African Journal of Clinical and Experimental Microbiology https://www.ajol.info/index.php/ajcem <p><em>African Journal of Clinical and Experimental Microbiology</em> is the official Journal of the African Society for Clinical Microbiology. It publishes original research, review papers, case reports/series, short communications and letters to the editors, in all aspects of Medical Microbiology including Bacteriology, Virology, Rickettsiology and Chlamydiology, Mycology, Mycobacteriology and Actinomycetes, Parasitology, Molecular Genetics in relation to microorganisms and humans, Clinical Microbiology, Clinical Veterinary Microbiology, and Public Health Microbiology.</p><p>Other websites associated with this journal: <a href="https://www.afrjcem.org/">https://www.afrjcem.org</a></p> en-US Copyright for articles published in this journal is retained by the journal. afrjcem@gmail.com (Samuel Sunday Taiwo) ajcem2019@gmail.com (Editor) Thu, 08 Apr 2021 11:23:15 +0000 OJS 3.1.2.4 http://blogs.law.harvard.edu/tech/rss 60 Applying lessons learnt from Ebola for effective COVID-19 response in Africa https://www.ajol.info/index.php/ajcem/article/view/205569 <p>The Ebola virus is transmitted to people from wild animals and spreads in the human population through human-to-human&nbsp; transmission via direct contact with blood, secretions, organs or other bodily fluids of infected people, and with surfaces and materials contaminated with these fluids. In December 2019, a novel coronavirus disease (COVID-19) caused by severe acute respiratory syndrome-coronavirus-2 (SARS-COV-2) emerged in Wuhan, China, attracting the notice of regional authorities and rapidly drawing global attention. In less than 4 months, COVID-19 spread through almost all countries and regions. The COVID-19 pandemic is wreaking havoc on the world economy, in addition to creating the current global public health crisis. According to the World Health Organization (WHO), 28,616 cases of Ebola were detected, and 11,310 people died during the outbreak in Guinea, Liberia and Sierra Leone. As of 17th December 2020, COVID-19 has killed 1,658,062 people, and positive cases have topped 74 million globally. Africa has suffered several outbreaks of Ebola Virus Disease (EVD); learning from the past is a good way to prepare for the future. We hope to highlight some of the lessons learnt from Africa’s response to previous epidemics that can help in the fight against the ravaging coronavirus pandemic.</p> <p><strong>Keywords</strong>: Ebola, COVID-19, WHO, transmission, global </p> <p>&nbsp;</p> <p><em><strong>French Title: Appliquer les leçons tirées d'Ebola pour une réponse efficace </strong></em><em><strong>au COVID-19 en Afrique</strong></em></p> <p>Le virus Ebola est transmis aux humains par des animaux sauvages et se propage dans la population humaine par transmission interhumaine par contact direct avec du sang, des sécrétions, des organes ou d'autres fluides corporels de personnes infectées, et avec des surfaces et des matériaux contaminés par ces fluides. En décembre 2019, une nouvelle maladie à coronavirus (COVID-19) causée par le syndrome respiratoire aigu sévère-coronavirus-2 (SRAS-COV-2) est apparue à Wuhan, en Chine, attirant l'attention des autorités<br>régionales et attirant rapidement l'attention mondiale. En moins de 4 mois, le COVID-19 s'est propagé dans presque tous les pays et régions. La pandémie de COVID-19 fait des ravages sur l'économie mondiale, en plus de créer la crise mondiale actuelle de santé publique. Selon l'Organisation mondiale de la santé (OMS), 28616 cas d'Ebola ont été détectés et 11310 personnes sont décédées au cours de l'épidémie en Guinée, au Libéria et en Sierra Leone. Au 17 décembre 2020, le COVID-19 avait tué 1658062 personnes et les cas positifs dépassaient 74 million dans le monde. L'Afrique a souffert de plusieurs flambées de maladie à virus Ebola (MVE); apprendre du passé est un bon moyen de préparer l'avenir. Nous espérons mettre en évidence certaines des leçons tirées de la réponse de l’Afrique aux épidémies précédentes qui peuvent aider à lutter contre la pandémie ravageuse de coronavirus.</p> <p><strong>Mots clés</strong>: Ebola, COVID-19, OMS, transmission, mondial </p> A.E. Aiyenuro, C.O. Onyeani, N.C. Uche Copyright (c) https://www.ajol.info/index.php/ajcem/article/view/205569 Wed, 07 Apr 2021 00:00:00 +0000 Neglect of common infectious disease outbreaks during the COVID-19 pandemic: an impending crisis in Nigeria? https://www.ajol.info/index.php/ajcem/article/view/205570 <p>Infectious diseases are major challenges of healthcare system in Nigeria. The coronavirus disease-19 (COVID19) pandemic has disrupted many systems including healthcare at all levels by creating disparities in the treatment, prevention, resource allocation and control of diseases in Nigeria. Premised on the foundation of circulating news and fact-checking platforms, this paper provides empirical evidence on varying perceptions on COVID-19 pandemic and apparent neglect of other infectious diseases while giving a critical analysis and<br>comparison between them.</p> <p><strong>Keywords</strong>: COVID-19; infectious diseases; neglect; Nigeria </p> <p>&nbsp;</p> <p><em><strong>French title: Négliger les flambées de maladies infectieuses courantes pendant</strong></em><br><em><strong>la pandémie COVID-19: une crise imminente au Nigeria?</strong></em></p> <p>Les maladies infectieuses sont des défis majeurs du système de santé au Nigeria. La pandémie de coronavirus19 (COVID-19) a perturbé de nombreux systèmes, y compris les soins de santé à tous les niveaux, en créant des disparités dans le traitement, la prévention, l'allocation des ressources et le contrôle des maladies au Nigéria. Fondé sur la diffusion d'informations et de plates-formes de vérification des faits, cet article fournit des preuves empiriques sur les différentes perceptions de la pandémie de COVID-19 et la négligence apparente d'autres maladies infectieuses tout en fournissant une analyse critique et une comparaison entre elles.</p> <p><strong>Mots clés</strong>: COVID-19; maladies infectieuses; négligence; Nigeria<em><strong><br></strong></em></p> T. Soyemi Copyright (c) https://www.ajol.info/index.php/ajcem/article/view/205570 Wed, 07 Apr 2021 00:00:00 +0000 A review of COVID-19 vaccines strategies and anti-vaxxers theories https://www.ajol.info/index.php/ajcem/article/view/205571 <p>In what is a global record time of getting the COVID-19 vaccines available within 11 months, the world has equally been faced with several myths and conspiracy theories dissuading the public from accepting vaccination as an important measure in the response to the pandemic. We reviewed the leading conspiracy theories and balanced these with the scientific basis of viral transmission and replication and the broad role of vaccination in tackling this challenge. We briefly examined the design of the leading vaccines, and provided recommendations for worldwide COVID-19 distribution, acceptance and use.</p> <p><strong>Keywords</strong>: COVID-19, vaccine, anti-vaxxer, review</p> <p>&nbsp;</p> <p><em><strong>French Title: Un examen des stratégies de vaccins COVID-19 et des théories anti-vaxxers</strong></em></p> <p>Dans ce qui est un temps record mondial pour obtenir les vaccins COVID-19 disponibles en 11 mois, le monde a également été confronté à plusieurs mythes et théories du complot dissuadant le public d'accepter la vaccination comme une mesure importante dans la réponse à la pandémie. Nous avons passé en revue les principales théories du complot et les avons équilibrées avec la base scientifique de la transmission et de la réplication virales et le rôle général de la vaccination dans la lutte contre ce défi. Nous avons brièvement examiné la conception des principaux vaccins et formulé des recommandations pour la distribution, l'acceptation et l'utilisation du COVID19 dans le monde.</p> <p><strong>Mots clés</strong>: COVID-19, vaccin, anti-vaxxer, revue</p> A. Adesokan, M.A. Obeid Copyright (c) https://www.ajol.info/index.php/ajcem/article/view/205571 Wed, 07 Apr 2021 00:00:00 +0000 Prognostic implication of hypocalcaemia in COVID-19: a systematic review https://www.ajol.info/index.php/ajcem/article/view/205572 <p>Coronavirus disease-2019 (COVID-19) has been declared as a pandemic affecting several millions of people worldwide. It has varied clinical manifestations ranging from asymptomatic to critical illness. It has led to the mortality of several affected individuals. However, the prognosis seems to vary from one person to the other and efforts are being made to identify the prognostic factors. Hypocalcaemia has been identified as a poor prognostic factor with a high frequency among individuals affected with COVID-19. This review aims to estimate the prevalence of hypocalcaemia among COVID-19 patients and identify the poor prognostic factors associated with the presence of hypocalcaemia in COVID-19 patients. Electronic medical databases were searched for publications on the prognostic implications of hypocalcaemia in COVID-19 infection, and relevant articles were selected for systematic review following PRISMA algorithm. The prevalence of hypocalcaemia among patients with COVID-19 was 40.0-74.4%. There was a significant association between the rate of hospital admission, intensive care unit (ICU) admission as well as septic shock and hypocalcaemia in patients with COVID-19. Hypocalcaemia is also associated with a higher mortality rate in these patients. COVID-19 patients with hypocalcaemia tend to have elevated C-reactive protein, interleukin6, alanine transaminase, procalcitonin, serum creatinine and low albumin.&nbsp;&nbsp; Hypocalcaemia is common in COVID-19 patients and is a poor prognostic factor in these patients. Presence of hypocalcaemia is&nbsp; associated with a severe illness and even death.</p> <p><strong>Keywords:</strong> COVID-19; hypocalcaemia; prognosis; systematic review </p> T.A. Azeez, S. Lakoh, O.T. Bamidele, E. Ekhaiyeme, S.A. Nwosu Copyright (c) https://www.ajol.info/index.php/ajcem/article/view/205572 Wed, 07 Apr 2021 00:00:00 +0000 Recent advances in the pathophysiology and management of sepsis: a review https://www.ajol.info/index.php/ajcem/article/view/205573 <p>Sepsis is a syndrome consisting of physiological, pathological and biochemical anomalies caused by infectious agents. It causes clinical organ dysfunction, which is identified by an acute increase in the Sequential (sepsis-related) Organ Failure Assessment (SOFA) score of two or more points. SOFA score is a score of three components that can be easily used at the bedside to track the clinical status of a patient while on admission, and these are altered respiratory rate of ≥ 22 breaths/minute, altered mental status, and systolic blood pressure of ≤ 100 mmHg. A patient with SOFA score of ≥ 2 has an attributable 2 - 25-fold increased risk of mortality compared to a patient with SOFA score of ˂ 2. This present review provides information on the new definition of sepsis and septic shock, aetiology, pathophysiology, biochemical, pathological and haematological changes, morbidity and mortality parameters, management, and<br>prognostic factors in patients with sepsis.