Search

Background: Infection is one of the major factors that determine clinical outcome among patients requiring intensive care unit (ICU) support. The attending mortality is high and depends on source of infection, organisms associated, timeliness and appropriateness of the treatment received. Methods&Materials: Case records of patientswhowere admitted into our 5bedded ICU over a 4 year period were retrospectively reviewed. The average number of admission was 20 per month. A preformed questionnaire was administered and data on clinical and microbiological profile of all the patients with documented infection was obtained. Results: Eighty four episodes of infections were identified in 76 patients. Road traffic accident 29/76(38.2%) and pulmonary embolism12/76(15.8%) were the leading cause of admission. The most common infection was skin and soft tissue infection (SSI) 30/84(35.7%) followed by UTI 23/84(27.4) and primary bacteraemia 18/84(21.4) with the least beingVAP3/84(3.6%). Most of the cases of UTI occurred in patients with RTA and renal failure, while the highest number of primary bacteraemia was seen among patients with burns and renal failure. The most frequent isolates were S. aureus 35/84(41.7%), K. pneumonia 18/84(21.4%) and E. coli 13/84(15.5%). K. pneumonia 2/5(40%) and P. aerugenosa 1/5(20%) were the leading cause of pneumonia, while S. aureus was the commonest cause of SSI 16/30(53.3%), primary bacteremia 10/18(55.6%) and line infection 5/5(100%). There were 3 cases of VAP one each caused by K. pneumonia, P. aerugenosa and S. aureus. High rate of resistance to cloxacillin 19/35(54.3%) and co-trimoxazole 17/26(65.4%) was noted among the S. aureus isolates. All the enterobactrecae isolates that were tested against meropenem were fully susceptible, while resistance rate to ceftriaxone was high; E. coli 5/9(55.6%), K. pneumoniae 10/14 (71.4%) and proteus spp 2/4 (50%). With exception to meropenem and colistin, ciprofloxacin had a better resistance profile against P. aerugenosa and isolated enterobactriacae compared to the other tested B-lactam agents. Conclusion: The study underscores the need to improve infection control practice in our ICU. Resistance to commonly used antibiotic was high and this makes the choice of empiric antibiotic difficult, hence measures to curtail the emergence of resistance pathogens need to be adopted. [ABSTRACT FROM AUTHOR]

Background: Infections are the leading cause of hospitalization and mortality in transplant recipients. Nigeria has a growing number of renal transplant recipients. The aim of this study was to determine the pattern of infections in renal allograft recipients in one of the major renal transplant centers in Nigeria. Methods & Materials: All case records of renal allograft recipients on follow up were retrieved. Those that had infection at any time after transplantation were selected. Demographic and clinical information were collected and analysed. Results: Thirty three case records were analysed out of which 24/33(72.7%) were males, with the mean age of 42.3 years (±7.38). The median duration of developing infection post-transplant was 270 days (Range 2 - 2190). Most of the infection occurred after 6month 15/33(45.5%). Urinary tract infection was the commonest infection 13/33(39.4%), followed by pneumonia 12(33.3%). There were two cases each (5.6%) of tuberculosis and non-typhoidal salmonella septicemia and one case (2.8%) of CMV colitis. Majority 6/9 (66.7%) of the pneumonia cases was gram negative pneumonia with P. aeroginosa been the commonest isolates 3/9(33.3%). Among those with UTI, E.coli, and Klebsiella spp were isolated with equal proportion 3/13(23.1%) while Enterococcus feacalis was the commonest isolate 4/13(30.8%). Among the tested isolates 61.5% and 50% of gram negative pathogens and S. aureus respectively were resistant to co-trimoxazole, while all the 2 isolated non-typhoidal salmonella were MDR. Overall mortality was 10/33(30.3%) out of which 5/10(50%) was due to pneumonia. Conclusion: There is need to strengthen infection surveillance among post-transplant patients in Nigeria. Infection with MDR pathogen is common and the outcome co-trimoxazole prophylaxis in renal transplantation in our center need to be reviewed. [ABSTRACT FROM AUTHOR]

