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Annals of African Medicine, Vol. 5, No. 3, 2006, pp. 162-163 LETTER TO THE EDITOR Bacteria Isolated From Blood of AIDS Patients Presenting with Recurrent Pyrexia and Antibiotic Sensitivity of Isolated Bacteria E. E. Okwori Department of Pathology and Laboratory Services, Federal Medical Centre, Makurdi, Benue State, Nigeria Code Number: am06037 Acquired immune deficiency syndrome (AIDS) was the presentation of usually fit young men with unusual protozoan and fungal infection and rare tumors, which drew attention to the syndrome. Subsequent description began to show the association of the syndrome with a broader range of infections. In the developed world, bacterial disease particularly pneumonia continue to feature in the top five HIV complicating conditions despite improvements in care based on antiretroviral therapy.1,2 In Sub-Sahara Africa it is mycobacterial and other bacterial diseases, which dominate the clinical presentations of HIV disease and contribute the majority of disease burden in both adults and children. 1, 2 At the Federal Medical Centre Makurdi, we see a many HIV/AIDS patients at sexually transmitted diseases (STD) clinic alone; about four thousand HIV infected patients are attending the clinic. The patients for this study were recruited from the STD clinic, general patients and the wards. All the patients had suffered from fever for three or more occasions and most were treated for malaria and typhoid fever. The repeated or recurrent fever made them to seek treatment at the Federal Medical Centre, being the only tertiary institution in the area. Diagnosis of the bacteraemia relied entirely on positive blood culture. Antibiotic sensitivity test was carried out on each positive plate, using antibiotic discs on nutrient and chocolate agar, depending on the organisms. All patients were full blown AIDS cases, with CD4 cell count of 150 -195 cells/µl. One hundred and ten patients were males, while 90 were females. Thirty five patients were children aged ≤5 years. There was only one significant bacterial growth from each patient, and 155 (77.5%) of the patients had significant bacterial growth. Eight children died in the pediatric wards. Seventy two (36%) of the positive cultures were salmonella enteritides, which were mainly among the adults, and had 97.2% (70/72) antibiotic sensitivity to ceftriaxone (Rocephin®) and (Zinnat®) (Cephalosporms®). Fifty eight (80%) and 42 (58.3%) were sensitive to ciproxine and chloramphenicol respectively. Thirty seven (18.5%) of the isolates from the blood of the people living with AIDS were salmonella typhimurium: it was 100% sensitive to Rocephin®, 94.6% and 83.8% sensitive to Zinnat® and Ciproxine® respectively. The sensitivity to chloramphenicol was 54.1% (20/37) while that of Augmentin® was 45.9% (12/37). Streptococcus pneumoniae accounted for 17 (8.5%) of the total isolates and all were sensitive to Zinnat® while 16 (94.1%) were sensitive to penicillin. Only one showed resistance to penicillin. Sixteen (8%) of the total isolates was salmonella paratyphi C and 9 of these patients were children; they showed 100% sensitivity to Rocephin®, 87.5 % sensitivity to Zinnat® and 62.5% sensitivity to chloramphenicol. Eight (4%) of the isolates were Escherichia coli; 87.5% and 75% were sensitive to Rocephin® and Zinnat® respectively, while only 25% were sensitive to ampicillin. Salmonella typhi only accounted for 2.5% (5/200) of the total organisms isolated from the blood. All were sensitive to Rocephin®, 80% to Zinnat® and 60% to chloramphenicol. The primary and main problem of people living with AIDS (PLWAs) is that there is break down in their immunity, thus susceptible to numerous infection and tumors. In the developing world like ours, people are exposed to all sorts of infective organisms from childhood. The organisms isolated from the blood of the AIDS patients are mainly salmonella species, which form about 65% of the total organisms. All the patients had CD4 cells below 200/µl. Transmission of salmonella species is by foeco-oral route. These organisms are common in our environment with poor hygienic conditions. Kankwaitira et al in Malawi also discovered a high incidence of non-typhi salmonella species from bacteraemic AIDS’ patients. 2,3 The organisms were more susceptible to the cephalosporins, but in Malawi the agents were more susceptible to the quinolones. 3 Before presenting to our hospital, the patients had already taken several antibiotics, especially the commonly available ones such as ampicillin, chloramphenicol, ampiclox and Septrin®. This may explain why the agents were resistant to such drugs. Isolation of salmonella typhi was from the children. The reason for this is not clear. Two (40%) of the patients were resistant to chloramphenicol, but all the five were susceptible to the cephalosporins. Cephalosporins are expensive and are out of reach by many AIDS patients in view of their poor financial status. That may explain why resistance to these drugs is not common at present. Seventeen (8.5%) of the isolates were streptococcus pneumoniae, which were complications of chest infections. Generally, streptococcal pneumonia is the leading cause of pneumonia in adults world wide, 4 and bacteraemia from this infection is common among HIV/AIDS patients. 4, 5 The poor immunity of these patients may explain this. Pneumococcal disease (PD) occurs in 23% of patients living with AIDS. 4 - 6 Recent advances in vaccination have dramatically altered the incidence of PD in children in developed countries, but HIV infected adults and children remain vulnerable. 6 The use of effective antibiotics in the treatment of AIDS patients with diagnosis of bacteriaemia is advocated. In view of the poor financial status of these patients, it is recommended that the price of the drugs, such as the cephalosporins and quinolones be subsidized by the government. References
Copyright 2006 - Annals of African Medicine |
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