Review of molecular subtyping methodologies used to investigate outbreaks due to multidrug-resistant enteric bacterial pathogens in sub-Saharan Africa

Background: In sub-Saharan Africa, molecular epidemiological investigation of outbreaks caused by antimicrobial-resistant enteric bacterial pathogens have mostly been described for Salmonella species, Vibrio cholerae, Shigella species and Escherichia coli. For these organisms, I reviewed all publications describing the use of molecular subtyping methodologies to investigate outbreaks caused by multidrug-resistant (MDR) enteric bacterial infections.Objectives: To describe the use of molecular subtyping methodologies to investigate outbreaks caused by MDR enteric bacterial pathogens in sub-Saharan Africa and to describe the current status of molecular subtyping capabilities in the region. Methods: A PubMed database literature search (English language only) was performed using the search strings: 'Africa outbreak MDR', 'Africa outbreak multi', 'Africa outbreak multidrug', 'Africa outbreak multi drug', 'Africa outbreak resistance', 'Africa outbreak resistant', 'Africa outbreak drug', 'Africa outbreak antibiotic', 'Africa outbreak antimicrobial'. These search strings were used in combination with genus and species names of the organisms listed above. All results were included in the review. Results: The year 1991 saw one of the first reports describing the use of molecular subtyping methodologies in sub-Saharan Africa; this included the use of plasmid profiling to characterise Salmonella Enteritidis. To date, several methodologies have been used; pulsed-field gel electrophoresis analysis and multilocus sequence typing have been the most commonly used methodologies. Investigations have particularly highlighted the emergence and spread of MDR clones; these include Salmonella Typhi H58 and Salmonella Typhimurium ST313 clones. In recent times, whole-genome sequencing (WGS) analysis approaches have increasingly been used. Conclusion: Traditional molecular subtyping methodologies are still commonly used and still have their place in investigations; however, WGS approaches have increasingly been used and are slowly gaining a stronghold. African laboratories need to start adapting their molecular surveillance methodologies to include WGS, as it is foreseen that WGS analysis will eventually replace all traditional methodologies

Multidrug Resistant Salmonella Concord is a Major Cause of Salmonellosis in Children in Ethiopia

Introduction: S. Concord in Ethiopia. The objective of this study was to determine the aetiology of febrile and diarrhoeic illness in Ethiopian children focussing on Salmonella.Methodology: Paediatric patients (n = 1;225) presenting with diarrhoea or fever from the paediatric outpatient department of Tikur Anbessa University Hospital; Addis Ababa (n = 825); and Jimma University Hospital; South West Ethiopia (n = 400); were investigated for pathogens from January to August 2006. Results: Parasites were detected in 337 cases; Salmonella in 65; and Shigella in 61. Serotyping of Salmonella (including 48 stored isolates) demonstrated the dominance of S. Concord: S. Concord (85); S. Typhimurium (7); S. Paratyphi B (2); S. Haifa (1); S. Typhi (2); S. Enteritidis (4); S. Butantan (2); S. Infantis (1); S. Pomona (1); Salmonella group M (28:y:-) (1); and S. Oskarshamn (1). Six isolates in serogroups B and D were untypeable. Of 81 S. Concord isolates; 30were invasive; most (86.5) were positive for ESBL production by E-test and 70were multiply resistant to trimethoprim-sulphamethaxole; ceftriaxone; chloramphenicol and gentamicin; of which over one quarter (27) also showed reduced susceptibility to ciprofloxacin.Conclusion: Multi-drug resistant S. Concord was the major cause of salmonellosis in two regions of Ethiopia. The strain isolated was highly invasive; highly antibiotic-resistant; and represents a threat to heath care globally

