Joseph Aje Anejo-Okopi

Factors Associated With Pulmonary Tuberculosis-HIV Co-Infection in Treatment-Naive Adults in Jos, North Central Nigeria

Background: Co-infection with tuberculosis and human immunodeficiency virus (TB-HIV) remains a major global health problem, with about 1.1 million new cases of TB in HIV-positive persons reported in 2011; 79% of the reported cases were amongst patients living in Africa. Advanced immune suppression remains the most important risk factor for tuberculosis in those with HIV, but epidemiological and clinical factors have also been identified. We sought to determine the prevalence and factors associated with pulmonary tuberculosis (PTB) in antiretroviral therapy (ART)- naive HIV-infected patients seeking HIV care services at a tertiary health facility in North Central Nigeria. Methods: We compared clinical and laboratory data for 218 HIV-1 positive adults with and without a diagnosis of pulmonary tuberculosis. Results from univariate analyses informed the selection of predictors to conduct multivariate analysis to determine which factors were associated with presence of PTB-HIV co-infection. Results: The prevalence of PTB-HIV co-infection in the evaluated cohort was 9.6%. Lower CD4+ cell count and the presence of oropharyngeal candidiasis were independently associated with PTB-HIV co-infection. CD4+ cell count was strongly associated with PTB-HIV co-infection (p=0.002) with the odds of co-infection reduced by 85% in those with a CD4+ cell count >100 cells/mm3 compared to those with <100 cells/ mm3. There was a strong association between oropharyngeal candidiasis and PTB-HIV co-infection, where the odds of co-infection are about 4.5 times higher in those with oropharyngeal candidiasis than those without candidiasis (p=0.008). Conclusion: PTB was prevalent among HIV patients seeking care in our setting. Severe immune suppression and oropharyngeal candidiasis were associated with PTB-HIV co-infection in our patients at presentation. Potential implications for severe immune suppression and advanced HIV disease are a poor clinical outcome and further spread of PTB. Strategies to encourage the early diagnosis of both HIV and TB should be considered

Antituberculosis drugs and hepatotoxicity among hospitalized patients in Jos, Nigeria.

Background: Tuberculosis (TB) could be fatal if left untreated, however, adverse effects of anti-TB medications (anti-TBs) themselves may limit treatment. We determined the incidence and clinical characteristics of hepatotoxicity in hospitalized patients receiving first-line anti-TB treatment. Methods: A retrospective cohort study of patients aged ≥18 years seen at the medical wards of the Jos University Teaching Hospital from January 2013 to June 2013 was carried out. Data were retrieved for 110 patients who were prescribed anti-TBs. Their demographic and clinical characteristics were described, and the incidence of symptomatic hepatotoxicity determined. The incidence of hepatotoxicity by strict American Thoracic Society criteria (symptomatic hepatotoxicity plus alanine transaminase in IU/L levels >3×upper limit of normal) was also determined. Results: Twenty patients developed symptomatic hepatotoxicity, giving an incidence of 18.2%. Furthermore, 18 (16.4%) patients had hepatotoxicity according to the American Thoracic Society criteria. Those with symptomatic hepatotoxicity unexpectedly had lower baseline alanine transaminase interquartile range (IQR) (35 [16–63] vs. 67 [4–226]; p =.04) and bilirubin (μmol/L): total IQR (15.3 [10.2–74.8] vs. 20.4 [20.4–20.4]; p =.01) and conjugated IQR (7.6 [5.1–34.8] vs. 10.2 [10.2–10.2]; p =.004). However, there were no significant differences in age, sex, body mass index, and duration of anti-TB treatment, human immunodeficiency virus infection status, antiretroviral therapy status, alcohol consumption, and the presence of hepatitis B surface antigen or hepatitis C virus antibody. Conclusion: Hepatotoxicity due to first-line anti-TBs, whether based on clinical features alone or backed by liver chemistry, is common among hospitalized patients in our environment. Studies to determine the predictors of hepatotoxicity to guide clinical interventions aimed at the prevention or timely identification of cases are needed.

Factors associated with a low CD4 count among HIV-1 infected patients at enrolment into HAART in Jos, Nigeria.

Aim:To determine the factors associated with a low CD4 count among HIV -1 positive patients. Study Design:Cross-sectional study. Place and Duration ofStudy:Adult HIV clinic at the Jos

Molecular characterization of cryptosporidium in children aged 0- 5 years with diarrhea in Jos, Nigeria

