Nasal Carriers Of Streptococcus Pneumoniae Among Children Between 0 – 5 Years Attending Benue State University Teaching Hospital Makurdi

Nasal Carriers Of Streptococcus Pneumoniae Among Children Between 0 – 5 Years Attending Benue State University Teaching Hospital Makurdi

Abstract

To isolate and identify the nasal carriage of Streptococcus pneumonia among children between 0-5years attending Benue State University Teaching Hospital, a total number of 50 nasal swab samples were collected from children and inoculated on a blood agar media. Various bacteria species have been implicated as etiological agents of respiratory tract infection often times these bacteria colonize the nostrils, mouth and throat acting as normal flora, before adverse event makes them becomes pathogenic. Our objective was to study one of these bacteria agents namely Streptococcus pneumoniae, its colonization rate and its antibiotic susceptibility profile.

All samples were processed following standard microbiological protocol and susceptibility was tested by disc diffusion method. The study shows prevalence rate for Streptococcus pneumonia to be 68%, 26% for Bacillus species and 6% for Staphylococcus aureus. Age range distribution was highest amongst children between 2 – 3 years with the occurrence rate of 95.38% followed by children between 4 – 5 years with the occurrence rate of 86.80% and children 0 – 1 with the occurrence rate of 17.36%. There was no significant difference between the zone of inhibition and resistant zone at p > 0.05. The study showed high resistance to Norflaxin, Amoxil and Ampiclox respectively. This study calls for the need for effective surveillance of antibiotic resistance.

Table of Contents

• Title Page
• Certification of Approval Page
• Declaration
• Dedication
• Acknowledgement
• Table of Content
• Abstract

Chapter One

1.0 Introduction

• 1.1 Background of the Study
• 1.1 Statement of the Problem
• 1.2 Aim of the Study
• 1.3 Objectives of the Study

Chapter Two:

2.0 Literature Review

• 2.1 Streptococcus pneumoniae (Pneumococcus)
• 2.2 Structure and Life Cycle
• 2.3 Evolutionary Background
• 2.4 Classification
• 2.5 Epidemiology
• 2.6 Nasopharyngeal Carriage of Streptococcus pneumoniae
• 2.7 Clinical Manifestations
• 2.8 Host Response and Immunology
• 2.9 Prevention
• 2.10 Treatment of Streptococcus pneumonia
• 2.11 Complications

Chapter Three:

3.0 Methodology

• 3.1 Area of Study
• 3.2 Sample Collection
• 3.3 Cultivation of the Micro Organism
• 3.4 Isolation of Pure Culture of Bacteria
• 3.5 Characterization of the Isolates
• 3.6 Gram Staining Reaction and Microscopy
• 3.7 Biochemical Test
• 3.7.1 Catalase Test
• 3.7.2 Coagulase Test
• 3.7.3 Urease Test
• 3.7.4 Oxidase Test
• 3.7.5 Bile Solubility Test
• 3.8 Antibiotics Susceptibility Testing

Chapter Four:

4.0 Result

• 4.1 Data Presentation

Chapter Five:

5.0 Discussion, Conclusion and Recommendations

• 5.1 Discussion
• 5.2 Conclusion
• 5.3Recommendations
• Reference
• Appendix

List of Tables

1. Frequency of occurrence of microorganisms isolated from the nasal cavity of 0-5 years children attending BSUTH
2. Age and sex classification of patients with Streptococcus pneumonia
3. Antibiotics Susceptibility test result of Streptococcus pneumonia showing their zones of inhibition Measured in millimeters

Chapter One

Introduction

1.1 Background of the Study

Streptococcus pneumoniae (Pneumococcus) bacteria are lancet-shaped, Gram-positive, facultative anaerobic bacteria with more than ninety (90) known serotypes. Streptococcus pneumoniae colonize the mucosal surfaces in the nasopharynx of human beings from the first day of life through transmission by contact with respiratory secretions, thereby making individuals especially children healthy carriers of the bacteria. After primary colonization of the nasopharynx, they can migrate to other sites, such as middle ear, sinus, lung, blood, or cerebrospinal fluid and cause damage, leading to invasive disease (Cunha, 2003). Pneumococcus is spread by airborne droplets and is a leading cause of serious illness, including bacteremia, meningitis, and pneumonia among children and adults worldwide (Nuorti and Whitney, 2010; Thigpen et al., 2011).

