PRESENCE OF CRYPTOCOCCUS SPECIES IN DOMESTIC CHICKEN (GALLUS GALLUS) DROPPINGS AND THE POSSIBLE RISK IT POSED TO HUMANS IN KABIGERIET VILLAGE, NAKURU COUNTY, KENYA.

OBJECTIVE: To isolate and identify Cryptococcus from domestic Chicken dropping. DESIGN: cross sectional study. SETTING: Kabigeriet village, Olenguorone Division, Nakuru county, approximately 282 km from Nairobi, Kenya. SUBJECTS: Sixty four domestic chicken droppings were sampled in thirty two homesteads after obtaining the farmers consent. RESULTS: Two species of Cryptococcus were isolated. CONCLUSION: Domestic chicken (Gallus gallus) harbor Pathogenic Cryptococcus in their dropping and their close proximity to human habitation poses a risk of AIDS to immunocompromised persons.

Oxacillin resistant Staphylococcus aureus among HIV infected and non-infected Kenyan patients.

BACKGROUND: Infections due to methicillin resistant S. aureus (MRSA) present global challenges to clinicians since therapeutic options are limited and suboptimal dosing contributes to heightened mortality and increased length of hospital stay particularly among the HIV infected patients. OBJECTIVES: To assess the prevalence and relative risk of MRSA infections in HIV infected patients. DESIGN: Cross sectional analytical study. SETTING: Kenya Medical Research Institute, Opportunistic Infection Laboratories in Nairobi. SUBJECTS: Four hundred and thirty six male and female patients aged one to 65 years, of whom 220 were HIV-infected and 216 were non-infected. RESULTS: There was 436 male (57.1%) and female (42.9%) respondents. The prevalence of MRSA was 26.3% with majority infecting the HIV infected patients (P=0.046). Likewise, the overall Staphylococcal infections were more common in HIV patients (P <0.001). The common test for MRSA oxacillin disk diffusion had a sensitivity and specificity of 100% and 92%. CONCLUSION: HIV is a predisposing factor to Staphylococcal infection and there are indications that treatment with beta-lactam antibiotics may no longer be relied on as sole empiric therapy for several ill HIV patients whose infections may be of MRSA in origin. There is need for an informed choice in administration of appropriate antibiotics in order to minimise treatment failures due to the multidrug resistance and Vanvomycin intermediate S. aureus (VISA) strains. Molecular epidemiology of MRSA strains in understanding new and emerging trends is recommended.

Pneumocystis jirovecii and microbiological findings in children with severe pneumonia in Nairobi, Kenya.

OBJECTIVE: To determine the significance of Pneumocystis jirovecii infection in the Kenyan paediatric population. DESIGN: Sixty samples of induced sputum from children aged < or =23 months, half of whom were human immunodeficiency virus (HIV) positive, admitted with severe pneumonia in Nairobi were subjected to immunofluorescent staining for detection of P. jirovecii and microbiological culture. RESULTS: P. jirovecii was detected in 8/60 (13%) as a copathogen with other respiratory pathogens. Five of eight samples with >5 oocysts were from HIV-positive children aged < or =6 months, while equivocally scored samples (< or =5 oocysts) were from HIV-negative children aged >6 months. Klebsiella pneumoniae was significantly recovered in 26/ 60 (43%), followed by Escherichia coli 11/60 (18%) and Staphylococcus aureus 8/60 (13%). Streptococcus pneumoniae, Haemophilus influenzae and Pseudomonas aeruginosa were isolated infrequently. Candida albicans was recovered from 27/60 (45%), while the frequency of C. tropicalis, C. glabrata and C. parapsilosis was 7%, 5% and 3% respectively. Multidrug resistance among E. coli and K. pneumoniae were: sulphamethoxazoletrimethoprim 100% vs. 69%, chloramphenicol 55% vs. 73% and ampicillin 100% vs. 89%. CONCLUSION: Paediatricians in Kenya should be aware of Pneumocystis pneumonia, irrespective of the patient's HIV status.

Detection of virulence-related genes by multiplex PCR in multidrug-resistant diarrhoeagenic Escherichia coli isolates from Kenya and Japan.

We compared serotypes, drug susceptibility and presence of virulence-related genes in diarrhoeagenic Escherichia coli isolates from children < 5 years from Kenya (n = 82) and Japan (n = 47). Multiplex PCR was used to detect genes coding for enteroaggregative adherence (aggR), heat-stable toxin (st), heat-labile toxin (It), verotoxin (vt), attaching and effacing mechanism (eaeA), enteroaggregative E. coli heat-stable enterotoxin 1 (astA) and enteroinvasive mechanism (invE). Kenyan E. coli O-serotypes were more diverse than those from Japan (29 vs. 12 serotypes) and exhibited high level multidrug resistance to World Health Organization (WHO) recommended antibiotics. Resistance rates to tetracycline, ampicillin and sulphamethoxazole-trimethoprim were 70.7, 65.9 and 68.3% respectively, but resistance to sulphamethoxazole-trimethoprim among the E. coli isolates from Japan was low (21%). Kenyan isolates harboured virulence-related genes in high frequency (82.9%) compared to those from Japan (25.5%) with aggR and astA being the most frequently detected genes. The presence of multiple virulence genes was associated with multidrug resistance and this merits further investigation.

