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Cerebral myiasis is extremely rare, and surgical intervention is the primary treatment used. Successful conservative management alone, without surgical removal of the brain infestation has not yet been published. We report the a case of a 24-year-old African homeless man who was found on the street in a state of decreased level of consciousness, with larvae exiting from the left supra and postauricular dirty wounds and from his left ear. The patient was diagnosed with post-traumatic cerebral myiasis of the left temporal lobe and cerebellum. It was treated successfully by debridement of the external wounds and administration of antibiotics, without surgical removal of the brain infestations. For the first time, this case illustrates the novelty and appropriateness of the conservative management of cerebral myiasis. This is also the first report of cerebral myiasis with cerebellar involvement and the second report of post-traumatic cerebral myiasis in literature. Continuous...

Extended Spectrum Beta Lactamase (ESBL) producing Escherichia coli is a global cause of life threatening infections. We determined the presence of ESBL and carbapenemase production in clinical isolates of E. coli and their antibiotic susceptibility. Clinical isolates of community and hospital acquired E. coli from 220 patients seen at a tertiary hospital were evaluated. Antibiotic susceptibility testing was by the modified Kirby-Bauer protocol while ESBL production was determined by the Double Disk Synergy Test (DDST). Carbapenem resistance was confirmed by the Modified Hodge Test. Of the 220 isolates, 122 (55.5%) were from females; 41 (18.6%) were ESBL positive. About 90% of the ESBL producing isolates were resistant to nine of the 15 antimicrobial agents tested. However, only one (2.4%) of the 41 ESBL producing isolates exhibited carbapenem resistance. The ESBL negative isolates were susceptible to Meropenem (100%), Cefepime (97.8%), Ceftriaxone (96.6%) and Cefotaxime (96.6%). All the ESBL producing isolates harbored detectable plasmids with sizes ranging from 2322 to 23,130 base pairs. Our findings show that although multidrug resistant ESBL producing E. coli are prevalent in both the hospital and the community in this environment, carbapenem resistance is still low. We recommend that institutions develop guidelines for the early phenotypic detection of ESBLs and carbapenem resistance.

Background : Neonatal morbidity and mortality are major public health challenges in our local environment with a huge percentage of deaths in the neonatal period attributable to sepsis. Aim : The aim of the study was to assess the factors that affect patients’ outcome with respect to sepsis in neonates. Methods : This was a prospective descriptive cross sectional study. Neonates with proven and suspected sepsis were recruited into the study. Outcome was assessed based on the length of hospital stay and mortality. Clinical response to treatment was also assessed. Results : Nine factors were identified as risk factors for mortality, birth weight (< 2500g P = 0.000, OR = 7.214, CI = 2.5 – 21.0), prolonged rupture of membranes (PROM) (P = 0.014, OR = 2.470, 95% CI = 1.2 -5.1), prolonged preterm rupture of membranes (PPROM) P = (0.046. OR = 2.1, 95% CI = 0.9 -4.6) multiple gestation (P = 0.009), an infectious clinical diagnosis (P = 0.046, OR = 0.480), frequent changes in antibiotics (P = 0.013). Others were a low Apgar score (P = 0.000), presence of organisms in intravenous fluids (P = 0.042, OR = 0.2, 95% CI = 0.02 – 1.3 and the presence of organisms in the blood stream (P = 0.007). Conclusion : This study determined the mortality rate in our environment due to sepsis to be 15.7%. Risk factors for a poor outcome include low birth weight, perinatal period, and maternal illness in pregnancy and isolation of a pathogen from the blood stream. Key words: Neonatal sepsis, prolonged stay, mortality, bactec 9050, microbact 12a, risk factors

Introduction Sexually Transmitted Infections are widespread, and have effects on the reproductive and sexual health of the general population particularly youths and adolescents. The study was done to assess the level of knowledge, perception and attitudes towards STI’s by undergraduate students. The objective was to understand and describe the drivers of sexual behaviour amongst university undergraduates and gain an insight into their perception of sexually transmitted infections. Methods This was a cross-sectional study. A structured self-administered questionnaire on risk factors for STI’s was given to respondents to answer. The study was conducted in October 2016. Results The mean age of the students (n=310) was 17.8 years+/-1.77 SD.: males were 0.39 times more likely to be sexually active than females [p= Conclusion The rates of sexual exposure and unprotected sex are still high among our youths. We need to invest in treatment and prevention programs regarding STI’s in the young and identify the barriers that prevent access to care such as a lack of appropriate and effective STI control programs. STIs are preventable and significant reductions in new infections are possible and needed. Prevention can minimise their negative impact and reduce healthcare costs.

