-resistant strains of Pseudomonas aeruginosa were found in 8% of cases.
Background: Studies comparing Influenza A and B in our community are extremely limited. Methods: Adult patients (n=1708) with ILI who visited the outpatient clinics or emergency department with FIA-positive nasal swab in two seasons were included in the analysis. Data on demographics, clinical presentation, comorbidities, and prolonged illness (revisit after 48 hours with same presentation and no admission), hospital admissions, death, and LOS were collected. Data on patients tested for H1N1 (309) by Cepheid Xpert Flu Assay (H1N1 positive, 143 [46%]; H1N1 negative, 166 [54%]) were also collected. Results: Prolonged illness was more frequent in patients with influenza B than those with influenza A (15.21% and 10.18%, respectively; P=0.002). There was no significant difference in frequency of total admissions, medical unit or intensive care unit admissions, LOS, and death between patients with influenza A and B. Total admissions were more frequent in H1N1-positive patients than H1N1-negative patients (23.1% and 13.3%, respectively; P=0.024). Prolonged illness was more frequent in H1N1-positive patients (23.1%) than H1N1-negative patients (4.8%) (P < 0.001). There was no statistically significant difference in admission to the medical unit or ICU, death, and LOS between H1N1-positive and H1N1-negative patients. The peak months of influenza A were December in the first season and October in the second season. April was the peak month of influenza B in both seasons. There was no statistically significant difference in the outcome of pregnant patients with influenza (either A or B) compared to non-pregnant women with influenza within the same childbearing age (maternal outcome was not studied). Conclusion: Prolonged illness was more frequent in flu B than in flu A patients. Patients with positive H1N1 had more frequent prolonged illness, and total hospital admissions than those with H1N1-negative patients. There was a different peak month(s) of patients with flu A compared to flu B.
Klebsiella pneumoniae is a gram-negative bacillus of the Enterobacteriaceae family, commonly associated with nosocomial infections. This pathogen is a serious public health problem as some of its strains are resistant to about 95% antimicrobials of the pharmaceutical market. This resistance is promoted by the production of the β-lactamase extended spectrum (ESBL) enzymes, one of the major causes of therapeutic failure. This review evaluated the incidence and distribution of resistance genes from Klebsiella pneumoniae to β-lactams worldwide. Our study was conducted with the subject the organism K. pneumoniae and β-lactamic resistance. The most reported genes were bla SHV-12 , bla CTX-M-2 and bla SHV-5 ; with bla SHV-12 being the most described. The last two were present in all continents, characterizing its cosmopolitan profiles. The greatest genetic diversity was observed in the Asian and Oceania, where 41 different genes were isolated. Additionally, our review points out the coexistence of different classes of β-lactamases in a single bacterial isolate. Finally, knowledge of mechanisms associated with resistance of K. pneumoniae is of great public interest and the verification of resistance genes shows a variation over time and location highlights the importance of evaluating the mechanisms or strategies by which these variations occur.
The BCG disease is a specific complication of the Bacille Calmette and Guerin (BCG) vaccine. It is often in the form of benign local BCGitis, however the BCGosis is a lethal disseminated disease that can occur in a patient with immunodeficiency. The prognosis depends on the immune status of the patient, and the quality of management. Therapeutic modalities are very controversial. In this article, the authors report a case of loco-regional BCGitis revealing an HIV infection.
Background: Current literature indicates the optimal replacement time of an intravenous catheter, ranges from when “clinically indicated” ( i.e. signs of complications such as infection, occlusion, and/or phlebitis) to three days. The time constraint is designed to prevent infection(s) and phlebitis, as well as to decrease the costs of healthcare, and the time spent by nurses, on patient care. Aim: To evaluate the impact of routine removal and re-siting of the peripheral intravenous catheter removal, compared to removal when “clinically indicated” by adults and/or pediatrics. Search Strategy: A search for literature was conducted via Cochrane Review and Web of Sciences™ Core Collection, MEDLINE, and PubMed to summarise the optimal timing for peripheral intravenous cannula replacement. One reviewer individually evaluated the trial(s), review(s), quality of the guidelines, and then, extracted the data. Selection Criteria: Criteria included guideline(s); randomized controlled trial(s); and reviews; all of which matched routine removal of peripheral intravenous cannulation, with re-sited when “clinically indicated”, only in patients in the hospital, partaking in intravenous medication and/or fluids. Articles of relevance to the topic, published in English, French, or Portuguese, prior to 2018, were reviewed. Conclusion: The effective implementation of evidence-based, guideline-based practice can decrease the catheter-related infection risk. While larger multi-site trials are required, present-day evidence asserts: the repetitive inserting of a peripheral intravenous device may raise the patient’s level of discomfort, increase the costs of healthcare, and does not decrease complications associated with peripheral intravenous devices. Implications for Practice: The clinically indicated intravenous catheter replacement procedure is cost-effective, compared with the recurring replacement procedure, which recurs every 72 hours; it has been suggested that healthcare institution(s) and hospital(s) have considered revising the policy, whereby intravenous catheters are replaced, if clinically indicated, only.
Background: Strongyloidiasis is self-limited by the complete immune system, it may be complicated and causes hyperinfection in immunocompromised patients. Objective: Here, we report a case of an immunocompromised patient with duodenal involvement of Strongyloides stercoralis. Case Report: A 65-year-old man presented with severe pain in central abdomen and periumbilical regions. He had no history of alcohol consumption, smoking and surgery but the history of RA (Rheumatoid Arthritis) and hypothyroidism taking immunosuppressive medications. The patient underwent endoscopy and colonoscopy which pathological analysis of the biopsies revealed remarkable findings in favor of Strongyloidiasis. After two consecutive day’s consumption of ivermectin 200µg/kg, the symptoms were completely removed. Also, the stool examination was negative for S. stercoralis larvae two weeks after end of the treatment. Conclusions: It seems that in immunocompromised patients with gastrointestinal symptoms assumption of parasite-like infections such as Strongyloidiasis should be considered as one of the diagnosis options. Due to the physiological and gut microbial alternations, these patients are more susceptible to infectious diseases.
