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      Characterization and Antimicrobial Susceptibility Profile of Bacteraemia Causing Pathogens Isolated from Febrile Children with and without Sickle Cell Disease in Kano, Nigeria

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          Abstract

          Background and Objectives

          Bacterial infection in sickle cell anaemic patients is a major cause of mortality and requires proper treatment with appropriate antibiotics. However, continue defiant of these infections causing pathogens to many antibiotics and inadequate screening methods in overburden health care facilities such as our in Kano, Nigeria necessitates the conduct of this study. A research was therefore conducted to isolate, characterize and test for antimicrobial susceptibility of bacteraemia-causing pathogens from febrile children with and without sickle cell disease in Kano, Nigeria.

          Method

          A total of 225 venous blood samples from suspected sickle cell anaemic children attending three selected hospitals within Kano metropolis were collected and screened for sickle cell disease, followed by blood culture using automated blood culture system. The bacteria isolated from confirmed febrile SCD and non-SCD children were characterized using microscopic, biochemical and serological techniques. Their susceptibility to commonly used antibiotics was tested using disc diffusion method.

          Results

          Of the 225 blood specimens screened, 68 (30.22%) were SCD positive, with the highest percentage (16%) among subjects within 1–2 years of age. A total of 11 genera of bacteria were isolated from both SCD and non SCD positive bloods, with Salmonella typhi having highest occurring rate in SCD positive children 27 (39.71%), followed by Streptococcus pneumoniae 10(14.71%), Salmonella Group B 9(13.24%), Staphylococcus aureus 4 (5.88%), and Escherichia coli 3 (4.41%). Majority of the isolates from SCD children 59 (86.76%) were highly susceptible to ciprofloxacin followed by cefuroxime 45 (66.18%), gentamicin 38 (55.88%), ceftriaxone 30 (44.12%), augmentin 39 (57.35%), ampicillin 25 (36.77%) and co-trimoxazole (22.06%).

          Conclusion

          Bacteraemia in SCD confirmed children in the three hospitals are caused by a combination of 11 genera of bacteria. The lesser rate of bacteraemia was found in non-SCD children. Resistance to commonly used antibiotics is on increase, but treatment with ciprofloxacin and some 3 rd generation cephalosporin are still promising.

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          Most cited references24

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          Bacteraemia in Kenyan children with sickle-cell anaemia: a retrospective cohort and case–control study

          Summary Background In sub-Saharan Africa, more than 90% of children with sickle-cell anaemia die before the diagnosis can be made. The causes of death are poorly documented, but bacterial sepsis is probably important. We examined the risk of invasive bacterial diseases in children with sickle-cell anaemia. Methods This study was undertaken in a rural area on the coast of Kenya, with a case–control approach. We undertook blood cultures on all children younger than 14 years who were admitted from within a defined study area to Kilifi District Hospital between Aug 1, 1998, and March 31, 2008; those with bacteraemia were defined as cases. We used two sets of controls: children recruited by random sampling in the same area into several studies undertaken between Sept 1, 1998, and Nov 30, 2005; and those born consecutively within the area between May 1, 2006, and April 30, 2008. Cases and controls were tested for sickle-cell anaemia retrospectively. Findings We detected 2157 episodes of bacteraemia in 38 441 admissions (6%). 1749 of these children with bacteraemia (81%) were typed for sickle-cell anaemia, of whom 108 (6%) were positive as were 89 of 13 492 controls (1%). The organisms most commonly isolated from children with sickle-cell anaemia were Streptococcus pneumoniae (44/108 isolates; 41%), non-typhi Salmonella species (19/108; 18%), Haemophilus influenzae type b (13/108; 12%), Acinetobacter species (seven of 108; 7%), and Escherichia coli (seven of 108; 7%). The age-adjusted odds ratio for bacteraemia in children with sickle-cell anaemia was 26·3 (95% CI 14·5–47·6), with the strongest associations for S pneumoniae (33·0, 17·4–62·8), non-typhi Salmonella species (35·5, 16·4–76·8), and H influenzae type b (28·1, 12·0–65·9). Interpretation The organisms causing bacteraemia in African children with sickle-cell anaemia are the same as those in developed countries. Introduction of conjugate vaccines against S pneumoniae and H influenzae into the childhood immunisation schedules of African countries could substantially affect survival of children with sickle-cell anaemia. Funding Wellcome Trust, UK.
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            Sickle hemoglobin (HbS) allele and sickle cell disease: a HuGE review.