Background In Nigeria, where malaria is endemic, greater than 70% of febrile illnesses are treated presumptively as malaria, often without a laboratory evaluation for other possible causes of fever. This cross-sectional study evaluated the presence of dengue virus infection in febrile patients, presumptively diagnosed of malaria infections in the clinic. Methodology Blood samples were collected from 529 febrile patients (246 in Jos and 283 in Maiduguri) attending the general outpatient clinics of the Jos University Teaching Hospital (JUTH) and the University of Maiduguri Teaching Hospital (UMTH) and tested for anti-dengue immunoglobulin M (IgM) and immunoglobulin G (IgG), as well as anti-non-structural protein (NS1) by ELISA. The samples were also evaluated for presence of P. falciparum malaria parasites by microscopic examination of Giemsa-stained blood smears. Results The prevalence of confirmed, highly suggestive and probable dengue virus infections categorized in relation to duration of illness since onset of fever were 2.3%, 5.5% and 1.5% respectively, while the prevalence of anti-flavivirus IgG and IgM seropositivity was 11.7%. In a total of 117 (22.1%) patients (32 in Jos, 85 in Maiduguri), malaria parasites were detected by blood smear microscopy, out of which 7 (6%) also had a positively confirmed, highly suggestive or probable dengue test result. Conclusion Although the high cross-reactivity of anti-flavivirus antibodies should be taken into account in the interpretation of the seroprevalence data, our findings suggest a significant presence of dengue virus in this environment, some of which may otherwise be misdiagnosed as malaria. These findings are strong enough to recommend serological screening for anti-dengue virus titer and NS1 antigen for all febrile patients, as part of fever diagnostic protocols in tropical regions. Given the prevalence of dengue virus infections, there is also a need for a dengue control program and public education to prevent outbreaks and occurrence of severe dengue complications.

Objective: A narrative review of advances in automated diagnostic tests for diagnosis of tuberculosis infections. Methods: Electronic databases were searched for tests on automation in Mycobacterium tuberculosis identication. Studies were selected and evaluated that tested for the performance of new and old methods in automated diagnosis with significant impact on the turn-around time of diagnosis and also positive impact on patient care with respect to outcomes. Results: A total of 40 studies were included. Overall, the gene expert system was found to be superior when applied to respiratory samples as opposed to other body fluids when compared to other test methods. High specificity estimates suggest that Nucleic Acid Amplification Tests (NAATS) should be the first-line test for rapid diagnosis of meningitis, but that they also need to be combined with the result of other tests in order to rule out disease. Discussion: Fully automated liquid culture methods overall are superior to mycobacterial culture on solid media, in terms of speed of diagnosis, ease of use and their accuracy with several user friendly systems that can be applied to the Nigerian environment. Conclusion: The DNA amplification tests provide a reliable way of increasing the specificity of diagnosis. Their superior diagnostic capability has been found to hold up in routine clinical practice, and they could confer several advantages on tuberculosis control programs.

Background/Objectives: Neonatal sepsis is an important cause of morbidity and mortality in the pediatric age group in spite of several attempts at mitigating its effects. This article determines the prevalence of neonatal sepsis and the pathogens responsible for sepsis as well as risk factors and outcome at the Babcock University Teaching Hospital. Methods: A retrospective analysis of laboratory records of consecutive babies delivered within and outside our hospital suspected of having sepsis over a 1-year period. Results: The isolation rate was 34% from 100 neonates with the predominant pathogens being coagulase-negative staphylococci (CONS), Staphylococcus aureus, and Klebsiella pneumoniae. The risk factors for sepsis were age

Background: Urinary tract infections (UTI’s) are among the commonest bacterial infectious disease in clinical practice with a wide range of etiologic agents. It frequently occurs in both the hospital and the community. Aims/Objectives: To determine the etiology of UTI at BUTH and obtain data on their susceptibility and resistance patterns. Methods: This was a prospective analysis of data on patients with UTI obtained from in and outpatients over a six month period. Samples had been obtained by clean catch mid-stream urine or suprapubic aspiration. The organisms had been identified by biochemical methods with susceptibility and resistance testing performed. Data analysis was with EPI-INFO version 3.5.1 Results: There were a total of 200 urine samples that had positive growth. Prevalent organisms were Escherichia coli (48%) and Klebsiella spp (24%), followed by Staphylococcus aureus (10%) and Coagulase Negative Staphylococci (6.5%). The risk factors for UTI were female gender (p = 0.00), Diabetes mellitus (p = 0.03) and genitourinary surgery (p = 0.04). Effective antibiotics in-vitro to Escherichia coli were Nitrofurantoin and Cefepime at 84.8% and 92.3% respectively; while Cotrimoxazole performed poorly (32.5% susceptibility). Conclusion: Urinary tract infections are an important cause of morbidity in our environment and inaccuracies in diagnosis will prolong morbidity and may lead to costly and unsafe treatments.The prevalent pathogens in our environment are the Gram negative bacilli, Escherichia coli and Klebsiella pneumoneae . Nitrofurantoin retains efficacy to both urinary pathogens. Keywords: Urinary Tract Infection, Catheterization, Escherichia coli , Risk factors, Nitrofurantoin