Background: With no known cure, accelerated development of vaccines became pertinent to contain the COVID-19 pandemic., Objectives: To assess the IgG antibody response to the viral spike protein and determinants of developing IgG antibodies after vaccination with two doses of the AstraZeneca vaccine., Methods: This was a prospective cohort study amongst healthcare workers. Serum samples were obtained before vaccination and at 4 and 12 weeks after the first and second doses of the vaccine respectively. Qualitatively testing for the presence of IgG antibodies to the viral spike protein was conducted using the Vidas SARS-CoV-2 IgG and IgM analyser while IgG antibodies were quantitatively assessed by antibody titre estimation using a stepwise two-fold serial dilution method., Results: A total of 155 subjects between the ages of 25 to 64 years were studied. 85 (54.8%) had positive anti-spike IgG antibodies before vaccination. Out of the remaining 70 subjects, 87.3% and subsequently 96.2% developed IgG antibodies to the viral spike protein 4 and 8 weeks after the first and second doses of the vaccine respectively. The AstraZeneca vaccine was found to stimulate antibody response more than natural infection. Prior positive IgG antibodies from natural infection was found to boost antibody response to vaccination. The antibody titre levels rose with vaccination but waned overtime after the second dose of the vaccine., Conclusion: The AstraZeneca COVID-19 vaccine elicits an immunogenic IgG antibody response that is augmented by prior infection but however declines a few weeks after the second dose of the vaccine., Contexte: En l'absence de remède connu, le développement accéléré de vaccins est devenu pertinent pour contenir la pandémie de COVID-19., Objectifs: Évaluer la réponse des anticorps IgG à la protéine de pointe virale après vaccination avec deux doses du vaccin AstraZeneca., Méthodes: Il s'agissait d'une étude de cohorte prospective parmi les travailleurs de la santé. Des échantillons de sérum ont été obtenus avant la vaccination et à 4 et 12 semaines après la premier et la deuxième doses du vaccin respectivement. Des tests qualitatifs pour la présence d'anticorps IgG dirigés contre la protéine de pointe virale ont été effectués à l'aide de l'analyseur Vidas SARS-CoV-2 IgG et IgM, tandis que les anticorps IgG ont été évalués quantitativement par estimation du titre d'anticorps à l'aide d'une méthode de dilution en série en deux étapes., Résultats: Au total, 155 sujets âgés de 25 à 64 ans ont été étudiés. 85 (54,8 %) avaient des anticorps IgG anti-pic positifs avant la vaccination. Sur les 70 sujets restants, 87,3 % puis 96,2 % ont développé des anticorps IgG contre la protéine de pointe virale 4 et 8 semaines après la première et la deuxième doses du vaccin respectivement. Le vaccin AstraZeneca s'est avéré stimuler la réponse anticorps plus que l'infection naturelle. Des anticorps IgG antérieurement positifs d’une infection naturelle ont été trouvés pour stimuler la réponse des anticorps à la vaccination. Les niveaux de titre d'anticorps ont augmenté avec la vaccination mais ont cependant diminué avec le temps après la deuxième dose du vaccin., Conclusions: Le vaccinAstraZeneca COVID-19 suscite une réponse immunogène en anticorps IgG qui est augmentée par une infection antérieure mais qui décline cependant quelques semaines après la deuxième dose du vaccin., Mots Clés: COVID-19, Travailleurs de la santé, Vaccination, vaccin AstraZeneca, Immunogène, Anticorps, réponse d'anticorps, Titre d'anticorps., Competing Interests: The Authors declare that no competing interest exists, (Copyright © 2023 by West African Journal of Medicine.)

Introduction: The COVID-19 pandemic continues to overwhelm health systems across the globe. We aimed to assess the readiness of hospitals in Nigeria to respond to the COVID-19 outbreak., Method: Between April and October 2020, hospital representatives completed a modified World Health Organisation (WHO) COVID-19 hospital readiness checklist consisting of 13 components and 124 indicators. Readiness scores were classified as adequate (score ≥80%), moderate (score 50-79.9%) and not ready (score <50%)., Results: Among 20 (17 tertiary and three secondary) hospitals from all six geopolitical zones of Nigeria, readiness score ranged from 28.2% to 88.7% (median 68.4%), and only three (15%) hospitals had adequate readiness. There was a median of 15 isolation beds, four ICU beds and four ventilators per hospital, but over 45% of hospitals established isolation facilities and procured ventilators after the onset of COVID-19. Of the 13 readiness components, the lowest readiness scores were reported for surge capacity (61.1%), human resources (59.1%), staff welfare (50%) and availability of critical items (47.7%)., Conclusion: Most hospitals in Nigeria were not adequately prepared to respond to the COVID-19 outbreak. Current efforts to strengthen hospital preparedness should prioritize challenges related to surge capacity, critical care for COVID-19 patients, and staff welfare and protection., Competing Interests: The authors have declared that no competing interests exist.

