DSpace Collection: Theses in Medical Microbiology Biology and Parasitology

BIOMAKERS OF SUPPURATIVE OTITIS MEDIA IN CHILDREN ATTENDING SELECTED HEALTH FACILITIES IN IBADAN

2019-04-30T09:26:28Z

Title: BIOMAKERS OF SUPPURATIVE OTITIS MEDIA IN CHILDREN ATTENDING SELECTED HEALTH FACILITIES IN IBADAN Authors: LASISI, A.O. Abstract: Suppurative otitis media or otorrhoea is a major health problem; especially in the first year of life. It could be acute (within 3 months duration) or chronic (greater than 3 months duration). Immunobiologic markers have been identified in otorrhoea, but their role in the outcome of disease remains relatively unknown. This study was aimed at determining the role of these markers in the development of Early Suppurative Otitis Media (ESOM) and the relationship of their levels in the Middle Ear Secretion (MES) and serum to the outcome of Acute Suppurative Otitis Media (ASOM). One tertiary (University College Hospital, Ibadan) and a community health (Bilal Health Center, Agodi) facilities were purposively selected. Participants included 186 consecutively recruited healthy neonates at birth and 22 children (1 to 12 years) who developed ASOM. The ASOM group was compared with 171 age-matched apparently healthy control subjects from among children at the University College Hospital, lbadan. Blood samples were collected from the neonates and subsequently monitored monthly for 12 months for development of ESOM. Ten milliliters of Blood (two samples taken at presentation and 3 months after) and MES were collected from the ASOM group who were treated and followed up for 10 months to determine resolution or chronicity (CSOM). The MES was cultured for bacterial infection. Neonatal serum and MES were analyzed for retinol and zinc using high performance liquid chromatography and atomic absorption spectrophotometry respectively. Enzyme Linked immunoassay was used to determine interferon gamma (IFN-y) and immunoglobulins (Ig), Data were analyzed using ANOVA at p=0.05. Incidence of ESOM was 37% among the neonates and the isolates were Pseudomonas aeruginosa. Staphylococcus aureets and Streptococcus spp. There was no significant difference in the mean serum IgG between neonates with ESOM and healthy neonates (1180.0mg/m1±6.3 vs 1370.2 mg/ml ±9.4). Neonatal cord retinol (0.9ug/L±0.1 vs 1.1ug/L±0.2), zinc (0.9ug/L±0.1 vs 1.1ug/L±0.2) and IFN-y (45.3pg/ml±4.2 vs 170.2pg/ml±24.5) were significantly higher in the normal neonates relative to those that developed ESOM. Serum retinoI was significantly lower in ASOM children (1.5ug/L±0.6) than healthy control (2.6ug/L±0.3) whereas there were no significant differences in their serum IgG, IgE, IgM, Zinc and IFN-y levels. In the 46% of ASOM children who developed CSOM, serum levels of IgM was significantly higher (1321.1mg/dL±21.2) and retinol was significantly lower (1.6ug/L± 0.1) than those that had resolved ASOM (666.1mg/dL±14.4 and 2.1 ug/L±0.1respectively. The MES levels of IgG (511.5mg/dL±9.7); lgE (102.0mg/dL±3.6) and IFN-y (73.1pg/ml±12.0) were significantly higher and MES lgA (85.40mg/dL±13.64) was significantly lower than resolved ASOM (203.4mg/dL±7.9, 60.4mg/dL±6.1, 27.2pg/ml±4.1and 228.30mg/dL±16.22 respectively). There were no significant differences in levels of MES IgM, serum IgM, IgA and lgE, IFN-y and zinc between the two groups. Reduced levels of neonatal retinol, zinc and IFN -y were associated with the development of early suppurative otitis media. Reduced middle ear secretion of IgA and IgG; and serum IgG and retinol were determinants of chronicity in acute suppurative otitis media. Immunoglobulins and retinol may be used in monitoring the progression from acute to chronic suppurative otitis media. Description: A Thesis in the Department of Medical Microbiology and Parasitology submitted to the Faculty of Basic Medical Sciences in partial fulfillment of the requirements for the degree of Doctor of Medicine(M.D) of the University of Ibadan

