Background: Foot ulcers in diabetes mellitus subjects cause morbidity and mortality and lead to non-traumatic amputations worldwide. Knowledge of the microbial burden in the ulcers may improve patients' care and management. Objectives: This prospective study was designed to isolate, identify and carry out antibiotic susceptibility testing on bacterial isolates associated with diabetic foot ulcers among subjects in University of Calabar Teaching Hospital. Methods: Subjects with diabetic foot ulcer were recruited after obtaining ethical clearance from the Research Committee and informed consent from the subjects. Samples were obtained from subjects using sterile swabs and subjected to microscopy and culture. Isolates were identified using standard bacteriological techniques. Kirby-Bauer method was used for susceptibility testing. Results: Out of the 50 subjects recruited, 19 (38.1%) were males and 31 (62.0%) were females with mean age of 55.4 ± 10.1 and a minimum age of 40.0 years. All the subjects had grade 4 wounds. The study recorded 100% infection rates among subjects with 70.0% polymicrobial infections. A total of 97 isolates were obtained from the 50 subjects accounting for the average of 1.94 isolates per subject. The most prevalent isolate was Staphylococcus aureus (32 (32.9%)), while the least isolated pathogen was Klebsiella pneumonia (10 (20.4%)). Females harboured more isolates (61 (62.9%)) than males (36 (37.1%)), but infection rates were not significantly associated with gender (χ² = 15.0, p ≥ 0.05). Erythromycin was the most effective antibiotic agent (65.6%) against S. aureus while gram-negative bacteria were more susceptible to augmentin (87.5%) and ciprofloxacin (75.0%). Conclusion: The multiple antibiotic resistance of the bacterial isolates calls for the need to monitor resistance. The best practice is to perform antibiotic susceptibility testing before treatment. Wounds should be evaluated for bacterial agents before treatment is instituted. Information on the mi.uction of morbidity and amputation rates on the patients.

This study was designed to identify and characterize the Candida species isolated from lower respiratory tract infections among HIV positive patients and to determine the prevalence rates of Candida infections among these subjects. Two early morning expectorate sputum samples were collected from 272 HIV positive subjects visiting the ART clinics and DOTS centre with cases of lower respiratory tract infection, over a period of 14 months from May 2009 to July 2010 in Calabar. Subjects were recruited for this study upon approval by the Ethical Research Committee of the University of Calabar Teaching Hospital and obtaining written informed consent from the patients. Samples were processed by standard methods for isolation of Candida. Speciation was done by a germ tube test, chlamydospore production on corn meal agar and sugar fermentation and assimilation tests using the Microexpress Candida identification kit (Tulip, India). Out of the 544 sputum samples collected from 272 subjects, Candida species were isolated from 40 (14.7%) and identified after confirming the growth in the second sample. The majority of Candida species among the Candida isolates were Candida albicans (80%) followed by Candida tropicalis 5 (12.5%), Candida dubliniensis 2 (5.0%) and Candida guilliermondii 1 (2.5%). The isolation rate of Candida species from sputum samples was found to be highest among subjects aged 25 -34 years, followed by those aged 15 -24 years. Twenty (7.3%) HIV seropositive subjects had bacterial infections, while 4 (1.5%) subjects had mixed fungal and bacterial infections. This study is the first of its kind to be carried out in Calabar and the South-South geopolitical region of Nigeria, and has shown that pulmonary candidiasis is a health problem among HIV positive patients in Calabar.

Background: Cryptococcus neoformans infection is a life threatening disease especially when associated with immunosupression like HIV/AIDS. The greatest burden of disease occurs in sub-Saharan Africa, where mortality is estimated to be 17%. The finding of cryptococcal antigen in the blood represents a condition of systemic invasion with the fungus. Clinical manifestation of infection with Cryptococcus neoformans in AIDS patients is generally more evident at CD4 cells ≤100 cells/µl. This study was carried out to determine cryptococcal antigenemia among HIV seropositive patients accessing care in ART clinics as patients are not screened routinely despite reports of relatively high co-infection rates with HIV. Methods: This prospective cross-sectional study was carried out on ART-treated and ART-naive HIV positive adult patients attending ART clinics in two tertiary hospitals in Calabar, Nigeria. The seroprevalence of cryptococcal antigen among the patients was determined using the cryptococcal antigen latex agglutination system (CALAS) (Wampole Laboratories, USA), according to the manufacturer's instruction. The CD4 count levels of each patient were determined by flow cytometry using the fluorescent activated cell sorter BD FACS Count system (Becton Dickinson). Results: Out of the 272 HIV positive subjects enrolled in the study, 116(42.6%) were ARV-naïve and 156(57.4%) were ARV-treated patients. A 5.1% cryptococcal antigenemia prevalence was established in the study. Infection rates were higher among subjects receiving ART 11/156 (7.1%) than in ARTnaïve subjects 3/116 (2.6%). Infection rates 5(35.7%) peaked at age 25-34 years. The mean CD4 counts of subjects with cryptococcal infection were 100.7±67.8 cells/µl, with a minimum CD4 count of 13.0. All the infections occurred among subjects with CD4 counts ≤200 cells/µl of blood. There was a statistically significant effect of cryptococcal antigenemia on the CD4 counts of the subjects (t=3.7, p=0.002). Conclusion: This study reveals that cryptococcal antigenemia is a health problem among HIV/ AIDS patients in our locality. Cryptococcal antigenaemia seem to be more common among HIV patients on ART. The CD4 count levels among the ART treated subjects could have been boosted by administration of ART

Opportunistic pulmonary infections arise more frequently in HIV patients with lower CD4 counts. A more detailed comparative study with other opportunistic infections may help formalize the use of CD4 count as an indicator of HIV/AIDS with opportunistic mycoses.

Background: Hand washing with soap and water is a good hand hygiene practice which reduces the chance of infection transmission through hand contact. This study was designed to determine the microbial hand carriage among nursery and primary school children in Calabar Metropolis and to assess the effect of hand washing in the reduction of bacterial hand carriage among these children.