Background. Neonatal sepsis is a significant cause of morbidity and mortality in developing countries, accounting for a large proportion of neonatal deaths annually. Every year, 4 million neonates die, and one-third of these deaths is attributed directly to neonatal sepsis. Objectives. To determine the prevalence of neonatal sepsis, characterise and identify causative organisms and identify possible risk factors. Specific objectives were to determine the aetiological agents responsible for neonatal sepsis at Lagos University Teaching Hospital and also to identify the risk factors responsible for the development of neonatal sepsis. Methods. Venous blood pairs were collected from clinically septic admitted neonates and inoculated into BACTEC Peds Plus (BD, USA) bottles aerobically in the BACTEC 9050 system. Organisms were identified using the Microbact 12A/E system and biochemicals. A structured questionnaire was used to collect data for risk factors, which were analysed with the SPSS version 17. Results. Of 250 neonates who were sampled, 85 (34%) had pathogens recovered from their bloodstream, with Klebsiella pneumoniae the predominant organism. Risk factors for sepsis were being delivered outside the hospital ( p =0.01), and by frequent changes in antibiotics ( p =0.00). Conclusion. The burden of neonatal sepsis is still high in our environment as evidenced by our isolation rate of 34%. A concerted effort needs to be made to reduce this.

Background: Hand hygiene has been described as the cornerstone and starting point in all infection control programs, with the hands of healthcare staff being the drivers and promoters of infection in critically ill patients. The objectives of this study were to access healthcare workers compliance with the World Health Organization (WHO) prescribed five moments of hand hygiene as it relates to patient care and to determine the various strata of healthcare workers who are in default of such prescribed practices. Methods: The study was an observational, cross-sectional one. Hand hygiene compliance was monitored using the hand hygiene observation tool developed by the WHO. A nonidentified observer was used for monitoring compliance with hand hygiene. The observational period was over a 60-day period from August 2015 to October 2015. Results: One hundred and seventy-six observations were recorded from healthcare personnel. The highest number of observations were seen in surgery, n = 40. The following were found to be in noncompliance before patient contact – anesthetist P = 0.00 and the Intensive Care Unit P = 0.00 while compliance was seen with senior nurses (certified registered nurse anesthetist [CRNA]) P = 0.04. Concerning hand hygiene after the removal of gloves, the following were areas of noncompliance - the emergency room P = 0.00, CRNA P = 0.00, dental P = 0.04, and compliance was seen with surgery P = 0.01. With regards to compliance after touching the patient, areas of noncompliance were the anesthetists P = 0.00, as opposed to CRNA P = 0.00, dental P = 0.00, and Medicine Department P = 0.02 that were compliant. Overall, the rates of compliance to hand hygiene were low. Discussion: The findings however from our study show that the rates of compliance in our local center are still low. The reasons for this could include lack of an educational program on hand hygiene; unfortunately, healthcare workers in developing settings such as ours regard such programs as being mundane. Conclusion: The observance of hand hygiene is still low in our local environment. Handwashing practices in our study show that healthcare workers pay attention to hand hygiene when it appears there is a direct observable threat to their wellbeing. Educational programs need to be developed to address the issue of poor hand hygiene.

Enterobacteriaceae cause a wide range of diseases including urinary tract infections, respiratory tract infections, sepsis, and gastroenteritis. They are the most frequently recovered pathogens from clinical samples and have varying susceptibility patterns. The study set out to determine the susceptibility profile of enterobacteriaceae species at the Babcock University Teaching Hospital. Enterobacteriaceae were identified using the Microbact 12A kit (Oxoid UK) and susceptibility was determined with the modified Kirby-Bauer Method in line with CLSI 2014 guidelines. Escherichia coli the main isolate was 100% susceptible to Piperacillin/Tazobactam, 94% susceptible to Amikacin, 76.5% susceptible to both Ampicillin/Sulbactam and Ceftazidime, 70.6% susceptible to Ceftriaxone and Meropenem, 67% susceptible to Ciprofloxacin, 58% Susceptible to Gentamicin and 23.5% susceptible to Amoxicillin/Clavulanic acid. Antibiotic resistance among Enterobacteriaceae is on the rise in Babcock University Teaching Hospital. Measures should be put in place to prevent more resistance and to prevent spread of resistant strains.