Salmonella non typhoidique : une cause rare d'infection urinaire

Le but de notre travail est d'analyser les aspects cliniques; bacteriologiques et therapeutiques des infections urinaires a Salmonella non typhi (SNT) dans notre region. Patients et methodes : Il s'agit d'une etude descriptive retrospective ayant concerne les cas d'infections urinaires a SNT diagnostiques a l'hopital Sahloul (Sousse; Tunisie) recenses sur une periode de six ans et demi (Janvier 2003-Juin 2009). Les souches ont ete identifiees grace a leurs caracteres morphologiques; biochimiques et antigeniques. Un antibiogramme a ete effectue. Resultats : 9 cas d'infection urinaire a SNT ont ete ainsi recenses; soit 0;079des infections urinaires colligees au laboratoire de microbiologie durant la meme periode. L'age moyen des patients etait de 45 ans. Un terrain debilite etait note chez 8 des 9 patients. Les facteurs favorisants notes etaient variables et parfois associes chez un meme patient: diabete (4 cas); traitement corticoide et immunosuppresseur (3 cas); insuffisance renale (3 cas); reflux vesico-uretral (1 cas); pathologie tumorale (4 cas); lupus erythemateux systemique (1 cas); hypertrophie prostatique (1 cas). Les serotypes notes etaient Salmonella enteritidis (8 cas); Salmonella typhimurium (1 cas). L'evolution sous antibiotherapie adaptee (duree moyenne de 16.4 jours) etait favorable dans 7 cas. Conclusion : L'infection urinaire a SNT survient en regle sur un terrain predispose notamment un diabete sucre; une uropathie ou un etat d'immunodepression. Le traitement antibiotique doit etre suffisamment prolonge pour eviter les complications et les recidives

Prevalence and Antibiotic-Resistance of Salmonella Isolated from Food in Morocco

Background: Salmonellosis remains one of the most frequent food-borne diseases worldwide; especially in developing countries. The emergence of antimicrobial resistance in Salmonella isolates from food can potentially compromise the treatment of these infections. This investigation was conducted for the first time in Morocco both to detect the occurrence of Salmonella in foods as well as to determine the antibiotic resistance profile of the Salmonella isolates. Methodology: In total; 11;516 food samples collected from 2002 to 2005 were investigated. Isolated Salmonella were characterized by serotyping and susceptibilities were determined for 15 antimicrobial drugs using the disc diffusion assay. Results: The overall percentage of Salmonella prevalence (n=105) was 0.91with rates of 71for slaughterhouses and 9for seafood. Sixteen different serotypes were identified among 104 Salmonella enterica isolates including serotypes Infantis (n=25); Bredeney (n=13); Blokley (n=11); Typhimurium (n=9); Mbandaka (n=8); Branderup II (n=7); and Kiambu (n=6); 1 isolate of Salmonella enterica belonged to subspecies II salamae. Twenty-nine percent of isolates (n=30/105) were resistant to at least one antimicrobial. Resistance to tetracycline was the most common finding (21); followed by resistance to ampicillin (13); amoxicillin+clavulanic acid (9); streptomycin (7); chloramphenicol (4) and nalidixic acid (3;8). None of the isolates was resistant to 3rd-cephalosporin and fluoroquinolones (i.e. ciprofloxacin). Multidrug resistance (MDR) was seen in 9.5of the isolates; mainly in S. Typhimurium DT104 with R-type ACSSuT and S. Hadar. Conclusions: Despite a low frequency of Salmonella isolation; S. Typhimurium DT104 was identified in the first step of the food chain. The study points out the need control antibiotic resistance in Salmonella isolated from food in Morocco to avoid the spread of MDR

Multidrug Resistance of Salmonella Enterica Serovars Typhi and Als in Western Kenya

