Open Access Original Research Article

Antibiotic Associated Diarrhea with Special Reference to Clostridium difficile

Ankita Anand, Renu Bharadwaj, Sae Pol

International Journal of TROPICAL DISEASE & Health, Page 1-10
DOI: 10.9734/IJTDH/2017/34541

Introduction: Antibiotic associated diarrhea (AAD) is a common side effect of treatment with antibiotics. Depending on the antibiotic used, up to 25% of patients experience such unpleasant bowel conditions. The normal flora is replaced by pathogenic organisms like Candida species, Clostridium difficile etc which play an important role in the causation of AAD. Almost all the antibiotics have been associated with diarrhea. C. difficile is known to occur as an outbreak in health care settings in cases of AAD. However reports from India are in-frequent. Aims: Our present study was undertaken to assess the role of different pathogen in causation of AAD and to evaluate the role of various antimicrobials in causation of AAD.

Study Design: Prospective observational study.

Place and Duration of Study: Department of Microbiology, B.J.  Government Medical College and Sassoon General Hospital, Pune from January 2014 to December 2015.

Materials and Methods: Stool samples of 70 patients developing AAD were included in the study. Individuals from all age groups were included in the study. Majority of the patients were from the age group 31 to 40 years with female preponderance Outdoor as well as Indoor patients from all faculties like medicine, surgery, obstetrics and gynecology and pediatrics were included in the present study. Samples were subjected to aerobic, anaerobic and fungal culture. C. difficile toxin was detected in stool by ELISA. PCR was also performed to look for the presence of C. difficile DNA in stool sample.

Results: Ceftriaxone (55.7%) was the commonest antibiotic causing AAD followed by amoxicillin (44.3%) and amoxicillin plus clavulanic acid (41.4%). Candida species was the major pathogen isolated from 58.6% of patients. Clostridium difficile associated diarrhea either by culture, PCR or toxin detection was seen in 18.6% of patients. Aerobic pathogens were detected in 18.6% cases of AAD. Klebsiella pneumonia (8.6%) was the commonest. No pathogens were detected in 4.3% cases.

Conclusion: Candida species (58.6%) is the major pathogen in AAD in our tertiary care center. However Clostridium difficile (18.6%) seems to be an emerging pathogen in our health care setting. It has been reported from the developed countries in epidemic proportions but seems to be just gaining foothold in India. Apart from stoppage of antibiotics, it is important to identify the pathogen in AAD so that appropriate management may be instituted.

Open Access Original Research Article

Frequency of Deworming, Parental Perception and Factors Associated with the Practice of Deworming School-age Children in North-East Nigeria

Madubueze Ugochukwu Chinyem, Una Alfred Friday, Tafawa Balewa Ibrahim, Iwu Anthony Chinedu, Azuogu Benedict Ndubueze, Madubueze Christian Chukwuemeka, Khalid Kasimu

International Journal of TROPICAL DISEASE & Health, Page 1-10
DOI: 10.9734/IJTDH/2017/34859

Aims: To assess the frequency of deworming among school children, assess parental perception of the practice and the factors influencing school child deworming practices among the parents/guardians in Bauchi State.

Study Design: It was a descriptive cross-sectional study carried out in Bauchi State North-East Nigeria in March 2016 among parents/guardians of primary school pupils. A multi-stage sampling technique was used to select 12 out of 36 primary schools for the study.

Methods: There were 598 participants. A semi-structured questionnaire was used to elicit variables such as frequency of de-worming, parental perception and predictors of parents/guardian deworming practices.

Results: Nearly half 272 (45.5%) of the guardians were aware of deworming, while only 118 (19.7%) of their school children had been dewormed but 572 (95.7%) guardians saw deworming as an important practice and 560 (93.6%) wanted their children dewormed. Binary logistic regression showed that being a male child and having a previously dewormed child were positive predictors for the practice of school children’s deworming.

Conclusion: The frequency of de-worming practice is low in North-East Nigeria, this was majorly due to lack of awareness. This underscores the need for scaling-up of deworming exercises alongside sensitization and health education of parents/ guardian of primary school pupils.