</p> <p><strong>Key words</strong>: Sepsis, septic shock, SOFA score, pathophysiology, management bundles</p> B.A. Adegboro, J. Imran, S.A. Abayomi, E.O. Sanni, S.A. Biliaminu Copyright (c) https://www.ajol.info/index.php/ajcem/article/view/205573 Wed, 07 Apr 2021 00:00:00 +0000 Quality of metagenomic DNA extracted for molecular identification of microorganisms from CSF samples of patients with suspected cerebrospinal meningitis in northern Nigeria https://www.ajol.info/index.php/ajcem/article/view/205574 <p><strong>Background:</strong> Following an increase in the practice of starting antimicrobial therapy prior to clinical sample collection, the ability to confirm pathogenic microorganisms of bacterial meningitis has decreased by approximately 30%. Culture results may be false negative when fastidious or culture-resistant bacteria are involved or when patient samples are obtained after antimicrobial therapy has started. Molecular diagnosis using PCR can be performed directly on clinical samples after metagenomic DNA (mDNA) extraction not requiring live organisms for a positive result. The specific objectives of this study are to perform mDNA extraction directly from cerebrospinal fluids (CSF) using appropriate spin column method, and to determine the quality of the mDNA elute.<br><strong>Methodology:</strong> Cerebrospinal fluid specimens were collected from 210 patients with suspected acute cerebrospinal meningitis (CSM) in the Federal Capital Territory and some States in Northern Nigeria during the 2017 and 2018 outbreak seasons. Metagenomic DNA was extracted from approximately 200µL of CSF specimens using the Qiagen QIAamp(R) DNA Mini kit specific for bacterial agents only. DNA quality check was performed on all DNA elutes using fluorometric, spectrophotometric and agarose gel electrophoresis methods.<br><strong>Results</strong>: Of the 210 CSF samples analyzed microbiologically, Gram reaction was positive in 94 cases (44.8 %) but only 17 (8.1 %) were culture positive for two of the three major bacterial causes of meningitis. One hundred and eighty (85.7%) samples had DNA&nbsp; concentrations ≥ 0.005 ng/µL, 55 (30.6 %) of these had DNA purity (A260/A280) of ≥ 1.7, 103 (57.2%) had purity value between 1.0 - 1.69, 14 (7.8%) had value of 0.57 - 0.99, and 8 (4.4%) failed purity evaluation with value of 0.00 at A260/A280.<br><strong>Conclusion</strong>: The essence of mDNA extraction is multipurpose. A multiplex PCR can be performed on the extracted mDNA to interrogate the presence of microbial pathogens of interest using specific primers and probes (when applicable). Quality mDNA from CSF samples will ensure successful qPCR results for rapid and accurate detection of bacterial pathogens in meningitis. This will&nbsp; eliminate the challenges associated with traditional culture methods.</p> <p><strong>Keywords</strong>: Meningitis, CSF, DNA Quality Check, Fluorometry </p> I.C. Peletiri, E.I. Ikeh, E. Nna, U.P. Ndike, Y.B. Usman, L.D. Durfa, C.N. Okonkwo, R. Murtala, C.R. Nnajide Copyright (c) https://www.ajol.info/index.php/ajcem/article/view/205574 Wed, 07 Apr 2021 00:00:00 +0000 Faecal carriage of extended-spectrum beta-lactamase-producing Enterobacteriaceae in healthy volunteers and hospitalized patients in Ouagadougou, Burkina Faso: prevalence, resistance profile, and associated risk factors https://www.ajol.info/index.php/ajcem/article/view/205575 <p><strong>Background:</strong> Extended spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE) are a serious challenge to patients’ treatment. The aim of this study is to determine the prevalence of ESBL-PE, investigate the associated resistance, and analyze the associated risk factors for acquisition of ESBL-PE.<br><strong>Methodology</strong>: A cross-sectional study was conducted on healthy volunteers and inpatients. After obtaining informed consent, rectal swabs were collected from each participant for isolation of Enterobacteriaceae on Hektoen enteric agar containing 4µg/L cefotaxime. The Enterobacteriaceae isolates were identified using biochemical tests and ESBL production was confirmed by the double-disc synergy test of amoxicillin and clavulanic acid. Antibiotic susceptibility test of each isolate was done by the disc diffusion method and interpreted using the recommendations of the European Committee on Antimicrobial Susceptibility Testing (EUCAST) clinical&nbsp; breakpoints version 5.0.<br><strong>Results</strong>: During the study period, prevalence of faecal ESBL-PE among the study participants was 54.5% (103/189); 53.5% among healthy volunteers and 55.7% among inpatients (p=0.87). The major ESBL-PE isolates was <em>Escherichia coli</em> (71%) followed by Klebsiella pneumoniae (16%). The isolates in hospitalized patients were resistant to norfloxacin (84.2%), cotrimoxazole (89.5%), and gentamicin (7.0%). The isolates from healthy volunteers were resistant to norfloxacin (86.2%), cotrimoxazole (82.8%), and gentamicin (1.7%).<br>Gender, age, and previous antibiotic use were not significantly associated with carriage of ESBL-PE (p=0.51).<br><strong>Conclusion</strong>: The high prevalence of ESBL-PE in this study is worrying. There is an urgent need to develop measures to monitor and limit the spread of these multidrug-resistant organisms in healthcare facilities and the community in Burkina Faso.</p> <p><strong>Keywords</strong>: faecal carriage, ESBL-PE, healthy volunteers, inpatients, Burkina Faso </p> S. Soré, S. Sanou, Y. Sawadogo, S. Béogo, S.N.P. Dakouo, M.D. Djamalladine, K.S. lboudo, B. Ouoba, J. Zoungrana, A. Poda, A.S. Ouédraogo, I. Sanou Copyright (c) https://www.ajol.info/index.php/ajcem/article/view/205575 Wed, 07 Apr 2021 00:00:00 +0000 Characterization of biofilm formation in clinical urinary isolates of <i>Staphylococcus aureus</i> from five hospitals in Lagos State, Nigeria https://www.ajol.info/index.php/ajcem/article/view/205576 <p><strong>Background:</strong> Biofilm formation by pathogens is of great clinical importance as it mediates persistence and resistance to antibiotics, hence posing difficulty in treatment and management of diseases. The aim of this study was to evaluate the biofilm forming potential of <em>Staphylococcus aureus</em> isolated from urine samples of females with urinary tract infection and to detect the presence of clumping factor (clfA) and intracellular adhesion (icaA) encoding genes.<br><strong>Methodology</strong>: A total of 50 S. aureus were obtained from urine samples of women in five hospitals in Lagos State, Nigeria. Isolates were confirmed by standard biochemical and novobiocin susceptibility tests. The isolates were screened for biofilm formation using three methods; Congo-red agar (CRA), tube, and tissue culture plate (TCP) methods. Detection of clfA and icaA genes was done by PCR.<br><strong>Results</strong>: The Congo red agar method showed that 39 (78%) of the isolates were biofilm producers while 11 (22%) were non-biofilm producers. However, the tube method indicated that 12 (24%) were strong biofilm producers, 26 (52%) were moderate biofilm producers, and 12 (24%) were non-biofilm producers. The standard TCP assay showed that strong biofilm producers (OD &gt; 0.240) were 13 (26%), moderate biofilm producers were 22 (44%), and weak or non-biofilm producers (OD &lt; 0.120) were 15 (30%). The tube method showed a good correlation with the TCP method for strong biofilm production. Ten (20%) isolates possessed clfA gene and 31 (62%)<br>possessed icaA gene.<br><strong>Conclusion:</strong> The ability of <em>S. aureus</em> to form biofilm is a key risk factor that can increase morbidity and mortality from infections they cause. Hence, rapid and sensitive phenotypic methods can be used in screening for biofilm formation thereby providing data that can guide therapy and control of the pathogen.</p> <p><strong>Keywords</strong>: <em>Staphylococcus aureus,</em> Biofilm, Clumping factor, Intracellular adhesion</p> C.I. Orjih, A. Ajayi, F.O. Alao, A.I. Adeleye, S.I. Smith Copyright (c) https://www.ajol.info/index.php/ajcem/article/view/205576 Wed, 07 Apr 2021 00:00:00 +0000 Comparative analysis of poliovirus-specific IgA and cytokine levels in the sera of<i> Ascaris lumbricoides</i>-infected and helminth-negative Nigerian children after oral poliovirus vaccination https://www.ajol.info/index.php/ajcem/article/view/205577 <p><strong>Background:</strong> Intestinal helminth infection is associated with altered immune responses and compromised vaccine efficacy in infected children. Altered immune response due to Ascaris lumbricoides infection may compromise efficacy of oral poliovirus vaccination in children. There is no information on humoral immune response during oral poliovirus (OP) vaccination of A. lumbricoides–infected Nigerian children. The objective of this study is to determine the serum levels of cytokines (tumour necrosis factor–alpha TNF-α,&nbsp; interferongamma IFN–γ, interleukins -4, -6, -8, -10) and poliovirus-specific IgA (PV-IgA) antibody in children infected with A. lumbricoides compared with helminth-negative children (control) before and after oral poliovirus vaccination.</p> <p><strong>Methodology</strong>: Twenty-three A. lumbricoides-infected children between ages 5-15 years (13 males and 10 females) and 23 age (4-15 years) and sex-matched helminth-negative children who met selection criteria were enrolled into the study after ethical approval and informed consent. Their stool samples were examined for helminth ova using concentration technique. Sera were collected before and 3 weeks after OP vaccinations, and serum concentrations of IFN–γ, TNF–α, IL-4, -6, -8, -10, and poliovirus-specific IgA concentrations were determined by enzyme-linked immunosorbent assay. The level of statistical significance was set at α0.05.</p> <p><strong>Results</strong>: Pre-vaccination serum levels of IFN–γ, IL–4, IL-6 and IL-8 were significantly higher in A. lumbricoides–infected children compared with pre-vaccination levels in helminth-negative children. Postvaccination serum levels of IFN–γ, IL–4 and IL-8 were&nbsp; significantly higher in A. lumbricoides–infected children compared with post-vaccination serum levels in helminth-negative children. In the A. lumbricoides-infected children, pre-vaccination serum levels of IL-6 and IL-8 were significantly higher compared with post vaccination levels while pre-vaccination serum levels of IFN–γ, IL–4 and IL-8 were significantly higher in helminth-negative children compared with the post-vaccination levels. There was no significant reduction in post-vaccination median serum level of PV-IgA&nbsp; compared with level before vaccination in A. lumbricoides-infected children. Also, there was no significant increase in post-vaccination median serum level of PV-IgA compared with level before vaccination in helminth-negative children.</p> <p><strong>Conclusion:</strong> Oral polio vaccine administration caused decrease expression of inflammatory cytokines (IL-6 and IL-8) in A. lumbricoides-infected school children, and A. lumbricoides infection may reduce PV-IgA production following OP vaccination.