Richard Omoregie

Molecular Epidemiologic Characterization of Enterocytozoon bieneusi in HIV-Infected Persons in Benin City, Nigeria

Molecular characterization of Enterocytozoon bieneusi has led to better understanding of microsporidiosis transmission in humans. This study aimed to detect and genotype E. bieneusi in human immunodeficiency virus (HIV)-infected persons. Stool specimens were collected from 463 HIV-infected patients and analyzed for E. bieneusi by polymerase chain reaction (PCR) and DNA sequence analysis of the internal transcribed spacer. E. bieneusi was detected in 77 HIV patients. CD4 cell counts < 200 cells/μL was associated with E. bieneusi infection (P = 0.09). E. bieneusi was significantly associated with weight loss (P < 0.0001), diarrhea (P = 0.006), fever (P < 0.0001), not being married (P < 0.0001), and flush type of toilet (P = 0.0007). Six known genotypes of D, A, IV, CAF2, EbpA, and Peru 8 in 31, 22, 14, 2, 1, and 1 patients, respectively, five novel genotypes of E. bieneusi, and one infection with mixed genotypes were observed in this study. Three of the novel genotypes were genetically distant to the genotypes commonly found in humans.

Prevalence of intestinal parasitic infections among HIV patients in Benin City, Nigeria.

This study was carried out to determine the presence of intestinal parasites and their correlation with CD4+ T-cell counts and demographics among human immunodeficiency virus (HIV)-positive patients in Benin City, Nigeria. Stool specimens from 2,000 HIV-positive patients and 500 controls (HIV-negative individuals) were examined for ova, cysts, or parasites, using standard procedures. In addition, patients blood samples were analyzed for CD4 counts by flow cytometry. An overall prevalence rate of 15.3% was observed among HIV-positive patients while 6.2% was noted among non-HIV subjects. HIV status was a significant (P<0.0001) risk factor for acquiring intestinal parasitic infections. Male gender, CD4 count <200cell/µl, and diarrhea were significantly associated with an increased prevalence of intestinal parasitic infections among HIV-positive patients. The level of education, occupation, and source of water among HIV patients significantly (P<0.0001) affected the prevalence of intestinal parasitic infections. Ascaris lumbricoides was the most predominant parasite in both HIV-positive patients and controls. A CD4 count <200 cells/µl was significantly associated with only Isospora belli and Cryptosporidium infections. The presence of pathogenic intestinal parasites such as A. lumbricoides, hookworm, Giardia intestinalis, Entamoeba histolytica, Trichuris trichiura, and Taenia species among HIV-infected persons should not be neglected. Cryptosporidium species and I. belli were the opportunistic parasites observed in this study. Routine screening for intestinal parasites in HIV-positive patients is advocated.

Urinary tract infection in a rural community of Nigeria.

Aim: To determine the prevalence of urinary tract infection (UTI) in Okada, a rural community in Nigeria, and the effect of age and gender on its prevalence as well as the etiologic agents and the susceptibility profile of the bacterial agents. Patients and Method: Clean-catch midstream urine was collected from 514 patients (49 males and 465 females). The urine samples were processed and microbial isolates identified. Susceptibility testing was performed on all bacterial isolates. Result: The prevalence of urinary tract infection was significantly higher in females compared to males (female vs. male: 42.80% vs. 10.20%; OR = 6.583. 95% CI = 2.563,16.909; P < 0.0001). Age had no effect on the prevalence of UTI. Escherichia coli was the most prevalent isolate generally and in females, while Staphylococcus aureus was the predominant isolate causing urinary tract infection in males. The flouroquinnolones were the most active antibacterial agents. Conclusion: An overall prevalence of 39.69% was observed in this study. Females had a 3 to 17 fold increase risk of acquiring UTI, than their male counterpart. Escherichia coli were the predominant isolates causing UTI.

Unusual Enterocytozoon bieneusi Genotypes and Cryptosporidium hominis Subtypes in HIV-Infected Patients on Highly Active Antiretroviral Therapy

Human immunodeficiency virus (HIV)-infected persons are commonly infected with Cryptosporidium species and Enterocytozoon bieneusi in both developed and developing countries, particularly patients with CD4+ cell counts below 200 cells/μL; 285 HIV-infected patients on highly active antiretroviral therapy (HAART) were enrolled in this study, and both stool and blood specimens were collected from participants. The stool specimens were analyzed and typed for E. bieneusi and Cryptosporidium spp. by polymerase chain reaction (PCR) and DNA sequencing. CD4 count was analyzed using flow cytometry. E. bieneusi and Cryptosporidium were detected in 18 (6.3%) and 4 (1.4%) patients, respectively. The E. bieneusi detected mostly belonged to a new genotype group that, thus far, has only been found in a few humans: genotype Nig4 in 2 patients and two new genotypes related to Nig4 in 12 patients. The Cryptosporidium detected included C. hominis (two patients), C. parvum (one patient), and C. felis (one patient), with the two C. hominis infections belonging to an unusual subtype family. Additional studies are required to determine whether some E. bieneusi genotypes and C. hominis subtypes are more prevalent in HIV patients on HAART.

