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285 Safiya Et Al., 2019 BAJOPAS Volume 11 Number 2 December, 2018 http://d x.doi.org/10.4314/bajopas.v 11i2.39 Bayero Journal of Pure and Applied Sciences, 11(2): 279 - 285 Received: July, 2018 Accepted: December, 2018 ISSN 2006 – 6996 A SURVEY OF BACTERIA AND FUNGI ASSOCIATED WITH SUSPECTED CASES OF MENINGITIS AMONG CHILDREN ATTENDING SOME SELECTED HOSPITALS IN KANO *Bello, S ., Mohammed, B. and Muhammad, Y. Department of Microbiology , Faculty of Life Sciences, Bayero University, Kano Correspondence Author: [email protected] ; 08064816750 ABSTRACT Bacterial meningitis is one of the most potentially serious infections occurring in the Children age group, with a high incidence of acute complications and risk of l ong-term morbidity and mortality. The aim of the research was to Survey the Bacteria and Fungi Associated with Suspected Cases of Meningitis among Children Attending Some Selected Hospitals in Kano State, Nigeria. Three hundred samples of cerebrospinal flu ids (CSF) were collected through lumbar puncture from Children aged 0-12years suspected of having Meningitis. The samples were subjected to macroscopic examination, microscopic examination, culture tests. Bacterial and fungal isolates were confirmed by bio chemical tests and serology. The isolates were subjected to antimicrobial sensitivity tests using standard techniques. The results obtained were analysed and a prevalence of 8.0% was obtained for bacteria while that of fungi was 0.33%. Analysis of the result according to age group showed that Children in the age group 0 -2years had the highest percentage of Meningitis (7.7%:23/300) while those in the age grougroupp 3 -4 years (0. 3%:1/300) and 11 -12 years had the lowest (0.3%:1/300). However there were no significant differences between the age group and the prevalence of Meningitis (0.1042). Analysis of the result accoaccordrdinging to occurrence of isolated organism showed that gram negat ive Bacteria Heamophilus influenzae type b had the highest frequency of occurrence (48:12/25) while thethe least were Neisseria meningitidis C/W135 (4%:1/25), Salmonella paratyphi C (4%:1/25), Streptococcus species (Viridans group) (4%:1/25) , Candida famata (4%:1/25). Analysis of the result in relation to the study sites showed that the highest number of positive cases were obtained from Muh ammad Specialist Hospital (MMSH) (52%:13/25) while the lowest from Aminu Kano TeachiTeachingng Hospiatal (AKTH) (4%:1/25). Howeve r there was a significant difference between the study sites and the number of positive cases (0.004). Antibiogram of the bacterial isolates showshoweded that ceftriaxone (91.7%:11/12) and ciprofloxacin (91.7%:11/12) were found to be most sensensitivesitive to Haemophilu s influenzae type b and least sensitive to trimethoprim sulfamethoxazole (8.3%:1/12). The yeast, Candida famata was found to be (100%:1/1) sensitive to ketaconazole, fflluconazole,uconazole, itraconazole and amphoteric in B. It can be concluded that the overall prevale nce of Bacteria in the study sites was 8.0% while that of fungi was 0.33%. Gram negative bacteria Haemophilus influenzae type b were found to be the major cause of meningitis in the study sites which are most sensitive to cefriaxone (91.7%:11/12) and cipro floxacin (91.7%:11/12) and least sensitive to trimethtrimethoprimoprim -sulfamethoxazole (8.3%:1/12). Keywords: Cerebrospinal fluid, Hospitals, isolates, meningitis, occurrence, paediatrics, sensitivity. INTRODUCTION pediatric population but may occur in Meningitis is an inflammation of the protective immunocompromised such as Children with cancer, membranes covering the brain and spinal cord, known previous neurosurgery, or cranial trauma or collectively as the meninges (Willey et al ., 2008; CDC, premature infants with low birth rates (Mann and 2014; Pick, et al ., 2016; Hasbun, 2017). The Jackson, 2008; Faust, 20 15; CDC, 2016). inflammation may be caused by infection with viruses, Kano state of Nigeria in sub- Saharan Africa is located bacteria, fungi, and parasites (Reid and Fallon, 1992; in the Meningitis belt where seasonal meningococcal Ginsberg, 2004; Cha´vez-Bueno and McCracken, epidemics occur during the dry season (Sultan et al., 2005; Willey et al ., 2008; Hasbun, 2017). 