Open Access Case Study

An Unusual Cause for Bowel Perforation- Leptospirosis

N. Raj Kumar, M. Maanasa Bhaskar, Shaktivel Harikrishnan, Nanda Kishore Maroju

International Journal of TROPICAL DISEASE & Health, Page 1-3
DOI: 10.9734/IJTDH/2018/41314

Leptospirosis is an acute febrile illness of zoonotic origin that is endemic in many tropical and subtropical regions. Infection results from direct or indirect exposure to infected reservoir host animals that carry the pathogenic leptospires in the renal tubules and are shed in their urine. The spectrum of disease is extremely wide-ranging from infections mimicking a number of other unrelated infections viz dengue and other viral hemorrhagic fevers, hepatitis or pyrexia of unknown origin to life-threatening complications including hepato-renal failure and multiorgan dysfunction. Gastrointestinal involvement in leptospirosis is rare and here we report a fatal case of leptospirosis with colonic perforation and multiorgan dysfunction with sepsis in a 65 yrs old male patient.

Open Access Short Research Article

Survival of Salmonella enterica ssp. enterica ser. Typhi in Brewed Pito Retailed in Accra

Osisiogu Udochukwu Emmanuel, Chudi-Oji Ifeoma Onyedika, Akanlu A. Servacious, Verner N. Orish

International Journal of TROPICAL DISEASE & Health, Page 1-6
DOI: 10.9734/IJTDH/2018/41604

Aim: This study aimed at ascertaining the survival ability of S. typhi in both fermented and unfermented pito.

Study Design:  The study followed an experimental design pattern.

Place and Duration of Study: The study was carried out at the Microbiology Laboratory of Radford University College, East Legon.

Methodology: S. typhi was introduced into pito samples and subsequently sub-cultured unto Salmonella-Shigella agar for 24 hours and the process repeated for five (5) consecutive days. The antimicrobial potential of pito against S. typhi was also investigated.

Results: Culture yielded no bacterial growth and pito had no significant antimicrobial effect on isolate.

Conclusion: The study, therefore, concluded that the alcoholic and nonalcoholic forms of pito could not be a route of transmission of S. Typhi. We recommend that the phytochemical compositions in sorghum should be extracted and its antimicrobial properties, especially against S. Typhi, investigated.

Open Access Original Research Article

Efficacy of Artesunate-amodiaquine Combination Therapy against Plasmodium falciparum Malaria in a Forty-two Day Follow-up in the Ikata-Likoko Area of Southwest Cameroon

Calvin Bisong Ebai, Irene Ule Ngole Sumbele, Jude Ebah Yunga, Leopold Gustave Lehman, Helen Kuokuo Kimbi

International Journal of TROPICAL DISEASE & Health, Page 1-13
DOI: 10.9734/IJTDH/2018/41651

Aims: The main aim of this study was to monitor the efficacy of artesunate-amodiaquine (AS-AQ) against Plasmodium falciparum malaria in a 42 day follow-up in the Ikata-Likoko area of Southwest Cameroon. Specifically the late clinical failure (LCF), late parasitological failure (LPF), adequate clinical and parasitological response (ACPR) and variation in haematological parameters were assessed. 

Study Design: Participants positive for P. falciparum parasitaemia in a baseline study were enrolled into the study and treated with AS-AQ following the WHO 2010 guidelines for the treatment of uncomplicated malaria. Follow-up was done according to WHO 2009 protocol for efficacy testing of antimalarial drugs. The study period was from June to September 2014.

Methods: During the follow-up, temperature, malaria parasitaemia (MP) and haematological parameters were recorded. Axillary temperature was used to monitor fever, MP through microscopy of Giemsa stained blood smears while haematological parameters were monitored through full blood count measured using an electronic blood cell analyser.

Results: The results showed LCF of 4% (4/101). The ACPR was 96.0% (97/101). Mean values of haematocrit (HCT) reduced significantly (P=.04) by day 14 before increasing. A constant reduction in mean cell volume (MCV) values were observed with the initial value being the highest (P=.04). Mean corpuscular haemoglobin concentration (MCHC) values increased significantly (P=.02) by day 28 and remained comparable. Fever reduced to 3% (3/101) by day 7, while mean body temperature remained below 37.5ºC after treatment. The mean temperature on day 0 (37.89ºC) was significantly highest (P=.03). Mild adverse events including abdominal pain, nausea, dizziness, anorexia and fatigue were observed in 21 (15.4%) participants.

Conclusion: AS-AQ remains effective against P. falciparum in the Ikata-Likoko area. However, there is need for continuous monitoring of its efficacy.