Etiologic agents of otitis media in Benin city, Nigeria

Background: Otitis Media continues to be a major presentation in the ear, nose and throat clinic. Aim: This study aimed to isolate, characterize and identify the bacteriological and mycological etiologic agents of otitis media in Benin city. Patients and Methods: Ear discharge from 569 (299 males and 270 females) patients diagnosed clinically of otitis media between August 2009 and August 2010 were processed to recover the bacterial and fungal etiologic agents. Susceptibility test was performed on all bacterial isolate. Result: Pseudomonas aeruginosa (28.3%) was the predominant bacteria isolate causing otitis media followed by Staphylococcus aureus (21.0%), Klebsiella sp (8.9%), Proteus sp (8.2%), Alkaligenes spp (4.3%), Streptococcus pneumoniae (3.9%), Escherichia coli (3.0%) and Citrobacter freundi (1.7%). Fungi isolated were Aspergillus niger (9.2%), Candida albicans (5.4%), Candida tropicalis (3.0%), Aspergillus flavus (2.1%) and Candida parasilopsis (1.5%). 413 had a single organism isolated from the middle ear culture while twenty (3.51%) patients had mixed organisms isolated. Infection was highest among 0 - 5 years, and lowest among aged 18 - 23. All bacterial isolates were poorly susceptible to the antibacterial agents. Conclusion: The study uncovers a high frequency of bacteria associated otitis media with the finding of fungi too as a significant etiologic agent.

Prevalence of Otitis Media in Okada Community, Edo State, Nigeria

Prevalence of Otitis Media in Okada Community, Edo State, Nigeria Aim. To determine the prevalence of otitis media in Okada, a rural community in Nigeria, and the effect of age and gender on its prevalence as well as susceptibility profile of the bacterial agents in the community. Material and Methods. Ear discharge from 500 (240 males and 260 females) patients with signs and symptoms of otitis media were processed to recover bacterial agents. Susceptibility test was performed on all bacterial isolates. Results. Male gender was a significant (P = 0.011) risk factor for acquiring otitis media (male Vs female; 36.25% Vs 25.38%. OR = 1.671 95 CI = 1.139, 2.454). Age significantly (P < 0.0001) affected the prevalence of otitis media with children within the age range of 0 - 5years having the highest prevalence of 78.41%. Pseudomonas aeruginosa was the predominant bacteria isolate causing otitis media generally and in both gender. All bacterial isolates showed were poorly susceptible to the antibacterial agents used as less than 50 percent of any bacteria genera were susceptible to any antibacterial agent. Conclusion. An overall prevalence of 30.6% of bacteriologically proven otitis media was observed in this study. The prevalence were higher in males and in children 5 years and younger. Following the high level resistance observed, rational use of antibacterial agents is advocated.

Molecular Characterization of Cryptosporidium spp. in HIV-infected Persons in Benin City, Edo State, Nigeria

The use of molecular tools in epidemiological investigations has provided new insights into the transmission of cryptosporidiosis in humans and animals. This study aimed to characterize the transmission of cryptosporidiosis in human immunodeficiency virus (HIV)-infected patients. Stool specimens were collected from 500 HIV-infected patients as part of the routine patient care. Cryptosporidium species in stool specimens were detected and differentiated using a small subunit rRNA-based polymerase chain reaction-restriction fragment length polymorphism technique. C. hominis and C. parvum were found and subtyped by DNA sequence analysis of the 60 kDa glycoprotein (gp60) gene. Cryptosporidium species were detected in 36 HIV patients and none were found among non-HIV patients. A CD4+ count

Candida colonisation in asymptomatic HIV patients attending a tertiary hospital in Benin City, Nigeria.

