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A case of urinary tract infection due to Candida albicans and responding to fluconazole is presented

The year 2020 made 52 years since the first report of Lassa fever (LF) outbreaks from Nigeria, but what progress has been made in its control? We sought to answer this through an epidemiologic analysis of the temporal and spatial trends of the outbreaks from 1969 to 2020. The analysis showed an overall strengthening of the outbreaks, hallmarked by the change from irregular to regular annual and from limited local to nationwide outbreaks, while there was a sharp contrast between the upward trend in case numbers and downward trend in case fatality. Pending the availability of effective vaccines, greater effort is required to reverse the upward trend in case numbers and sustain the downward trend in case fatality. We discuss the factors associated with the observed trends as well as the prerequisites for further improvements.

Background: The general lack of comprehensive data on the trends of Lassa fever (LF) outbreaks contrasts with its widespread occurrence in West Africa and is an important constraint in the design of effective control measures. We reviewed the contribution of LF to admissions and mortality among hospitalized patients from 2001 to 2018 in the bid to address this gap. Methods: Observational study of LF caseload and mortality from 2001 to 18 in terms of the contribution of confirmed LF to admissions and deaths, and case fatality (CF) among patients with confirmed LF at a specialist center in Nigeria. The diagnosis of LF was confirmed using reverse transcription polymerase chain reaction (RT-PCR) test, and medians and frequencies were compared using Kruskal-Wallis, Mann-Whitney and χ2 tests, with p -values <0.05 taken as significant. Results: The contribution of confirmed LF to deaths (362/9057, 4.0%) was significantly higher than to admissions (1,298/185,707, 0.7%; OR [95% CI] = 5.9 [5.3, 6.7], p < 0.001). The average CF among patients with confirmed LF declined from 154/355 (43%) in 2001-09 to 183/867 (21.1%) (OR [95% CI] = 2.9 [2.2, 3.7], p < 0.001) in 2011-18. The annual CF declined from 94% in 2001 to 15% in 2018 whereas the caseload increased from 0.3 to 3.4%. The outbreaks were characterized by irregular cycles of high caseload in 2005-2007, 2012-2014, and 2016-2018, and progressive blurring of the seasonality. Conclusion: LF outbreaks in Nigeria have upgraded spatially and temporally, with the potential for cycles of increasing severity. The strategic establishment of LF surveillance and clinical case management centers could be a pragmatic and cost-effective approach to mitigating the outbreaks, particularly in reducing the associated CF. Urgent efforts are needed in reinvigorating extant control measures while the search for sustainable solutions continues.

Next-generation sequencing (NGS) has the potential to transform the discovery of viruses causing unexplained acute febrile illness (UAFI) because it does not depend on culturing the pathogen or a priori knowledge of the pathogen's nucleic acid sequence. More generally, it has the potential to elucidate the complete human virome, including viruses that cause no overt symptoms of disease, but may have unrecognized immunological or developmental consequences. We have used NGS to identify RNA viruses in the blood of 195 patients with UAFI and compared them with those found in 328 apparently healthy (i.e., no overt signs of illness) control individuals, all from communities in southeastern Nigeria. Among UAFI patients, we identified the presence of nucleic acids from several well-characterized pathogenic viruses, such as HIV-1, hepatitis, and Lassa virus. In our cohort of healthy individuals, however, we detected the nucleic acids of two novel rhabdoviruses. These viruses, which we call Ekpoma virus-1 (EKV-1) and Ekpoma virus-2 (EKV-2), are highly divergent, with little identity to each other or other known viruses. The most closely related rhabdoviruses are members of the genus Tibrovirus and Bas-Congo virus (BASV), which was recently identified in an individual with symptoms resembling hemorrhagic fever. Furthermore, by conducting a serosurvey of our study cohort, we find evidence for remarkably high exposure rates to the identified rhabdoviruses. The recent discoveries of novel rhabdoviruses by multiple research groups suggest that human infection with rhabdoviruses might be common. While the prevalence and clinical significance of these viruses are currently unknown, these viruses could have previously unrecognized impacts on human health; further research to understand the immunological and developmental impact of these viruses should be explored. More generally, the identification of similar novel viruses in individuals with and without overt symptoms of disease highlights the need for a broader understanding of the human virome as efforts for viral detection and discovery advance.

