NASAL CARRIERS OF STREPTOCOCCUS PNEUMONIAE AMONG CHILDREN BETWEEN 0 – 5 YEARS

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.
 
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
i.   To isolate and identify Streptococcus pneumonia from the nasal cavity.
ii.  To determine the antimicrobial susceptibility pattern.
iii. To evaluate the colonization rate of Streptococcus pneumonia.