Background : Candidiasis is the commonest opportunistic fungal infection in patients infected with human immunodeficiency virus (HIV). CD4+ lymphocyte counts have been found to be a marker of HIV disease progression. Aim : This study focused on determining the spectrum of Candida isolates in urine, stool, and oral specimens among HIV patients in a tertiary hospital. Methods : A total of 300 subjects comprising of 200 HIV patients and 100 non-HIV subjects were used for this study. Three samples (urine, stool, and oral swab) were collected from each subject. Each specimen was processed using standard microbiological techniques and emergent Candida isolates were identified with CHROMagar™ Candida and sugar fermentation tests. Results : The overall prevalence of Candida colonisation among HIV patients was 52.5%. HAART-naive patients had a significantly higher prevalence (OR = 3.65; 95% CI = 2.03–6.56; p<0.0001) than their counterpart on highly active antiretroviral therapy (HAART) (OR = 1.99; 95% CI = 1.13–3.50; p=0.0232). Female gender was a significant risk factor for acquiring Candida infection (OR = 3.40; 95% CI = 1.14–10.13; p=0.0289). The effect of age on prevalence of candidiasis was observed among HIV patients on HAART (p=0.0161). A CD4+ count <200 cells/µl was a significant risk factor for acquiring candidal infection only among HAART-naive patients (OR = 4.37; 95% CI = 1.60–11.95; p=0.0042). The five species of Candida recovered from this study were C. albicans, C. krusei, C. parapsilosis, C. tropicalis, and C. glabrata. Conclusion : There is a significant relationship between antiretroviral therapy, CD4+ counts, and the prevalence of candidiasis.BACKGROUND Candidiasis is the commonest opportunistic fungal infection in patients infected with human immunodeficiency virus (HIV). CD4+ lymphocyte counts have been found to be a marker of HIV disease progression. AIM This study focused on determining the spectrum of Candida isolates in urine, stool, and oral specimens among HIV patients in a tertiary hospital. METHODS A total of 300 subjects comprising of 200 HIV patients and 100 non-HIV subjects were used for this study. Three samples (urine, stool, and oral swab) were collected from each subject. Each specimen was processed using standard microbiological techniques and emergent Candida isolates were identified with CHROMagar™ Candida and sugar fermentation tests. RESULTS The overall prevalence of Candida colonisation among HIV patients was 52.5%. HAART-naive patients had a significantly higher prevalence (OR = 3.65; 95% CI = 2.03-6.56; p<0.0001) than their counterpart on highly active antiretroviral therapy (HAART) (OR = 1.99; 95% CI = 1.13-3.50; p=0.0232). Female gender was a significant risk factor for acquiring Candida infection (OR = 3.40; 95% CI = 1.14-10.13; p=0.0289). The effect of age on prevalence of candidiasis was observed among HIV patients on HAART (p=0.0161). A CD4+ count <200 cells/µl was a significant risk factor for acquiring candidal infection only among HAART-naive patients (OR = 4.37; 95% CI = 1.60-11.95; p=0.0042). The five species of Candida recovered from this study were C. albicans, C. krusei, C. parapsilosis, C. tropicalis, and C. glabrata. CONCLUSION There is a significant relationship between antiretroviral therapy, CD4+ counts, and the prevalence of candidiasis.

Prevalence of Malaria and Anemia among Pregnant Women Attending a Traditional Birth Home in Benin City, Nigeria

OBJECTIVES To determine the prevalence of malaria and anemia among pregnant women attending a traditional birth center as well as the effect of herbal remedies, gravidity, age, educational background and malaria prevention methods on their prevalence. METHODS Blood specimens were collected from 119 pregnant women attending a Traditional Birth Home in Benin City, Nigeria. Malaria parasitemia was diagnosed by microscopy while anemia was defined as hemoglobin concentration <11 g/dL. RESULTS The prevalence of malaria infection was (OR=4.35 95% CI=1.213, 15.600; p=0.016) higher among primigravidae (92.1%). Pregnant women (38.5%) with tertiary level of education had significantly lower prevalence of malaria infection (p=0.002). Malaria significantly affected the prevalence of anemia (p<0.05). Anemia was associated with consumption of herbal remedies (OR=2.973; 95% CI=1.206, 7.330; p=0.017). The prevalence of malaria parasitemia and anemia were not affected by malaria prevention methods used by the participants. CONCLUSION The overall prevalence of malaria infection and anemia observed in this study were 78.9% and 46.2%, respectively. Higher prevalence of malaria infection was associated with primigravidae and lower prevalence with tertiary education of subjects. Anemia was associated with consumption of herbal remedies. There is urgent need to control the prevalence of malaria and anemia among pregnant women attending traditional birth homes.

Effects of Gender and Seasonal Variation on the Prevalence of Bacterial Septicemia Among Young Children in Benin City, Nigeria

Aim To determine the effects of gender and seasonal variations on the prevalence of bacterial septicaemia among children 5 years and younger, and to identify the bacterial agents responsible for septicaemia and their antibiotic susceptibility profiles. Methods Blood was collected from 1,724 children (967 males and 757 females) aged 1 day to 5 years with clinical signs and symptoms of septicaemia. This study was carried out from 1 January to 31 December 2007 at the University of Benin Teaching Hospital, Benin City, Nigeria. The blood samples were processed to diagnose bacterial septicaemia. Bacterial isolates were identified and susceptibility test was performed using standard techniques. Results An overall prevalence of 22.10% of confirmed bacterial septicaemia was observed in this study. Generally, gender and seasonal variations did not significantly affect the prevalence of bacterial septicaemia, though females (50.57%) during the dry season had significantly (p < 0.001) higher prevalence than their male counterparts (19.91%). Staphylococcus aureus was the predominant bacterial isolate causing septicaemia in both seasons, while Citrobacter freundii was the least frequent. Pseudomonas aeruginosa was not recovered during the dry season. Most isolates were susceptible to gentamicin and cefuroxime, but only 1.44% of Staphylococcus aureus strains were susceptible to ceftriaxone. Conclusion Bacterial septicaemia was observed in 22.1% of children 5 years and younger with clinical signs and symptoms of septicaemia. Seasonal variation did not affect the prevalence. Effect of gender was only noticed in the dry season, where females had a higher prevalence than males. Gentamicin and cefuroxime were the most active antibacterial agents. Rational use of antibiotics is advocated.