In our setting, 6.0% of tuberculosis isolates are rifampicin resistant. Mutations associated with probe E commonly due to codon 531 are the most predominant cause of rifampicin resistance. Mutations at probe C (codons 518-523) were uncommon. A change in mutation may have occurred in one of the patients.

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Background Several case reports abound in literature about cases of histoplasmosis misdiagnosed as tuberculosis (TB). Nigeria is one of the highest TB burdened countries but data on histoplasmosis in Nigeria are sparse in the literature. The aim of this research was to investigate patients with presumptive pulmonary tuberculosis (TB) in Calabar, Nigeria, for histoplasmosis. Methods This was a descriptive cross-sectional study of 213 participants with presumptive diagnosis of pulmonary TB between April 2020 and March 2021. Urine samples were collected from selected patients for Histoplasma antigen test using enzyme immunoassay assay kits (IMMY, USA), while sputum samples were collected for GeneXpert test for confirmed diagnosis of TB and conventional PCR for the diagnosis of histoplasmosis. Results Of the 213 participants enrolled into the study, ninety-four subjects (44.0%) were confirmed TB patients, 75 (35.0%) were HIV-positive, 41 (19.0%) had advanced HIV disease (AHD), while 138 (37.0%) were HIV-negative. Twenty-seven of the 213 participants were positive for Histoplasma by antigen test and/or PCR, giving an overall prevalence rate of 12.7%. The prevalence of histoplasmosis amongst confirmed TB patients of 7.0% (7/94) was significantly lower than 16.8% (20/119) in unconfirmed TB patients (p = 0.04). Participants on anti-TB therapy also had significantly lower rate of histoplasmosis compared to those not on anti-TB drugs (p = 0.00006). Conclusion Histoplasmosis is not uncommon amongst presumptive TB patients. There should be proper microbiological investigation of patients presenting with symptoms suggestive of TB to exclude cases of histoplasmosis.

Background: Cryptococcosis is a global disease problem. Although seen more frequently in the severely immuno-suppressed, it can also be seen in patients without apparent immuno-suppression. Patients with pulmonary Cryptococcosis typically present with cryptococcal pneumonia while brain cryptococcosis present with meningitis. Case presentation: Here we present our experience in the management of a 33-year-old immunocompetent man, diagnosed of invasive pulmonary Cryptococcal disease with spread to the brain. This case is unique because the patient was previously treated for tuberculosis and presented with typical bronchopulmonary (difficulty in breathing and cough), thoracic (diminished breath sounds and dull percussion notes), extra-thoracic (intra-cranial space occupying lesion) as well as Computed Tommography (CT) Scan features attributable to lung cancer. Diagnosis of Cryptococcosis was made by identification of oval thick-walled yeast on histology of lung biopsy specimen.Conclusions: We conclude that invasive Cryptococcosis affecting the lung and brain may present with a clinical picture similar to metastatic lung cancer. We recommend routine fungal stains and fungal culture in suspected cases.

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Aim: Extended spectrum β-lactamases are transferable plasmid mediated resistance mechanisms found mainly among Enterobacteriaceae which confer resistance to numerous β-lactam antibiotics. The aim of the study was to determine the rate of rectal colonization of surgical patients with Escherichia coli carrying extended spectrum β-lactamases. Subjects and methods: We collected and cultured rectal swabs from 192 surgical patients in the

Aim: Bloodstream infections are a major cause of morbidity and mortality worldwide. The prevalence of causative microorganisms varies from one geographical region to another. This study was aimed at determining the etiological agents prevalent in our environment and their susceptibility profile. Study design: This is a retrospective study carried out at the University of Calabar Teaching Hospital, Calabar, Nigeria. Methodology: Blood culture results of patients documented over a two-year period were retrieved and analyzed. Blood culture positive isolates were detected using conventional method and Oxoid signal blood culture systems. Antimicrobial sensitivity tests were carried out by Kirby-Bauer disc diffusion method. Methicillin resistance in Staphylococcus aureus and coagulase negative Staphylococcus species (CoNS) was detected by disk diffusion method using 30 µg cefoxitin disk. ESBL production was detected by phenotypic confirmatory disc diffusion test (PCDDT) and the double disc synergy test (DDST). Results: A total of 413 blood culture antimicrobial susceptibility test results were analyzed, of which 116 (28.09%) were identified as culture positive. Sixty-nine (59%) of the positive isolates were from female patients. Out of 116 positive cultures, 58.62% (68/116) were Gram positive organisms, 40.52% (47/116) were Gram negative organisms, non albicans Candida accounted for 0.86% (1/116).  Staphylococcus aureus (n=41, 35.3%) was the predominant isolate and showed high sensitivity to levofloxacin (100%), Linezolid (100%) and Amikacin (100%). Twelve isolates of S. aureus were methicillin resistant, while 1 isolate was inducible clindamycin resistant. Of the 116 isolates identified in this study, forty-three (43) were multidrug resistant with highest number of multidrug resistant isolates from Staphylococcus aureus (n=20). 21.28% (n=10) of the Gram-negative isolates were positive for extended spectrum beta lactamases. Conclusion: A high rate of antimicrobial resistance is observed among microorganisms causing blood stream infections. This emphasizes the need for antimicrobial sensitivity testing in the management of blood stream infections.

Tuberculosis is a global health problem which has been compounded by the emergence and rapid spread of drug resistant strains. Phenotypic drug susceptibility testing of Mycobacterium tuberculosis usually requires homogenization of cultures using 3-5mm glass beads. In resource limited settings, these important material may either not be readily available in the country as in our case requiring that one orders them from abroad or they may be too expensive. In both situations, this would impact on the usually lean budget. In our centre were we recently introduced tuberculosis culture and drug susceptibility testing using the Microscopic Observation Drug Susceptibility (MODS) technique, we successfully used glass fragments from a broken car windshield obtained from a mechanic workshop to homogenize solid cultures to prepare positive controls. All cultures homogenized with these local beads gave consistent MODS results. The challenge of the limited availability of resources for research in resource limited settings can be met by adapting available materials to achieve results.