CLINICAL PROFILE AND OUTCOME OF ADULT PATIENTS WITH INVASIVE STAPHYLOCOCCUS AUREUS INFECTION IN AMINU KANO TEACHINGHOSPITAL, KANO BY DR TAMBUWAL, SIRAJO HALIRU MBBS (UDUS) 2003 DEPARTMENT OF INTERNAL MEDICINE, USMANU DANFODIYO UNIVERSITY TEACHING HOSPITAL (UDUTH) SOKOTO A DISSERTATION SUBMITTED TO THE NATIONAL POSTGRADUATE MEDICAL COLLEGE OF NIGERIA IN PART FULFILMENT OF THE REQUIREMENT FOR THE AWARD OF A FELLOWSHIP IN INTERNAL MEDICINE (SUBSPECIALTY-INFECTIOUS DISEASES) NOVEMBER, 2016 ii CERTIFICATION 1 We hereby declare that the writing and execution of the study contained in this dissertation was carried out by DR TAMBUWAL SIRAJO HALIRU under the supervision of PROF A.G. HABIB, DR. H.M LIMAN AND DR. G. ILIYASU Signature………………………… Date………………………… PROFESSOR A.G HABIB (FWACP, FRCP, FAMS) Professor of Medicine (Infectious Diseases and Tropical medicine) Department of Medicine, Aminu Kano Teaching Hospital, Kano. Signature……………………… Date………………………… DR H.M LIMAN (FMCP) Consultant Nephrologist, Department of Medicine, Usmanu Danfodiyo University Teaching Hospital, Sokoto. Signature……………………… Date……………………… DR. G. ILIYASU (FWACP) Consultant Infectious Diseases, Department of Medicine, Aminu Kano Teaching Hospital, Kano. iii CERTIFICATION 11 I certify that this work was carried out by DR TAMBUWAL SIRAJO HALIRU in the Department of Medicine, Usmanu Danfodiyo University Teaching Hospital, Sokoto, under the supervision of Professor. A.G Habib, DR H.M Liman and DR. G Iliyasu. …………………………………………………………………………………………….. HEAD OF DEPARTMENT OF MEDICINE USMANU DANFODIYO UNIVERSITY TEACHING HOSPITAL, SOKOTO iv DECLARATION I hereby declare that this work was done by me, DR TAMBUWAL SIRAJO HALIRU of Department of Medicine, Usmanu Danfodiyo University Teaching Hospital, Sokoto and that it has not been submitted to any other college for the award of a fellowship or degree, or sent for publication. SIGNATURE…………………………………………….. DATE……………………………………………………... v DEDICATION This work is dedicated to my wife Safinatu Abubakar, without whose support it would not have been possible, and to my parents Alhaji Haliru Tambuwal and late Malama Aishatu Abdullahi who passed on a love of reading and respect for education. vi ACKNOWLEDGEMENTS My appreciation goes to Professor A.G. Habib, Dr. H.M Liman and Dr. G Iliyasu for being my mentors and guides. Professor A.G Habib has been a source of inspiration throughout my training, I am highly indebted to him. My thanks go to all the people that were involved in this study, particularly Mr. Bashar Usman Mohd of the microbiology department AKTH Kano, the technical head microbiology department, AKTH Kano, Malam Nasiru Mohd. My sincere gratitude goes to all my colleagues in the department of internal medicine for their support in various ways during the course of my training and while carrying out this study. vii Contents CERTIFICATION 1 ............................................................................................................................... ii CERTIFICATION 11 ............................................................................................................................ iii DECLARATION ................................................................................................................................... iv DEDICATION ........................................................................................................................................ v ACKNOWLEDGEMENTS ................................................................................................................... vi LIST OF TABLES .................................................................................................................................. x LIST OF FIGURES ............................................................................................................................... xi ABBREVIATION................................................................................................................................. xii ABSTRACT .......................................................................................................................................... xv CHAPTER ONE ..................................................................................................................................... 1 1.0 INTRODUCTION ...................................................................................................................... 1 1.1 DEFINITION OF THE RESEARCH PROBLEM ........................................................................... 3 1.2 RELEVANCE OF THE STUDY TO CLINICAL PRACTICE ................................................. 3 1.3 JUSTIFICATIONS FOR THE STUDY ..................................................................................... 4 1.4 AIMS AND OBJECTIVE ........................................................................................................... 5 1.4.1 AIMS....................................................................................................................................... 5 CHAPTER TWO .................................................................................................................................... 6 2.0 LITERATURE REVIEW ........................................................................................................... 6 2.1 BACKGROUND ........................................................................................................................ 6 2.2 BACTERIOLOGY ..................................................................................................................... 6 2.3 TOXINS AND OTHER VIRULENT FACTORS ...................................................................... 7 2.4 PATHOGENESIS ....................................................................................................................... 8 2.41 INVASIVE STAPHYLOCOCCUS AUREUS INFECTIONS ....................................................... 10 2.5 RISK FACTORS FOR INVASIVE STAPHYLOCOCCUS AUREUS INFECTION ................ 14 2.6 LABORATORY DIAGNOSIS ................................................................................................. 15 2.7 ANTIBIOTIC RESISTANCE ................................................................................................... 15 2.8 PREVENTION ......................................................................................................................... 16 viii CHAPTER THREE .............................................................................................................................. 18 3.0 METHODOLOGY ................................................................................................................... 18 3.1 BACKGROUND OF THE STUDY AREA ............................................................................. 18 3.2 STUDY DESIGN ...................................................................................................................... 18 3.3 STUDY POPULATION ........................................................................................................... 19 3.3.1 INCLUSION CRITERIA ...................................................................................................... 19 3.3.2 EXCLUSION CRITERIA............................................................................................................ 19 3.4 SAMPLE SIZE ......................................................................................................................... 20 3.5 SAMPLING METHOD ............................................................................................................ 20 3.6 INSTRUMENTS OF DATA COLLECTION .......................................................................... 20 3.7 STUDY PROTOCOL ............................................................................................................... 21 3.7.1 STUDY PATIENTS AND SOURCE OF DATA ................................................................. 21 3.7.2 DEFINITIONS ...................................................................................................................... 22 3.7.3 MICROBIOLOGICAL ANALYSIS .................................................................................... 24 3.7.4 DATA COLLECTION ......................................................................................................... 25 3.8 DATA ANALYSIS ................................................................................................................... 26 3.9 ETHICAL CONSIDERATION ................................................................................................ 26 3.10 LIMITATIONS OF THE STUDY ................................................................................................ 26 CHAPTER FOUR ................................................................................................................................. 27 4.0 RESULTS ....................................................................................................................................... 27 4.1 PATIENT CHARACTERISTICS ................................................................................................... 28 4.1.1 AGE AND SEX DISTRIBUTION .............................................................................................. 28 4.2 PATTERN OF PRESENTATION .................................................................................................. 30 4.2.1 CLINICAL FEATURES .............................................................................................................