A Prospective Study of Etiological Agents Among Febrile Patients in Sierra Leone

Background: Corneal opacification due to keratitis is a leading cause of blindness, with fungal pathogens being important causative agents. Thus, a prospective study was designed to identify the etiological agents; and assess the epidemiological features and risk factors for infective keratitis in India with particular reference to fungal keratitis.Methods: Corneal scrapings were collected from 151 patients and subjected to direct microscopic examination by gram’s stain, KOH wet mount, followed by fungal culture in sabouraud’s dextrose agar and bacterial culture in MacConkey’s agar and blood agar. Identification of fungal growth was done by colony morphology, slide culture and lacto phenol cotton blue wet mount preparation.Results: Out of the 151 cases of keratitis, 65 (43.0%) showed fungal elements on KOH smear. By culture methods, microbial etiology (fungal/ bacterial) was established in 68 (45.0%) patients. Aspergillus spp. (57.7%) was the most frequently isolated fungus, followed by Fusarium (15.4%), Penicillium (7.7%), Curvularia (9.6%), Alternaria (5.8%) and Candida albicans (1.9%). History of trauma with vegetative and non-vegetative material and prior ophthalmologic intervention were the major identifiable risk factors.Conclusions: Thus, aspergillus spp. is the most common cause for fungal keratitis in India, with A. fumigatus and A. flavus being the most familiar species, followed by Fusarium. Bacterial isolates were responsible for considerably fewer cases of keratitis.

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Causes of hospitalization and predictors of HIV-associated mortality at the main referral hospital in Sierra Leone: a prospective study

BMC Public Health ◽

10.1186/s12889-019-7614-3 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 2

Author(s):

Sulaiman Lakoh ◽

Darlinda F. Jiba ◽

Joseph E. Kanu ◽

Eva Poveda ◽

Angel Salgado-Barreira ◽

...

Keyword(s):

Hiv Infection ◽

Prospective Study ◽

Sierra Leone ◽

Hospital Admissions ◽

Public Health Problem ◽

Referral Hospital ◽

High Morbidity ◽

Treatment Access ◽

Diarrheal Illness ◽

A Prospective Study

Abstract Background HIV infection is a growing public health problem in Sierra Leone and the wider West Africa region. The countrywide HIV prevalence was estimated at 1.7% (67,000 people), with less than 30% receiving life-saving ART in 2016. Thus, HIV-infected patients tend to present to health facilities late, with high mortality risk. Methods We conducted a prospective study of HIV inpatients aged ≥15 years at Connaught Hospital in Freetown—the main referral hospital in Sierra Leone—from July through September 2017, to assess associated factors and predictors of HIV-related mortality. Results One hundred seventy-three HIV inpatients were included, accounting for 14.2% (173/1221) of all hospital admissions during the study period. The majority were female (59.5%, 70/173), median age was 34 years, with 51.4% (89/173) of them diagnosed with HIV infection for the first time during the current hospitalization. The most common admitting diagnoses were anemia (48%, 84/173), tuberculosis (24.3%, 42/173), pneumonia (17.3%, 30/173) and diarrheal illness (15.0%, 26/173). CD4 count was obtained in 64.7% (112/173) of patients, with median value of 87 cells/μL (IQR 25–266), and was further staged as severe immunosuppression: CD4 < 100 cells/μL (50%, 56/112); AIDS: CD4 < 200 cells/μL (69.6%, 78/112); and late-stage HIV disease: CD4 < 350 cells/μL (83%, 93/112). Fifty-two patients (30.1%, 52/173) died during hospitalization, 23% (12/52) of them within the first week. The leading causes of death were anemia (23.1%, 12/52), pneumonia (19.2%, 10/52), diarrheal illness (15.4%, 8/52) and tuberculosis (13.6%, 7/52). Neurological symptoms, i.e., loss of consciousness (p = 0.04) and focal limb weakness (p = 0.04); alcohol use (p = 0.01); jaundice (p = 0.02); cerebral toxoplasmosis (p = 0.01); and tuberculosis (p = 0.04) were significantly associated with mortality; however, only jaundice (AOR 0.11, 95% CI [0.02–0.65]; p = 0.01) emerged as an independent predictor of mortality. Conclusion HIV-infected patients account for a substantial proportion of admissions at Connaught Hospital, with a high morbidity and in-hospital mortality burden. These findings necessitate the implementation of specific measures to enhance early HIV diagnosis and expand treatment access to all HIV-infected patients in Sierra Leone.

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