Background: Biomarkers of susceptibility to COVID-19 are being investigated by many scientists all over the world. The ABO blood group antigens are the most frequently studied genetic markers. Reports from China and USA have shown that people with blood group A are more susceptible to COVID- 19 while those with blood group O are least susceptible., Methods: The ABO blood group of 51 patients with COVID-19 admitted at the University of Abuja Teaching Hospital, Nigeria was determined and compared with the ABO blood group distribution in the general population., Results: Out of the 51 patients, 39 (76.5%) were males and 12 (23.5%) were females, giving a male: female ratio of 3.25:1. Out of the 51 patients, 29 (56.9%) had blood group O, 12 (23.5%) had blood group A, 10 (19.6%) had blood group B and none (0%) had blood group AB. This blood group distribution was comparable to the blood group distribution in the general population., Conclusion: Preliminary analysis of the blood group distribution of COVID-19 patients being managed at the University of Abuja Teaching Hospital in Nigeria found no relationship between COVID-19 and ABO blood group. More studies are needed particularly in Africa to determine if ABO blood group can be a biomarker of susceptibility to COVID-19 among Africans., Competing Interests: The authors certifies that there is no conflict of interest in connection with the submitted article., (Copyright © 2021 by West African Journal of Medicine.)

COVID-19 is a global pandemic, with attendant high morbidity and mortality. There is no previous documentation of its coinfection with Mycobacterium tuberculosis; the single most common cause of death from an infectious disease. Management and survival from this "cruel duel" in a low resource country will be daunting. We report the case of a middle-aged man who survived and the lessons learned from a COVID-19 treatment centre in the north-central of Nigeria. The patient presented with symptoms and clinical features of COVID-19 and Mycobacterium tuberculosis was confirmed with laboratory investigation. The patient commenced anti-tuberculous medications, received nutritional support and other supportive treatment for COVID-19 infection. He was discharged home to continue follow up at the medical outpatient and the DOTS clinic. Early recognition and prompt treatment are critical for a favourable clinical outcome.

The objective of this study was to describe the epidemiology of COVID-19 in Nigeria with a view of generating evidence to enhance planning and response strategies. A national surveillance dataset between 27 February and 6 June 2020 was retrospectively analysed, with confirmatory testing for COVID-19 done by real-time polymerase chain reaction (RT-PCR). The primary outcomes were cumulative incidence (CI) and case fatality (CF). A total of 40 926 persons (67% of total 60 839) had complete records of RT-PCR test across 35 states and the Federal Capital Territory, 12 289 (30.0%) of whom were confirmed COVID-19 cases. Of those confirmed cases, 3467 (28.2%) had complete records of clinical outcome (alive or dead), 342 (9.9%) of which died. The overall CI and CF were 5.6 per 100 000 population and 2.8%, respectively. The highest proportion of COVID-19 cases and deaths were recorded in persons aged 31-40 years (25.5%) and 61-70 years (26.6%), respectively; and males accounted for a higher proportion of confirmed cases (65.8%) and deaths (79.0%). Sixty-six per cent of confirmed COVID-19 cases were asymptomatic at diagnosis. In conclusion, this paper has provided an insight into the early epidemiology of COVID-19 in Nigeria, which could be useful for contextualising public health planning.

There is minimal data on antibiotic resistance from savannah northern Nigeria. A retrospective study of 438 patients seen in 12 months (2000) with microbial pathogens from urinary and respiratory tracts was undertaken. Antibiotic susceptibilities were determined using stokes disc diffusion technique. Resistance in Escherichia coli (E. coli) reached 91-96% to cotrimoxazole, tetracycline and ampicillin but was 11%, 17% and 28% to colistin, nitrofurantoin and nalidixic acid. Resistance of other uropathogens (Klebsiella and Proteus spp) reached 83-99% to cotrimoxazole, tetracycline and ampicillin but was 14-40% to colistin, nitrofurantoin and nalidixic acid. Pneumococci were non-susceptible to penicillin (93%), cotrimoxazole (92%), tetracycline (84%), ampicillin (53%), chloramphenicol (21%) and cefazolin (8%). Antibiotic resistance is widespread in savannah northern Nigeria. Resistance is less to chloramphenicol, colistin, nalidixic acid, nitrofurantoin and the latter generation cephalosporins and quinolones than to penicillin, ampicillin, cotrimoxazole and tetracycline.