African Journal of Clinical and Experimental Microbiology

COVID-19 and Dengue co-infection in paediatric patients: An endemic in a pandemic

S. Pavani — 2023-10-27

Background: The clinical presentation and outcome of COVID-19 are likely to be complicated by co-infection with other endemic viruses such as Dengue. This study aimed to investigate the occurrence of co-infections of SARS-CoV-2 and Dengue viruses in paediatric patients from Osmania General Hospital, Hyderabad, Telangana, during the COVID-19 pandemic.

Methodology: This was a cross-sectional study of 420 paediatric patients (aged 5-17 years) with febrile illness, consecutively recruited from the hospital from June to November 2021. Serum samples were collected and tested for SARS-CoV-2 antibodies, and COVID-19 positive samples were further analysed for Dengue IgM antibodies by enzyme linked immunosorbent assay (ELISA).

Results: Of the 420 patients, serum samples of 109 (26.0%) were reactive for SARS-CoV-2 antibodies. Of these, 13 were reactive for Dengue IgM antibodies, giving a co-infection rate of 3.1% (1.9% females and 1.2% males). The three most common symptoms in the co-infected patients were joint ache (myalgia) in 53.8% (75.0% in females, 20.0% in males, p=0.1026), fever in 46.2% (50.0% in females, 40.0% in males, p=1.000), and rash in 46.2% (62.5% in females, 20.0% in males, p=0.2657).

Conclusion: These findings suggest that paediatric patients with COVID-19 may be susceptible to Dengue. Understanding the presence of multiple viral infections in paediatric patients is crucial for accurate diagnosis, management, and prognosis. Further research is needed to explore the potential synergistic mechanisms of these co- infections.

In vitro antimicrobial activity of Mathesia® on bacterial isolates of wound infections in University Clinics and Hospital Centre of Mont Amba, Kinshasa, Democratic Republic of the Congo

H.L. Nkasa — 2023-10-27

Background: Mathesia is a hydro-alcoholic emulsion, colourless and somewhat viscous, based on extracts of medicinal plants and containing saponins, polyphenols, tannins, and reducing sugars. In this study, we proposed to carry out an in vitro study of the antibacterial activity of phytomedicine Mathesia on strains of bacteria isolated from diabetic foot ulcers and chronic wounds of patients in care in the University Clinics and the Hospital Centre of Mont Amba in Kinshasa, Democratic Republic of the Congo.

Methodology: This in vitro study was carried out in the bacteriology laboratory of the Higher Institute of Medical Technology of Kinshasa from February to June 2022. The Kirby-Bauer disc diffusion method on MuellerHinton agar was used for antibacterial assay of different concentrations of Mathesia on 7 different Grampositive and Gram-negative bacterial species isolated from chronic wounds. The minimum inhibitory concentration (MIC) of Mathesia for the isolates was determined by broth dilution method on Mueller Hinton broth media.

Results: The results from this study showed that Mathesia has an inhibitory effect upon the 7 bacterial species at MIC value of less than 100 μg/ml. The lowest MIC value of 1.95 μg/ml was obtained against Staphylococcus aureus, Staphylococcus epidermidis and Proteus species.

Conclusion: The results obtained in this study corroborate previous studies which demonstrated effectiveness of Mathesia on Escherichia coli, Streptococcus pyogenes and Aspergillus species. This activity could also be justified by the presence of phenolic acids, tannins and flavonoids which possess antibacterial properties.

Prevalence and phenotypic characteristics of Acinetobacter baumannii isolated from critically ill patients in two healthcare facilities in Ebonyi State, Nigeria

O. Ogbonna — 2023-10-27

Background: The intrinsic property of Acinetobacter baumannii to survive in harsh conditions on environmental surfaces and its ability to resist commonly used antibiotics in hospitals make this pathogen to be one of the most prevalent causes of hospital infections. The present study was aimed at determining the prevalence of A. baumannii among critically ill patients in two tertiary hospitals; Alex Ekwueme-Federal University Teaching Hospital, Abakaliki (AE-FUTHA) and Mater Misericodiae Hospital Afikpo (MMHA) in Ebonyi State, southeast Nigeria.