</p> <p><strong>Keywords:</strong> Ascaris lumbricoides infection, cytokines, children, poliovirus vaccination </p> K.S. Akinwande, G.O. Arinola Copyright (c) https://www.ajol.info/index.php/ajcem/article/view/205577 Wed, 07 Apr 2021 00:00:00 +0000 Haemoglobin phenotypes and the risk of asymptomatic malaria parasitemia among blood donors in northwest Nigeria: clinical implications in the practice of tropical transfusion medicine https://www.ajol.info/index.php/ajcem/article/view/205612 <p><strong>Background</strong>: In malaria-endemic populations, sickle cell trait (SCT) protects against both severe and non-severe malaria, but inconsistencies exist about protective effect of SCT on asymptomatic malarial parasitemia (AMP). Surprisingly, the effect of Hb-phenotypes on AMP has not been explored among blood donors in Nigeria or other malaria-endemic countries, where risks of AMP and transfusion transmitted malaria (TTM) are high. The objective of this study is to determine risk of AMP with respect to donor Hb-phenotypes (SCT versus HbAA), and elucidate clinical implications of AMP with respect to risk of TTM vis-à-vis the practice of transfusion medicine in Nigeria, and by implication other malaria-endemic tropical countries.<br><strong>Methodology:</strong> Analysis of 100 blood donors with AMP (cases) and 100 donors without AMP (controls) was performed. Frequencies of SCT and HbAA (determined by Hb electrophoresis) among cases and controls were compared by X<sup>2 </sup>-test. Risks of AMP (detected by microscopy) with respect to Hb-phenotypes were expressed as Odds ratios (OR) by case-control logistic regression.<br><strong>Results</strong>: In comparison with blood donor without AMP (controls), donors with AMP had lower frequencies of SCT (12% vs 28%, p&lt;0.05) with corresponding higher frequencies of HbAA (88% vs 72%, p&lt;0.05). HbAA is associated with high risk of AMP (OR=2.91, 95%CI: 2.10-3.48, p=0.021), while SCT is associated low risk of AMP (OR=0.49, 95%CI: 0.27-0.73, p=0.032).<br><strong>Conclusion:</strong> This finding shows that donor SCT is a surreptitious mitigator of the risk of AMP and TTM in the tropics. Therefore, patients who are selectively transfused with HbAA blood (e. g. neonates and sickle cell disease patients) could be at greater risks of TTM, and such patients need closer post transfusion monitoring. The risk of TTM calls for diligent post transfusion haemovigilance in Nigeria and other malaria endemic tropical countries in Africa</p> <p><strong>Keywords</strong>: blood donors, sickle cell trait, asymptomatic malaria parasitemia, transfusion transmitted malaria</p> K.M. Kani, Z. Ibrahim, A. Habeeb, U.A. Ibrahim, S.G. Ahmed Copyright (c) https://www.ajol.info/index.php/ajcem/article/view/205612 Thu, 08 Apr 2021 00:00:00 +0000 Intestinal schistosomiasis in an apparently healthy rural population in Bayelsa State, Nigeria https://www.ajol.info/index.php/ajcem/article/view/205613 <p><strong>Background:</strong> Schistosomiasis is endemic in Nigeria and three species; <em>Schistosoma haematobium, Schistosoma mansoni,</em> and <em>Schistosoma intercalatum</em> have been reported in Niger Delta, Nigeria. This study aimed to determine the prevalence of schistosomiasis in rural communities of Bayelsa State, Nigeria.<br><strong>Methodology:</strong> Four rural homogeneous communities; Otuegala, Immiringi, Otuesega, and Ibelebiri in Ogbia Local Government Area of Bayelsa State, Nigeria, were randomly selected for the study. A structured questionnaire was administered to each participant in their native language and used to collect participant’s biodata and swimming history. Stool samples collected from all participants were examined qualitatively by wet preparation and after formolethol concentration. Data were analyzed using SPSS version 20.0 software and results presented in proportion and tables.<br><strong>Results:</strong> A total of 829 participants (age range 1 - 80 years) were recruited for the study. Helminth ova were identified in the stool samples of 218 (26.3%) participants. Among 380 males examined, 82 (21.6%) were infected, while out of 449 females examined, 138 (30.3%) were infected. The ova of seven helminths identified and their frequency of occurrence were; <em>S. intercalatum</em> 86 (10.4%), <em>Ascaris lumbricoides</em> 53 (6.4%), <em>S. mansoni</em> 35 (4.2%), <em>Trichuris trichiura</em> 22 (2.6%), hookworm 20 (2.4%) and <em>Taenia spp</em> 2 (0.2%). Schistosoma haematobium was identified in non-urine contaminated stool sample of an eight-year old boy. A total of 11 (1.3%) participants had double infections, affecting 7 (63.6%) females and 4 (36.4%) males, with the commonest combination being <em>S. intercalatum</em> and <em>A.</em><br><em>lumbricoides</em> 6 (0.7%), followed by <em>S. intercalatum</em> and hookworm 4 (0.5%), and S. mansoni and hookworm 1(0.1%).<br><strong>Conclusion</strong>: <em>S. intercalatum</em> was the most prevalent intestinal helminthic infection in this study, which is a rare finding in most epidemiological investigations. The affinity of Schistosoma species to establish double infections with hookworm and other intestinal helminths should be taken into account during chemoprophylaxis.</p> <p><strong>Keywords</strong>: Schistosomiasis, Chemoprophylaxis, Prevalence, Rural Population</p> E.M. Odoya, E.U. Edosomwa, O.I. Iribhogbe, A.A. Damina, O.A. Asojo Copyright (c) https://www.ajol.info/index.php/ajcem/article/view/205613 Thu, 08 Apr 2021 00:00:00 +0000 Antimicrobial resistance patterns and transferable traits in Enterobacteriaceae isolates from poultry in Tlemcen, Algeria https://www.ajol.info/index.php/ajcem/article/view/205615 <p><strong>Background:</strong> Antibiotics are overused in poultry industry, and this has resulted in the emergence of multidrug resistant (MDR) bacteria. The current study is aimed at determining antimicrobial resistance (AMR) patterns of Enterobacteriaceae isolates from poultry in the west of Algeria.<br><strong>Methodology:</strong> Different chicken samples (kidney, bone and intestine) were collected and processed for culture using standard microbiological methods to isolate Enterobacteriaceae. Isolates were identified biochemically using API 20E, while isolated Escherichia coli was typed for O1, O2 and O78 antigens using slide agglutination with specific antisera. All identified isolates were tested against 26 antibiotic disks using the Kirby Bauer disk diffusion method according to the CLSI standards. The minimum inhibitory concentrations (MICs) of chloramphenicol, tetracycline, nalidixic acid, ofloxacin and ciprofloxacin were determined for selected isolates. Conjugative plasmid transfer, plasmid incompatibility and colicin tests were used to detect transferable resistance traits in 48 selected <em>E. coli</em> isolates.<br><strong>Results</strong>: One hundred and thirty-eight bacteria species were isolated, which included <em>Escherichia coli</em> (n=107), <em>Salmonella spp</em> (n=11), <em>Klebsiella spp</em> (n=8), <em>Enterobacter spp</em> (n=7), <em>Pseudomonas spp</em> (n=3) and <em>Citrobacter </em><em>spp</em> (n=2). Serotyping identified 24 agglutinable <em>E. coli</em> isolates with O78:K80 (n=11), O1:K1 (n=9) and O2:K1 (n=4). Antibiotic susceptibility showed high frequency of <em>E. coli</em> resistance to nalidixic acid (89.7%), tetracycline (82.2%), streptomycin (82.2%), nitrofurantoin (68.2%), ampicillin (45.8%), ticarcillin (44.9%), piperacillin<br>(42.1%), and chloramphenicol (15.9%). The percentage of multi-drug resistance isolates (resistance to more than 3 antibiotic classes) was 87.9%. The results of conjugative transfer in 48 <em>E. coli</em> isolates shows that the most important resistance traits transferred by plasmids are ASTeSuTmp (18.5%) and SuTmp (12.3%).<br><strong>Conclusion</strong>: This study confirmed the presence of multiple antibiotic resistant <em>E. coli</em> and other members of family Enterobacteriaceae in poultry in Algeria, and showed that these antibiotic resistance traits are easily disseminated by plasmids, with dire consequences on human health.</p> <p><strong>Keywords</strong> : Poultry, Enterobacteriaceae, antimicrobial resistance, conjugation, plasmid.</p> <p>&nbsp;</p> <p><strong><em>French title:&nbsp;</em> Profils de résistance aux antimicrobiens et caractères transférables des isolats d'entérobactéries provenant de volailles à Tlemcen, Algérie</strong></p> <p>&nbsp;</p> <p><strong>Contexte</strong>: Les antibiotiques sont surutilisés dans l'industrie de la volaille, ce qui a entraîné l'émergence de bactéries multirésistantes (MDR). L'étude actuelle vise à déterminer les profils de résistance aux antimicrobiens (RAM) des isolats d'Enterobacteriaceae provenant de volailles dans l'ouest de l'Algérie.&nbsp; <br><strong>Méthodologie:</strong> Différents échantillons de poulet (rein, os et intestin) ont été prélevés et traités pour la culture en utilisant des méthodes microbiologiques standard pour isoler les Enterobacteriaceae. Les isolats ont été identifiés biochimiquement en utilisant l'API 20E, tandis que Escherichia coli isolé a été typé pour les antigènes O1, O2 et O78 en utilisant l'agglutination sur lame avec des antisérums spécifiques. Tous les isolats identifiés ont été testés contre 26 disques antibiotiques en utilisant la méthode de diffusion sur disque de Kirby Bauer selon les normes CLSI. Les concentrations minimales inhibitrices (CMI) du chloramphénicol, de la tétracycline,<br>de l'acide nalidixique, de l'ofloxacine et de la ciprofloxacine ont été déterminées pour certains isolats. Des tests de transfert plasmidique conjugatif, d'incompatibilité plasmidique et de colicine ont été utilisés pour détecter des traits de résistance transférables dans 48 isolats sélectionnés d'<em>E. coli.</em><br><strong>Résultats:</strong> Cent trente-huit espèces de bactéries ont été isolées, parmi lesquelles<em> Escherichia coli (n=107), Salmonella spp (n=11), Klebsiella spp (n=8), Enterobacter spp (n=7), Pseudomonas spp (n=3) et Citrobacter spp (n=2)</em>. Le sérotypage a identifié 24 isolats d'<em>E. coli</em> agglutinables avec O78: K80 (n=11), O1: K1 (n=9) et O2: K1 (n=4). La sensibilité aux antibiotiques a montré une fréquence élevée de résistance d'E. coli à l'acide nalidixique (89,7%), à la tétracycline (82,2%), à la streptomycine (82,2%), à la nitrofurantoïne (68,2%), à<br>l'ampicilline (45,8%), à la ticarcilline (44,9%), à la pipéracilline (42,1%) et le chloramphénicol (15,9%). Le pourcentage d'isolats de résistance multi-médicaments (résistance à plus de 3 classes d'antibiotiques) était de 87,9%. Les résultats du transfert conjugatif dans 48 isolats d'<em>E. coli</em> montrent que les traits de résistance les plus importants transférés par les plasmides sont ASTeSuTmp (18,5%) et SuTmp (12,3%).<br><strong>Conclusion</strong>: Cette étude a confirmé la présence de multiples <em>E. coli</em> résistants aux antibiotiques et d'autres membres de la famille des Enterobacteriaceae chez les volailles en Algérie et a montré que ces traits de résistance aux antibiotiques sont facilement disséminés par les plasmides, avec des conséquences désastreuses sur la santé humaine.