Background: The threat to human health posed by antibiotic resistance is of growing concern. Many commensals and pathogenic organisms have developed resistance to well established and newer antibiotics. This is a cross-sectional study within two hospital settings to determine in vitro antibiotic susceptibilities of Salmonella species isolated in blood; cerebral spinal fluid; pus and stool collected from in- and out-patients. The inclusion criteria was non restrictive to in- and out-patient but preference to severe diarrhea cases with negligible changes to previous treatment regimen was observed. The study was carried out from February 2004 - June 2005. Fifty-three diarrhea patients within the hospital who were chosen by convenient sampling and consented to participate in the study were considered. Methodology: Either blood or pus was collected using vacutainer tubes and syringe; swabs respectively; and cerebral spinal fluid by lumbar puncture from patients who had fever (temp = 38oC) and diarrhea. Stool samples were also colle cted and all specimens analyzed for the presence of Salmonella by routine microbiological procedures. The isolates were subjected to antibiotic susceptibility testing using disc diffusion technique. Results: In St. Elizabeth Mukumu Mission Hospital; Salmonella enterica serovar Typhi was most common (56.6; n=33); followed by S. typhimurium (34; n=18); while in Maseno Mission Hospital only S. typhimurium was isolated. Whereas S. typhi was more commonly isolated in male adults and female children (P = 0.9); S. typhimurium was more common in female and male children (P=0.1). All the isolates were sensitive to ciprofloxacin. However; S. typhi was resistant to streptomycin; ampicillin; chloramphenical and cotrimoxazole; S. typhimurium to tetracycline; sulfamethoxazole; cotrimoxazole; ampicillin; chloramphenical and streptomycin. Conclusions: S. typhi displayed a high resistance pattern to most antibiotic screened than S. typhimurium

Invasive Salmonellosis in Malawi

The incidence of invasive salmonellosis has increased among children and HIV-infected adults in Malawi. This has been associated with the emergence of drug resistance in the non-typhoidal Salmonella serovars Enteritidis and Typhimurium. In contrast; S. Typhi isolates have remained fully sensitive to commonly used antibiotics and the estimated incidence of typhoid fever; although still present; has fallen slightly among both adults and children. Infection with S. Typhi is not closely associated with underlying immuno- suppression but it is possible that the non-typhoidal Salmonellae have adapted to the person-person human transmission niche in this frequently immunosuppressed population. The huge burden of invasive salmonellosis in Malawi; the high associated mortality; and the recent emergence of drug resistance emphasise the need for a better understanding of the epidemiology and the need for vaccine development

Typhoid Fever in Ethiopia

This review focuses on the reports of salmonellosis by investigators in different parts of Ethiopia; in particular focusing on the levels of typhoid fever. Many of the reports are published in local journals that are not available online. There have been seven studies which diagnosed typhoid fever by laboratory culture and there is no coordinated epidemiological surveillance. All conducted research and reports from different health institutions in Ethiopia indicate that typhoid fever was still a common problem up to the most recent study in 2000 and that the extensive use of first-line drugs has led to the development of multiple drug resistance. In the sites covered by this review; the total number of published cases of typhoid fever dropped over time reflecting the decline in research capacity in the country. Data on the proportion of patients infected by different serovars of Salmonella suggest that the non-Typhi serovars of Salmonella are increasing. The published evidence suggests that typhoid fever is a current public health problem in Ethiopia although population based surveys; based on good microbiological diagnosis; are urgently needed. Only then can the true burden of enteric fever be estimated and the benefit of public health control measures; such as health education; safe water provision; improved food hygienic practices and eventually vaccination; be properly assessed

Salmonelloses non typhoidiques en milieu pediatrique africain

A l'hopital pediatrique Albert Royer de Dakar; l'etude des salmonelles non typhoidiques de (1985-1989) a permis de colliger 35 dossiers. Elles representent 0;4 pour cent des hospitalisations et sont survenues essentiellement (83 pour cent) chez l'enfant age de moins de 3 ans; presentant surtout un terrain pathologique sous-jacent. Les principales formes cliniques ont ete septicemiques (46 pour cent) et digestives (31 pour cent). Parmi les formes localisees (23 pour cent) ; les meningites purulentes ont represente 45 pour cent. Un seul portage asymptomatique a ete decele. Les 17 serotypes de Salmonella isoles appartiennent a 8 serogroupes. S. enteridis et S. typhimurium ont constitue 51 pour cent des isolats. La sensibilite aux antibiotiques des differents serotypes a ete variable; les cephalosporines de troisieme generation et la gentamycine ayant inhibe plus de 80 pour cent des souches. La duree moyenne de l'antibiotherapie a ete de 21 jours avec une mortalite s'elevant a 17 pour cent. L'association ampicilline-gentamycine; bien que critiquable; garde son indication en traitement de 1ere intention a cause des disponibilites en produits