Introduction Cryptosporidium is an important cause of diarrhea in children and immune-compromised individuals. Recent advances in molecular diagnostics have led to the discovery of subtype families that are thought to be more commonly associated with diarrhea. We aimed to isolate and characterize Cryptosporidium spp among children with diarrhea in Jos, Nigeria. Methods Stool samples were collected from165 children aged 0-5 years with diarrhea. Cryptosporidium oocysts were examined by wet mount preparation, using formalin ether and a modified acid fast staining method. DNA was extracted from positive samples using QIAamp DNA stool mini kit and PCR-RFLP assay was carried out after quantification. Genotyping and phylogenetic analysis were done to determine the subtype families and their relatedness. Results From the 165 children studied, 8 (4.8%) were infected with Cryptosporidium. PCR-RFLP assay and genotype characterization found the following Cryptosporidium species: C. hominis 6 (75%) and C. parvum 2 (25.0%), with family subtypes Id-5, Ie-1 and IIa-1, IId-1 respectively.The most common species was C. hominis and the frequent subtype was C. hominis-Id 5 (62.5%). Conclusion Cryptosporidium is not an uncommon cause of diarrhea in children, with C. hominis being the dominant species. Also C. hominis Id is the commonest sub-family subtype. Put together, zoonotic species may be an important cause of diarrhea in children aged 0-5 years in Jos, Nigeria.

Postexposure prophylaxis for Lassa fever: Experience from a recent outbreak in Nigeria

Background: Secondary transmission of Lassa fever (LF) occurs in the community and in health-care facilities, and is associated with high fatality in Nigeria. We investigated the role of oral ribavirin postexposure prophylaxis (orPEP) in preventing LF among the primary contacts of confirmed cases from December 2015 to March 2016. Materials and Methods: Epidemiological and clinical data of LF contacts were prospectively collected. However, information regarding ribavirin adverse effects (AEs) were collected retrospectively through a telephone interview. High-risk contacts were clinically monitored ΁ orPEP. Results: Thirty-five (94.6%) out of the 37 individuals enrolled in the study were contacts of confirmed LF cases, and friends and family members (54%) constituted the largest group. However, only 29 (83%) individuals were classified as high-risk contacts. Twenty-one (60%) of contacts were prescribed ribavirin with 6 (28.6%) of them reporting AEs. Body weakness (33%) was the most frequent AE, but there was no incidence of treatment discontinuation due to AE. Furthermore, there were no reported cases of LF among all respondents (0%), whether they had orPEP or not. Conclusion: Secondary transmission of LF seems uncommon and the benefit of orPEP is uncertain. Although AEs of ribavirin may not be uncommon, they are rarely serious enough to cause treatment interruption. More emphasis should be on supporting persons looking after LF cases adopt measures that minimize the risks of exposure.

Isolation and polymerase chain reaction detection of virulence invA gene in Salmonella spp. from poultry farms in Jos, Nigeria

Background: Salmonella serovars are one of the most common food-borne pathogens, and poultry consumption is responsible for the majority of routes of infection worldwide. There is a paucity of documented data regarding the prevalence of virulence determinant genes in Salmonella serovars in Nigeria. The aim of the study was to isolate Salmonella spp. in selected poultry farms in Jos Metropolis, Plateau State, Nigeria. Methodology: A total of eighty samples were conveniently collected from 18 commercial poultry. The samples were from poultry droppings, egg shells, workers′ hands, and feeds. The samples were examined for the presence of Salmonella by standard microbiological techniques. The isolates were phenotypically confirmed using biochemical characterization and virulence gene determined by polymerase chain reaction (PCR). Results: The overall isolation percentage of Salmonella species was 28.75% (23/80). DNA extraction was carried out on the isolated 23 Salmonella isolates and 11 successfully quantified. Of the 11 isolates, ten (91.0%) successfully amplified using the invA gene-specific primers by PCR method. The result indicates the presence of Salmonella in poultry farms, and this posed a major concern for public health. Conclusion: The result showed that the use of PCR amplification of virulence genes in suspected Salmonella spp. from poultry farms proved to be efficient and could serve as an alternative rapid tool for the detection of Salmonella spp. Further large studies with the use of more virulence genes are needed to understand the Salmonella epidemiology in poultry farms that serves as a major protein source of the nation.

Bacterial and antibiotic susceptibility pattern of urinary tract infection isolated from asymptomatic and symptomatic diabetic patients attending tertiary hospital in Jos, Nigeria