</p> <p><strong>Mots clés</strong>: volaille, entérobactéries, résistance aux antimicrobiens, conjugaison, plasmide. </p> M.S. Barka, A. Cherif-Anntar, I. Benamar Copyright (c) https://www.ajol.info/index.php/ajcem/article/view/205615 Thu, 08 Apr 2021 00:00:00 +0000 Impact of decalcification on antibacterial properties of eggshell against selected poultry pathogens https://www.ajol.info/index.php/ajcem/article/view/205623 <p><strong>Background:</strong> Eggshell which is primarily composed of more than 98% calcium carbonate crystal, serves as the physical protective and active barrier structure of egg content. Recently, antimicrobial properties of eggshell are fast becoming center of interest among stakeholders of poultry industry. However, few studies have focused on the rigidity factor of calcium components of eggshell as antimicrobial agent. Thus, this study was designed to determine the effect of decalcification on the ability of eggshell to inhibit common poultry and egg bacterial pathogens.<br><strong>Methods</strong>: Raw eggshell denoted as calcified eggshell (CES) and decalcified eggshell (DES) were extracted and made into fine powder. Standard protocol was used for preparations of CES and DES at concentrations of 10, 5, 2.5 and 1.25 mg/ml, and their antibacterial assays on selected bacterial pathogens (<em>Bacillus subtilis, Klebsiella pneumoniae, Pseudomonas aeruginosa, Escherichia coli</em> and <em>Salmonella Typhi</em>) were performed by agar diffusion method. Gentamicin 80mg solution (CC1) and distilled water (CC2) served as controls. Data were analysed with SPSS version 20.0 and presented as mean±SD for descriptive statistics. Friedman's two-way test ANOVA was used to compare the differences in mean values between CES, DES, CC1 and CC2 at significance level of p&lt;0.05.<br><strong>Results:</strong> The mean zone diameter of inhibition produced by DES (range 13–28mm) for the isolates was significantly higher (p&lt;0.05) than that produced by CES (range 10-21mm). However, the mean zone diameter of inhibition produced by CC1 (gentamicin) (range 16-40mm) was higher than that produced by DES or CES (p&lt;0.05). The concentrations of DES and CES have no significant antibacterial effect on <em>B. subtilis</em> and<em> K. pneumoniae</em> (p&gt;0.05), but had inverse effect on <em>P. aeruginosa.</em> Overall, DES had a better inhibitory effect than CES against <em>B. subtilis, K.</em> <em>pneumoniae </em>and<em> P. aeruginosa,</em> but notably, neither DES nor CES had inhibitory effect on <em>E. coli </em>and<em> S. Typhi.</em><br><strong>Conclusion</strong>: Poor antibacterial effect of CES may be attributed to the calcium-protein interactions within bacterial cell membrane, which hinders absorption or mobility mechanism of the antibacterial factor of the eggshell, but decalcification had significant impact on the antibacterial profile of the eggshell for some bacterial isolates. However, <em>S. Typhi</em> and <em>E. coli</em> were totally resistant to both DES and CES. Breed of eggs with minimal calcified eggshell to withstand transportation fragility, may enhance antibacterial index and shelf-life of table eggs.</p> <p><strong>Keywords</strong>: Decalcification; Antibacterial; Eggshell; Poultry; Pathogens </p> T.V. Balogu, B.C. Chukwueze, T.P. Okonkwo Copyright (c) https://www.ajol.info/index.php/ajcem/article/view/205623 Thu, 08 Apr 2021 00:00:00 +0000 <i>Salmonella</i> Dublin associated with abortion in dairy cattle in Algiers and comparison of different diagnostic methods https://www.ajol.info/index.php/ajcem/article/view/205626 <p><strong>Background</strong>: In cattle, many serotypes of Salmonella enterica are responsible for a wide variety of clinical manifestations, which can cause considerable economic loss. Some serotypes can cause cows to abort sporadically, such as the Dublin serotype. This study was carried out on different cattle farms in the Algiers region to determine the prevalence of <em>Salmonella Dublin</em> using bacteriological and immunological methods.<br><strong>Methodology</strong>: The prevalence of Salmonella was determined by bacteriological analysis in accordance with the reference method AFNOR NF U 47-100 on faecal samples collected from 184 cattle belonging to 19 different farms, and serotyping for <em>S. Dublin.</em> Immunological analysis by enzyme-linked immunosorbent assay (ELISA) for S. Dublin was carried out on milk samples collected from 91 cattle. A survey of case (n=5) and control (n=14) farms for comparative analysis was performed to demonstrate a link between abortion in cows and prevalence of S. Dublin with both bacteriological and immunological methods. Sensitivity, specificity, Cohen Kappa coefficient, McNemar test odds ratios, and confidence intervals were calculated using Winepiscope 2.0 and StatA 9.1 software,<br>and p&lt;0.05 was considered as statistically significant.<br><strong>Results</strong>: The bacteriological results showed a prevalence of 7.6% (95%CI: 3-10), for <em>Salmonella</em> and serotyping revealed a prevalence for <em>S. Dublin</em> of 2.7%. The immunological analysis of milk by the ELISA technique revealed a prevalence of 13.2% (95%CI: 5-20) for <em>S. Dublin</em>. The comparative study between immunological results from milk and bacteriological results from faeces for detecting <em>S. Dublin&nbsp;</em> showed poor agreement between the two tests (k=0.25), with enzyme immunoassay being significantly more sensitive than the bacteriological test (p&lt;0.05). The results of the survey did not demonstrate a clear association between bacteriological detection of <em>S.</em> <em>Dublin</em> in faeces and abortion in cows (OR=8.66, 95%CI: 0.58-130.12). However, with the immunological analysis of milk for <em>S. Dublin,</em> there was a significant positive association (OR=62.33, 95%CI: 2.13-18.22) between a positive antibody response to <em>S. Dublin</em> in milk and the presence of abortions on the farm.<br><strong>Conclusion</strong>: In view of these results, we can conclude that Salmonella infections should systematically feature in the differential diagnosis of abortions in dairy cattle in Algeria.</p> <p><strong>Keywords</strong>: <em>S. Dublin</em>, cattle, faeces, milk, abortion, immunology, bacteriology, Algiers </p> Dj Hezil, S. Zaidi, H. Benseghir, R. Zineddine, N. Benamrouche, F. Ghalmi Copyright (c) https://www.ajol.info/index.php/ajcem/article/view/205626 Thu, 08 Apr 2021 00:00:00 +0000 Prevalence, characteristics and antibiogram profile of Escherichia coli O157:H7 isolated from raw and fermented (nono) milk in Benin City, Nigeria https://www.ajol.info/index.php/ajcem/article/view/205631 <p><strong>Background</strong>: Most Escherichia coli strains are harmless commensals, but some serotypes can cause serious food poisoning in their hosts, and are infrequently responsible for product recalls due to food contamination. The present study was carried out to determine the occurrence of <em>E. coli</em> O157:H7 and other <em>E. coli</em> strains from raw and fermented (nono) milk in Benin City, Nigeria.<br><strong>Methodology</strong>: A total of 66 (33 raw and 33 nono) milk samples were obtained from retailers from 3 different stations in Aduwawa market, Benin City, Nigeria between January and June, 2017. Samples were analysed by cultural methods for faecal coliforms using M-Fc agar, <em>E. coli</em> using Chromocult coliform agar, and <em>E. coli</em> O157:H7 using sorbitol MacConkey agar supplemented with cefixime and potassium tellurite. Presumptive <em>E. </em><em>coli </em>and<em>E. coli</em> O157:H7 isolates were confirmed by polymerase chain reaction (PCR) assay using specific primers. Antimicrobial susceptibility profile of confirmed isolates was performed using the Kirby-Bauer disk diffusion method, with zones of inhibition interpreted according to the guidelines of Clinical and Laboratory Standards Institute (CLSI). Data were&nbsp; analysed using the SPSS version 21.0.<br><strong>Results</strong>: From the 66 nono and raw milk samples assessed in this study, all (100%) were phenotypically positive for <em>E. coli</em> O157:H7. A total of 19 E. coli O157:H7 and 41 other strains of <em>E. coli</em> were confirmed by PCR. The resistance profile of the 19 E. coli O157:H7 isolates showed 100% (19/19) resistance to penicillin G and ampicillin; 94.7% (18/19) to chloramphenicol; 89.5% (17/19) to erythromycin; and 78.9% (15/19) to sulfamethoxazole and oxytetracycline, while the sensitivity profile showed that 100% (19/19) E. coli O157:H7 isolates were sensitive to gentamicin and ofloxacin. The resistance profile of other 41 <em>E. coli</em> isolates showed 100% (41/41) resistance to penicillin G and ampicillin; 97.6% (40/41) to chloramphenicol; and 92.7% (38/41) to erythromycin, while 97.6% (40/41) were sensitive to&nbsp; gentamicin and kanamycin. Ten <em>E. coli</em> O157:H7 isolates (52.6%) showed extensive drug resistance pattern to 11 antibiotics in 7&nbsp; antimicrobial classes with multiple antibiotic resistance (MAR) index of 0.46.<br><strong>Conclusion</strong>: Findings from the present study clearly indicated that the safety and quality of fresh and fermented milk were not satisfactory and could be of public health concern.</p> <p><strong>Key words:</strong> Nono, Escherichia coli; Pathotypes, Resistance index, Public health, Milk </p> I.H. Igbinosa, C. Chiadika Copyright (c) https://www.ajol.info/index.php/ajcem/article/view/205631 Thu, 08 Apr 2021 00:00:00 +0000 Correlation between faecal indicator bacteria in diarrheagenic stools and hospital wastewaters: Implication on public health https://www.ajol.info/index.php/ajcem/article/view/205634 <p><strong>Background</strong>: Hospital wastewaters contain blends of inorganic, natural constituents and contaminants that carry significant health risk when released directly into the environment. The aim of this study is to investigate the correlation between faecal indicator bacteria in diarrheagenic stools and wastewaters generated in University of Medical Sciences Teaching Hospital complex, Akure, Nigeria.<br><strong>Methodology</strong>: Quantification of faecal indicator bacteria was carried out on diarrheagenic faecal samples collected from 55 hospitalized patients and 68 wastewater samples from the medical laboratory science and laundry units of the hospital over of period of 12 weeks. Standard membrane filtration technique was performed using membrane intestinal enterococcus (m-ENT), membrane faecal coliform (m-FC), membrane lauryl sulphate (MLSA), eosin methylene blue (EMB) and Salmonella-Shigella (SS) agar plates, which were incubated at 37ºC for 24 hours (MLSA, EMB and SSA), 44ºC for 24 hours (m-FC); and 37ºC for 48 hours (m-ENT). Bacterial colonies on agar plates were counted and expressed as colony forming units (CFU) per 100ml of diarrheagenic stool and wastewater. Pearson’s<br>correlation analysis was used to determine the relationship between the level of faecal indicator bacteria in diarrheagenic stools and wastewaters at p&lt;0.05 level of significance (and 95% confidence interval).