Background: Following its first recognition in early 1960s, the increasing incidence of nosocomial and community-acquired methicillin resistant Staphylococcus aureus (MRSA) infections has become a global problem. The emergence of multiple-drug resistant MRSA strains and dissemination of epidemic antibiotic clones including presence of wide spectrum of virulence and predisposing risk factors complicate diagnosis, chemotherapy and control causing significant morbidity and mortality. Detection of MRSA strains in domestic animals and protozoan has widened the epidemiologic characters of the organism and may influence infection control policies. Objectives: To review the emergence and epidemiologic spread of resistant strains of MRSA, molecular/genetic basis of resistance in the organism and challenges facing control strategies worldwide. It also aims to suggest intervention strategies so as to checkmate the spread of MRSA infections. Methods: By reviewing local and international literatures on MRSA infections coupled with practical experience in the field of this endeavour. Result/Conclusion: MRSA has shown increasing endemic and epidemic spread in the last four decades causing serious medical and socioeconomic difficulties. Routine and regular surveillance (uncommon in poor-resourced developing areas of especially sub-Saharan Africa), good hospital practices and personal hygiene, public enlightenment, development of effective therapeutic agents and rational administration of antibiotics based on reliable test results will limit the spread of MRSA infections.
Lassa fever is an acute immunosuppressive illness of increasing public health concern causing severe morbidity and significant mortality (Case fatality rate (CFR) ≥ 50%) especially in epidemic cases. Although Lassa fever has emerged (following its first detection (1969) in Lassa town, Nigeria) as one of the most prevalent and debilitating viral haemorrhagic fevers endemic in West Africa region (Nigeria inclusive), yet, the control/prevention of the regular outbreak of the disease has become an herculean task in the areas affected; there is inadequate healthcare facility (including Laboratory/diagnostic and care centres), poor socioeconomic environment, lack of awareness among the populace and presence of favourable ecologic niche for the survival and propagation of the natural host and reservoir mouse (Mastomys natalensis) of Lassa virus . Lassa fever is mainly transmitted by contact with excretions and secretions of infected rats via foods and water as well as exposure to other contaminated items. Lassa virus is a member of an Old World Arenariruses, of family Arenaviridae. It is an enveloped, single-stranded (SS) bisegmented RNA virus with ability to replicate very rapidly. It consists of 4 lineages; 3 members are identified as ancenstral strains found in Nigeria, while the fourth is domiciled in other West Africa Countries. Lassa virus infects almost every tissue in human body resulting in multisystemic dysfunction. The incubation period is generally between 6 to 21 days resulting in 3 stages of clinical manifestation viz: Acute phase characterized by flu-like, non-specific illness; haemorrhagic phase accompanied with gastrointestinal symptoms and cardiovascular/neurologic complications. Currently, there is no clinically certified Lassa fever vaccine thus complicating deterrent or preventive measures. Hence, there is need for intensification of educational programs for the populace on the useful control measures against Lassa fever. The stakeholders need to prioritize intervention and support program and also speed up the processes leading to the production of effective vaccine to limit the menace of Lassa fever outbreak and associated morbidity, fatality and high socio-economic cost.
Hepatitis C virus (HCV) is a major cause of chronic liver disease resulting in cirrhosis and hepatocarcinoma. It is believed to be widespread in Africa but its epidemiology is incomplete and is yet to be determined in many areas of the sub-saharan Africa including Nigeria. Using third generation enzyme immuno-assay (EIA-3) and recombinant immunoblot assay (RIBA) technique as confirmatory test, we examined the prevalence of HCV antibodies in 226 blood donors and 226 patients attending Aminu Kano Teaching Hospital (AKTH) in Kano, Nigeria and evaluated the risk factors of HCV transmission in this environment. HCV antibodies were detected in 0.4% and 2.2% blood donors and patients respectively. The overall HCV seroprevalence was 1.3%. There was increased infection acquisition with increasing age; one (16.7%) HCV infection occurred in 25-34 years age group and 5 or 83.3% in subjects > 45 years in age which was significant (P< 0.05). The ratio of infection in male to female was 1:5. Evidence of previous exposure via transfusion was common in HCV seropositive subjects and could be a major risk factor of acquisition in this environment. Adequate screening of blood products in sub-Saharan Africa (Nigeria inclusive) may minimize the risk of HCV transmission and associated health complications.
Ebola virus disease (EVD) is an unusual infection, and one of the most virulent emerging viral diseases known causing severe morbidity and significant mortality. In recent epidemic outbreak of EVD in West African countries of Guinea, Sierra Leone and Liberia (the 3 nations epi-centre of the epidemic), the disease has affected over 25,000 people resulting in more than 10,000 deaths, (Case Fatality Rate, CFR>40%; i.e. from December, 2013-March, 2015). Following the first outbreak of EVD in Sudan and Democratic Republic of Congo (DRC) in 1976, several epidemics (>20 outbreaks) of the disease have been recorded particularly in poor-resourced areas of the East, Central and West-Africa resulting in significant mortality. CFR of EVD is 25-90 percent. Ebola virus is transmitted to humans by wild animals (mainly non-human primates) and spreads in human population via close contact with blood, body fluids and secretions of infected patients. EVD can also be acquired through direct contact with infected corpses. It is characterized (at initial stage) by non-specific flu-like symptoms including headache, fever, myalgia and malaise following incubation period of 2-21 days. This may terminate into severe systemic manifestations including diffuse internal and external bleeding, shock and death if untreated early. Non recognition of the specific natural host of Ebola virus and rapid progression of infection including slow mounting of acquired immunity against EVD by infected host complicate control measures. The socioeconomic cost of EVD epidemic outbreak is colossal. Despite notable advances in healthcare-related technology enhancing the diagnosis, treatment / management and prevention / control of infectious or viral diseases, the response of the stakeholders over the years geared toward controlling the spread of the disease left much to be desired. No clinically certified drugs or vaccines against EVD are yet available. There is the urgent need by stakeholders to device appropriate preventive / control measures including development of effective drugs and vaccines to checkmate the spread of EVD and associated severe morbidity, high mortality and devastating socioeconomic impact.
Enterococci cause recurrent infections, especially among hospitalized patients. Their potential for resistance to multiple antibiotics and incumbent treatment failure constitutes a significant cause of morbidity and mortality. In this study, we aimed to determine the distribution of Enterococcus species from clinical samples and their antibiotic resistance profiles to supporting patients’ treatments based on informed-decision. We conducted a cross-sectional study at SRM Medical College Hospital, Tamil Nadu, India, from January to December 2014. Sixty Enterococcus isolates, from different clinical samples, were included in the study. The isolates were identified to species level based on sugar fermentation and biochemical reactions. The antibiotic susceptibility profile was determined using disk diffusion and agar dilution methods based on CLSI guidelines. The majority of Enterococcus isolates were recovered from urine samples (51.67%) and pus (38.33%). The predominant isolates were E. fecalis (55%) and E. fecium (33.30 %,). Others were E. avium (3.3%) and 1.7 % each for E. durans and E. raffinosus. Overall, the isolates demonstrated the highest frequency of resistance to high-level gentamicin (33.30%), and one-third (33.30%) of the isolates were multidrug-resistant. Because the majority of the drug-resistant isolates were from urine and pus samples, we concluded that suspected cases of UTIs, wound infections, and sepsis need critical evaluation for possible enterococcal infection. Clinical use of gentamicin, among other antibiotics, shall be closely monitored while treating infections.
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