2005; WHO, 2015; CDC, 2014; Abdussalam et al., Bacterial Meningitis is one of t he most potentially 2014). Despite the advancement in diagnosis and serious infections in infants and older Children treatment of infectious diseases, meningitis is stillstill because it is associated with a high rate of acute considered as an important cause of mortality and complications, risk of long-term morbidity and morbidity, especially in the Children population (Tac(Taconon mortality (HudeckovaIde et al ., 2010; Ide and and Flower, 2012; Águeda et al., 2013: Abdulkareem Awopeju, 2015; Muller, 2016; Pick et al ., 2016; et al. , 2014). Hasbun, 2017). Fungal Meningitis is rare in the 279 BAJOPAS Volume 11 Number 2 December, 2018 Therefore, a regular surveillance of the etiology and Macroscopic Examination of Cerebrospinal Fluid their antibiotic susceptibility is imperative for Cerebrospinal fluid (CSF) samples were observed appropriate case management and infection control. macroscopically to determined the presence of The aim of the research was to Survey the Bacteria turbidity, blood, pigment and clots (Cheesbrough, and Fungi Associated with Suspected Cases of 2010). Meningitis among Children attending Aminu Kano Latex Agglutination Test Teaching Hospital (AKTH), Murtala Muhammad Directigen TM Meningitis combo Test is a presumptive Specialist Hospital (MMSH) and Hasiya Bayero Latex Agglutination test for the direct qualitative Pediatric Hospital (HBPH) in Kano, State. detection of antigens to Haemophilus influenzae type b, Streptococcus pneumoniae , Escherichia coli , group MATERIALS AND METHODS B Streptococcus and Neisseria meningitis group A, B, Study Area C, Y, or W135 in Cerebrospinal fluid. Three hospitals were selected for the study include; The test was conducted using (BD Directigen TM Aminu Kano Teaching Hospiatal (AKTH) located in Ireland-0214011JAA) test kit according to Tarauni Local Government Area of Kano State, Manufacturer’s instruction. A drop of positive control Murtala Muhmmad Specialist Hospital (MMSH) and was dispensed onto circles 1 through 6 of row, Hasiya Bayero Pediatric Hospital (HBPH) in Municipal negative control onto circles 1 through 6 of row and Local Government Area of Kano State, located at 50microlitre of test sample (CSF) was dispensed onto latitude 10 o 33N to 11 o 15N and longitude 34 oCE to 8 o circles 1 through 6 of sample rows and in circles 20CE (NPC, 2006).The Hospitals were strategically labeled “A” and “B” on the test card. Rows positive located for access to both urban and rural population and negative are used for control. Reagent A (control from the 44 Local Governments Areas of Kano State. latex suspension) was dispense onto the “A” Circle, Study Population Reagent “B” (control latex suspension) onto the ‘’B’’ The study population comprised of Children with circle. A drop of latex suspension Reagent 1 was suspected cases of Meningitis attending Aminu Kano dispensed onto the circle in column 1, rows positive, Teaching Hospital (AKTH), Murtala Muhmmad negative and sample. The procedure was repeated for Specialist Hospital (MMSH) and Hasiya Bayero the remaining latex suspensions (Reagent 2-6) in Paediatric Hospital (HBPH) in Kano State. rows positive, negative and sample columns. The Inclusion Criteria samples and latex reagents in each circle were mixed Children of both sexes aged 0-12years with suspected with a different plastic stirrer then placed on a rotator cases of Meningitis whose parents or caregivers at a speed of 12rpm for 10mins and read immediately consented were enrolled for the study. under a high intensity incandescent light. Positive test Exclusion Criteria shows agglutination. Any degree of agglutination Non- consenting parents or caregivers of Children present in one of the latex reagents indicates the from both sexes aged 0-12 years and Children above presence of corresponding antigen. 12years were excluded in the study. Agglutination in two or more latex reagents or the Sample Size Determination corresponding Reagent A (Reagent 1-5) or Reagent B Sample size was 200 obtained using the formular (Reagent 6) renders the reaction uninterpretable. below Negative test shows no agglutination. Positive control Where; (Lwanga and Lemeshow, 1991) yield strong agglutination within 10 minutes, negative N = minimum sample size control shows no agglutination. Agglutination in any z = point of normal distribution curve equivalent at of the negative control circles renders the reaction 95% (1.960) confidence interval uninterpretable. q = complementary probability of q = 1- p Microscopic Examination of Cerebrospinal Fluid p = prevalence rate from previous work = 13.7% Gram Staining and Auramine-Phenol Fluorochrome (Mado et al. , 2013) Staining for the Detection of Mycobacterium d = degree of precision margin of error = 0.05 tuberculosis were carried out (Cheesbrough, 2010). N= (1.960) 2x 0.137 x (1-0.137) Culture (0.05) 2 A centrifuged sediment of cerebrospinal fluid was = 3.8416x0.137 x 0.863 inoculated onto blood agar, chocolate agar, 0.0025 MacConkey for bacterial culture and Sabauroud = 0.4541962096 37 dextrose agar for fungal culture (Cheesbrough, 2010). 0.0025 Colonies observed were further characterized by Gram = 181.67848384 staining, biochemical tests and serological tests. N = 181 Based on the local prevalence obtained
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