<br><strong>Results</strong>: The faecal coliform counts (log 10 CFU/100ml) ranged from 1.18 to 1.54 in diarrheagenic stools, 1.32 to1.64 in laboratory wastewater and 1.08 to 2.19 in laundry wastewater. <em>Escherichia coli</em> count (log 10 CFU/100ml) ranged from 1.08 to 1.40 in diarrheagenic stools, 1.20 to 1.86 in laboratory wastewater and 0.30 to 1.81 in laundry wastewater. Intestinal enterococci count (log 10 CFU/100ml) ranged from 0 to 0.30 in diarrheagenic stools, 0.78 to 0.90 in laboratory wastewaters and 0.48 to 1.11 in laundry wastewaters. Pearson’s correlation co-efficient showed that all the faecal indicator bacteria count in diarrheagenic faecal samples exhibited positive correlation with those in laboratory wastewaters, but not with those from laundry wastewaters.<br><strong>Conclusion</strong>: The findings suggest that diarrheagenic stools should be properly disinfected after the performance of laboratory tests to prevent transmission of potential pathogens, and wastewater generated from hospitals should be treated prior to discharge into the environment, to prevent possible infections in the community.</p> <p><strong>Keywords</strong>: Correlation, faecal indicator bacteria, public health, transmission, wastewater </p> A. Olalemi, B. Oladejo, M. Bayode Copyright (c) https://www.ajol.info/index.php/ajcem/article/view/205634 Thu, 08 Apr 2021 00:00:00 +0000 Microbial contamination of Naira notes circulating in Bauchi metropolis: prevalence, microbial load and detection of extended spectrum beta-lactamase producing Gram-negative bacteria https://www.ajol.info/index.php/ajcem/article/view/205635 <p><strong>Background:</strong> Globally, contamination of banknotes with various microbial species is increasingly being reported. This usually results from improper handling during exchange of goods and services. In the present study, we aimed to determine the microbial load, prevalence and the presence of Extended Spectrum Beta Lactamase (ESBL) among bacteria isolated from the Nigerian Naira notes circulating in Bauchi metropolis.<br><strong>Methodology</strong>: A total of 400 Naira notes of various denominations were randomly collected aseptically, cultured and total viable counts determined. The isolated microbial species were identified using standard microbiological techniques. Antibiotic susceptibility of the isolates and detection of ESBL were determined by Kirby-Bauer’s disc diffusion method and Double Disc Synergy Test (DDST), respectively.<br><strong>Results</strong>: All the 400 samples collected were contaminated with various microbial species. The highest mean colony count was detected in 20 Naira notes (28.5%), while the least was observed in 1000 Naira note (3.3%). Fourteen different microbial species were isolated from the contaminated currency notes, predominantly <em>Escherichia coli </em>(25.0%), and <em>Staphylococcus aureus</em> (12.0%). Some fungal species mainly <em>Aspergillus flavus</em> and <em>Aspergillus niger </em>were also isolated. Majority of the bacteria isolates resistant to the third generation cephalosporins (72.1%) were ESBL positive.<br><strong>Conclusion</strong>: The study shows that Naira notes circulating in Bauchi metropolis were heavily contaminated with various microbial species, and a high proportion of the isolated Gram-negative bacteria were ESBL producers. Efforts should thus be made to improve hygiene practices in the study area. Importantly, businesses should be encouraged to adopt the use of electronic transactions.</p> <p><strong>Keywords</strong>: Currency notes, Naira, Microbial contamination, ESBL</p> M. Usman, J. Sani, A. Ibrahim, A. Olowo-okere Copyright (c) https://www.ajol.info/index.php/ajcem/article/view/205635 Thu, 08 Apr 2021 00:00:00 +0000 Point prevalence survey of antimicrobial consumption and resistance: 2015-2018 longitudinal survey results from Nigeria https://www.ajol.info/index.php/ajcem/article/view/205636 <p><strong>Background</strong>: Nigeria joined the global community in monitoring antimicrobial prescribing practices since 2015. Results of individual hospital Global Point Prevalence Survey (Global-PPS) have stimulated efforts at instituting hospital-based antimicrobial stewardship (AMS) programmes. We report the trends of antimicrobial prescribing rates and quality indicators for 3 surveillance periods; 2015, 2017 and 2018.<br><strong>Methodology</strong>: The web-based Global-PPS for surveillance of antimicrobial use in hospitals (www.globalpps.com) was completed by each participating hospital site for all inpatients receiving antimicrobials on a selected day in 2015, 2017 and 2018. Data included details on antimicrobial agents, reasons and indications for treatment and a set of quality prescribing indicators. Data were validated by the web-based data management system of University of Antwerp, exported into Microsoft Excel and analyzed with EPI INFO version 7.2.<br><strong>Results</strong>: Thirteen hospitals participated in the survey involving a total of 5,174 inpatients. Mean weighted overall antimicrobial prescribing prevalence was 70.7% which declined over the years from 71.7% in 2015 to 59.1% in 2018 (p&lt;0.001). The rate of documentation of date for post prescription review improved from 27.9% in 2015 to 48.5% in 2018 (p&lt;0.001) while the rates of targeted treatment declined from 12.0% in 2015 to 5.2% in 2018 (p&lt;0.001). There was no significant change in the choice of parenteral drug administration (64.5% in 2015, 65.1% in 2017 and 62.6% in 2018; p=0.6803), and but there was significant increase in documentation of reasons for prescription in case notes (62.2% in 2015, 74.5% in 2017, and 70.9% in 2018; p=0.008). Overall, the main indications for therapeutic prescribing were skin and soft tissue infections (20.8%), sepsis (15.9%) and pneumonia (11.6%). The top three antibiotics for therapeutic use were ceftriaxone (18.2%), metronidazole (15.3%) and ciprofloxacin (10.4%).<br><strong>Conclusions:</strong> The survey showed reduction in the overall antimicrobial prescribing rate especially in hospitals that had introduced AMS programmes. Among the quality prescribing indicators, documentation of post prescription review date showed improvement. The Global-PPS serves as a cost effective, flexible and userfriendly tool in instituting AMS programmes in hospitals.</p> <p><strong>Keywords</strong>: antimicrobial prescribing, hospital, global-point prevalence survey, quality indicators</p> C.D. Umeokonkwo, O.O. Oduyebo, A. Fadeyi, A. Versporten, O.I. Ola-Bello, A. Fowotade, C.J. Elikwu, I. Pauwels, A. Kehinde, A. Ekuma, H. Goossens, A.N. Adedosu, I.N. Nwafia, P. Nwajiobi-Princewill, F.T. Ogunsola, A.T. Olayinka, K.C. Iregbu Copyright (c) https://www.ajol.info/index.php/ajcem/article/view/205636 Thu, 08 Apr 2021 00:00:00 +0000 Roll out of a successful antimicrobial stewardship programme in Lagos University Teaching Hospital Nigeria using the Global-Point Prevalence Survey https://www.ajol.info/index.php/ajcem/article/view/205638 <p><strong>Background:</strong> Antimicrobial resistance (AMR) has become a public health emergency with increasing rates and spread globally. Antimicrobial stewardship (AMS) has been advocated to reduce the burden of antimicrobial resistance, promote rational and appropriate use of antibiotics and improve clinical outcomes. Education and training are one of the AMS interventions to improve antimicrobial use. We present the roll out of a successful AMS programme with education and training using the Global-PPS as data collection tool to measure AMS interventions and impact.<br><strong>Methodology</strong>: This was a cross sectional study on the implementation of an AMS programme at the Lagos University Teaching Hospital. Global PPS was conducted in 2015 to collect baseline data which was used to identify targets for quality improvement in AMS and was repeated in 2017 and 2018 to measure impact of AMS interventions. AMS interventions included education, feedback of Global-PPS result and writing of the hospitalwide antibiotic policy based on the baseline data.<br><strong>Results</strong>: Out of the 746 inpatients surveyed, 476 (68.3%) had received at least one antimicrobial on the days of Global-PPS. The antimicrobial prescribing rates reduced significantly over the three time periods. In 2015, 82.5% were placed on antimicrobials, 65.5% in 2017 and 51.1% in 2018 (p&lt;0.00001). The documentation of indication for treatment significantly improved from 53.4% in 2015 to 97.2% in 2018 (p&lt;0.0001). Stop review date also significantly improved from 28.7% to 70.2% in 2018 (p&lt;0.00001). Surgical prophylaxis for more than 24 hours reduced significantly from 93.3% in 2015 to 65.7% in 2018 (p=0.002) even though the prevalence was still high. The three most commonly administered antimicrobial groups were third generation cephalosporins, imidazole derivatives and quinolones. The most commonly prescribed antibiotics for surgical prophylaxis were ceftriaxone and metronidazole in 2015 and ceftriaxone in 2017.<br><strong>Conclusion</strong>: The use of education and training as AMS intervention in a limited resource setting clearly made impact on antimicrobial prescribing patterns in the hospital. Global-PPS is useful to set quality improvement targets and for monitoring, evaluation and surveillance of an AMS programme.</p> <p><strong>Keywords</strong>: Antibiotic, Stewardship, Resistance, Education, Global-PPS </p> P.O. Oshun, A.A. Roberts, C.S. Osuagwu, P.E. Akintan, I.B. Fajolu, O.I. Ola-Bello, O.O. Odukoya, B. Akodu, A.A. Okunowo, A. Versporten, I. Pauwels, H. Goosens, A.A. Busari, A.W. Olusanya, O. Nwaiwu, E.O. Temiye, A.O. Osibogun, C.O. Bode, Antimicrobial Stewardship Committee, O.O. Oduyebo Copyright (c) https://www.ajol.info/index.php/ajcem/article/view/205638 Thu, 08 Apr 2021 00:00:00 +0000 Empirical antibiotherapy as a potential driver of antibiotic resistance: observations from a point prevalence survey of antibiotic consumption and resistance in Gombe, Nigeria https://www.ajol.info/index.php/ajcem/article/view/205640 <p><strong>Background</strong>: Empirical use of antibiotics is a standard practice in the treatment of infections worldwide. However, its over utilization without subsequent culture and antibiotic susceptibility testing could be a major driver of resistance.<br>Over reliance on empirical antibiotherapy is common in most developing countries where antibiotic policies and availability or utilization of clinical microbiology laboratory are suboptimal. A standardized approach to point prevalence survey (PPS) on antimicrobial use (AMU) in hospitals was employed to assess the antimicrobial prescribing practices in Federal Teaching Hospital Gombe (FTHG), Nigeria.<br><strong>Methodology:</strong> A PPS was conducted in April 2019 at FTHG by recruiting all in-patients present in the hospital on the day of survey. Data obtained from patients’ records included details of the type and indication for antibiotherapy. A customized online application developed by the University of Antwerp (www.global-pps.be) was used for data-entry, validation, analysis and reporting.