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Biomedical subjects

D Montefiore

Publications and source records attributed to D Montefiore.

At least 19 recordsLinked to original sources
PubMed1989

The problem of bacterial resistance to antibiotics among strains isolated from hospital patients in Lagos and Ibadan, Nigeria.

Bacterial infections are still an important cause of illness and death in developing countries, where the widespread and indiscriminate use of antibiotics has led to serious problems of resistance to the older, less expensive agents. The results of routine sensitivity testing of clinical isolates from patients in Lagos and Ibadan, Nigeria show a high prevalence of strains resistant to penicillin, tetracycline, ampicillin, co-trimoxazole and chloramphenicol, with between 70% and 90% of strains of Enterobacteriaceae, including Escherichia coli and Klebsiella and Proteus species being resistant to many of the commonly available antibiotics. These resistance rates are generally higher than those found in Europe, although in some countries in southern Europe rates are not dissimilar to those found in Nigeria. Control of antibiotic use in developing countries is probably impossible at the present time, as in many cases antibiotics are used for self-treatment without prescription. For hospital patients, the use of the older and cheaper anti-bacterial agents is unlikely to be either medically or cost effective without adequate laboratory diagnostic facilities to provide guidance on possible therapy within the financial resources of the patients.

Anti-Bacterial Agents↗
PubMed1989

An in-vitro study on ciprofloxacin and other anti-microbials against gram-negative bacteria isolated from patients in Ibadan, Nigeria.

The high prevalence of common clinical isolates that are resistant to multiple antibiotics calls for regular review of the anti-microbial sensitivity pattern among bacteria of clinical significance in our environment. In the present study an increasing percentage of common isolates from hospitalized patients have been found to be resistant to Gentamicin and Cefotaxime, which play an important role in the chemotherapy of infections. Of special significance is the finding that over 60% of pseudomonads are now resistant to Gentamicin. The new fluoroquinolone, Ciprofloxacin, showed strong activity against all the isolates tested, with MIC values within the range of those reported as sensitive from many overseas centres. It should prove to be a valuable agent in the management of infections due to these organisms.

Anti-Bacterial Agents↗
PubMed1980

Herpesvirus hominis type 2 infection in Ibadan. Problem of non-venereal transmission.

Examination of sera from blood donors, from patients attending a special treatment clinic, a family planning clinic, and an antenatal clinic showed that the prevalence of herpes virus hominis type 2 antibodies among the adult population in Ibadan is similar to that in other parts of the world. The possibility of non-venereal transmission of herpes virus infection was confirmed by the finding that herpesvirus hominis type 2 could survive on cloth samples under humid tropical conditions for long enough to allow transmission of infection via fomites.

Adult↗
PubMed1979

Herpesvirus hominis antibodies among children and young adults in Ibadan.

A total of 422 sera collected from children and young adults living in Ibadan, Nigeria, has been examined for the presence of antibodies to type 1 and type 2 herpesvirus hominis. Type 1 antibodies were rapidly acquired from the age of 1 year onwards, reflecting the relatively poor living standards and the overcrowded accommodation among the population studied. Type 2 antibodies were acquired between the ages of 3 and 5 years. It is suggested that non-venereal spread of the virus must be responsible; prolonged survival of the virus on fomites, owing to the high environmental humidity, possibly accounts for this.

Adolescent↗
PubMed1978

Pyogenic meningitis in Ibadan, Nigeria. A 15-month prospective study.

Between January 1976 and March 1977, cerebrospinal fluid samples from 2130 patients at University College Hospital, Ibadan, Nigeria were examined, 130 patients were shown to have pyogenic meningitis. The commonest causative bacteria were Streptococcus pneumoniae (53.8%), Haemophilus influenzae (23%), Neisseria meningitidis (7.7%) and Klebsiella spp. (3%). Most of the infections occurred in very young children: 47% of all patients were under 1 year of age, and 69% were under 5 years old. The overall case fatality rate was 30% (Strep. penumoniae infection 28.6%, H. influenzae and N. meningitidis infection both 20%). All 4 patients with klebsiella infection died. There was a noticeable increase in the incidence of Strep. pneumoniae strains showing resistance to tetracycline, between 1974 and 1976, and this was attributed to the widespread use and abuse of the antibiotic among the general population. Two strains of H. influenzae were found to be resistant to ampicillin; such strains have not previously been reported from Nigeria. The results of the study support the use of a combination of ampicillin and gentamicin in the initial treatment of pyogenic meningitis in Ibadan.

Adolescent↗
PubMed1978

Bacterial infections, sensitivity patterns, and chemotherapy among hospital patients in the tropics.