Open Access Original Research Article

Detection of Carbapenem and Colistin Resistant Gram-negative Bacteria in a Tertiary Care Hospital, Visakhapatnam, India

Alugupalli Amar Sahas, Payala Vijayalakshmi, Pilli Hema Prakash Kumari, Swapna Sasapu, Ratna Harika Dusi, R. V. Manasa

International Journal of TROPICAL DISEASE & Health, Page 1-11
DOI: 10.9734/IJTDH/2018/41856

Aims: Among the most clinically significant multidrug-resistant bacteria are the carbapenemase-producing Enterobacteriaceae (CPE) which are detected all over the globe, with a marked endemicity according to enzyme type. These bacteria usually remain susceptible to polymyxins like colistin; however increasing use of colistin causes acquired colistin resistance which may now be added to the carbapenem resistance trait in Enterobacteriaceae. The present study was aimed to isolate and identify Gram-negative Enterobacteriaceae organisms from various clinical samples of patients suffering with various infections and to study the antibiogram of Gram-negative Enterobacteriaceae organisms with reference to carbapenem and colistin antibiotics.

Methodology: Different clinical samples collected from both in-patients and out-patients constituted the material for the study. Demographic variables of the patient were recorded include age, sex, type of patient (in-patient or out-patient) and type of samples. Standard microbiological techniques were used for the identification of pathogenic bacteria which include Gram staining, cultural and biochemical methods. Antibiotic susceptibility testing was performed according to Clinical Laboratory Standards Institute (CLSI) guidelines using Mueller-Hinton agar plates. Extended-spectrum beta-lactamase (ESBL) production was tested with the CLSI confirmatory test using Ceftazidime (30 µg) disc alone and in combination with Clavulanic acid (10 µg). The bacterial isolates which were resistant to imipenem through disk-diffusion method were regarded to be screening positive and were further confirmed by EDTA combined disc test. Modified-Hodge test and E-test method were used to identify the carbapenem and colistin resistant strains. Frequency and percentages were calculated for categorical and ordinal variables. Chi-square test was carried out and p-value ≤0.05 were considered statistically significant.

Results: Male predominance (59%) is seen while compared to females (41%). The maximum cases were reported in the age group 51-60 years (31%). Majority of the isolates like Klebsiella species (30.6%) followed by E. coli (25.9%) and few isolates reported were Proteus species (5.8%). Extended spectrum beta-lactamase production was identified in test isolates at a range of 95.2% by using ceftazidime/clavulanic acid combination antibiotic susceptibility test. The prevalence rate of metallo-beta lactamase isolates was quite high i.e. 66.6% and carbapenemase producers was 77.3%. The major isolates were Klebsiella spp. and E. colishows Metallo-beta-lactamase production.

Conclusion: The study helps the clinicians in choosing the correct antimicrobial agent which contribute not only to better treatment but their judicious use will also help in preventing the emergence of drug resistant strains which are still sensitive.

Open Access Original Research Article

Health Managers’ Knowledge of Essential Drugs and the Availability of Essential Drugs in Primary Health Care Centres in Sokoto, Northwest Nigeria

L. A. Jamil, M. T. O. Ibrahim, B. A. Isah, A. Chika, K. J. Awosan, A. Mohammed

International Journal of TROPICAL DISEASE & Health, Page 1-8
DOI: 10.9734/IJTDH/2018/39854

Background: The significant indicator to access to effective treatment is the constant availability of essential drugs in health facilities and the accessibility to essential drugs is part of the fulfilment of the right to the highest attainable standard of health, that is, the right to health. There is compelling evidence of reduced availability of essential drugs which poses a significant barrier to access to medicines.

Objective: To determine the knowledge of essential drugs by health managers and the availability of essential drugs in primary health care (PHC) centres in Sokoto state, North-Western Nigeria.

Methodology: The study population comprised of selected Primary Health Care Centres and their supervisory managers across Sokoto state. The study was cross-sectional and descriptive.

Results: Sixty-six primary health care managers and their corresponding health facilities participated in the study. The mean age of the health managers was 43 years with 46 females and 20 males. This study found mean availability of essential drugs in the primary health care centres with 57.5% having adequate essential drugs, the knowledge of essential drugs among the primary health care facility managers was poor and the knowledge has a significant effect on the availability of essential drugs (p<0.001).

Conclusion: Poor knowledge on essential drugs and its management by the Primary Health Facility Managers was a major contributing factor to the availability of essential drugs in the PHCs which consequently affects health service delivery at the health facilities. Training and re-training of primary health care managers on essential drugs and its management by the Sokoto state government through the State Primary Health Care Development Agency (SPHCDA) are recommended.