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Newborn jaundice (NNJ), especially due to ABO incompatibility, is a major global health concern. Phototherapy is standard treatment, with exchange transfusions reserved for severe cases. However, in some babies these therapies may be ineffective, requiring additional immunomodulatory treatments. Limited access to these treatments in developing countries creates a critical gap, worsening jaundice severity. A 22-hour old term neonate presented with rapidly progressive severe neonatal hyperbilirubinemia (NNJ) within 15 hours of life, consistent with ABO incompatibility based on discordant maternal and infant's blood types (mother: O, baby: B-positive). Despite aggressive initial management with phototherapy and exchange transfusions, the NNJ exhibited limited improvement. Sepsis and G6PD deficiency were considered as potential contributing factors, although confirmatory testing for G6PD deficiency was deferred due to unavailability of the diagnostic test in our setting. Given a sibling's documented successful response to methylprednisolone for a similar presentation, a brief course of low-dose intravenous methylprednisolone (1mg/kg/day in 2 divided doses) (off-label use) was cautiously initiated. This resulted in a rapid and significant improvement in the neonate's hyperbilirubinemia. Methylprednisolone was prescribed for 3 days after which it was discontinued. Following close observation for 3 days and confirmation of no neurological sequelae, the neonate was discharged home in stable condition. Managing severe, worsening NNJ, especially with multiple aetiologies, is complex. Standard therapies may be inadequate. While promising, immunomodulatory therapies like IVIG may be limited in resource-poor settings. Methylprednisolone shows potential but lacks strong clinical evidence. Well-designed studies are essential to explore its safety and efficacy, particularly in developing countries with limited treatment options., Competing Interests: The authors affirm that they have no competing financial interests or personal, (Copyright © 2024 Nigerian Medical Association.)

Background: Methicillin-Resistant Staphylococcus aureus (MRSA) is both a human commensal and a pathogen that causes neonatal infection which is associated with significant morbidity and mortality. Its genetic flexibility and versatility have equipped it with the ability to develop resistance to numerous antibiotics. Outbreaks of infections in neonatal intensive care units as well as community infections have been reported mostly in developed countries. However, there is a paucity of data on neonatal MRSA infection in developing countries. The study aims to highlight cases of MRSA infection, describe the clinical presentation, and outline the antibiotic susceptibility pattern among term neonates in our facility., Methodology: It was a prospective cross-sectional hospital-based study carried out from October 2018 to July 2019. A total of 248 term neonates with suspected sepsis were enrolled in the study and had their blood samples taken for investigations including blood culture. Bacterial identification and antibiotic susceptibility patterns were carried out using MicrobactTM24E (Oxiod UK) and Staph ID and modified Kirby-Bauer disk diffusion technique respectively., Results: Out of the 248 subjects enrolled in the study, 34.2% had proven sepsis, with Staphylococcus species accounting for 56.4% of these cases. Among those with staphylococcal sepsis, 56.3% were found to have MRSA infection. Notably, the majority (94.4%) of cases originated from outside the hospital, presenting as neonatal sepsis with non-specific clinical features. Sensitivity testing revealed that ciprofloxacin and chloramphenicol were the most effective antibiotics against the identified pathogens., Conclusion: The presence of MRSA infections in neonates poses a critical public health threat. This trend underscores the emergence of antimicrobial resistance, potentially compromising treatment efficacy and jeopardizing neonatal well-being. Urgent and decisive measures are necessary to curb this trajectory., (Copyright © 2024 Nigerian Medical Association.)

Enterobacter agglomerans formerly termed Erwina herbicola but now called Pantonea agglomerans is a ubiquitous gram-negative bacterium that rarely causes mild and opportunistic infection in humans. Sources of infection are myriad causing both local and systemic disease across all systems of the body. Infection is often fulminant and fatal in neonates. We aim to report another facet of the infection as seen in our centre. Of the 248 neonates recruited into the study, 94 had bacteria isolated from their blood, eight (8.5%) of whom had E. agglomerans sepsis. Infection was acquired from the community though its source could not be determined. The clinical features were non-specific running a mild course. Toxic granulation, elevated immature polymorph count and procalcitonin level was found in 50% and 75% of the neonates. Isolate was sensitive to most tested antibiotics, showing 100% sensitivity to gentamicin and ciprofloxacin and the survival rate was excellent (87.5%)., (© The Author(s) [2022]. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Clostridioides difficile infections (CDI) has emerged worldwide as a serious antimicrobial-resistant healthcare-associated disease resulting in diarrhea and pseudomembranous colitis. The two cytotoxic proteins, toxin A (TcdA) and toxin B (TcdB) are the major virulence factor responsible for the disease symptoms. We examined time-dependent oxidative detoxification of TcdA and TcdB using different molar ratios of protein:Cu 2+ : H 2 O 2 . The metal-catalyzed oxidation (MCO) reaction in molar ratios of 1:60:1000 for protein:Cu 2+ : H 2 O 2 at pH 4.5 resulted in a significant 6 log 10 fold reduction in cytotoxicity after 120-min incubation at 37 °C. Circular dichroism revealed that MCO-detoxified TcdA and TcdB had secondary and tertiary structural folds similar to the native proteins. The conservation of immunogenic epitopes of both proteins was tested using monoclonal antibodies in an ELISA, comparing our MCO-detoxification approach to a conventional formaldehyde-detoxification method. The oxidative detoxification of TcdA and TcdB led to an average 2-fold reduction in antibody binding relative to native proteins, whereas formaldehyde cross-linking resulted in 3-fold and 5-fold reductions, respectively. Finally, we show that mice immunized with a vaccine consisting of MCO-detoxified TcdA and TcdB were fully protected against disease symptoms and death following a C. difficile infection and elicited substantial serum IgG responses against both TcdA and TcdB. The results of this study present copper ion-catalyzed oxidative detoxification of toxic proteins as a method highly suitable for the rapid production of safe, immunogenic and irreversible toxoid antigens for future vaccine development and may have the potential for replacing cross-linking reagents like formaldehyde., (Copyright © 2020 Elsevier Inc. All rights reserved.)