A prospective clinical and bacteriological review of the pattern of bacterial infections and chemotherapy among 1931 patients admitted to University College Hospital, Ibadan, between July and September, 1976, showed that 394 patients (20%) had bacterial infections, but 940 patients (49%) received antimicrobial chemotherapy. Thus 58% of the patients were treated either prophylactically or without bacteriological confirmation of infection. Infections of the respiratory tract were commonest (28%), followed closely by wound infections (26%). Septicaemia accounted for 20% of all infections and this was particularly common among children. There was a preponderance of infections due to gram-negative bacteria (69%), with Klebsiella spp. being the most frequently encountered. Among the gram-positive organisms, Staphylococcus aureus accounted for the majority of the infections, particularly infections of wounds, while Salmonellae were responsible for the majority of septicaemias, except among young children, where Klebsiella spp. were predominant. Approximately 90% of urinary tract infections were caused by Klebsiella, Escherichia coli and Proteus spp. Almost all the patients with meningitis were children (93%) and the commonest infecting organisms were Haemophilus influenzae and Streptococcus pneumoniae. The most commonly used antibiotics (penicillin, streptomycin and ampicillin) did not bear a close relationship to the sensitivity patterns of bacteria causing infections in the hospital. Comparison of the bacterial sensitivity patterns for 1963, 1967, 1974 and 1976 showed that the current usage of antibiotics had led over the years to increasing proportions of resistant organisms.

Anti-Bacterial Agents↗
PubMed1977

Septicaemia in the tropics. A prospective epidemiological study of 146 patients with a high case fatality rate.

A prospective study showed that during the first 6 months of 1976, 146 patients out of a total of 3938 admitted to a hospital in Nigeria were suffering from septicaemia, or developed the condition while in hospital. Findings differed from those reported from developed countries in that the majority of infections were community acquired, those most frequently and severely affected were the very young, and salmonella spp. and Staphylococcus aureus were the most important pathogens. However, other gram-negative organisms, particularly klebsiella spp. and Pseudomonas aeruginosa also occurred frequently among the very young, in whom they produced a high mortality. The type of epidemiological pattern, and the bacteria responsible for the bloodstream infections reflect a differing age structure of the population in tropical countries from that in temperature developed countries, as well as the fact that bacterial infections are still one of the most important causes of illness and hospital admission among tropical communities.

Adolescent↗
PubMed1977

Laboratory diagnosis of tuberculosis in a developing country 1968-1975.

The paper records the results of a retrospective study of laboratory findings on samples sent for diagnosis of possible tuberculosis among patients attending or admitted to hospital during the 8 years, 1968-1975. Out of a total of 23 419 such samples, 2479 were positive for tubercle bacilli: both direct microscopy and cultural examinations were carried out, except in the case of many sputum samples which were strongly positive on direct film examination. It was found that the simple examination of stained smears would detect 77% of positive sputa, but was unsatisfactory for other specimens, where cultural examination was essential. Among the positive samples, only sixty-nine came from children under 15 years old: this low figure probably represents selection in hospital attendance or submission of samples, rather than a true comparison with the incidence of clinical tuberculosis in adults. The type of infections evident in children differed from that apparent for all age groups combined, in the high proportion of cases of tuberculous meningitis among the younger age group. The yearly figures give little indication of a fall in the incidence of clinically significant tuberculosis over the past 8 years. A vigorous effort is required for case finding and treatment if there is to be substantial improvement over the next 8 years.

Adolescent↗
PubMed1976

Serious infections due to Pseudomonas aeruginosa.

Infections due to Ps. aeruginosa are a problem in the tropics as in other parts of the world. Over a four year period, 15 patients attending University College Hospital, Ibadan, were proved to have septicaemia due to this organism and 13 patients died rapidly as a direct result of the infection. The two patients who survived the acute episode had received immediate treatment with at least one antibiotic active against Ps. aeruginosa: a third patient, who received immediate appropriate antibiotic therapy, was already suffering from aplastic anaemia and died rapidly despite treatment. The remaining patients received inappropriate antibiotic therapy because pseudomonas infection was not suspected at the time the diagnosis of septicaemia was made. Patients most at risk appear to be the very young and those with pre-existing malignant or other conditions affecting the defence mechanisms of the body: it is suggested that routine initial management of such patients should include a blood culture, followed by immediate treatment with an antibiotic combination that includes at least one agent likely to be active against Ps. aeruginosa. The development of medical services can lead to the introduction of ophthalmic or other operations on tissues that are highly susceptible to infection before facilities are provided for the maintenance of a pathogen-free environment. Following an outbreak of eye infection after cataract extractions, carried out in an old and unsatisfactory theatre, wide-spread room contamination was demonstrated with the same strains of Ps. aeruginosa that had been responsible for the clinical infections. Chemical disinfection of the theatre floor failed to eliminate the organisms, although other experiments suggested that the drying effect of air-conditioning would be successful in this respect. The wisdom of introducing such operations before the provision of adequate facilities is seriously questioned.

Adult↗
PubMed1975

Incidence of Herpesvirus hominis antibodies among blood donor populations.

The microneutralization test was used to determine the occurrence of antibodies to Herpesvirus hominis Type 1 and Type 2 in sera from patients attending the Special Clinic, Bristol Royal Infirmary, with proven herpes genitalis, and in sera taken from blood donors in Bath, Dursley, and Bristol, as well as from donors in three different prison populations. The findings in patients with herpes genitalis indicate that the test accurately reflects the antibody response expected in relation to the type of herpes virus isolated from the lesions. The incidence of Type 2 antibodies among the blood donors ranged from 5 per cent. for donors from the Bath area up to 60 per cent. among donors from Dartmoor prison. The findings suggested that Type 2 herpes infection could spread among longterm prison populations, and it is postulated that this may be due to both homosexual contact, and also by non-sexual contact, either directly or via fomites.

Adolescent↗