Methodology: This was a hospital-based cross-sectional study of 300 consecutively selected critically ill hospitalized patients in the two hospitals over a period of 6 months, from whom a total of 300 different clinical samples were collected. The specimens were processed by standard microbiological culture methods at the Applied Microbiology Laboratory Unit of Ebonyi State University (EBSU), Abakaliki. All isolated bacteria from cultures were phenotypically screened for A. baumannii by conventional biochemical test scheme and antibiotic susceptibility of test (AST) of confirmed isolates was done using the Kirby–Bauer disc diffusion technique, with AST results interpreted according to the Clinical and Laboratory Standards Institute (CLSI) guideline.

Results: Of the 300 critically ill patients, clinical samples of 21 (7.0%) were positive for A. baumannii, with 20 (10.0%) of 220 samples from AE-FUTHA and 1 (1.3%) of 80 samples from MMHA. Analysis of the different isolation sites showed that catheter urine (16.0%, 11/70) from AE-FUTHA and (2.0%, 1/50) from MMHA was the most frequent site of A. baumannii isolation. A. baumannii isolates showed high resistance rates to tetracycline (100.0%), trimethoprim- sulphamethoxazole (100.0%), ceftriaxone (81.0%) and amikacin (81.0%), while low resistance rate was demonstrated to meropenem (14.3%), imipenem (19.0%) and polymyxin B (33.3%). The multiple antibiotic resistance index (MARI) of the A. baumannii isolates was 12.1, with average MARI value of 0.57.

Conclusion: Early diagnosis of infection caused by A. baumannii and its treatment with meropenem, imipenem or polymyxin B can reduce the risks of mortality and morbidity in A. baumannii infection of critically ill patients.

The CLIMIDSON Manual for Antimicrobial Stewardship Programmes in Nigerian Health Care Facilities

K.C. Iregbu — 2023-10-27

Antimicrobial stewardship (AMS) remains a cornerstone of efforts aimed at improving antimicrobial-related patient safety. It slows the development and spread of antimicrobial resistance (AMR), while helping clinicians to improve clinical outcomes and minimise harm by improving antimicrobial prescribing. AMS programmes (ASPs) are driven through various processes and people. An AMS structure comprises the core elements that should be in place to support the ASP including the AMS team, treatment guidelines, and surveillance of AMR and antimicrobial use (AMU). This manual aims to provide a practical guide to health care facilities in Nigeria and other low-and- middle-income countries, for establishing, implementing and sustaining ASPs, and is structured into 14 sections. Section 1 introduces the subject matter and gives background information on the current situation of AMS in Nigeria. It describes the efforts of the National Antimicrobial Stewardship Working Group (NASWOG), an arm of the Clinical Microbiology and Infectious Diseases Society of Nigeria (CLIMIDSON), in identifying the AMR issues in health care facilities in the country and providing evidence-based recommendations for ASPs. Section 2 describes the goals of AMS and core elements which must be in place for successful and sustainable ASPs. Section 3 presents how a health care facility could start an ASP depending on the size, highlighting the important role of point prevalence survey (PPS) in obtaining baseline data on AMU and prescribing practice in health care facilities, which is useful in developing an action plan. Although management support is key for a successful ASP, the governance of the programme rests with the AMS committee, which composition and size will depend on the level of health care facility. Section 4 describes AMS strategies, which include the core and supplemental strategies. Every hospital should aspire to do at least a core strategy, although it may be convenient to start with other stewardship activities and supplemental strategies. Section 5 describes the antibiotic policy and guidelines, which provide the framework for all AMS activities, and is an effective means of changing behaviour in antimicrobial prescribing. The guidelines should be written by a multidisciplinary team and due consideration must be given to the local antibiotic susceptibility data and the common infectious disease syndromes in the facility or region. Dissemination of the policy and guidelines should be given wide publicity. At the primary health care facilities, where there may be no doctors to prescribe, “standing orders” are used to guide antibiotic prescribing. Section 6 describes the critical importance of stakeholder engagement to a successful ASP. If stakeholders are more informed about AMR issues and ASP, they are better able to positively support the programme. AMS stakeholders will differ from facility to facility but generally include health care facility management, clinicians, pharmacists, nurses, infection prevention and control (IPC) practitioners, clinical microbiologists, other relevant laboratory staff, and patients. The importance of education and training to the successful implementation of AMS is presented in section 7. Health care facilities should provide induction and in-service training to all staff on AMS and IPC. Training objectives should be clear and targets of education and training should include AMS committee and team(s), clinicians, pharmacists, nurses and other health care staff, patients and caregivers, and advocacy and community campaigns. Sections 8 and 9 explain how monitoring and evaluation (M&E) of ASP, and feedback to stakeholders are conducted. Monitoring and evaluation are critical to identifying the impact of intervention measures and opportunities for improvement. This involves the evaluation of the structures, processes and outcomes of ASPs. Sections 10 and 11 delved into the roles of clinical microbiology laboratory support for AMS, and diagnostic stewardship as well as information and communication technology (ICT) in ASPs. The clinical microbiology laboratory should provide quality antibiotic susceptibility testing data, and standard antibiograms periodically to the AMS committee. Sections 12, 13 and 14 enumerated the core elements of outpatient ASP, institutional mentoring in AMS, and system building approach to sustainability of ASP. The recommendations for outpatient AMS in this document apply to either stand-alone clinics and casualties or those located in secondary or tertiary hospitals.