            Sickle cell disease is caused by a variant of the beta-globin gene called sickle hemoglobin (Hb S). Inherited autosomal recessively, either two copies of Hb S or one copy of Hb S plus another beta-globin variant (such as Hb C) are required for disease expression. Hb S carriers are protected from malaria infection, and this protection probably led to the high frequency of Hb S in individuals of African and Mediterranean ancestry. Despite this advantage, individuals with sickle cell disease exhibit significant morbidity and mortality. Symptoms include chronic anemia, acute chest syndrome, stroke, splenic and renal dysfunction, pain crises, and susceptibility to bacterial infections. Pediatric mortality is primarily due to bacterial infection and stroke. In adults, specific causes of mortality are more varied, but individuals with more symptomatic disease may exhibit early mortality. Disease expression is variable and is modified by several factors, the most influential being genotype. Other factors include beta-globin cluster haplotypes, alpha-globin gene number, and fetal hemoglobin expression. In recent years, newborn screening, better medical care, parent education, and penicillin prophylaxis have successfully reduced morbidity and mortality due to Hb S.
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              Factors affecting the implementation of childhood vaccination communication strategies in Nigeria: a qualitative study

              Background The role of health communication in vaccination programmes cannot be overemphasized: it has contributed significantly to creating and sustaining demand for vaccination services and improving vaccination coverage. In Nigeria, numerous communication approaches have been deployed but these interventions are not without challenges. We therefore aimed to explore factors affecting the delivery of vaccination communication in Nigeria. Methods We used a qualitative approach and conducted the study in two states: Bauchi and Cross River States in northern and southern Nigeria respectively. We identified factors affecting the implementation of communication interventions through interviews with relevant stakeholders involved in vaccination communication in the health services. We also reviewed relevant documents. Data generated were transcribed verbatim and analysed using thematic analysis. Results We used the SURE framework to organise the identified factors (barriers and facilitators) affecting vaccination communication delivery. We then grouped these into health systems and community level factors. Some of the commonly reported health system barriers amongst stakeholders interviewed included: funding constraints, human resource factors (health worker shortages, training deficiencies, poor attitude of health workers and vaccination teams), inadequate infrastructure and equipment and weak political will. Community level factors included the attitudes of community stakeholders and of parents and caregivers. We also identified factors that appeared to facilitate communication activities. These included political support, engagement of traditional and religious institutions and the use of organised communication committees. Conclusions Communication activities are a crucial element of immunization programmes. It is therefore important for policy makers and programme managers to understand the barriers and facilitators affecting the delivery of vaccination communication so as to be able to implement communication interventions more effectively. Electronic supplementary material The online version of this article (doi:10.1186/s12889-017-4020-6) contains supplementary material, which is available to authorized users.
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                Author and article information

                Journal
                Mediterr J Hematol Infect Dis
                Mediterr J Hematol Infect Dis
                Mediterranean Journal of Hematology and Infectious Diseases
                Mediterranean Journal of Hematology and Infectious Diseases
                Università Cattolica del Sacro Cuore
                2035-3006
                2018
                15 February 2018
                : 10
                : 1
                : e2018016
                Affiliations
                [1 ]Department of Microbiology, Aminu Kano Teaching Hospital, Kano State, Nigeria
                [2 ]Department of Microbiology, Faculty of Life Sciences, Bayero University, Kano, P.M.B. 3011, Kano State, Nigeria
                [3 ]Department of Haematology, Aminu Kano Teaching Hospital, Kano State, Nigeria
                [4 ]Division of Microbiology, Department of Science Laboratory Technology, Nigerian Institute of Leather and Science Technology, Zaria, Kaduna State, Nigeria
                Author notes
                Correspondence to: Ibrahim Yusuf. Department of Microbiology, Faculty of Life Sciences, Bayero University, Kano, P.M.B. 3011, Kano State, Nigeria. Tel: +2347037865734. E-mail: iyusuf.bio@ 123456buk.edu.ng
                Article
                mjhid-10-1-e2018016
                10.4084/MJHID.2018.016
                5841934
                29531653
                2e71279e-07e3-4b9c-8478-1f1d462d7bbc
                Copyright @ 2018

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by-nc/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 28 August 2017
                : 29 January 2018
                Categories
                Original Article

                Infectious disease & Microbiology
                bacterial infection,antimicrobial,bacteraemia,sickle cell disease,children,nigeria

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