EPIDEMIOLOGY OF HUMAN BRUCELLOSIS IN OYO STATE OF NIGERIA

2019-04-30T09:28:12Z

Title: EPIDEMIOLOGY OF HUMAN BRUCELLOSIS IN OYO STATE OF NIGERIA Authors: ALAUSA, K. O. Abstract: Brucellosisis a zoonosis, primarily a disease of domestic animals which under special circumstances, may be readily transmitted to man. The epidemiological picture of the disease varies from area to area in different parts of the world and has to be studied carefully in planning control and eradication programmes. In Nigeria, where livestock management is still largely unscientific and bovine brucellosis is known to be endemic (Esuruoso, 1975b), there are only scanty data on the epidemiology and clinical presentation of man brucellosis. Therefore, the present study, which covered a period of three and half years between September 1973 and February 1977, was undertaken with the objectives of collecting adequate and reliable data on the epidemiology of human brucellosis in Oyo State of Nigeria in order to be able to formulate a realistic control programme. The study also aimed at expanding medical and applied scientific knowledge in the field of brucellosis and occupational medicine in Nigeria. Over 70 per cent of the total 55 million Nigerians (1963 census report) live in rural areas and form settlements. Medical and other social services are grossly inadequate in the whole country and the few amenities are concentrated in the capital cities and other big towns, with the rural agricultural areas virtually neglected. Agriculture is the mainstay of the Oyo State economy, and approximately 5 per cent of the State’s labour force are engaged in agricultural work. Cow meat is the most readily available animal protein to the people of Oyo state, the resent epidemiological study was undertaken largely in several farm settlements over Oyo state, but the central based at the Department of Medical Microbiology. University college hospital, Ibadan, where also the clinical aspects of the study were carried. The pilot sero- epidemiological evaluation on human brucella antibodies carried out on 1600 people of various occupation and age groups living in Ibadan, capital of Oyo State, revealed on overall sero-positivity rate of 50.2 per cent. Significantly higher prevalence of infection was found among the occupationally exposed peculation including herdsmen, abattoir workers and veterinarians, than the general population, including blood donors, pregnant women and school children. The important identifiable sources of human infection include direct transmission from infected animal through abraded skin, nasopharyngeal mucosa and the conjunctives. Other sources of human infection are by ingestion of infected milk, especially on the ferms, or eating of roast meat (barbecue), which is becoming popular at portion among the cities in the urban centres. Further epidemiological investigations carried out In several livestock farms showed that the important factors determining the rate and level of human brucellosis in Oyo State include: (1) the geographical location of the form; (2) the number of cattle per head of population and the frequency or contact with infected animals; (3) the rate of active infection in the cattle herd; (4) the system of animal husbandry: whether scientific or traditional methods; and (5) imported bovine Infection from neighboring countries. An outbreak of active bovine brucellosis with human involvement which was investigated during the study revealed that the hazards caused by Br,abortus infections are of great social and pubic heath important in Oyo state. The economic loss to the livestock industry due to brucellosis if estimated, would run into millions of naira (#) annually, judging from the high rate of abortion and infertility among heifers in some farms. The public health consequences are also enormous, considering the fact that protein undernutrition is very common in Nigeria (Morley, 1973), especially in the rural areas (oyenuga 1976) and the ill-health which prevents the farmers from taking proper care of their livestock. An economically viable livestock industry will be difficult to achieve under the present stage of endemic brucellosis in Oyo state. The practical problems of controlling brucellosis in a developing economy were highlighted, as the ideal slaughter technique leading to eradication of bovine infection is not feasible because of the present poor state of livestock industry in Oyo state. However, realistic control measures, based on the improvement of the existing agricultural, social, and health systems in the state, are possible. Immediate inter-control measures include hygiene on the farm and abattoirs, avoidance of raw milk and introduction of vaccination programmes for beef cattle in settled herds. In addition, every effort should be made to improve the social and medical services in the rural areas of the state. The long-term control measures should include the establishment of clinical and laboratory services, health education of farmers and abattoir workers, full coordination in the medical and veterinary services, widespread pasteurization of fresh milk, the establishment of a state-federal co-operative Brucellosis control programme, and finally industrial for the improvement of the working conditions of the livestock farmers. The suggested future studies which are directly indicated from the present study include (1) large scale epidemiological survey of Nigeria to determine the overall socio-economic significance of human brucellosis, and therefore, to formulate a national control program, (2) further evaluation of the role played by brucellosis among patients with pyraxis of undetermined origin, pregnant women with second –trimester abortions and patient with neuro-psychiatric disorder and (3) production of safe and effective human immunizing agent against brucellosis, especially among the occupationally exposed individuals in areas with endemic bovine disease. Description: A THESIS IN THE DEPARTMENT OF MEDICAL MICROBIOLOGY SUBMITTED TO THE FACULTY OF MEDICINE IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF MEDICINE OF THE UNIVERSITY OF IBADAN.