Post-exposure prophylaxis for HIV: A 10-year review of data from a tertiary health facility in northcentral Nigeria

E.S. Audu — 2023-10-27

Background: Post-exposure prophylaxis (PEP) for human immunodeficiency virus (HIV) is the use of short-term antiretroviral therapy (ART) following a single risk exposure to a potential source of HIV infection. If commenced within 72 hours following exposure, PEP has been reported to be very effective in preventing replication and spread of the virus and therefore prevent acquisition of infection. PEP is recommended for exposures occurring in both occupational and non-occupational settings. The objectives of this study are to review the profile of patients and determine the reasons for accessing PEP services in our facility with a view to recommending evidence-based solutions and ultimately contributing to achieving zero transmission of HIV.

Methodology: A retrospective review of records of patients who received PEP for HIV in our facility over a 10- year period was carried out. Demographic and clinical variables of interest were extracted from the medical records and the PEP register of 252 eligible patients. Data were presented as frequencies, means, percentages and range. Bivariate analysis to determine association of clinical and demographic variables was carried out using the Statistical Package for the Social Sciences (SPSS) with p<0.05 considered as statistical significance.

Results: The mean age of the 252 patients studied was 26.25±11.81 years, and females accounted for 52.7%. The commonest reason for seeking HIV PEP was occupational exposure from sharps or needle sticks or splashes in 43.3% (109/252), while rape/sexual assault was the most common non-occupational reason for PEP in 29.0% (73/252) cases. Most (72.6% and 95.2%) of the patients presented within 24 hours and 72 hours respectively following exposure. While females accounted for 98.6% of cases of rape and sexual assault, children aged 10 years and below made up 28.8%.

Conclusion: Although most patients sought PEP for HIV due to occupational exposure, majority of those who came for non- occupational exposure were due to rape or sexual assault, most of which occurred in children and adolescents. There is need to institute measures aimed at reducing the menace of rape and sexual assault especially of minors in our society and for health facilities to have psychosocial support mechanisms for these patients.

Prevalence of asymptomatic significant bacteriuria and antibiotic susceptibility pattern of bacterial isolates in HIV-infected patients in Ilorin, Nigeria

M.I. Bale — 2023-10-27

Background: Urinary tract infection (UTI) is one of the most common type of infections worldwide, and this is usually preceded by asymptomatic significant bacteriuria (ASB). The emergence of antibiotic resistance in bacteria responsible for UTI makes this entity of public challenge, which has been fueled by human immunodeficiency virus (HIV) infection. This study determined the prevalence of ASB and antimicrobial susceptibility pattern of bacteria isolated from urine samples of selected HIV-infected patients in Ilorin, Nigeria.

Methodology: A cross-sectional study of 300 randomly selected HIV-positive patients from Sobi Specialist and Civil Service hospitals in Ilorin, Kwara State, Nigeria, was conducted from January to March 2019. Clean-catch midstream urine samples were aseptically collected from each selected participant, cultured on CLED and Blood agar plates, and incubated aerobically at 37oC for 24 hours. The bacterial growth on the culture plates were identified using standard microbiological techniques. The Kirby-Bauer disk diffusion method was used to determine the antibiotic sensitivity of the bacterial isolates against a panel of antibiotics.