Background/objective: The relative balance between Th1 and Th2 cytokines appears crucial in the outcome of infections. We assayed the levels of some proinflammatory Th1 cytokines, interleukin-2 (IL-2) and interferon-gamma (IFN-gamma), and anti-inflammatory Th2 cytokines, IL-4 and IL-10 in homozygous haemoglobin (Hb) AA, heterozygous HbAS-genotyped and sickle cell (HbSS) individuals with uncomplicated Plasmodium falciparum malaria., Methods: Levels of Th1 and Th2 cytokines of 111 children aged 1-5 years with uncomplicated malaria and 89 healthy controls were determined by enzyme linked immunosorbent assay and haematological parameters were estimated using the automated Swelab counter (Boule Medical, Stockholm, Sweden)., Results: Th1 and Th2 cytokine levels were significantly higher in HbAA and HbAS-genotyped patients compared to their respective healthy controls (P<0·05). IFN-gamma, IL-2, and IL-10 were significantly elevated in HbAA compared to HbAS and HbSS subjects (P<0·05). The mean haematological parameters (total white cell count and monocytes) of HbSS-infected children were significantly higher compared to those of HbAA and HbAS subjects (P<0·05); however, their mean packed cell volume was significantly lower compared to others (P<0·05)., Conclusion: Our results showed a stronger Th1 cytokine response in HbAA than HbAS and HbSS individuals; this may suggest an immunocompetence of the HbAA individuals in early infection.

Background and Purpose: In areas where malaria is endemic, drug prophylaxis is required for people with sickle cell disease. Chloroquine resistance has been associated with the Plasmodium falciparum multidrug resistance 1 (Pfmdr1) mutant gene. This study tested for the Pfmdr1 86Y mutation in P. falciparum isolates from individuals with sickle cell disease and sickle cell trait, who also underwent hemoglobin genotyping., Methods: Blood samples were collected from patients presenting with symptoms of malaria in an endemic region. The subjects were screened for hemoglobin genotype using hemoglobin electrophoresis and P. falciparum Pfmdr1 genotyping was carried out using polymerase chain reaction-restriction fragment length polymorphism., Results: 229 subjects, comprising 144 with hemoglobin AA genotype, 57 with hemoglobin AS genotype and 28 with hemoglobin SS genotype, were enrolled in this study. There was no significant difference in the infective rate of malaria in the 3 groups (p>0.05). However, the prevalence of Pfmdr1 86Y was higher in those with hemoglobin SS genotype than in hemoglobin AA and AS subjects (p<0.05)., Conclusions: Uncontrolled use of chloroquine is a major cause of chloroquine resistance in Nigeria. Chloroquine prophylaxis may be the underlying cause of the high prevalence of Pfmdr1 86Y mutant gene in individuals with hemoglobin SS genotype.

Background & Objectives: High mortality and morbidity in sickle-cell disease has been associated with malaria infection especially in countries where chloroquine is used. Chloroquine resistance has been associated with the emergence of Pfcrt mutant genes. This study aimed at comparing the prevalence rate of Pfcrt T76 mutation in Plasmodium falciparum isolates from infected individuals with sickle-cell disease and sickle-cell trait. This study was carried out in Benin City between the months of April and June 2006. This period is marked with high transmission rate of malaria., Methods: The genotype of the subjects was screened using haemoglobin electrophoresis system and the P. falciparum. Pfcrt genotyping was carried out using PCR-restriction fragment length polymorphism (RFLP)., Results: Four hundred and twenty-four subjects comprising of 207 haemoglobin AA, 136 haemoglobin AS and 81 haemoglobin SS typed individuals were enrolled for this study. No significant difference existed in the prevalence rate of malaria in the three groups (p > 0.05). However, the prevalence rate of Pfcrt K76T mutant gene was higher in the haemoglobin SS genotyped individuals than the haemoglobin AA and AS subjects (p < 0.05)., Interpretation & Conclusion: An uncontrolled use of chloroquine has been incriminated as the major cause of chloroquine resistance in Nigeria. Therefore, rapid intervention measures are needed as a matter of urgency to curb the up rise in the prevalence of the chloroquine resistant genes in our environment.