Streptococcus pneumoniae is a leading cause of bacterial pneumonia, meningitis, bacteraemia, otitis media, and sinusitis and continues to be a significant cause of morbidity and mortality in humans (Schaumburg, 2013). Carrier harbors a specific infectious agent in the absence of discernible clinical disease and serves as a potential source of infection for others. Carriers are significantly dangerous to community and in hospital. Among different carrier’s categories, nasal carriers are those who harbor infectious agents in their nasal cavity. Important pathogens are Staphylococcus aureus, Streptococcus pyogenes, Streptococcus pneumoniae, Niesseria meningitidis, Haemophilus influenzae (mostly non-capsulate) Cheesbrough (2000).

Streptococcus pneumoniae is one of the most common human pathogens and is capable of causing a wide range of infections in human. Although primary streptococcal infections are not common, a great deal of the virulence from this organism occurs through cross-infection by spread from patient to patient in hospitals and other institutional settings. In contrast, healthy individuals have a small risk of contracting an invasive infection caused by Streptococcus pneumoniae, but they can be carrier organism. Because its primary habitat is most squamous epithelium of the anterior nostrils, most invasive Streptococcus pneumoniae infections are assumed to arise from nasal carrier (Von Eiff et al., 2001).

Around 14.5 million episodes of severe pneumococcal disease occur annually in the world, causing 1,612,000 deaths; 825,000 of them among children under 5 years old, representing 11% of the total number of infant deaths. In the year 2000, the estimated number of serious pneumococcal diseases to occur globally was 14.5 million, leading to about 826 000 deaths in children aged one month to five years (O’Brien et al., 2009). Streptococcus pneumoniae is the leading cause of potentially life-threatening community acquired diseases and is associated with an estimated global mortality rate that is in the same order of magnitude as that of tuberculosis (3-5 million deaths per year). Pneumonia is the leading cause of death in children worldwide and the most important pathogen causing the disease is the bacterium Streptococcus pneumoniae (the pneumococcus) (O’Brien et al., 2009).

Streptococcus pneumonia was given the name “the forgotten killer” in children in 2008 by the World Health Organization (WHO) (Wardlow, 2006), which accounts for more than one third of acute bacterial sinusitis and more than one half of community-acquired bacterial pneumonia (File, 2006). It remains a major cause of childhood morbidity and mortality, where at least 1.2 million children die of pneumococcal infections each year as stated by the WHO in 2007 and 70% of them in Africa and Southeast Asia; mostly in developing countries (Williams, 2002). Infections caused by Streptococcus pneumoniae including pneumonia, meningitis, bacteremia, sinusitis and otitis are extremely common, and their associated morbidity and mortality place a tremendous financial burden on the society (Hoffman et al., 2005). Pneumococcal diseases are a major public health problem all over the world. Resistance of Streptococcus pneumoniae to penicillin and other antibiotics is increasing worldwide (Applebaum, 2002). Many bacteria, including Streptococcus pneumonia (pneumococcus) have become resistant to one or more classes of antibiotics which in turn lead to treatment failures.

The last two decades of the 20th century were marked by an increasing resistance rate among several bacteria. Threat of resistance has been observed in Staphylococcus spp., Enterococcus spp., Pseudomonas spp. and Enterobacteriaceae, which are the major pathogens in nosocomial infections. Misdiagnosis and unnecessary prescription of antibiotics, as well as lack of education on bacterial antibiotic resistance are important factors in the emergence of resistance with attendant public health and economic loss consequences (Applebaum, 2002).

1.2 Statement of the Problem

Streptococcus pneumoniae (pneumococcus) is a commensal but also a pathogen that plays an important role in the pathogenesis of respiratory tract infections (RTIs) such as pneumonia and otitis media in infants and young children. In addition, the pneumococcus may also cause invasive diseases such as meningitis and sepsis (O’Brien et al., 2009).