Antifungal drug susceptibility of Candida albicans.

OBJECTIVE: To determine the susceptibility of clinical isolates of Candida albicans and to establish the minimum inhibitory concentrations (MIC) to commonly used antifungal drugs. DESIGN: Laboratory based experiment. SETTING: Mbagathi District Hospital, Nairobi, Kenya. SUBJECTS: Candida albicans isolated between 1998 and 2000 from the sputa of HIV/AIDS patients and throat swabs of children with acute respiratory infections (ARI). METHODS: Susceptibility to amphotericin B, clotrimazole, nystatin, and 5-fluorocytosine was done using agar dilution method (NCCLS 1997). RESULTS: Among the ARI isolates 29.3% and among HIV isolates 22.4% had MIC>0.5 microg/ml to amphotericin B. Over 80% of the ARI isolates had MICs > 1 microg/ml to clotrimazole. The MIC range of most isolates to nystatin was 4-16 microg/ml while most isolates were susceptible to 5-fluorocytosine. There were no significant differences in susceptibility between ARI and HIV isolates to commonly used antifungal drugs. CONCLUSION: Although fungal resistance has not been extensively studied, susceptibility tests showed some Candida albicans have increased MICs to commonly used antifungal drugs. The results call for further investigations on fungal resistance especially in the context of opportunistic infections in HIV/AIDS.

Mycoplasma pneumoniae in children with pneumonia at Mbagathi District Hospital, Nairobi.

OBJECTIVE: To determine the prevalence of mycoplasma pneumoniae in nasopharyngeal aspirates of children under five years of age suffering from pneumonia. DESIGN: Cross-sectional survey. METHODS: Two primer sets targeting the genes coding for adhesion protein and 16S rRNA were used in PCR and M. pneumoniae specific antibodies were detected using commercial article agglutination kit. Microbiological investigations to isolate common acute respiratory infectious pathogens were also carried out. RESULTS: M. pneumoniae was detected in nasopharyngeal aspirates of 33.7% of the cases by PCR while serology was positive in only 4.1%. M. pneumoniae alone (single detection) was detected in 25% of the cases while 75% occurred with other acute respiratory infectious (ARI) pathogens. However, the results did not correlate with clinical outcome or the severity of pneumonia. No significant aetiology was found in 28% of the cases investigated, however microbiological investigations by culture revealed the presence of other aetiological agents as follows: Streptococcus pneumoniae (26%), Klebsiella pneumoniae (1%), Staphylococcus aureus (3%), E. coli (2%), parainfluenza viruses (5%), Salmonella(1%), adenovirus (4%), RSV (22%) and Candida spp(13%), Mycoplasma pneumoniae was more prevalent in children aged between six months and three years. Cases of M. pneumoniae PCR positive and S. pneumoniae exhibited similar seasonal distribution with peaks in May and September. However, there was no relationship between M. pneumoniae PCR positive and the severity of pneumonia. CONCLUSION: More investigation is required to establish the significance of atypical pathogens in respiratory infections in Kenya.

Plant essential oils with promising antifungal activity.

OBJECTIVE: To establish therapeutic efficacy of Tagetes minuta extracts. DESIGN: Laboratory-based experiment. METHOD: In vitro fungitoxicity test of essential oils was studied on Trichophyton mentagrophytes, Microsportum gypsum, Candida albicans ATCC 10231, Cryptococcus neoformans, Aspergillus niger and Penicillium species. The effect of oil on sporulation, budding and germination of fungal conidia was studied. The lowest active concentration (lac) was determined and compared with that of one per cent clotrimazole and one per cent nystatin. RESULTS: T. minuta essential oils were more effective on filamentous fungi than the standard antifungal drugs (p<0.05) but was less active on the yeast. It was fungicidal on filamentous forms of fungi and fungistatic on the yeast. The activity of the flower oil was significantly higher than that of the leaves (p=0.015). The oil significantly inhibited conidia germination but had no effects on budding of yeast. Gas chromatograph analysis of the oil showed a total of 30 compounds with five major peaks. CONCLUSION: The fungitoxicity of T. minuta oil can be exploited for its antifungal properties if toxicity and the active compound is studied further.