ABSTRACT
Gastroenteritis is an infection of the gut (intestines) with viruses, bacteria, or other microbes. You may develop diarrhea, sickness (vomiting), tummy (abdominal) pain and other symptoms. This study evaluated the incidence of gastroenteritis in three (3) different clinics in Umuahia. A total of 48 faecal specimens were collected using sterile plastic bottles with air-tight screw cap tops from 3 different hospitals within Umuahia. Salmonella sp, Shigella sp, Escherichia coli and Staphylococcus aureus with a percentage occurrence of 37.5%, 29.2%, 20.8%, and 12.5% respectively, were found to cause gastroenteritis .It was observed that Abia state specialist has the highest rate of bacterial load with a percentage distribution of 22(45.8%) followed by Amara-Jane hospital with percentage distribution of 17(35.4%), whereas, Mouau clinic has the least bacterial load with a percentage distribution of 9(18.8%). Out of 48 samples, 4 clinical Bacteria were isolated and tested for antibiotics susceptibility, Ciprofloxacin was the most effective antimicrobial agent with 45 representing (93.8%) susceptibility followed by Gentamicin with 40 representing (83.3%), Levofloxacin37(77.1%), Ampiclox 22(45.8%) ,Norfloxacin 18(37.5%) and Amoxil17(35.4%), Streptomycin 13(27.1%), whereas Chloramphenicol has the least percentage susceptibility of 6 representing (12.5%). It was observed that the bacterial isolates showed high rate of resistance Chloramphenicol with the percentage resistance of 42(87.5%), followed by Erythromycin 39(81.3%), Rifampicin 36(75.0%), then Streptomycin 35(72.9%), Amoxil 31(64.6%), Norfloxacin 30(62.5%) and moderately resistant to Ampiclox26(45.8%), whereas Ciprofloxacin has the least percentage resistance of 3 representing (6.3%). This emphasizes the need for continuous evaluation of the quality of common antibiotics, prudent drug prescription and judicious use of these antibiotics in gastroenteritis management.
TABLE OF CONTENTS
Title
Page i
Certification ii
Dedication iii
Acknowledgement iv
Table
of Contents v
List
of Tables viii
Abstract ix
CHAPTER
ONE
1.0 Introduction 1
1.1 Aims and Objectives 3
CHAPTER
TWO
2.0 Literature
Review 5
2.1 Bacterial
Gastroenteritis 5
2.1.1 Epidemiology 5
2.1.2 Pathophysiology 6
2.1.3 Medical Examination 7
2.2 Bacterial Pathogens Associated With
Gastroenteritis 8
2.2.1 AeromonasSpecies 8
2.2.2 Bacillus
cereus 9
2.2.3 Campylobacter
Species 10
2.2.4 Clostridium
difficile 12
2.2.5 Clostridium
perfringens 13
2.2.6 Escherichia
coli 14
2.2.7 Listeria
monocytogenes 15
2.2.8 Plesiomonasshigelloides 16
2.2.9 Salmonella Species 17
2.2.10 Shigella Species 17
2.2.11 Staphylococcus
aureus 19
2.2.12 Vibrio and Vibrio-Like Species 20
2.3 Gastroenteritis in Nigeria
21
CHAPTER THREE
3.0 Materials and Method 23
3.1 Collection of Samples 23
3.2 Sterilization of Materials 23
3.3 Preparation of Culture Media 23
3.4 Inoculation and Isolation 23
3.5 Purification
of Isolates 24
3.6 Identification of the Isolates 24
3.7 Gram
Staining 24
3.8 Biochemical Test 25
3.8.1 Catalase Test 25
3.8.2 Indole Test 25
3.8.3 Citrate Utilization Test 25
3.8.4 Hydrogen Sulphide (H2S)
Production Test 25
3.8.5 Motility,
Indole, Urease (MIU) 26
3.8.6 Coagulase Test 26
3.8.7 Oxidase Test 27
3.9 Antibiotic Susceptibility Testing 27
CHAPTER FOUR
4.0 Results 28
4.1 Morphological identification, Biochemical
Identification, Gram Reaction
and Sugar
Utilization Profile of bacterial isolates from Stool samples 28
4.2 Percentage occurrence of bacterial
isolates from the stool samples
28
4.3 Distribution of Bacterial Isolates from
the stool samples
28
4.4 Antibiotics Sensitivity Pattern of the
Bacterial Isolates from the stool
Samples
28
4.5 Antibiotics Resistance Pattern of the
Bacterial Isolates from the stool
Samples 29
4.6 Overall
Antibiotic Susceptibility and resistance pattern of all the isolates
from
the stool specimens.
