Research Article: Intestinal candidiasis and antibiotic usage in children: case study of Nsukka, South Eastern Nigeria

Date Published: December , 2017

Publisher: Makerere Medical School

Author(s): Ifeoma M Ezeonu, Ntun W Ntun, Kenneth O Ugwu.


Overgrowth of candida results from factors that disrupt the intestinal microbial balance, such as the use of antibiotics. Unregulated antibiotic use and rampant practice of self-medication in Nigeria, is a cause for concern.

A total of 314 stool specimens were collected from children <1 to 12 years of age in Nsukka, South Eastern Nigeria and screened for candida species using standard methods. Questionnaires were used to collect relevant information on the participants. Out of the 314 participants, 31.2% had candidiasis, indicated by growth of ≥105 CFU/ml. Four different species of candida were identified. Candida albicans had the highest prevalence (59.0%), while Candida krusei had the least prevalence (6.0%). Of the 314 participants, 46.5% had diarrhoea, out of which 58.9% had intestinal candidiasis while only 14.3% of the non-diarrhoeic children had candidiasis. Of 208 participants who had taken antibiotics within three weeks of the study, 42.3% had candidiasis compared to 20.8% of those with no recent history of antibiotic use. The results of this study showed a high prevalence of intestinal candidiasis among children in Nsukka. Strong associations were observed between the presence of intestinal candidiasis and diarrhoea, age and use of antibiotics (p<0.001).

Partial Text

There is a growing appreciation of the abundance and diversity of the trillions of micro-organisms that live on and within the human body and how they influence human health and disease1,2. The most heavily colonized organ of the human body is the gastrointestinal tract (GIT); the colon alone is estimated to contain over 70% of all the microbes in the human body3,4. Bacteria are the predominant colonizers of the GIT but other groups of organisms are present in low numbers5. The majority of primary gastrointestinal tract colonizers are friendly bacteria; typical among them is the Lactobacillus family. The balance between friendly and unfriendly bacteria in the intestinal tract is so important that having the correct balance is synonymous with good physical health6.

Pearson Chi-Square (χ2) and Fisher’s two-tailed exact test (SPSS version 21) were used for analyses of categorical variables. The regression component of Chi Square controlled confounding variables.

Candida species, otherwise known as intestinal yeasts, constitute one group of organisms that inhabit the GIT. Overgrowth of these yeasts (intestinal candidiasis), can result from conditions that cause perturbation of the gastrointestinal microbiota, especially those that reduce the population of lactic acid bacteria. Antibiotic use is by far the commonest cause of Candida overgrowth. In Nigeria, antibiotic sale is unrestricted, and virtually every available antibiotic can be obtained over-the-counter, without prescription. Moreover, there is the rampant practice of self-medication among the lower-income class, which is extended even to children.




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