Background: Chlamydia infections have been reported to cause silent infections in communities which becomes endemic and could remain unnoticed for a very long time. In most parts of Nigeria these organisms are not screened for, and hence relative information about frequencies of the organisms are sparse., Method: Five hundred and sixty five blood samples and ten umbilical cord fluids were collected from various patients attending clinics in South Eastern Nigeria and were screened for Chlamydia Complement Fixing Antibody (CCFA). Endocervical swabs and urethral discharges or swabs were collected from patients whose serum was positive and were cultured into embryonic eggs which was later observed, harvested and stained using the Romanowsky-Giemsa staining techniques. The positive sera were further confirmed by distinguishing the species of Chlamydia using the monoclonal antibody spot test kit., Result: Of the five hundred and sixty five (565) samples collected only three hundred and forty were positive to CCFA, of which 141 were males and 204 females. From the cultured samples 230 were positive for Chlamydia trachomatis and 99 positive to Chlamydia pneumoniae. Statistical analysis using the student's t test at 95% confidence interval shows that there was no significant difference between the number of females and males that presented themselves for screening., Conclusion: Proper screening of patients to include Chlamydia should be encouraged at all levels of medical diagnosis in the country so as to proffer treatment. Otherwise the infection will remain a "silent epidemic", as is the case currently.

Of the 876 rodents caught in different parts of Ekpoma, Nigeria, and environs, 218 were Mastomys natalensis, while 658 were other rodents. Of the 218 M. natalensis caught, 102 (46.79%) were positive for complement fixing antibody to Lassa virus.

There is a broad group of venereal disease that is referred to as the "Tropical Venereal Disease". They are so-called because they are most frequently seen in the tropical and sub-tropical areas of the world. Among them are conditions like chancroid, lymphogranuloma venereum (LGV or climatic bubo) and granuloma inguinale (chronic venereal sores). Chancroid is variously called "soft sore" or "soft chancre" because it bleeds easily and "ulcus moile".1 It is an acute infection and auto-innoculable disease. The extent of chancroid genital ulceration in Nigeria is greater in the Northern partly due to permissive sexual practices especially for men.

The trypanosomostatic and trypanosomicidal effects of four anti-protozoal drugs, namely halofantrine hydrochloride, chloroquine phosphate, benzoylmetronidazole and pyrimethamine, on species of trypanosomes, viz. Trypanosoma brucei brucei (MBOS/NG/94/NITR) Bassa strain, T. congolense (MBOS/NG/93/NVRI) Zaria strain and T. brucei gambiense (MHOM/NG/92/NITR) Abraka strain, were investigated. In vitro and in vivo studies on these drugs vis-a-vis the parasites were carried out. The histopathological changes in organs and tissues of experimentally infected rats were also studied. Results from the in vitro studies indicated that halofantrine hydrochloride, chloroquine phosphate, benzoylmetronidazole and pyrimethamine appeared to be effective trypanosomicidal agents against T. brucei brucei (Bassa strain), T. congolense (Zaria strain) and T. brucei gambiense (Abraka strain). The in vivo studies showed that these drugs were sub-curative by prolonging the survival period of the trypanosome-infected rats, but not necessarily curing the infection. Histopathological findings indicated inflammatory reactions characterised by infiltration to variable degrees in the majority of tissues, mostly in the lungs and liver. The most consistent lesions were interstitial pneumonia, multifocal necrosis and oedema. Pathological findings showed the T. brucei brucei and T. brucei gambiense strains studied to be both intravascular and extravascular parasites. These results suggest that halofantrine hydrochloride, chloroquine phosphate, benzoylmetronidazole and pyrimethamine could be used as supportive, suppressive and/or synergistic/additive drugs in the treatment of African trypanosomiasis. Their effects on species of trypanosomes have been studied and are reported for the first time.

Two plant products, Euphorbia hirta leaves and fruits of Musa sapientum, were evaluated as principal ingredients for selective cultivation of fungi. Sapientum glucose agar supported the growth of both dermatophytic, yeast-like, and saprophytic fungi; growth on this medium compared favourably with growth on Sabouraud glucose agar, a standard mycological medium. Sporulation and pigment formation were stronger on sapientum glucose agar than on Sabouraud glucose agar, although fungal growth on the latter was more luxuriant. Addition of Euphorbia extract to mycological media remarkably enhanced fungal growth on the media, and concomitantly suppressed bacterial growth to a similar extent as did antibiotics. The results of this study suggest that Euphorbia sapientum glucose agar can safely be recommended as a cheap and efficient medium for routine isolation of fungi in both clinical and general mycological studies.