Results: The overall prevalence of ASB among the participants was 22.3%. Staphylococcus aureus (41.8%, 28/67), Escherichia coli (25.4%, 17/67), and Klebsiella pneumoniae (17.9%, 12/67) were the predominant bacterial isolates. Staphylococcus aureus was resistant to amoxicillin-clavulanate (64.3%), ceftriaxone (53.6%), ciprofloxacin (64.3%), and nalidixic acid (71.4%); E. coli was also resistant to amoxicillin-clavulanate (70.6%), ceftriaxone (53.6%), ciprofloxacin (52.9%) and nalidixic acid (64.7%); and K. pneumoniae was moderately resistant to amoxicillinclavulanate (50.0%) and resistant to ciprofloxacin (58.3%) and nalidixic acid (75.0%). Multidrug resistance (MDR) was observed in 40.8% of the isolates.

Conclusion: The isolation rate of high MDR bacteria highlights the growing challenge of ASB and UTIs that are becoming increasingly difficult to treat with available antibiotics. Health professionals should be aware of regional resistance pattern to consider in the current empirical antimicrobial therapy for ASB and UTIs among HIV-infected patients. Strategies to mitigate spread of resistance are urgently needed in the study area.

Automated blood culture systems for isolation of bacterial pathogens of bloodstream infection: The experience of Bobo-Dioulasso Teaching Hospital, Burkina Faso

A. Nagalo — 2023-10-27

Background: Identification of the causative agent is an essential requirement for better treatment of bloodstream infection. The BacT/Alert 3D (BioMérieux, Marcy l’Étoile, France), is a blood culture system equipped with CO₂ sensors to monitor the growth of microorganisms in blood culture bottles designed to optimize bacterial growth. The aim of this study was to determine the performance of this equipment in detecting bacterial pathogens from patients with bloodstream infection in the context of low-and-middle-income countries (LMICs), with Bobo-Dioulasso Teaching Hospital as a case study.

Methodology: A cross-sectional study was conducted over a period of 5 months at the Sourô Sanou University Hospital, Bobo-Dioulasso, Burkina Faso, a low-income country. Blood samples from a total of 231 patients with clinical suspicion of bloodstream infections were collected and processed according to the manufacturer's instructions.

Results: Sixty-nine of the 231 blood culture samples of patients were positive, giving a bacteriological yield of 29.9%. Escherichia coli, Salmonella spp, and Staphylococcus aureus were the top three bacterial species isolated.

Conclusion: The implementation of the BacT/Alert 3D system has significantly enhanced the diagnosis of bacteraemia in the Bobo-Dioulasso Teaching Hospital. This enhancement is marked by time savings in patient care, reduced staff workload, and an increased bacteriological yield over time.

Bioactive components of Syzygium aromaticum bud and their effects on selected pathogenic bacteria

A. Mohammed — 2023-10-27

Background: The decline in the effectiveness of common antibiotics is due to microbial resistance and has sparked research interest in discovering new antimicrobial agents from plants. The objective of this study was to evaluate the effectiveness of clove extracts on selected pathogenic bacteria and identify the active antibacterial components.

Methodology: The active components of Syzygium aromaticum (clove) buds were extracted using methanol and ethyl acetate and identified by Gas Chromatography-Mass Spectrometry (GC-MS) analysis. Antibacterial screenings against selected pathogenic bacteria were conducted using the agar-well diffusion method.

Results: The extracts showed activities against Staphylococcus aureus, Escherichia coli and Pseudomonas aeruginosa at 100 mg/ml, so that the diameters of the methanol extracts were 4.00-25.00 mm, 3.00-26.00 mm and 0.00 -16.00 mm, while the ethyl acetate extracts were 3.00-24.00 mm, 4.00-22.00 mm and 0.00-14.00 mm respectively. The ethyl acetate extract showed higher MIC and MBC at 3.125 and 6.5 mg/mL and 12.5 mg/mL, indicating a more lethal effect than the methanol extract. Nineteen bioactive compounds were identified the extracts.

Conclusion: The study justifies the use of the clove plant by traditional herbalists to treat bacterial infections due to the presence and synergy of the plant's various bioactive components.