1.3 Aim of the Study

The aim of this study is to evaluate the antimicrobial susceptibility pattern and also determine the rate of nasal carriage of Streptococcus pneumonia among children between 0 – 5 years attending Benue State University Teaching Hospital Makurdi.

1.4 Objectives of the Study

1. To isolate and identify Streptococcus pneumonia from the nasal cavity.
2. To determine the antimicrobial susceptibility pattern.
3. To evaluate the colonization rate of Streptococcus pneumonia.

Chapter Five

5.0 Discussion, Conclusion and Recommendation

5.1 Discussion

The widespread use of broad-spectrum antibiotics has led to the emergence of nosocomial infections caused by drug resistant microbes (Courvalin and Weber, 2005; Chikere et al., 2008). In this study, the carriage rate of Streptococcus pneumoniae among children according to the gender of the participants was higher among the females with a percentage of 18 (52.94%) than males 16 (47%). This result corroborates the findings of El-Mahmood, (2010) and Cheng, (2003) who reported the carriage rate of Streptococcus pneumoniae amongst sick children to be 22(19.3); 28(23.7) and 20(6.9) and 27(9.2) in males and females respectively. The carriage rate of Streptococcus pneumoniae was higher among the participants who were sick (57.8 %) whereas the rate in healthy children who participated in the study was observed and recorded as 42.8 %. This was in agreement with the findings of Kandakai-Olukemi and Dido (2009) who recorded a prevalence of 42.04 % among healthy carriers and in contrast with the findings of Christian et al. (2009) who recorded a high prevalence rate of 82.0 % and 76.7 % among healthy and sick carriers respectively.

The highest prevalence rate of 95.83 % was recorded among children aged 2 – 3 years while the lowest prevalence rate of 17.36 % was observed among children aged 0 – 1 suggesting age could be a determining factor to carriage rate of the organism in the nasopharynx. Streptococcus pneumoniae isolated from sick children were susceptible Ciprofloxacin, Gentamycin, Streptomycin, Rifampicin, Erythromycin, Chloramphenicol and Levoflaxacin and resistant to Noflaxin, Amoxil and Ampiclox in sick children, which is in agreement with the findings of Kandakai-Olukemi and Dido (2009). In line with the assertions by Doughari et al. (2005), the findings of this study have important implications for practicing physicians with regard to empirical antibiotic selection, for authorities involved in hospital formulary decisions, and in the development of policies regarding antibiotic utilization, infection control and public healthcare towards children.

5.2 Conclusion

The 68% Streptococcus pneumoniae reported in the present depicts that the study level of carriage in this locality can be attributed to the low personal hygiene and poor health education which persists in Nigeria compared to USA. During this period under review, a total of 50 results were analyzed. Streptococcus pneumoniae has the highest colonization rates of (68%) followed by Bacillus species (26%) and the least prevalent was Staphylococcus aureus with (6%).

Amongst the 68% of carriers of Streptococcus pneumoniae, children between 0 – 1 years has the colonization rate of (17.76%), children between 2 – 3 years has the colonization rate of (95.83%), children 4 – 5 years has the colonization rate of (86.8%). Therefore Streptococcus pneumoniae is highly prevalent between the ages of 2 – 3 years.

In conclusion, however, the judicious use of antibiotics by health workers and efforts to control procurement and use of antibiotics officially in all localities in Nigeria will probably help to limit the increasing rates of drug resistance to pathogens especially Streptococcus pneumoniae. Therefore, it is of prime importance that all sectors (medicine, veterinary, horticulture, etc.) using antibiotics cooperate to minimize the proliferation of resistant Streptococcus pneumoniae bacteria, which may more generally have important consequences for virulence evolution and disease control especially among children.

5.3 Recommendation

It is important for hospitals to improve the processes of care known to impact nosocomial infection rates by ensuring adequate adherence to standard operating procedures to avoid the spread of the pathogenic organism especially Streptococcus pneumoniae since it has been observed that resistance to drugs is worse with hospital related pathogens. There is also a high need of sensitization among the general public and most especially mothers on the need for avoidance of drug abuse and misuse especially towards children. Emphasis on good hygiene and good infection control and indiscriminate use of antibiotics plays a unique role in preventing its transmission.

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