Cord blood was obtained from 164 neonates at birth and investigated for the presence of aflatoxins. 14 of the samples were neonates without jaundice and 150 from neonates with jaundice. There was significant reduction (P > 0.05) in birth weight of jaundiced neonates with aflatoxin. Neonates with jaundice have high mean concentration of aflatoxin B1 (32.3 ng/ml and 35.6 ng/ml). Aflatoxin G1 was not detected in any of the groups. The rate of detection was higher in wet (81.8%) than dry season (50.0%). These findings show that neonates are exposed to aflatoxin prenatally and that high incidence of jaundice occurred in the wet warm months.

The adherence capacity of Candida species to female vaginal epithelial cells was examined. The results showed that in four groups of patients studied, the highest adherence was with epithelial cells collected from pregnant diabetic women (47% adherence, and 1,700 adherent yeasts). Pregnant or diabetic women had 39% each of adherence to epithelial cells but differed in the number of adherent yeasts (1,400 and 1,000 respectively). The diabetic and pregnant women therefore appeared differential attachment to epithelial cells from different physiologically adapted women.

Rabbit anti-antibody raised against Plesiomonas shigelloides infections using standard immunological procedures. Ten (50%) of 20 rats died when only P. shigelloidess was injected while 2(10%) died [P < 0.05]; following injection of another group of 20 rats with P. shigelloides 24hours after administration of rabbit-Plesiomonas anti-antibody. In another scheme, 14(70%) of 20 rats died when p.shigelloides and colloidal carbon particles (CCP) were administered while only 4(20%) died (p<0.05) following injection of P. shigelloides and CCP 24 hours after administration of rabbit-Plesiomonas anti-antibody. No death was recorded for control rats which received only CCP. This study highlights a novel approach in the management or prevention of P. shigelloides infection in our environment.

Of 1400 pupils from two public primary schools in Ekpoma, Edo State, Nigeria, who were screened for dermatophyte infection, 188 (13.4%) were infected. The causative agents isolated included Microsporum audouinii in 88 (46.8%), Trichophyton mentagrophytes in 48 (25.5%), T. rubrum in 40 (21.3%), T. tonsurans in four (2.1%) and Epidermophyton floccosum in eight (4.3%). There were significant differences in the rate of infection between male and female schoolchildren as well as between children from different socioeconomic backgrounds.

Three Yersinia species Yersinia enterocolitica, serogroup 0:9, Yersinia intermedia, serogroup 0:52.54 and Yersinia fredricksenii, serogroup 0:44.45 were experimentally inoculated into 249 giant African snails, Achachatina marginata, and the rate of recovery, as well as change (loss or gain) in weight determined. Results obtained showed that there was a high recovery rate of the inoculated Yersinia serogroups. Also, the snails showed loss in weight which increased with increase in recovery rate. No death of the infected snail was recorded. This study has revealed that snails (Achachatina marginata) could be potential carriers of Yersinia spp. and may therefore, play a role in the epidemiology of yersiniosis in our environment.

Sixteen isolates of four species of Yersinia comprising five of Yersinia enterocolitica and Yersinia fredricksenii, four of Yersinia intermedia and two of Yersinia kristensenii isolated from domestic and wild animals in villages in Edo and Delta States, Nigeria, were evaluated for their pathogenicity using laboratory animal models and virulence characteristics tests which included autoagglutinability, calcium dependency for growth, heat-stable enterotoxin production and conjunctivities in guinea pig eye. Results obtained revealed that Yersinia enterocolitica isolates were enteropathogenic as demonstrated by the production of diarrhoea and eventual recovery from faeces, spleen and liver of the infected animals. Three (60%) (2 serotypes 0:3 and 1 serotype 0:8) of the five Yersinia enterocolitica isolates were lethal to the animals. Other Yersinia isolates (Yersinia kristensenii, Yersinia fredricksenii and Yersinia intermedia) were uniformly non pathogenic to the animals. However, a strain of Yersinia intermedia isolate produced diarrhoea in the inoculated animals and caused lethality in guinea pigs and mice, but was negative for autoagglutination test, calcium dependency, conjunctivities, and positive for heat-stable enterotoxin production. We are of the view that this strain may be another Yersinia intermedia--like bacterium, previously isolated in Nigeria. Results therefore, suggest an emergence of a pathogenic Yersinia intermedia species in this environment.