Reducing the risks of nuclear war—the role of health professionals

Kamran Abbasi — 2023-10-27

No Abstract

COP28 Climate Change Conference: Time to treat the climate and nature crisis as one indivisible global health emergency

Kamran Abbasi — 2023-10-27

No Abstract

Genital mycoplasmas and gynaecologic cancer: A systematic review

C.C. Ezeanya-Bakpa — 2023-10-27

Studies on genital mycoplasmas (GM) role in gynaecologic cancers (GC) such as cervical, endometrial, ovarian, vaginal, vulva and fallopian tube, is limited. This review was conducted to evaluate an association between GM and GC. The systematic study was conducted in accordance with PRISMA guidelines across online databases including Embase, Google Scholar, PubMed, Scopus, and Web of Science from inception to August, 2022. We included crosssectional and case-control studies examining possible connection of GM infection and development of GC, and all evidence-based studies with likely association between GM infection and incidence of GC were studied. Selection criteria aided identification, screening, and risk of bias assessment. Thirteen studies with at least moderate risk of bias, were included. The most commonly associated GMs was Mycoplasma genitalium followed by Ureaplasma urealyticum and Mycoplasma hominis. Studies reported disease advancement with GMs most especially in cases of co-infection. The most associated GCs were cervical, ovarian and endometrial. Infection with U. urealyticum, M. hominis, and M. genitalium was associated with cervical cancer risk (OR 1.31-1.41), and M. hominis and M. genitalium had associated risk with ovarian (RR 0.93-1.92) and endometrial cancer (OR 1.36- 2.07). No association was found with vaginal, vulva and fallopian tube cancers.

Microbial menace to kidney health: A review of the role of infections in acute kidney injury

N. Medugu — 2023-10-27

Acute kidney injury (AKI) of infectious aetiology is a complex condition that requires a comprehensive microbiological evaluation. This includes sepsis workup, evaluation of urinary tract infection (UTI), assessment for viral, fungal, and bacterial infections, consideration of the patient's microbiome, and vigilance towards antibiotic toxicity. Advanced molecular diagnostic tools such as metagenomic sequencing and rapid point-of-caretesting, may offer future advances in accurate and timely identification of infectious aetiologies in AKI. Careful antibiotic selection, dosing, and duration, taking into account renal function and potential toxicity, are crucial in the era of increasing antibiotic resistance. The information presented in this review were obtained through a thorough literature search using relevant search terms on various databases including PubMed, Embase, and Cochrane Library. The review identified bacterial sepsis and UTI as common infectious syndromes associated with AKI, but also emphasized the need to consider other infectious aetiologies including viral, fungal and parasitic infections in certain clinical scenarios. The review also discussed the potential role of advanced molecular diagnostic tools in identifying infectious aetiologies in AKI and the importance of careful antibiotic selection, dosing, and duration. In conclusion, a comprehensive microbiological evaluation, coupled with the use of advanced diagnostic techniques and antibiotic stewardship, is vital for the effective management of AKI from suspected infectious aetiology, which can aid optimize patient outcomes.

A review of the legal and ethical perspectives in HIV/AIDS management in Nigeria

H.K. Obaro — 2023-10-27

Human immunodeficiency virus (HIV) infection and acquired immune deficiency syndrome (AIDS) remain major public health issues in Nigeria and other developing countries. Discrimination even among healthcare workers (HCWs), which includes poor service delivery at the point-of-care and human rights abuses, are the main factors that continue to hinder HIV eradication in developing countries, and these spread across all levels of HIV/AIDS services, from counseling and testing, to treatment and care. People living with HIV/AIDS (PLWHA) have continued to suffer from unethical conduct, human rights abuses, discrimination, and stigmatization from HCWs, employers of labor, educational institutions, religious houses, and the public. There exist Federal and some State laws that protect the rights and privileges of PLWHA, prevent discrimination and stigmatization from the general public, prevent employers from discriminating against persons with HIV infection, protect workers who criticize hazardous conditions in the workplace, and offer compensation to victims of HIV-related human rights abuses and employees for contracting job-related diseases. However, HIV-related human rights abuses, stigmatization, and discrimination, have continued unabated, not because there are no laws to protect victims, but due to ignorance of the law, complicated by the fact that some existing laws have remained dormant with regard to implementation and enforcement. Domestication of these laws by various State Governments in the country and enforcement by relevant institutions are also big issues. It is imperative for healthcare professionals to be aware of current professional standards and the general public to be aware of laws protecting victims of the virus.