Laura Prieto-Pérez

Osteomyelitis: A Descriptive Study

Background To analyze the incidence and clinical-microbiological characteristics of osteomyelitis (OM) in a tertiary Spanish hospital. Methods All cases diagnosed with OM between January 2007 and December 2010 were retrospectively reviewed. The variables examined include epidemiological characteristics, risk factors, affected bone, radiographic changes, histology, microbiological culture results, antibiotic treatment, and the need for surgery. Results Sixty-three cases of OM were diagnosed. Twenty-six patients (41.3%) had acute OM whereas 37 patients (58.7%) were classified as chronic OM. OM may result from haematogenous or contiguous microbial seeding. In this group, 49 patients (77.8%) presented with OM secondary to a contiguous source of infection and 14 patients had hematogenous OM (22.2%). Staphylococcus aureus was the most commonly found microorganism. Conclusions OM mainly affected patients with risk factors related to the presence of vascular diseases. Antibiotic treatment must be guided by susceptibility patterns of individual microorganisms, although it must be performed together with surgery in most of the cases.

Field Evaluation of Malaria Microscopy, Rapid Malaria Tests and Loop-Mediated Isothermal Amplification in a Rural Hospital in South Western Ethiopia.

Background In up to one third of the hospitals in some rural areas of Africa, laboratory services in malaria diagnosis are limited to microscopy by thin film, as no capability to perform thick film exists (gold standard in terms of sensitivity for malaria diagnosis). A new rapid molecular malaria diagnostic test called Loop-mediated isothermal DNA amplification (LAMP) has been recently validated in clinical trials showing exceptional sensitivity and specificity features. It could be a reliable diagnostic tool to be implemented without special equipment or training. Objective The objective of this proof of concept study was to confirm the feasibility of using LAMP technique for diagnosis of malaria in a rural Ethiopian hospital with limited resources. Methodology/Principal Findings This study was carried out in Gambo General Hospital, West Arsi Province (Ethiopia), from November 1st to December 31st 2013. A total of 162 patients with a non-focal febrile syndrome were investigated. The diagnostic capability (sensitivity, specificity, positive predictive and negative predictive values) of rapid malaria tests and microscopy by thin film was evaluated in comparison with LAMP. Eleven (6.79%) out of the 162 patients with fever and suspected malaria, tested positive for LAMP, 3 (1.85%) for rapid malaria tests and none of the eleven cases was detected by thin film microscopy. Conclusions/Significance LAMP can be performed in basic rural laboratories without the need for specialized infrastructure and it may set a reliable tool for malaria control to detect a low level parasitemia.

Leprosy ulcers in a rural hospital of Ethiopia: pattern of aerobic bacterial isolates and drug sensitivities

BackgroundPlantar ulcers, which commonly occur in leprosy patients, tend to recur increasing physical disability. The aim of this study is to identify both the bacteriological profile of these ulcers and the antibiotic susceptibility of the isolated bacteria.Materials and methods68 leprosy patients with chronic ulcers attending the in-patient department of Gambo General Hospital, West Arsi, were included in this study. Proper sample collection, inoculation on culture media, and final identification using biochemical methods were undertaken.Results66 patients (97.1%) had a positive culture. A total of 81 microorganisms were isolated. Multiple organisms (two or more) were isolated in 15 (22.7% out of positive culture) patients. The main isolation was Proteus spp (30.9%), followed by Escherichia coli (21.0%), Staphylococcus aureus (18.5%) and Pseudomonas aeruginosa (9.9%). In the total number of the isolated bacteria, the antibiotics with less resistance were gentamicin (18.5%), fosfomycin (22.2%) cefoxitin (24.7%), ceftriaxone (25.9%) ciprofloxacin (25.9%), and amoxicillin-clavulanic acid (28.49%).ConclusionThe bacteriological study of plantar ulcers of leprosy patients revealed Enterobacteriaceae and S. aureus as the main pathogens involved in such infections. The results of this study may guide empirical therapy in a rural area hospital where culture and susceptibility testing facilities are scarce.

Mycological profile of tinea capitis in schoolchildren in rural southern Ethiopia

