ASSESSMENT OF BACTEREMIA AND MYCOTOXIN EXPOSURE IN SEVERE ACUTE MALNOURISHED (SAM) INFANTS AND YOUNG CHILDREN POPULATION IN OGUN STATE, NIGERIA

Abstract

ABSTRACT Malnutrition is one of the leading causes of morbidity and mortality among children, it suppresses the immune system, leading to increased susceptibility and severity of infections. Presence of Bacteria and Mycotoxins in Severe Acute Malnourished (SAM) children are a significant concern making these children highly vulnerable to the harmful effects of fungal toxins and bacteria due to their weakened immune system and often poor diet. Severe Acute Malnutrition in children is often attributed to food mycotoxin exposure, bacteremia, and liver enzyme derangement. The objectives of this study were to assess the level of mycotoxin exposure, bacteremia and functionality parameters among SAM children in Ogun State. A Socio-demographic survey was carried out on 40 voluntary participants (mothers/caregivers) to know their level of mycotoxin awareness, knowledge and attitude towards childhood infections and avoidable causes using semi-structured questionnaire. Blood samples were collected from twenty (20) confirmed SAM children enrolled after clinician’s assessment as recommended by the laboratory protocols. Using spectrophotometric methods, blood samples were screened forserum enzymes, Alanine Aminotransferase (ALT), Aspartate Aminotransferase (AST) and Alkaline Phosphatase (ALP)which served as diagnostic indicators for some diseases. Urea, Electrolytes (sodium, potassium,chloride, bicarbonate) and creatinine were assessed using ABX Pentra 400 C Analyzer.Full blood countwas done using Medonic Automated blood Analyzer. Blood samples for bacteriological analysis were cultured on Brain Heart Infusion broth, and isolates were identified by morphological and biochemical tests. Antibiotics susceptibility test was carried out by Kirby-Bauer using disc diffusion method using 10 antibiotics belonging to 4 classes of antibiotics. Extraction and quantification of mycotoxins from blood was done using High Performance Liquid Chromatography. Student’s t-test and Chi-square were used for the statistical analyses (P < 0.05). The level of awareness of mycotoxins and childhood infection as well as avoidable causes was very low (14%) among caregivers (p < 0.05). The mean value for ALP and AST activities among the test group were normal while ALT (39.1 U/L) was higher than acceptable standard (25 U/L). Hyponatremia was found in 35% of the samples, 10% had hypokalaemia and hypochloremia (low chloride) while 55% had no electrolyte derangement. The mean value for packed cell volume, white blood cell, neutrophiles and lymphocyte counts were 39.9%, (5.9 x 109/L), 52.4% and 41.6% respectively. Two (10%) of the SAM children had bacteraemia (Escherichia coli) growth and the isolates were 100% resistant to Ampicillin, Cloxacillin and Cotrimoxazole.The prevalence of Ochratoxin was 55% while Aflatoxin was 45%. The highest mycotoxin concentration identified was Aflatoxin B1 (19.7844 µg/ml) while the lowest was Ochratoxin (0.0399 µg/ml). The ranges of the Aflatoxin and Ochratoxin were 0.1169ug/ml to 19.7844 u ug/ml and 0.0399 to 0.1171ug/ml, respectively. This study showed that attitudes of caregivers towards childhood infection and avoidable causes is very low, no association was found between bacteremia and level of mycotoxins and serum enzymes deranged in 10% of the children which contributed to mortality in SAM children.