Cholera outbreak investigation, Gajala community, Birnin Kudu Local Government Area (LGA), Jigawa State, Nigeria, September 2015

Abstract

Background: Nocardiosis is a clinical and diagnostic challenge, compounded by lacunae in existing literature. Our objectives were to establish the clinical spectrum of this disease in our setting, describe the most common causative agent of the disease and to ascertain differences in our patient population from available data.Methods & Materials: This was a 10 year (2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013) retrospective study carried out at a tertiary care centre in South India, of 131 cases of nocardiosis. The electronic medical records were studied and data analysed.Results: Sixty three percent were male, 23% of all in the sixth decade of life. The most common sites of infection were the skin and the eye -36 (27%) patients each and the lower respiratory tract -35 patients(26%). 48 (37%) patients were on immunosuppressant therapy, either a triple drug therapy following renal transplant, autoimmune disorders/ haematological malignancies on combination immunosuppressants or patients on prolonged corticosteroids. Of 36 patients with nocardiosis of the eye, 30 (83%) were corneal ulcers with history of trauma with vegetative matter or soil, and 5(14%) were endophthalmitis following intraocular lens implantation. 16(46%) patients with respiratory tract nocardiosis had a previous lung pathology. 11(8%) were HIV associated nocardiosis. Disseminated disease was seen in 7(5.3%) patients following renal transplant and in 3(2.3%) patients with SLE, all on triple drug immunosuppression. The most common organism isolated was Nocardia asteroides in 73(56%), followed by Nocardia spp in 32(24%), aerobic actinomycetes in 24(18%) and Nocardia brasiliensis in 2(1.5%). All patients responded to treatment with cotrimoxazole alone or in addition to surgical debridement for cutaneous and subcutaneous lesions. There was only one Nocardiosis related death in this cohort of patients. Antimicrobial susceptibility testing performed on 72 isolates showed 6.9% , 9.7%, 31%, 38%, 75%, 42%, 31%, 74% susceptibility to penicillin, ampicillin, erythromycin, tetracycline, cotrimoxazole, chloramphenicol, cefazolin and triple sulfa respectively.Conclusion: We report a predominance of nocardiosis from the eye and nocardiosis following immunosuppression. The most common species isolated was N.asteroides. A paucity in HIV associated nocardiosis is striking. Antimicrobial susceptibility showed 75% susceptibility to cotrimoxazole, the drug of choice, which was reflected by a good response to therapy in this cohort. http://dx.

Descriptive epidemiology of cholera outbreak in Nigeria, January–November, 2018: implications for the global roadmap strategy

“…In general, the distribution of cholera cases by age and sex in Nigeria is dynamic given the mixed available evidence. For instance, some studies have reported higher number of cholera cases in adults than in children [11–16] and vice-versa [17, 18], and some studies have similarly reported higher number of cholera cases in females than in males [4, 12, 19] and vice-versa [20, 21].…”

“…The lack of a homogenous definition of cholera especially in an endemic setting such as Nigeria made the direct comparison of our findings with similar studies challenging. For example, studies in Nigeria have used 5 years [12, 17, 40], 2 years [21, 41, 42], and no age restrictions [14, 19] for the definition of suspected cholera cases. Thus, this challenge should be prioritised by the GTFCC given the relevance to cholera case management and assessment of cholera burden, which would be strategic in the objective assessment of the global roadmap goals of cholera elimination by 2030.…”

Retrospective Analysis of the Serovars and Antibiogram of Vibrio cholerae Isolates of the 2017 Ilorin Cholera Outbreak, Nigeria

“…A study reported higher number of cholera cases in adults than in children [ 16 ], whereas more cholera cases were reported in children than adults by another study [ 17 ]. Furthermore, some studies have reported higher number of cholera cases in females than in males [ 16 ] and vice-versa [ 18 ]. In conformity with the findings of Nnaji et al [ 18 ], our study showed significant association between the number of cholera cases and the sex of patients.…”

“…Furthermore, some studies have reported higher number of cholera cases in females than in males [ 16 ] and vice-versa [ 18 ]. In conformity with the findings of Nnaji et al [ 18 ], our study showed significant association between the number of cholera cases and the sex of patients.…”