Two hundred and fifty apparently healthy pregnant women attending the Obstetrics and Gynecology Clinic of the Lagos University Teaching Hospital (LUTH), Lagos, Nigeria were screened for a comparison of the prevalence of HIV seropositivity and hepatitis B surface antigenemia (HBs Ag) amongst them. The Karpas AIDS cell test for HIV seropositivity and Bioman Hepatitis test kits were used as described by the manufacturers. HIV seropositive cases were confirmed using the Western blot test. Results revealed that out of the 250 pregnant women screened, 2 (0.8%) and 11 (4.4%) were HIV-1 and HBs Ag seropositive, respectively. However, the same 2 pregnant women now constituting 2 (18.2%) of the 11 HBs Ag positive pregnant women were simultaneously HIV-1 seropositive. Antibody to HIV-2 was not recorded in all HIV seropositive cases. This is the first report on the simultaneous prevalence of HBs Ag and HIV seropositivity among apparently healthy pregnant women in Lagos, Nigeria.

Stool specimen from 994 patients with Acute Diarrhoeal Diseases were processed for bacterial agents known to be responsible for acute diarrhoea. These were from patients seen at the Lagos University Teaching Hospital over a 9 month period. The pattern that emerged showed Shigella isolates made up by 36 flexneri; 29 boydii, 21 dysenteriae and 4 sonnei; Salmonella isolates were typhi 3, typhimurium 12, enteritidis 3, Oranienburg 9, others 8; Yersinia enterocolitica 14; Campylobacter species 20; Enterotoxinogenic E. coli 12, Vibrio cholerae 5; Enteropathogenic E. coli 35; Enterotoxinogenic E. coli 12; Enteroinvasive E. coli 5. Shigella was by far the most common with 43.6% of the isolates EPEC with 17% Salmonella 12% Campylobacter species 9.7%. Yersinia enterocolitica 6.7% ETEC 6%, Vibrio cholera 2.5% and EIEC 2.5%. The isolates are discussed in relation to age groups and seasons of the year. Oral glucose-electrolyte therapy was evaluated in 48 infants with acute diarrhoea. Pcv, electrolyte, Blood Urea, gain in body weight and fluid intake were monitored. Acceptability and effectiveness of the ORT in our Community were confirmed. There was no excess gain in body weights or puffiness of face and eyelids in the study subjects.

Toxoplasma gondii antibodies were found in the sera of 22.86% of people in the Jos area of Plateau State, Nigeria. The incidence of antibodies in Nigerian food animals was 17.40%, the highest being in sheep (21.92%) and lowest in goats (13.88%). Cattle and horses were roughly equally infected--about 17.0%. The zoonotic potential of T. gondii in food animals is stressed and epidemiological factors are reviewed.

Fourteen isolates of yersiniae belonging to three species isolated from cattle and pigs were tested for their sensitivity to 12 antimicrobial agents by the tube dilution technique. All the isolates were sensitive to gentamicin and 93.0%, 93.0%, 85.7% and 85.7% sensitive to tetracycline, nitrofurantoin, chloramphenicol and sulphamethoxazole-trimethoprim, respectively. There were no consistent differences in the rates and patterns of resistance based on source, species and serotypes of organisms.

A new differential and selective medium, DYS agar, was developed and evaluated from the isolation of Yersinia enterocolitica. Ther bile salts content of the medium resulted in high selectivity, and inclusion of arabinose, lysine, and arginine rendered Y. Enterocolitica very distinct from Proteus spp., Pseudomonas spp., and other members of the family Enterobacteriaceae. DYS medium was more efficient for the isolation of Y. enterocolitica from experimentally inoculated fecal specimens than MacConkey, deoxycholate-citrate, and salmonella-shigella agars. Although the medium showed selectivity similar to that of another relatively new medium. Y medium (a selective medium for Y. enterocolitica containing sodium oxalate). DYS agar was found to be superior to Y medium in terms of differentiation of Y. enterocolitica from other intestinal organisms. DYS medium is simple to prepare.

Five Yersinia strains, biochemically mimicking Yersinia intermedia, were isolated from patients with acute diarrheal diseases seen at the University of Lagos (Nigeria) Teaching Hospital between October 1979 and September 1982. The five isolates utilized citrate as their source of carbon and fermented sucrose, L-rhamnose, and alpha-methyl-D-glucoside, but unlike any other Y. intermedia biogroup, they failed to ferment D-melibiose or D-raffinose. They all belonged to serogroup O:52,53. Four autoagglutinated and were calcium dependent for growth at 37 degrees C. Three caused conjunctivitis in the guinea pig eye model, but none possessed the 42-megadalton virulence plasmid. Four of the isolates caused diarrhea in orally infected mice and rabbits but were nonlethal for these animals. These results suggest that these isolates represent yet another Yersinia species with disease-producing capabilities in humans.