Open Access Original Research Article

Incidence of Tuberculosis in Diabetic Patients

Yasir Mehmood, Hammad Yousaf, Humayun Riaz, Syed Atif Raza, Syed Saeed-Ul-Hassan, Muhammad Shafique, Maryum Arshad Bajwa, Qasim Waseem, Zia Mohy-Ud-Din Khan

International Journal of TROPICAL DISEASE & Health, Page 1-6
DOI: 10.9734/IJTDH/2017/34704

Tuberculosis is an infectious disease, which is caused by bacteria (Mycobacterium tuberculosis). The disease is mostly transmitted from person to person, usually by inhaling bacteria (Mycobacterium tuberculosis) carrying air droplets. Tuberculosis most commonly affects the lungs, but it can also affect any other organ. The infection doesn`t always result in disease. The human immune cells can check and control pathogens, so that progression to disease only occurs in about 10% of adults. However the bacterial infection may remain latent and can reactive at any time, also after decades if e.g. the immune system is weakened. If left untreated, tuberculosis is a life-threatening illness. Main objective of this study is to highlight incidence and severity of the diabetic patients which can suffer from TB.

The most commonly used diagnostic tool for tuberculosis is a simple skin test or smear microscopy, though blood tests are becoming more commonplace. A small amount of a substance called PPD tuberculin (tuberculin purified protein derivative) is injected just below the skin of your inside forearm. You should feel only a slight needle prick. Another test for tuberculosis (TB) blood test, also called an Interferon Gamma Release Assay could be performed.

Open Access Original Research Article

Comparative Analysis of Clinical Factors Affecting Quality of Life among HIV Positive Clients in Peer Support Group in a Tertiary Hospital in Anambra State, Nigeria

Adaeze O. Okonkwo, Chinomnso C. Nnebue, Adaeze N. Anaekwe, Achunam S. Nwabueze, Chidebe O. Anaekwe, Benjamin S. C. Uzochukwu

International Journal of TROPICAL DISEASE & Health, Page 1-11
DOI: 10.9734/IJTDH/2017/35396

Background: The new test and treat paradigm for HIV positives irrespective of CD4 count may significantly reduce HIV and related illnesses. Further inroad into the effects of social support and clinical factors on quality of life (QoL) of these clients could improve management strategies. This study compared the support group and non-support group memberships for clinical determinants of QoL among HIV positive clients in a tertiary hospital in Anambra state, Nigeria.

Methods: This was an institution based comparative study of 482 HIV positive clients selected using a two -stage sampling. Data collection was by interview using WHOQOLHIV-Bref and semi-structured questionnaire, while analysis was with statistical package for social sciences version 22.0. Chi-square test was used to identify statistically significant associations between variables, with level of significance set at p value of < 0.05.

Results: Differences were found in duration of HAART treatment (p=0.003), year client first tested positive (p=0.028) for both groups, and between QoL among support group members thus:HIV stage (p=0.041) and adherence (p=<0.001) in physical domain; number of months on HAART (p=0.041) in psychological domain; HIV stage (p=0.009), adherence (p=0.014) in level of independence domain; adherence (p= 0.012) in social relationships domain; HIV stage (p=0.047) in environment domain and none in spirituality domain.

Conclusions: This study found that some clinical factors as well as support group membership influence QoL and the extent depends on domains. We recommend that these factors, domains and support group membership should be put in perspective in planning care of HIV clients.

Open Access Review Article

Epidemiological Trends of Lassa Fever Outbreaks and Insights for Future Control in Nigeria

J. O. Olayiwola, A. S. Bakarey

International Journal of TROPICAL DISEASE & Health, Page 1-14
DOI: 10.9734/IJTDH/2017/32823

The pattern of Lassa fever outbreaks in Nigeria over the years is worrisome and increasingly becoming more challenging with frequent and widening geographical spread. Lassa fever is endemic and fast becoming hyper-endemic in Nigeria. It affects the largest number of people, creating a geographical network of endemic foci encompassing a population of perhaps 180 million from Guinea to Nigeria. Lassa fever presents signs and symptoms indistinguishable from those of febrile illnesses such as malaria and other viral haemorrhagic fevers such as Ebola. Frequent human exposure to the virus is therefore possible due to the human population explosion in the endemic area and therefore given opportunities for infection with this virus, and subsequently the disease. Clinical diagnosis of Lassa fever is difficult however it should be suspected in patients showing fever with temperature (≥ 38°C) not responding adequately to antimalarial and antibiotic treatments. Laboratory diagnosis by serological, cell culture and molecular techniques is reliable although very expensive. For now there is supportive treatment but no licensed vaccine yet; therefore, public awareness and advocacy are vital in educating and sensitizing the citizenry on the risk associated with overcrowding and unhygienic practices both in our communities and health institutions in Nigeria and its environs. This review summarizes the trends and pattern of outbreaks of Lassa fever in Nigeria and other aspects of diagnosis and prevention including reasons for the lack of a vaccine and proposes plans to prevent future outbreaks.