Urinary tract infection (UTI) is an infection caused by the presence and growth of microorganisms in the urinary tract. In most cases empirical antimicrobial treatment is usually initiated before the laboratory results are made available; hence the need for antibiotic susceptibility test to enhance management of UTI. The study was designed to determine the bacterial profile and antibiotic susceptibility pattern of urinary tract bacteria isolated from symptomatic and asymptomatic diabetic patients at Bingham University Teaching Hospital Jos. 100 mid-stream urine samples (app. 20 mls) were aseptically collected into sterile containers after informed consent of diabetic patients of ages 20 years and above were analyzed at Central Diagnostic Laboratory NVRI Vom. The isolates were identified using standard bacteriological techniques after been cultured on MacConkey and CLED agars. Antibiotic sensitivity testing was done in accordance with NCCLS disc diffusion methods. The results were then analyzed using chi square test. Of the 100 urine samples, different bacterial uropathogens were isolated, with a prevalence of 40%. The bacteria isolates were; Coagulase negative Staphylococci (CNS) (37.5%), Escherichia coli (24%), Klebsiella pneumoniae (12.5%), Staphylococcus aureus (15%) and Streptococcus spp (10%). Esherichia coli and Klebsiella pneumoniae were highly resistant to most antibiotics used, while coagulase negative staphylococci, Staphylococcus aureus and Streptococcus spp were highly sensitive to most antibiotics used in this study. Self-medication including antibiotics is clearly a major culprit. Behavioral Change Communication to all stake holders is increased to cover all radio and TV stations in the state. In addition, investigations (routine microscopy, culture and sensitivity of urine) be completed before treatment is commenced in order to mitigate acquisition and spread of drug resistance by bacteria. Correspondence to: Joseph Aje Anejo-Okopi, Department of Microbiology Faculty of Natural Sciences University of Jos, Nigeria, E-mail: josephokopi@ yahoo.com

Prevalence of Hepatitis B Virus Infection Among Patients with Chronic Kidney Disease in Jos University Teaching Hospital (JUTH) Jos, Nigeria

The frequency of hepatitis B virus in patients with CKD undergoing haemodialysis maintenance has a medical importance in the transmission of the infection and the cause of kidney disease. We aimed to determine sero-prevalence of HBV in patients with chronic kidney disease. A total of 110 blood samples were collected from nephrology Department of Jos University Teaching Hospital and screened for HBsAg marker. HBsAg was detected using rapid chromatographic immunoassays for qualitative detection of HBsAg and was performed using one-step test strips for detection of HBsAg in serum sample. Out of the 110 patients selected, 56 were males and 54 females with an overall 15.5% HBsAg positivity. It was observed that HBsAg positive increases with prolonged duration of haemodialysis maintenance. The prevalence of HBsAg among Chronic Kidney Disease patients is high, however there was no significant association between HBV and chronic kidney disease in this cross-Sectional survey.

The Seroprevalence of Herpes Simplex Virus Type-1 Among Children in Jos, Nigeria

This study was to determine the prevalence rate of Herpes Simplex Virus Type-1 (HSV-1) among children in Jos metropolis. Herpes simplex virus type-1 is mostly acquired in childhood and is responsible for orolabial ulcers or lesions. Prevalence of oro-facial herpes simplex virus type-1 infection is a common worldwide problem. There is little or no public awareness of herpes simplex virus in Jos, plateau state, Nigeria. A total of 188 samples were collected and analyzed using Enzyme Linked Immunosorbent Assay (ELISA) kit by GeneFront Inc. CA. USA to test for HSV-1 specific glycoprotein IgG. Out of the 188 samples tested, 157 (83.5%) were seropositive. The seroprevalence among male was 86.8%, and female 78.4%. The Age group 6-10 years had the highest prevalence of 88.8% while 0-5yrs had 75.0% which had significant association (P <0.05). This study showed high prevalence of HSV-1, with the highest prevalence in aged 6-10 years which suggests that, HSV-1 is common among school-aged children. HSV-1 infection is acquired during early childhood and therefore age is an important factor in the epidemiology of HSV-1 infection. Further larger studies are needed in North Central Nigeria.

Nonadherence to first‑line antiretroviral therapy among human immunodeficiency virus‑1 infected children at the Jos University Teaching Hospital, Jos, Nigeria

Background: Nonadherence to antiretroviral therapy (ART) may encourage the development of resistance to antiretroviral drugs (ARVs). Poor adherence is known to be associated with ART failure which could compromise the benefits of ART in children. Therefore, it is important to identify the reasons why children on ART may fail to take their ARVs. In this study, we described the characteristics of human immunodeficiency virus-1 (HIV-1) infected children with ART nonadherence as well as the reasons for their nonadherence. Methodology: A retrospective cohort study in which data on 580 HIV-1 infected children enrolled on ART between February 2006 and December 2010 at the pediatric HIV clinic of the Jos University Teaching Hospital, Jos, was analyzed. Subjects were aged 2 months to 15 years. Information on adherence was obtained by child or caregiver self-report. They also had repeated adherence counseling during each clinic follow-up visit and were taught the use of alarm clocks daily for reminding them of when the next ARV dose will be due. Results: There were 30 (5.2%) children with non-adherence to ART. Among children with nonadherence, majority were: Children aged 1-10 years (76.7%), males (53.3%) and did not know their diagnosis of HIV (90.9%). The odds of nonadherence was two times higher among children who failed first-line ART compared with those who did not (odds ratio [95% confidence interval], 2.28 [1.03-5.02], P = 0.04). The most common reason for nonadherence was: Forgot to take medications (46.7%). Conclusion: The low rate of nonadherence to ART in this study could be attributed to repeated adherence counseling during each clinic follow-up visit and the use of alarm clocks daily for reminders on when the next ARV dose will be due.