GROUP B STREPTOCCAL INFECTIONS IN IBADAN

2019-05-28T10:58:26Z

Title: GROUP B STREPTOCCAL INFECTIONS IN IBADAN Authors: ONILE, B. A. Abstract: This present study on group B streptococcal (GBS) diseases was carried out between 1977 and 1982 in Ibadan, the largest indigenous Black African city, and capital of Oyo State of Nigeria, with an estimated population of two million. Patients were those attending the University College Hospital, Adeoyo State Hospital and Jericho Maternity Hospital, the largest three government owned hospitals serving the whole population of Ibadan and the surrounding districts. Group B streptococcus (Streptococcus agalactiae) has now been established as a leading cause of neonatal sepsis in temperate countries, although it was previously recognized only as a major pathogen among the bovidae. The objectives of this study were to establish the types of human infections caused by this organism in Ibadan, a. tropical African city. It was also intended to determine the extent of the problem posed by this organism which had not previously been reported in Nigeria. Also by studying the factors that could contribute to the transmission and the development of infection and by performing antibiotics sensitivity testing on strains it was intended to formulate a comprehensive control policy for GBS infections in Nigeria. Todd Hewitt broth containing 8mg/L gentamicin was used as an enrichment medium for the primary isolation of the organism. The ability of Streptococcus agalactiae to produce an orange pigment under anaerobic conditions on Columbia and Islam agar plates was used for a quick presumptive identification of the organism; while its gram reaction, its ability to hydrolyse sodium hippurate and its inability to hydrolise aecsculin were used as confirmatory tests. These were further confirmed by streptococcal grouping using the slide co-agglutination technique. A total of 1,038 patients were screened for colonization by the organism. Five hundred and eighty-eight (56.6%)of the patients were females of child bearing age; 150 (14.5%) were adult males and 300 (20.9%) were newborn babies of both sexes. An average vaginal colonization rate of 10.5 per cent was obtained for the women of child bearing age. Among 150 antenatal patients tested, 29(19.3%) were colonized. Colonisation rates among 236 pregnant women in labour and 200 female patients attending the clinic for the treatment of Sexually Transmitted Diseases (STD) were 17.6 and 19 per cent respectively. The differences in vaginal colonization rates among the various groups of female patients were not statistically significant (P>0.05). There was no significant association between genital carriage of GBS and STD among the female patients: genital carriage was generally associated with females, whether they had STD (P<0.01) or not (P< 0.01). There was however a strong association between genital GBS carriage and STD among the male patients (P<0.05) but this could not be linked with any particular STD. Using the external auditory meatus as an indicator site of superficial neonatal GBS colonization, it was found that 4.5 per cent of the 300 newborns screened in the hospitals were colonized by this organism. All serotypes of GBS were encountered: the commonest being types III (56.1%), Ic (14.4%) and X (11.4%). Type Ia was very rare indeed. There was a high incidence of R. (43.9%) and X (12.1%) antigens, being associated especially with types II and III strains. This high incidence of R and X strains were not, however, associated with zoonotic transmission of the organism. Both neonatal aid adult GBS infections were encountered during the course of this study. The early onset and the late onset types of neonatal sepsis were also encountered. Three newborns with the early syndrome were described and they all presented with septicaemia within the first 24 hours of birth. The predisposing factors were prematurity, premature rupture of the membranes, maternal fever and low birth-weight. They were caused by types Ic and II organisms. The patient presented with meningitis in association with epidural effusion at the age of four weeks. It was due to the type III organism. All the neonates responded favourably to systole treatment with gentamicin and ampicillin. Adult GBS infections were encountered only among females who presented with a somewhat bimodal age distribution. There was a younger group of patients with a mean age of 27 years presenting with urogenital symptoms mostly following premature rupture of the membranes, prolonged labour and surgery; and a 50-year old patient presenting with multiple skin abscesses complicating diabetes mellitus. One of the infecting strains in this study was the type X organ is. There was no mortality among the patients described. Using the Modified Stoke's Method of antibiotics sensitivity testing, it was shown that all the strains were sensitive to penicillin G, cefotaxime, chloramphenicol and erythromycin but 96.7 per cent were resistant to tetracycline. The minimum inhibitory concentrations (MIC) of penicillin G was determined for the GBS strains as this was the usual antibiotic used for treating infections caused by them. 95.6 percent had an MIC of 0.1 iu/ml; 3.2 per cent an MIC of 0.5 iu/nl and 1.2 per cent an MIC of iu/ml. The MIC results corroborate the results of sensitivity testing using the Modified Stokes Method, thus explaining the favourable clinical response of the patients who were all treated with penicillin in combination with other antibiotics. This study therefore showed that there were only occasional cases of GBS sepsis in Ibadan among neonates and also among adults. The female genital tract was confirmed to be a major colonized site by this organise with an average carrier rate of 16 per cent. The risk of developing neonatal infection as reported in literature is about one per 100 colonized infants. From this figure a neonatal infection rate of 2 - 4 cases per 1000 births was expected for Ibadan. However from the result of collaborative studies no neonatal cases were recorded during a 4-month period; and there were only cases of neonatal sepsis reported during a 2 year period at the University College hospital Ibadan; this was an incidence of 0.4 cases per 1000 births. A possible explanation for the low incidence of neonatal GBS sepsis in this report is the preponderance of the type III organism in the female vagina. Type III GBS possesses immunogenic antigens which could evoke the development of maternal antibodies of the IgG type that would be protective for newborn babies. Another possible explanation is the fact that other pyogenic organisms including the enterobacterioceae predominate in infections in the Tropics, thus competing with GBS. An increased incidence of GBS infections was associated with a decline in the incidence of infection caused by the enterobacterioceae in the United States of America. Potentially therefore, the latter could pose a major health problem in future when infections due to the other organisms have been controlled. As a result of the foregoing, a comprehensive control policy for an outbreak of GBS disease was formulated which included treatment of cases and prophylaxis of neonatal infections. Description: A THESIS IN THE DEPARTMENT OF MEDICAL MICROBIOLOGY SUBMITTED TO THE COLLEGE OF MEDICINE IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF MEDICINE, UNIVERSITY OF IBADAN.