Meningites a Salmonella a Ouagadougou; Burkina Faso: etude retrospective de 24 cas observes entre 1984 et 1993

"Les auteurs rapportent des aspects epidemiologiques relatifs a 24 cas de meningites a Salmonella diagnostiques entre 1984 et 1993 au laboratoire de Bacteriologie du Centre Hospitalier National Yalgado Ouedraogo (CHN-YO) de Ouagadougou. 13 des 24 cas sont survenus chez des enfants de moins de 12 mois et 18/24 chez des enfants de moins de 3 ans; 14 des 24 patients etaient du sexe masculin. Salmonella typhi a ete le serotype le plus frequement en cause. Une etude de la sensibilite des souches a ete faite en faisant les disques d'Ampicilline (AMP); d'Amoxicilline + acide clavulanique (AMC); de cefotaxime (CTX); de Gentamicine (GEN); de Chloramphenicol (C) et de Sulfamethoxazol-trimethoprime (SXT); mais les differences de sensibilite aux antibiotiques n'etaient pas significatives du fait des petits nombres de souches testees. 10 cas de guerison ont ete observes contre 8 cas de deces et 6 ""evasions"""

Septicemies a Salmonella au Centre Hospitalier National Yalgado Ouedraogo (CHN-YO) de Ouagadougou; Burkina Faso

"Entre janvier 1984 et decembre 1993; 12.843 hemocultures ont ete analysees au laboratoire de Bacteriologie du Centre Hospitalier National Yalgado Ouedraogo (CHN-YO) de Ouagadougou; au Burkina Faso: parmi les 2.211 (17;2 pour cent) hemocultures positives observees; 1.540 (12;0 pour cent) etaient observees dues a des Salmonella; soit 69;6 pour cent des cultures positives. Le serotype Typhi representait 69;7 pour cent des isolats; les salmonelles paratyphiques 10;8 pour cent et les salmonelles dites ""mineures"" 19;5 pour cent. La repartition mensuelle des cas a montre une recrudescence des salmonelloses pendant l'hivernage; de juin a octobre. L'etude de la sensibilite des souches aux antibiotiques in vitro a permis d'observer un important taux de resistance au Cotrimoxazol (47;1 pour cent) et des sensibilites moyennes aux Cyclines (73;8 pour cent); a l'Ampicilline (79;5 pour cent) et a l'Amoxicilline (85;8 pour cent). Les plus importants taux de sensibilite ont ete obtenus avec les Cephalosporines de troisieme generation (93;1 pour cent); le Chloramphenicol (95;7 pour cent) et les Fluoroquinolones (100 pour cent)"

Renal transplantation in a developing country: the Egyptian 17 year experience

This article addresses some of the major epidemiological; clinical; financial and social issues related to the practice of renal transplantation in Egypt. It highlights the limited availability facing the tremendous need for this line of treatment. It provides an overview of the transplant activity in the country; with a brief description of the medical and surgical protocols generally adopted by most groups. As a representative sample; the results of treatment of the Cairo Kidney Centre are given; emphasising the importance of local ecological factors in modifying the outcome; expressed as short and long term patient and graft survival. The effects of the high prevalence of 6 infective agents are described; including cytomegalovirus (CMV); Hepatitis B and C viruses; salmonellosis; tuberculosis and schistosomiasis. [abstract terminated]

Salmonella meningitis. [case report]

Salmonella infections in children occur mainly as gastroenteritis which is a self limiting disease. Typhoid is the next common form; where antiiotics are warranted. Rarely; localised infections can occur especially in the younger age groups. The patient in this case had salmonella meningitis which is a rare form of salmonella infection with a bad prognosis