Turning the tides against infectious diseases: The microbial pathologist’s nexus ( 5)
Continued from yesterday
HAVE cooperated with other colleagues across the country to write two professional books for the use of our students and professionals in Medicine and other relevant health professions. I have actively pursued standard curriculum development and execution till date. I have had the opportunity to lecture at various times as Associate Lecturer, full time Lecturer and/ or Adjuncts Lecturer/ Professor in many Universities in Nigeria including University of Ilorin, Benue State University, University of Calabar, Ekiti State University, Bingham University, Afe Babalola University and University of Medical Sciences. I have also lectured Postgraduate Doctors during revision courses organized by the National Postgraduate Medical College of Nigeria. The response from my students has always been that of enthusiasm and appreciations. ( Odimayo et al 2010; Odimayo and Nwokedi ( Eds) 2014; Odimayo ( Ed) 2016).
Respected Ladies and gentlemen, we just have to keep the pace of studies. Because if we don’t do it, some other persons may also fail to do it and that means suffering for our people. So we study common microbial agents responsible for many diseases and their antibiotic sensitivity pattern included in the list are: Agents of female genital discharge( Nwadioha et al 2009). Where we found the commonest being Candida species in 42% of cases, next to which was Gardnerella vaginalis. Trichomonas vaginalis and Neisseria gonorrhoea were rarely isolated. Studies on Bacteria agents of Acute Pneumonia in HIV seropositive patients showed that Streptococcus Pneumoniae was still the commonest followed Pseudomonas aeruginosa ( Nwokedi et al2009), Inour comparative study of bacterial isolates from the urine samples of AIDS and nonAIDS patients in Benue, Nigeria, we found no difference in the sensitivity pattern of agents causing Urinary tract infection in HIV and non- HIV patients. However, HIV positive patients had wider spectrum of organisms such as candida species, Pseudomonasaeruginosa,( Okwori et al 2010). In our bacterial isolates in blood cultures of children with suspected septicaemia in a Nigerian Tertiary Hospital( Nwadioha et al 2010), we found Escherichia coli was the commonest Gram negative while Staphylococcus aureus was the commonest Gram positive bacterial agent. We found a low prevalence of Urinary Tract Infection( UTI) among Children newly diagnosed with Primary Nephrotic Syndrome and Acute Glomerulonephritis ( Adedoyin et al 2010). Antibiotic sensitivity testing of clinically significant bacterial isolate in Ilorin( Odimayo et al 2011). Bacterial Isolates in Blood Cultures of children with suspected septicaemia in Ilorin, Staphylococcusaureusw as the most common isolate, followed by Salmonella species ( Adedoyin et al2013). In a cross sectional study conducted to determine the epidemiology and antibiotic sensitivity pattern of bacteria isolated from blood cultures of sep
Iticemic patients in Ekiti State University Teaching hospital, Ado Ekiti, commonest isolates were Staphylococcus aureus, Klebsiella species and Enterococci ( Nwadioha et al 2015). Other studies conducted to determine agent of infection in various sites and their sensitivity pattern include microbiologic review of seminal fluids; Antibiotic Profile of Urinary Pathogens; antibiotic sensitivity profile of E. coli associated with specific infections. Evaluation of Uropathogens in Bladder Outlet Obstruction Secondary to Benign Prostatic Hyperplasia ( Nwadioha et al 2016, Odimayo et al 2016a, Odimayo et al 2016b, Adegun et al 2017). Our contributions in the identification of agents responsible for specific diseases and their antibiotic pattern is central to early and effective commencement of therapy for patients with infectious diseases in order to save lives. It is also invaluable in the development of antibiotic prescription policies in our hospitals. In general, we found alarming increase in resistance of bacterial agents of infection to common antibiotics from 2006 till present. Our various studies and that of others have shown 60 to 87% resistance to common antibiotics in our environment. These are caused majorly by misuse of antibiotics, yet 59.9% of drug sellers consistently sell antibiotics to buyers without doctors’ prescription. Currently, out of pocket ( OOP) expenses for health care by Nigerians is among the highest in the world ( Federal Ministries of Agriculture, Environment and Health 2017; Awosan et al 2018).
Mr Vice Chancellor Sir, Late in 2007, we did a retrospective study to determine the seroprevalence of Hepatitis B viral infection among patients attending Aminu Kano Teaching Hospital in Kano metropolis using hepatitis B surface antigen ( HBSAG) as a marker. Over the 3 years period, a total of 6,395 patients comprising of 4,040 males and 2,355 females including adults and children tested for HBSAG from January 2004 to December 2006 were analysed. Among these patients, 703( 11.4%) comprising of 240 ( 10.2%) females and 490 ( 12.1%) males were positive for HBSAG. The highest prevalence was seen at the extremes of life in which 19.4% and 16.9% were seen among patients below 10years and above 50 years respectively. The yearly trend of HBV surface antigenemia was 220 ( 14.6%) in 2004, 235 ( 10.1%) in 2005 and 275 ( 10.7%) in 2006. We concluded that the prevalence of HBSAG among patients attending Aminu Kano Teaching Hospital, Kano was high and highest prevalence was seen at the extremes of life. The presence of hepatitis B surface antigen ( HBSAG) in the serum of an individual indicates carrier state or active acute or chronic infection with hepatitis B virus. The presence of hepatitis B surface antibody ( HBSAB) usually indicates resolved infection or following effective hepatitis B vaccination. We went further to assess the HBV situation in Makurdi. Our target was on the community. This we did through multiple Hepatitis B Virus health education and screening activities in Makurdi. This stem from an initial pilot study which showed a high prevalence of HBV in Makurdi, Nigeria. The series of community screening were conducted between
April 2008 and June 2009. We reviewed a total of 676 individuals consisting of 430 males and 246 females screened for hepatitis B virus using HBSAG as marker and a community prevalence of 12.7% with a male to female ratio of 2.3: 1 was discovered.
Table 4: Sex distribution of HBSAG sero- prevalence among subjects
Sex No. of subjects tested No. positive
Male 430 69
Female 246 17
Total 676 86
Male: Female ratio = 2: 3 : 1 : Z = 343.14; P- Value < 0.0001
Highest rate of 21.2% rate was found among the 30- 34 years age group. That was a very high prevalence and showed that the infection was more common among young adults and middle aged individuals with significant male preponderance. We therefore recommended mass screening among the populace, appropriate treatment for infected individuals and immunization of Hepatitis B virus negative individuals irrespective of age and occupation. We successfully screened and vaccinated thousands of people in Benue state. Many infected individuals were further evaluated and treated as appropriate. We continue to pursue the mission of control of hepatitis B virus through health education, vaccination and treatment till date.
In the course of practice as a Consultant Microbial Pathologist, a few cases of liver cancers were seen among middle aged individuals. All of those seen were positive for hepatitis B virus for variable duration of time. Such patients are normally referred to relevant Consultants. However, knowing the fate of such patients in term of short life expectancy, we were moved to further pursue the control of HBV in our society.
Therefore from determining the prevalence of hepatitis B viruses, we went further to see the prevalence of those individuals whose infection is aggressive enough to possibly result in cancers or result in increased HBV transmissibility. Hepatitis B e antigen is a marker of aggressive HBV infection. We had to settle for that because of the cost of HBV viral load which was prohibitive and difficult to come by in our environment.
We determined the prevalence of Hepatitis B ‘ e’ Antigen ( HBEAG) among hepatitis B surface antigen positive patients in Makurdi, Nigeria.
Odimayo is Professor of Microbial Pathology/ Infectious Diseases delivered this inaugural lecture series 1 in Ilorin, recently.
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