HUMAN LOIASIS IN WESTERN NIGERIA

2019-03-28T16:20:30Z

Title: HUMAN LOIASIS IN WESTERN NIGERIA Authors: OGUNBA, EUGENE OLATUNDE Abstract: An attempt has been made in this study to bridge some of the gaps in our knowledge of loiasis in Western Nigeria. At this same time, areas for future research which might lead to a better understanding of the disease pattern in loiasis are highlighted. This thesis is made up of both laboratory and field studies which were carried out at the University College Hospital, lbadan, and in villages in the Western State of Nigeria respectively. Tha sample population for the prevalence study comprised of 10830 school pupils and 1399 adults drawn from villages in divisions all over the Western State. Blood samples were examined parasitologically for microfilariae of Loa loa and the results obtained were analysed and utilised in determining the geographical distribution of loiasis within the state. Vectors of Loa Loa were determined in Ijebu and Remo divisions and the role of the common blood sucking mosquitoes in the transmission of loiasis was assessed in Ibadan city. The observation that Mansonia africana would allow the development of Mf Loa to the mature third stage larva raises the possibility that the Loa Loa population in Western Nigeria might be different from the other known population; therefore the local population was measured and compared with the Kumba (Cameroon) population. Some of the manifestations often associated with Loiasis were discussed on tho basis of the observations made in villages during the prevalence studies; furthermore the association that may exist between Loiasis, endomyocardial dibrosis, ABO blood groups and haemoglobulin genotypes, elephantiasis and hydrocoele were examined and discussed. The results of the present study show that loiaisis is endemic in the Western State of Nigeria, with most of the transmission taking place in the rain-forest and freshwater swamp zones. It has also been shown that, C.silacea and C.dimidiata are the vectors of Loa Loa in both the Ijebu and Remo divisions of the State. Even though M.aficana supportod the development of Mf Loa to the natural larval stage, this mosquito is not important as a vector in nature. The importance of M.africana lies in its possible use as a laboratory vector in preference to Chrysops species because of its short period of larval development. There is no preferential infection by Loa Loa of any of the groups and the haemoglobin genotypes studied. It has also been shown that there is no protective effect in any of the groups studied either in terms of preventing infestation or in the intensity of infection. Therefore none of the blood groups or haemoglobulin genotypes in this study is at an advantage or disadvantage with respect to loiasis. There is yet no conclusive evidence with which to incriminate loiasis with endomyocardial fibrosis, elephantiasis and hydrocoole formation in infected patients. Description: A THESIS IN THE DEPARTMENT OF CHEMICAL BIOCHEMISTRY SUBMITTED TO THE COLLEGE OF MEDICINE IN PARTIAL FULFILMENT OF THE DEGREE OF DOCTOR OF PHILOSOPHY OF THE UNIVERSITY OF IBADAN