<br><strong>Results</strong>: Of the total 326 patients who were on admission on the day of survey, 70.6% and 73.4% were on at least one antibiotic in adult and paediatric wards respectively. Most commonly used antibiotics include beta lactams such as cephalosporins (29.2%) and penicillins (22.8%), fluoroquinolones (12.4%), aminoglycosides (9.1%) and macrolides (3.4%). Among patients on antibiotics, route of&nbsp; administration was mainly parenteral (71.6%) while 44.8% were on more than one antibiotic. Overall, 91.3% of the antibiotic treatments were empirical with adults, children and neonates accounting for 96.4%, 77.6% and 100.0% respectively. Empirical antibiotic use is also high in medical wards (86.3%), surgical wards (89.9%) and intensive care unit (100.0%).<br><strong>Conclusion</strong>: There is predominance and over-reliance on empirical antibiotherapy in our hospital. It further exposes the poor utilization of clinical microbiology laboratory and the potential for development of antibiotic resistance with resultant increase in morbidity/mortality and poor patient safety. There is need for further studies to highlight the dangers of over-reliance on empirical antibiotherapy and herald improvement in development and implementation of antibiotic stewardship programme.</p> <p><strong>Keywords</strong>: Empirical antibiotherapy, antimicrobial resistance, point prevalence survey, antimicrobial stewardship </p> <p>&nbsp;</p> <p><strong><em>French title:L'antibiothérapie empirique comme moteur potentiel de la résistance aux antibiotiques: observations d'une enquête</em></strong><br><strong><em>ponctuelle de prévalence de la consommation et de la résistance aux antibiotiques à Gombe, au Nigéria</em></strong></p> <p>&nbsp;</p> <p><strong>Contexte</strong>: L'utilisation empirique d'antibiotiques est une pratique courante dans le traitement des infections dans le monde entier. Cependant, sa surutilisation sans culture ultérieure ni test de sensibilité aux antibiotiques pourrait être un facteur majeur de résistance. Le recours excessif à l'antibiothérapie empirique est courant dans la plupart des pays en développement où les politiques d'antibiotiques et la disponibilité ou l'utilisation du laboratoire de microbiologie clinique sont sous-optimales. Une approche standardisée de l'enquête de prévalence ponctuelle (PPS) sur l'utilisation des antimicrobiens (AMU) dans les hôpitaux a été utilisée pour évaluer les pratiques de prescription d'antimicrobiens au Federal Teaching Hospital Gombe (FTHG), au Nigéria.<br><strong>Méthodologie</strong>: Un PPS a été réalisé en avril 2019 au FTHG en recrutant tous les patients hospitalisés présents à l'hôpital le jour de l'enquête. Les données obtenues à partir des dossiers des patients comprenaient des détails sur le type et l’indication de&nbsp; l’antibiothérapie. Une application en ligne personnalisée développée par l'Université d'Anvers (www.global-pps.be) a été utilisée pour la saisie, la validation, l'analyse et le reporting des données.<br><strong>Résultats</strong>: Sur les 326 patients au total qui étaient admis le jour de l'enquête, 70,6% et 73,4% prenaient au moins un antibiotique dans les services pour adultes et pédiatriques respectivement. Les antibiotiques les plus couramment utilisés comprennent les bêta-lactamines telles que les céphalosporines (29,2%) et les pénicillines (22,8%), les fluoroquinolones (12,4%), les aminosides (9,1%) et les macrolides (3,4%). Parmi les patients’ sous antibiotiques, la voie d'administration était principalement parentérale (71,6%) tandis que 44,8% prenaient plus d'un antibiotique. Dans l'ensemble, 91,3% des traitements antibiotiques étaient empiriques, les adultes, les enfants et les nouveau-nés représentant respectivement 96,4%, 77,6% et 100,0%. L'utilisation empirique d'antibiotiques est également élevée dans les services médicaux (86,3%), les services chirurgicaux (89,9%) et les unités de soins intensifs (100,0%).<br><strong>Conclusion</strong>: Il y a une prédominance et une dépendance excessive à l'antibiothérapie empirique dans notre hôpital. Il expose en outre la mauvaie utilisation du laboratoire de microbiologie clinique et le potentiel de développement d'une résistance aux antibiotiques avec une augmentation résultante de la morbidité/mortalité et une mauvaise sécurité des patients. Des études supplémentaires sont nécessaires pour mettre en évidence les dangers d'une dépendance excessive à l'antibiothérapie empirique et annoncer une amélioration dans le développement et la mise en œuvre d'un programme de gestion des antibiotiques.</p> <p><strong>Mots clés</strong>: antibiothérapie empirique, résistance aux antimicrobiens, enquête ponctuelle de prévalence, gestion des antimicrobiens</p> <p>&nbsp;</p> <p>&nbsp;</p> M.M. Manga, M. Ibrahim, U.M. Hassan, R.H. Joseph, A.S. Muhammad, M.A. Danimo, O. Ganiyu, A. Versporten, O.O. Oduyebo Copyright (c) https://www.ajol.info/index.php/ajcem/article/view/205640 Thu, 08 Apr 2021 00:00:00 +0000 Antibiogram of Pseudomonas species: an important tool to combat antibiotic resistance for patient safety in Gombe, Nigeria https://www.ajol.info/index.php/ajcem/article/view/205643 <p><strong>Background</strong>: Pseudomonas species are responsible for different healthcare-associated infections and are inherently resistant to many commonly used antibiotics. Hospital antibiograms are either absent or not regularly available in most healthcare facilities in Nigeria. The objective of this study is to present the antibiogram of Pseudomonas isolates in Federal Teaching Hospital Gombe (FTHG) in order to guide antibiotic prescription for better patient safety in the hospital.<br><strong>Methodology</strong>: The is a hospital-based cross-sectional study. A total of 4309 bacterial isolates were recovered from aerobic cultures of routine clinical specimens including urine, sputum, blood, swabs, aspirates, biopsies, seminal fluids and cerebrospinal fluids at the Medical Microbiology laboratory of the hospital between January and December 2019. Pseudomonas species were identified by colony morphology, Gram-reaction and conventional biochemical tests. Antibiotic susceptibility testing was performed on each Pseudomonas isolate using the modified Kirby-Bauer disk diffusion method on Mueller-Hinton agar and results interpreted according to the guideline of the Clinical and Laboratory Standards Institute (CLSI). Data were analysed using the Statistical Package for Social Sciences (SPSSTM) software version 23.0.<br><strong>Results</strong>: Of the total 4309 bacterial isolates, 436 (10.1%) Pseudomonas species were identified, with majority (49.8%) from urine specimens. Antibiotic susceptibility test results revealed average susceptibility rates of 73.8%, 70.1%, 66.2%, 59.5%, and 34.3% to ciprofloxacin, gentamicin, levofloxacin ceftazidime, and carbenicillin respectively. These rates fluctuate only slightly for each of the antibiotic during the 12 months period of survey.<br><strong>Conclusion</strong>: Pseudomonas species were most sensitive to ciprofloxacin and gentamicin among the first line antibiotics in FTHG in 2019. Regular updates and presentation of hospital antibiogram especially for intrinsically resistant bacteria such as Pseudomonas involved in healthcare associated infections, is an important tool in combating antimicrobial resistance and ensuring patient safety.</p> <p><strong>Keywords</strong>: antibiogram, Pseudomonas, antimicrobial resistance, antimicrobial stewardship, patient safety </p> M.M. Manga, M. Ibrahim, E.W. Isaac, M.D. Hassan, G. Muhammad, U.M. Hassan, Z. Yunusa-Kaltungo Copyright (c) https://www.ajol.info/index.php/ajcem/article/view/205643 Thu, 08 Apr 2021 00:00:00 +0000 Effects of rinsing on <i>Staphylococcus aureus</i> load in frozen meats and fish obtained from open markets in Benin City, Nigeria https://www.ajol.info/index.php/ajcem/article/view/205645 <p><strong>Background</strong>: <em>Staphylococcus aureus</em> is a ubiquitous bacterium present in the environment and one of the leading causes of superficial and deep infections. In the food industry, it is acclaimed to be globally responsible for several food-borne diseases. This study was designed to isolate methicillin-resistant <em>S. aureus</em> (MRSA) and determine the effect of rinsing on MRSA load in frozen meat and fish obtained from open market in Benin City.<br><strong>Methodology</strong>: Forty frozen meat samples (15 beef, 10 fish and 15 chickens) were randomly obtained from five markets in Benin City. The samples were analysed before and after rinsing using standard culture-based techniques to determine heterotrophic bacterial count, isolation of S. aureus, MRSA, and antibiotic susceptibility testing. Data were analysed using SPSS version 21 and Microsoft excel 2016, and association between variables were measured using Student’s t-test with a probability level of &lt; 0.05.<br><strong>Results</strong>: The natural logarithm (LN) of heterotrophic bacterial count (CFU/g) before rinsing were 11.53±1.25 (beef), 11.16±0.95 (fish) and 11.42±1.58 (chicken), while the counts after rinsing were 2.70±0.45 (beef), 2.68±0.25 (fish) and 2.79±0.49 (chicken) (p&lt;0.05). Sixteen of the 40 (40%) were positive for S. aureus, of which 4 (10%) were MRSA. Amongst the frozen meat evaluated in the study, beef had the highest frequency of <em>S. aureus</em> contamination (46.7%) followed by chicken (40.0%) and fish (30.0%). The profile of antibiotic resistance of <em>S.</em><em>aureus</em> showed that they were least resistant to ciprofloxacin (6%) but showed high resistance to erythromycin (94%), amoxicillin/clavulanic acid (87.5%) and trimethoprim-sulfamethoxazole (81%). Multiple antibiotic resistance index of <em>S. aureus</em> was calculated to be 0.63.<br><strong>Conclusion</strong>: The findings in this study revealed that frozen foods could act as a vehicle for the dissemination of antibiotic-resistant bacteria (ARB) and potential health risks for consumers.</p> <p><strong>Keywords</strong>: <em>Staphylococcus aureus</em>; antibiotic-resistant bacteria; MRSA; frozen meat; rinsing</p> <p>&nbsp;</p> <p><strong><em>French title:&nbsp; Effets du rinçage sur les charge de Staphylococcus aureus dans les viandes congelées et les poissons obtenus sur les marchés</em> ouverts de Benin City, Nigéria</strong></p> <p><strong>Contexte</strong>: Staphylococcus aureus est une bactérie ubiquitaire présente dans l'environnement et l'une des principales causes d'infections superficielles et profondes. Dans l'industrie alimentaire, il est reconnu pour être globalement responsable de plusieurs maladies d'origine alimentaire. Cette étude a été conçue pour isoler <em>S. aureus</em> résistant à la méthicilline (SARM) et déterminer l'effet du rinçage sur la charge de SARM dans la viande et le poisson congelés obtenus sur le marché libre de Benin City.<br><strong>Méthodologie</strong>: Quarante échantillons de viande congelée (15 bœuf, 10 poissons et 15 poulets) ont été obtenus au hasard sur cinq marchés de Benin City. Les échantillons ont été analysés avant et après le rinçage en utilisant des techniques de culture standard pour déterminer le nombre de bactéries hétérotrophes, l'isolement de <em>S. aureus,</em> le SARM et les tests de sensibilité aux antibiotiques. Les données ont été analysées à l'aide de SPSS version 21 et de Microsoft Excel 2016, et l'association entre les variables a été mesurée à l'aide du test t de Student avec un niveau de probabilité &lt;0,05.