Tinea capitis is a known common infection among schoolchildren in developing countries that is still underreported in Ethiopia. The aim of this study was to examine the epidemiologic and etiologic profile of tinea capitis among school-aged children in a rural area in southern Ethiopia. We collected demographic and clinicodermatological data from school children aged 3-12 years with tinea infections. Pathologic specimens were taken for potassium hydroxide (KOH) mount and mycological culture. Dermatophyte species were identified by macroscopic examination of the colony and microscopic examination of fungal cultures. A total of 634 schoolchildren were screened in the study; 128 cases were suspected for tinea capitis based on clinical examination of which 99 patients (mean age 6.7 years within a range of 4-12 years), who were subsequently positive, either based on KOH examination or showed growth of dermatophytes on culture, were included in our study. The ratio of males to females was 3:1. A total of 88 patients (89.9%) had a culture positive for dermatophytes. The zoophilic species Trichophyton verrucosum was the most prevalent isolate (n = 29 cases), followed by the anthropophilic species T. tonsurans (n = 27). The other Trichophyton species implicated were T. mentagrophytes (n = 14), as well as T. schoenleinii, T. soudanense, and T. violaceum. Only 11 of the isolates belonged to the genus Microsporum: M. audouinii (n = 8), M. ferrugineum (n = 2), and M. gallinae (n = 1). T. verrucosum, followed by T. tonsurans were the most frequent causative agents in this study.

Tinea nigra palmaris: a clinical case in a rural Ethiopian hospital

ABSTRACT Tinea nigra is an infrequent, superficial fungal infection, mainly caused by Hortaea werneckii, which is still underreported in Ethiopia. An asymptomatic 62-year-old male patient sought a rural hospital of Ethiopia, showing dark plaques on the palms of both hands. A superficial mycosis was suspected and a direct light microscopic mycological examination from skin scrapings revealed short brownish hyphae. To our knowledge, this is the first case of tinea nigra from the Ethiopian highlands. This may be due to the actual rarity of the condition or to underreporting.

Performance of light-emitting diode-based fluorescence microscopy to diagnose tuberculosis in a rural hospital of ethiopia

In resource-limited settings such as Gambo General Hospital (Oromya Region, Ethiopia) that see a high incidence of tuberculosis (TB), diagnosis of pulmonary TB (PTB) is mainly made by sputum examination using microscopy for acid-fast bacilli (AFB).[1,2] However, the sensitivity of the test is poor, and case detection rates are low. In rural areas of low-income countries, mycobacterial culture or automated methods as GeneXpert MTB/RIF assay are generally not available for the rapid diagnosis of TB.[3] Fluorescence microscopy (FM) using auramine O staining is more sensitive than conventional microscopy using Ziehl–Neelsen (ZN) staining.[1-3] However, the infrastructure necessary for conventional FM is not possible in most health services due to high cost; short life of the specialized mercury lamp; higher lamp warm-up time, maintenance, and alignment; and need for dark examination rooms.[3,4] New FMs employing light-emitting diodes (LED-FM) have the combined advantages of light and FM while minimizing their disadvantages; they are inexpensive, easy to maintain and operate and do not require a dark room.[3,4]

Diagnosis of cutaneous anthrax in resource-poor settings in West Arsi Province, Ethiopia

INTRODUCTION Cutaneous anthrax is a zoonotic disease caused by the spore-forming bacterium Bacillus anthracis, which typically presents with ulcers after contact with animals or animal products, and is rarely seen in high-income countries but is common in those with low- and middle-incomes. Objective. The aim of this study is to show the main clinical characteristics of cutaneous anthrax in endemic areas. MATERIAL AND METHODS The study describes the main clinical characteristics of cutaneous anthrax in eight patients (six female and two male, age range 1 - 56 years) admitted to the rural General Hospital of Gambo, West Arsi Province of Ethiopia from 2010-2013. RESULTS In all cases, lesions began as an erythematous papule located on exposed sites (n=7 head; n=1 thigh) and subsequently became a necrotic black eschar surrounded by an edematous halo. Two patients presented with painful ipsilateral adenopathy near the black eschar. Four patients developed a malignant pustule on the suborbital region of the face. Patients responded positively to treatment, and the lesions resolved, leaving eschars. However, one patient suffered the loss of an eyeball, and another died 12 hours after starting treatment. CONCLUSIONS Physicians working in rural areas of resource-poor settings should be trained in the clinical identification of cutaneous anthrax. Early antibiotic treatment is essential for decreasing morbidity and mortality.

Black Eschars in the Highlands of Ethiopia

A 1-year-old boy, living in close contact with farm animals in the rural highlands of southwest Ethiopia, was brought to the emergency room because of two black eschars on his left thigh (Figure 1 ) and a painful ipsilateral adenopathy in the groin. According to the clinical history obtained by his mother, the lesions started as tiny papules 4–5 days earlier and had grown to the size of a coin. No other symptoms or signs were found in the clinical examination, and the white blood cell count was 7,600/mm3. The physician on call suspected cutaneous anthrax, and a microbiologist obtained a specimen of the exudate just under the eschar. Gram-positive bacilli were seen under the microscope (Figure 2 ), and the following day, a grey and dry colony described as “Bacillus-like” was seen on the surface of the culture plate.1 With the clinical diagnosis of a malignant pustule, the patient was admitted to the hospital and was treated with intravenous penicillin G for 10 days, and the case had a favorable outcome.