29
CHAPTER FIVE
5.0 Discussion, Conclusion and Recommendation
36
5.1 Discussion
36
5.2 Conclusion
38
5.3 Recommendations 38
References 39
Appendix I :
Pictures Of Plates 43
LIST
OF TABLES
|
TABLE
|
TITLE
|
PAGE
|
|
4.1
|
Morphological identification, Biochemical
Identification, Gram Reaction and Sugar Utilization Profile of bacterial
isolates from the stool samples
|
30
|
|
4.2
|
Percentage
occurrence of bacterial isolates from the stool samples
|
31
|
|
4.3
|
Distribution of Bacteria Isolates from the stool
samples
|
32
|
|
4.4
|
Antibiotics Sensitivity Pattern of the Bacterial
Isolates from the stool Samples
|
33
|
|
4.5
|
Antibiotics Resistance Pattern of the Bacterial
Isolates from the stool samples
|
34
|
|
4.6
|
Overall Antibiotic Susceptibility and resistance
pattern of all the isolates from the stool specimens
|
35
|
CHAPTER
ONE
1.0 INTRODUCTION
Enteric diseases is a common illness
and accounts for substantial proportion of consultation by doctors and health
care centers. It is a major cause of morbidity and mortality in poor and
developing countries. Several studies have been conducted with a view to
establish the importance of different enteric bacteria in the etiology of acute
diarrhea. However, the relative incidence of the pathogens varies from place to
place and also in same geographic region from time to time. This present
investigation was a hospital based study comprising of patients suffering from
gastroenteritis. It includes the microbiological examination of bacteria which
is considered to be the etiological agent of enteric diseases in patients.The
enteric diseases are caused by the members of family Enterobacteriaceae and Vibrionaceae.
These pathogens are named as enteric pathogens which belong to the genera that
initiate infection by invading the intestinal epithelium. The enteric pathogens
belonging to the family Enterobacteriaceae are predominantly facultative
anaerobic bacteria flora of large intestine of human beings. These are
generally non-spore forming, non acid fast and gram negative straight or curved
rod. These organisms are classified based on their mode of use of lactose in
MacConkey agar medium, the most popular medium for the isolation of fecal
bacilli. The enteric disease causing members of family Enterobacteriaceae are E.coli,
Shigella, Salmonella, Proteus, Klebsiella pneumoniae, Citrobacter freundii,
Enterobacteraerogenes. The pathogens belonging to family Vibrionaceae
are also responsible for enteric disease .The organism Vibrio cholera causing
cholera is characterized by Gram negative curved rod that actively motile. The
vibrio colonies can be identified by the use of selective media like TCBS,
MacConkey and blood agar. Socio-economically backward classes of population
frequently receive the epidemics of diarrhea disease, accounting high morbidity
and mortality among the people. The mortality rate due to diarrheal infection
is a robust indicator of the overall health status of population. As per the
SRS (sample registration system) data infant mortality was 91% in 2001 &
87% in 2002 due to diarrhea disease. The CRD (crude death rate) in Orissa in
2001 &2002 was 10.4 and 9.8% respectively. Data on severe diarrhea and
gastroenteritis in children was 14.2% (as per Registration general of India,
1998 -2000).As per available report under the Orissa multi disease surveillance
system 144672 diarrhea cases are registered in 2003 & 1,56,872 diarrhea
cases in 2002. 15-40 % of all death among the children aged < 5years are due
to diarrhea disease. The united nation said that no. of suspected cholera cases
in Zimbabwe since August 2008 has claimed above 12600 with 570 deaths because
of lack of water treatment, Brocken sewage pipe. As on 26thNov 2008
more than 3000 people have died from cholera. As it is being mentioned earlier
world 25% death is caused by bacteria every year. It can be eradicated by
developing sophisticated medical facilities and proper hygienic condition.
Chemotherapeutic agent like antibiotics kills or stops the growth of
susceptible microorganism. These drug include beta-lactame, aminoglycosidesand,
fluoroquinolones, Tetracyclines, chloramphenicol, sulfonamide, these are
effective against enterococci. But in recent year strain develops resistant to
antibiotic has become international problems. Plants derived substances have
become matter of great interest owing to their versatile application (Baris et
al., 2006). Medicinal plants are the richest bio-resources of drug of
traditional system of medicine, modern medicine, food supplement and folk
medicine, pharmaceutical intermediate and chemical entities of synthetic drug.
A number of interesting outcome have been found with the use of mixture of
natural product to treat disease, most notably the synergic effect of
polypharmacological application of plant extract (Gibbons, 2003).The herbal
extract obtained from Aeglemarmelos, Menthaspicata and Ocimum sanctum can
be used to treat enteric disease. Piperitone obtained from plant essential oil
enhances the bactericidal activity of nitrofurantoin and furazolidone against
bacteria belonging to family Enterobacteriaceae. Menthaspicata & Menthapiperita
contain 40.12 % & 20.32% carvone respectively. Pure carvone and piperitone
equally increases the bactericidal activity of nitrofurantoin. Ethanolics leaf
extract are more effective towards the bacterial species. It contains shahidine
an unstable oxazoline which is active against Gram +ve / Gram –ve both.
Ethanolic leaf extract of Ocimum sanctum contain biologically active
compound like urosolic acid, apigenin and luteolin which are responsible for
antimicrobial activity. There are long term studies continuing, looking at long
term effect of enteric pathogens, therefore there is a need of screening of new
compound having antimicrobial activity against pathogens.
1.1 AIMS AND OBJECTIVES
The
aim of this study is to determine the prevalence of gastroenteritis among
patients from 3 different hospitals within Umuahia.
The
objectives are;
1. To
isolate and identify the bacteria isolates present in the stool samples
obtained from the 3 different hospitals in Umuahia.
2. To
determine the percentage occurrence of the bacterial isolates from the various
stool samples.
3. To
carry out the antimicrobial sensitivity testing of the various isolates.
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