<br><strong>Résultats</strong>: Le logarithme naturel (LN) du nombre de bactéries hétérotrophes (UFC/g) avant rinçage était de 11,53±1,25 (bœuf), 11,16±0,95 (poisson) et 11,42±1,58 (poulet), tandis que les comptages après rinçage étaient de 2,70±0,45 (bœuf), 2,68±0,25 (poisson) et 2,79±0,49 (poulet) (p&lt;0,05). Seize des 40 (40%) étaient positifs pour<em> S. aureus</em>, dont 4 (10%) étaient SARM. Parmi les viandes congelées évaluées dans l'étude, le bœuf présentait la fréquence la plus élevée de contamination par S. aureus (46,7%), suivi du poulet (40,0%) et du poisson (30,0%). Le profil de résistance aux antibiotiques de S. aureus a montré qu'ils étaient les moins résistants à la ciprofloxacine (6%) mais présentaient une résistance élevée à l'érythromycine (94%), à l'amoxicilline/acide clavulanique (87,5%) et au triméthoprime-sulfaméthoxazole (81%). L'indice de résistance aux antibiotiques multiples de S. aureus a été calculé à 0,63.<br><strong>Conclusion</strong>: Les résultats de cette étude ont révélé que les aliments surgelés pourraient servir de vecteur de dissémination de bactéries résistantes aux antibiotiques (ARA) et de risques potentiels pour la santé des consommateurs.</p> <p><strong>Mots clés</strong>: <em>Staphylococcus aureus;</em> bactéries résistantes aux antibiotiques; SARM; viande congelée; rinçage</p> A.G. Ogofure, E.O. Igbinosa Copyright (c) https://www.ajol.info/index.php/ajcem/article/view/205645 Thu, 08 Apr 2021 00:00:00 +0000 Communication: Implementation of biosafety in infection control: a 10-year review https://www.ajol.info/index.php/ajcem/article/view/205644 <p>Biosafety is an important issue globally, as a line of defence that protects health personnel, public and the environment from exposure to hazardous agents. Most developing nations have weak health systems and consequently weak biosafety. Engaging in an external quality program such as an accreditation process will help build capacity and competence in all areas. The Centre for Human Virology and Genomics (CHVG) laboratory of the Nigerian Institute of Medical Research, Lagos, Nigeria started its biosafety program in compliance to international standards stipulated by ISO 15189:2012, in its journey towards laboratory accreditation. Accreditation is widely used to attest for laboratory competence. In the quest for laboratory accreditation, several processes were implemented to ensure compliance, one of which was biosafety. Simple remedial actions and policies that have worked in other climes were applied over a 10-year period in the CHVG laboratory. A significant drop in nonconforming incidences and laboratory accidents was seen while biosafety audits showed improvement in safety practices.</p> <p><br><strong>Keywords</strong>: Biosafety, Infection control, audit</p> <p>&nbsp;</p> <p><em><strong>French Title: Mise en œuvre de la biosécurité dans la lutte contre les infections: un examen décennal</strong></em></p> <p>La biosécurité est une question importante à l'échelle mondiale, en tant que ligne de défense qui protège le personnel de santé, le public et l'environnement de l'exposition à des agents dangereux. La plupart des pays en développement ont des systèmes de santé faibles et, par conséquent, une faible sécurité biologique. S'engager dans un programme de qualité externe tel qu'un processus d'accréditation aidera à renforcer les capacités et les compétences dans tous les domaines. Le laboratoire du Centre de virologie humaine et de génomique (CHVG) de l'Institut nigérian de recherche médicale de Lagos, au Nigéria, a commencé son programme de biosécurité conformément aux normes internationales stipulées par ISO 15189: 2012, dans son parcours vers l'accréditation des laboratoires. L'accréditation est largement utilisée pour attester la compétence du laboratoire. Dans la recherche de l'accréditation des laboratoires, plusieurs processus ont été mis en œuvre pour assurer la conformité, dont l'un était la biosécurité. Des mesures&nbsp; correctives simples et des politiques qui ont fonctionné sous d'autres climats ont été appliquées sur une période de 10 ans dans le laboratoire du CHVG. Une baisse significative des incidents non conformes et des accidents de laboratoire a été observée tandis que les audits de biosécurité ont montré une amélioration des pratiques de sécurité.</p> <p><strong>Mots clés</strong>: Biosécurité, Contrôle des infections, audit </p> M.O. Uwandu, F.A. Ige, A.P. Okwuraiwe, C.K. Onwuamah, R.A. Audu Copyright (c) https://www.ajol.info/index.php/ajcem/article/view/205644 Thu, 08 Apr 2021 00:00:00 +0000 Using longitudinal antibiotic point prevalence survey (PPS) to drive antimicrobial stewardship programmes in a Nigerian tertiary hospital https://www.ajol.info/index.php/ajcem/article/view/205650 <p><strong>Background</strong>: Antimicrobial stewardship (AMS) provides a means of tackling antimicrobial resistance (AMR). Unfortunately, in Nigeria, like in some other low-and-middle-income countries (LMICs), AMS practice has been lacklustre due to poor institutional support amongst other factors. Efforts were made to address this situation by engaging with the management of National Hospital Abuja, Nigeria, using antibiotic prescription information obtained through repeated point prevalence survey.<br><strong>Methodology:</strong> Two rounds of antibiotic PPS were conducted in 2015 and 2017 using the Global Point Prevalence Survey (G-PPS) format. Data were collected from all inpatients receiving antibiotics on the selected day of study, including patient characteristics, antimicrobial prescription details, laboratory results and information on a set of quality indicators. The data were uploaded to an online G-PPS application hosted at the University of Antwerp in Belgium for validation, analysis and reporting.<br><strong>Results:</strong> The PPS data showed that hospital-wide antibiotic use prevalence increased from 58% in 2015 to 61% in 2017. Surgical prophylaxis beyond 24 hours also increased from 88-90% in 2015 to 100% in 2017, and only minority of therapies were supported by laboratory input for diagnosis and monitoring; 22% in 2015 and 5% in 2017.<br><strong>Conclusion</strong>: These results were used for evidence-based engagement with the management to formally support AMS activities in the hospital. Positive outcomes were the formal reconstitution and inauguration of AMS committee in 2018 as well as the issuance of a formal policy statement by the hospital in 2020. The ease and free availability of Global PPS methodology makes it ideal in driving antimicrobial stewardship programme (ASP) in LMICs like Nigeria.</p> <p><strong>Keywords:</strong> Antibiotic stewardship checklist, institutional support, point</p> <p>&nbsp;</p> <p><em><strong>French Title: Utilisation d'une enquête longitudinale sur la prévalence ponctuelle des antibiotiques (PPS) pour conduire des programmes de gestion des antimicrobiens dans un hôpital tertiaire nigérian</strong></em></p> <p><strong>Contexte</strong>: La gestion des antimicrobiens (AMS) offre un moyen de lutter contre la résistance aux antimicrobiens (RAM). Malheureusement, au Nigéria, comme dans certains autres pays à revenu faible ou intermédiaire (PRFI), la pratique de la MGS a été médiocre en raison d'un soutien institutionnel insuffisant, entre autres facteurs. Des&nbsp; Longitudinal PPS for AMS programmes <br>efforts ont été faits pour remédier à cette situation en collaborant avec la direction de l'hôpital national d'Abuja, au Nigéria, en utilisant les informations sur les prescriptions d'antibiotiques obtenues grâce à une enquête ponctuelle répétée de prévalence.<br><strong>Méthodologie:</strong> Deux séries d'antibiotiques PPS ont été menées en 2015 et 2017 en utilisant le format Global Point Prevalence Survey (G-PPS). Des données ont été recueillies auprès de tous les patients hospitalisés recevant des antibiotiques le jour sélectionné de l'étude, y compris les caractéristiques des patients, les détails de la prescription d'antimicrobiens, les résultats de laboratoire et les informations sur un ensemble d'indicateurs de qualité. Les données ont été téléchargées sur une application en ligne G-PPS hébergée à l'Université d'Anvers en Belgique à des fins de validation, d'analyse et rapports.<br><strong>Résultats:</strong> Les données PPS ont montré que la prévalence de l'utilisation d'antibiotiques à l'échelle de l'hôpital est passée de 58% en 2015 à 61% en 2017. La prophylaxie chirurgicale au-delà de 24 heures est également passée de 88 à 90% en 2015 à 100% en 2017, et seule une minorité de thérapies a été soutenue par entrée de laboratoire pour le diagnostic et la surveillance; 22% en 2015 et 5% en 2017.<br><strong>Conclusion:</strong> Ces résultats ont été utilisés pour un engagement fondé sur des données probantes avec la direction afin de soutenir officiellement les activités AMS à l'hôpital. Les résultats positifs ont été la reconstitution formelle et l'inauguration du comité AMS en 2018 ainsi que la publication d'une déclaration de politique formelle par l'hôpital en 2020. La facilité et la disponibilité gratuite de la méthodologie Global PPS la rend idéale pour conduire le programme de gestion des antimicrobiens (ASP) en PRFI comme le Nigéria.</p> <p><strong>Mots clés:</strong> liste de contrôle pour la gestion des antibiotiques, soutien institutionnel, enquête ponctuelle de prévalence, déclaration de politique prevalence survey, policy statement </p> <p>&nbsp;</p> P. Nwajiobi-Princewill, N. Medugu, M. Gobel, A. Aigbe, A. Versporten, I. Pauwels, H. Goossens, K.C. Iregbu Copyright (c) https://www.ajol.info/index.php/ajcem/article/view/205650 Thu, 08 Apr 2021 00:00:00 +0000 Improved <i>Cryptosporidium</i> case findings using immunofluorescent microscopy on concentrated stool https://www.ajol.info/index.php/ajcem/article/view/205646 <p><strong>Background:</strong> Diarrhoea is a major cause of morbidity in Cape Town, South Africa, and mortality is attributed to a failure to recognize the severity of the condition. Cryptosporidium and Giardia are increasingly recognized as important causes of diarrhoea in Africa however, suboptimal diagnostic techniques may lead to underappreciation of their significance. Our objectives are to compare the diagnostic yield of direct immunofluorescent antigen (DFA) microscopy on concentrated stool samples for Cryptosporidium and Giardia, with the current approach of wet mount microscopy for Giardia and auramine fluorescent stain for Cryptosporidium on unconcentrated stool.<br><strong>Methodology</strong>: Stool specimens (n=104) received at our hospital laboratory for routine microbiological investigations were used for the study. Direct wet-mount auramine-phenol fluorescent microscopy (auramine) detection of Cryptosporidium oocysts and wet mount iodine microscopy for Giardia detection, were performed on unconcentrated stool samples, while DFA stain for simultaneous detection of Cryptosporidium and Giardia was performed on sodium-acetate formalin concentrated stool samples. The diagnostic yields of the tests were compared using the MEDCALC® version 18.0<br><strong>Results</strong>: Of the 104 stool specimens received for microbiological analysis, only 66 (63.5%) had specific Cryptosporidium requests while 38 (36.5%) had no Cryptosporidium specific requests. Of the 66 specimens, 9 (13.6%) were positive for Cryptosporidium oocysts with DFA while only 1 (1.5%) was positive with auramine staining (p=0.013). The one auramine-positive specimen was also positive by DFA. Auramine stain microscopy gave a sensitivity of 11.1% (95%CI: 0.28-48.25%) and specificity of 100% (95%CI: 93.7%-100%) when compared to DFA. Of the 38 stool specimens without specific Cryptosporidium request, DFA yielded 5 (13.2%) additional positive results. Taken together, Cryptosporidium was detected in 14/104 (13.5%; 95%CI: 8.36–21.7%) specimens and only 1 of 14 (7.1%) specimens with the current routine laboratory testing approach. Giardia was detected by DFA in 3/104 (0.9%) specimens, while direct iodine wet mount microscopy did not yield any positive results (0%). All 3 Giardia-positive specimens had Cryptosporidium oocysts detected by DFA.<br><strong>Conclusion</strong>: These data suggest that a large proportion of Cryptosporidium cases remain undetected by the laboratory due to suboptimal testing methods, and failure by clinicians to specifically request for Cryptosporidium detection. There is need to periodically assess the effectiveness of diagnostic microbiology laboratory approaches to diarrhoea, and access to improved diagnostic laboratory techniques will contribute to more accurate differential diagnosis and a broadened understanding of local aetiology of diarrhoea diseases in Africa.</p> <p><strong>Keywords</strong>: Cryptosporidium, Giardia, diarrhoea, stool concentration, DFA, microscopy </p> <p><em><strong>French Title: Amélioration des découvertes de cas de Cryptosporidium à l'aide de la microscopie immunofluorescente sur des selles concentrées</strong></em></p> <p><strong>Contexte</strong>: La diarrhée est une cause majeure de morbidité au Cap, en Afrique du Sud, et la mortalité est attribuée à l'incapacité de reconnaître la gravité de la maladie. Cryptosporidium et Giardia sont de plus en plus reconnus comme des causes importantes de diarrhée en Afrique, cependant, des techniques de diagnostic sous-optimales peuvent conduire à une sous-estimation de leur importance. Nos objectifs sont de comparer le rendement diagnostique de la microscopie à antigène immunofluorescent direct (DFA) sur des échantillons de selles concentrées pour Cryptosporidium et Giardia, avec l'approche actuelle de la microscopie à montage humide pour Giardia et la coloration fluorescente auramine pour Cryptosporidium sur des selles non concentrées.<br><strong>Méthodologie</strong>: Des échantillons de selles (n=104) reçus au laboratoire de notre hôpital pour des examens microbiologiques de routine ont été utilisés pour l'étude. La détection directe par microscopie fluorescente auramine-phénol à montage humide (auramine) des oocystes de Cryptosporidium et la microscopie à l'iode à montage humide pour la détection de Giardia, ont été effectuées sur des échantillons de selles non concentrées, tandis que la coloration DFA pour la détection simultanée de Cryptosporidium et de Giardia a été réalisée sur de l'acétate de sodium formaline concentré échantillons de selles. Les rendements diagnostiques des tests ont été<br>comparés à l'aide de MEDCALC® version 18.0<br><strong>Résultats</strong>: Sur les 104 échantillons de selles reçus pour l'analyse microbiologique, seuls 66 (63,5%) avaient des demandes spécifiques de Cryptosporidium tandis que 38 (36,5%) n'avaient pas de demandes spécifiques de Cryptosporidium. Sur les 66 échantillons, 9 (13,6%) étaient positifs pour les oocystes de Cryptosporidium avec DFA tandis que seulement 1 (1,5%) était positif avec coloration à l'auramine (p=0,013). Le seul échantillon positif à l'auramine était également positif au DFA. La microscopie à l'auramine a donné une sensibilité de 11,1% (IC 95%: 0,28-48,25%) et une spécificité de 100% (IC 95%: 93,7% -100%) par rapport au DFA. Sur les 38 échantillons de selles sans demande spécifique de Cryptosporidium, le DFA a donné 5 (13,2%) résultats positifs supplémentaires. Pris ensemble, Cryptosporidium a été détecté dans 14/104 (13,5%; IC à 95%: 8,36–21,7%) et seulement 1 des 14 échantillons (7,1%) avec l'approche actuelle des tests de routine en laboratoire. Giardia a été détecté par DFA dans 3/104 (0,9%) échantillons, tandis que la microscopie directe à l'iode sur monture humide n'a donné aucun résultat positif (0%). Les 3 échantillons positifs à Giardia avaient des oocystes de<br>Cryptosporidium détectés par DFA.<br><strong>Conclusion</strong>: Ces données suggèrent qu'une grande proportion des cas de Cryptosporidium ne sont pas détectés par le laboratoire en raison de méthodes de test sous-optimales et de l'échec des cliniciens à demander spécifiquement la détection de Cryptosporidium. Il est nécessaire d'évaluer périodiquement l'efficacité des approches de laboratoire de microbiologie diagnostique pour la diarrhée, et l'accès à des techniques de laboratoire de diagnostic améliorées contribuera à un diagnostic différentiel plus précis et à une compréhension élargie de l'étiologie locale des maladies diarrhéiques en Afrique.</p> <p><strong>Mots clés:</strong> Cryptosporidium, Giardia, diarrhée, concentration des selles, DFA, microscopie </p> D. Cox, F.J.L. Robberts Copyright (c) https://www.ajol.info/index.php/ajcem/article/view/205646 Thu, 08 Apr 2021 00:00:00 +0000 Non-tuberculous mycobacteria isolated from patients with suspected tuberculosis in Abidjan, Ivory Coast https://www.ajol.info/index.php/ajcem/article/view/205647 <p><strong>Background</strong>: Apart from tuberculosis caused by Mycobacterium tuberculosis complex (MTBc) species, there are many other&nbsp; mycobacterial infections due to nontuberculous mycobacteria (NTM). These are rarely identified in many low resource settings in Africa because of the lack of accurate identification methods. The aim of the study is to identify NTM species involved in respiratory infections in Abidjan, Ivory Coast.<br><strong>Methodology</strong>: Isolates routinely identified as NTM by the detection of MPT64 antigen between 2015 and 2018 at the Centre for Diagnosis and Research on AIDS and other Infectious Diseases (CeDReS) of the University Hospital of Treichville, were included in the study. Bacterial strains were sub-cultured on three different Lowenstein-Jensen media in order to determine their cultural characteristics, and molecular identification of the strains was performed first by polymerase chain reaction (PCR) assay followed by reverse hybridization (GenoType Mycobacterium CM and AS kits, Hain Lifescience, Germany). The Cohen’s kappa statistical coefficient<br>was used to evaluate the degree of agreement of the phenotypic with the molecular method.<br><strong>Results</strong>: Of 62 NTM isolates tested with the molecular method, 54 (87.1%) tested positive and the main species identified were Mycobacterium fortuitum (52%), followed by Mycobacterium abscessus (13%) alone or in combination with other species. Thirty-six (58.1%) of the 62 NTM isolates were identified phenotypically, out of which 31 (86.1%) were correctly identified by molecular method. The comparison of molecular and phenotypic methods revealed a good concordance, allowing the use of cultural patterns as identification tests in resource limited settings. However, MTBc isolates were identified among the NTM isolates, indicating that even if the rapid test for detection of MPT64 antigen is quite accurate, it could lack sensitivity and specificity in some cases.<br><strong>Conclusion</strong>: Mycobacterium fortuitum and M. abscessus were identified as the main NTM species circulating in Abidjan but there is need for additional evaluation of MPT64 antigen detection assay for MTBc.</p> <p><strong>Keywords</strong>: non-tuberculous mycobacteria, identification, PCR, GenoType CM/AS, culture</p> <p>&nbsp;</p> <p><em><strong>French Title: Mycobactéries non tuberculeuses isolées chez des patients suspects de tuberculose à Abidjan, Côte d'Ivoire</strong></em></p> <p><strong>Contexte</strong>: Outre la tuberculose causée par les espèces du complexe Mycobacterium tuberculosis (MTBc), il existe de nombreuses autres infections mycobactériennes dues à des mycobactéries non tuberculeuses (MNT). Ceux-ci sont rarement identifiés dans de nombreuses régions à ressources limitées, notamment en Afrique en raison du manque de méthodes d'identification précises. Le but de l'étude était d'identifier les espèces de MNT impliquées dans les infections respiratoires à Abidjan, en Côte d'Ivoire.<br><strong>Méthodologie:</strong> Des isolats identifiés en routine comme étant des MNT par la détection de l'antigène MPT64 entre&nbsp; Non-tuberculous mycobacteria in Ivory Coast&nbsp; 2015 et 2018 au Centre de diagnostic et de recherche sur le sida et autres maladies infectieuses (CeDReS) sis au sein du CHU de Treichville, ont été inclus dans l'étude. Les souches bactériennes ont été réisolées sur trois milieux de Lowenstein-Jensen différents afin de déterminer leurs caractéristiques culturales, et l'identification moléculaire des souches a d'abord été réalisée par un test réaction de polymérisation en chaîne (PCR) suivi d'une hybridation inverse (kits GenoType Mycobacterium CM et AS, Hain Lifescience, Allemagne). Le test statistique kappa de Cohen a été utilisé pour évaluer le degré d’accord entre le phénotype et la méthode moléculaire.<br><strong>Résultats</strong>: Sur 62 isolats de NTM testés avec la méthode moléculaire, 54 (87,1%) ont été trouvés positifs les principales espèces identifiées étant Mycobacterium fortuitum (52%), suivi de Mycobacterium abscessus (13%) seul ou en association avec d'autres espèces. Trente-six (58,1%) des 62 isolats de MNT ont été identifiés phénotypiquement, parmi lesquels 31 (86,1%) ont été correctement identifiés par la méthode moléculaire. La comparaison des méthodes moléculaires et phénotypiques a révélé une bonne concordance, permettant l'utilisation de caractères culturaux comme tests d'orientation dans des zones à ressources limitées. Cependant, des isolats de MTBc ont été identifiés parmi les isolats de MNT, indiquant que même si le test rapide de détection de l'antigène MPT64 est assez précis, il pourrait manquer de sensibilité et de spécificité dans certains cas.</p> <p><strong>Conclusion</strong>: Mycobacterium fortuitum et M. abscessus ont été identifiés comme les principales espèces de MNT circulant à Abidjan mais il est nécessaire de procéder à une évaluation supplémentaire du test de détection de l'antigène MPT64 pour l'identification des MTBc.</p> <p><strong>Mots clés:</strong> mycobactéries non tuberculeuses, identification, PCR, GenoType CM/AS, culture </p> T. Ouassa, M.S. N’Guessan-Kacou, K.A. Kouakou Copyright (c) https://www.ajol.info/index.php/ajcem/article/view/205647 Thu, 08 Apr 2021 00:00:00 +0000 Correspondence: Doctors do not use the medical microbiology laboratory when infectious diseases are suspected https://www.ajol.info/index.php/ajcem/article/view/205649 <p><em><strong>French Title: Les médecins n'utilisent pas le laboratoire de microbiologie médicale en cas de suspicion de maladies infectieuses</strong></em></p> S. Lawson, H.E. Omunakwe Copyright (c) https://www.ajol.info/index.php/ajcem/article/view/205649 Thu, 08 Apr 2021 00:00:00 +0000