Leishmania (Kinetoplastida): species typing with isoenzyme and PCR-RFLP from cutaneous leishmaniasis patients in Ethiopia.

Cutaneous leishmaniasis (CL) is an increasing public health problem in Ethiopia. There is a concern that it is spreading with increased incidence. In this study, we used isoenzyme electrophoresis and internal transcribed spacer one (ITS1) PCR-RFLP techniques to identify Leishmania species from CL patients in Ethiopia. We obtained isolates from 55 localized cutaneous leishmaniasis (LCL), 3 diffused cutaneous leishmaniasis (DCL) and 36 biopsy samples from 34 LCL and 2 DCL cases from All Africa Leprosy and Tuberculosis Rehabilitation and Training Center (ALERT) and clinically diagnosed CL cases from Ochollo village. Both isoenzyme and ITS1 PCR-RFLP techniques showed that Leishmania aethiopica (L. aethiopica) was the aetiologic agent in all cases. Our study also showed that ITS1 PCR-RFLP could identify Leishmania species from biopsy samples and suggests the method could be used for epidemiological surveillance of leishmaniasis in Ethiopia and for species-specific diagnosis.

Field evaluation of a fast anti-Leishmania antibody detection assay in Ethiopia.

A fast agglutination screening test (FAST) for the detection of Leishmania antibodies in human serum samples was evaluated under harsh field conditions in northern Ethiopia. Test performance was compared with a standard serological test, namely the direct agglutination test (DAT), and with parasitology. In total, 103 suspected cases were recruited for the study. Based on parasitological examination, 49 patients were confirmed of having visceral leishmaniasis (VL) and the other 54 suspected cases were parasitologically negative. Field evaluation of FAST was possible in blood samples of 89 patients. FAST had 4 false negative results and 13 false positive results. DAT had 2 false negative results and 20 false positive results. A good degree of agreement (86.9%) was observed between FAST and DAT (kappa value 0.73). In this field-based evalauation, the sensitivity and specificity of FAST were found to be 91.1% (95% CI 77.9-97.1) and 70.5% (95% CI 54.6-82.8), respectively, compared with 95.3% (95% CI 82.9-99.2) and 62.3% (95% CI 47.9-74.9) for DAT. FAST had a high predictive value of a negative test, demonstrating that FAST could be utilised to exclude rapidly non-VL patients from a large population of suspects with fever and splenomegaly in endemic areas.

Antibiotic sensitivities of common bacterial pathogens in urinary tract infections at Gondar Hospital, Ethiopia.

OBJECTIVE: To determine the prevalence and sensitivity trends of urinary bacterial isolates. DESIGN: A cross-sectional study. SETTING: Gondar College of Medical Sciences (GCMS) Teaching and Referral Hospital, north west Ethiopia. SUBJECTS AND METHODS: Four hundred and twenty urine specimens from 70 in-patient and 350 out-patient cases were studied by quantitative culture method and anti-microbial sensitivity test was done by disc diffusion technique. RESULTS: One hundred and seventy two pathogenic organisms were isolated from 166 patients; the isolation rate was 39.5 %. Among the isolates E. coli, S. aureus, Klebsiella species, coagulase negative Staphylococcus species and Citrobacter species were common accounting for 46.0%, 18.0%, 10.0%, 8.0% and 6.0%, respectively. Of the total isolates 71.5% were Gram negatives. Sensitivity tested against ten antibiotics showed that resistance was common, and the effectiveness of tetracycline, ampicillin, co-trimoxazole, chloramphenicol and penicillin was under 50.0%. The resistance rate was 71.5%, 62.2%, and 62.2%, 54.7% and 40.8%, respectively. Polymixin B, cefoxitin, gentamycin and erythromycin controlled over 76.0% of the common infective agents. Ciprofloxacin did control 98.3% of the organisms. CONCLUSION: Resistance was found to be very high to the commonly used antibiotics. The sensitivity rate for the recently introduced ciprofloxacin was above 98%. Therefore, this antibiotic may be used for empirical therapy of urinary tract infection (UTI) when culture and sensitivity testing is impossible. Strict control on the use of antibiotics and appropriate measures against over the counter availability and self-medication is recommended.

Multiple drug resistance in urinary pathogens at Gondar College of Medical Sciences Hospital, Ethiopia.

OBJECTIVE: To determine multiple drug resistance and its associated factors of urinary pathogens. DESIGN: Cross-sectional study. SETTING: Gondar College of Medical Sciences teaching and Referral Hospital, Northwest Ethiopia, between January and October 2000. SUBJECTS AND METHODS: Mid stream urine samples from 420 subjects were studied by quantitative culture method. Designed Questionnaires were used for data collection on the previous use of antimicrobials, catheterisation and hospitalisation. MAIN OUTCOME MEASURES: Rates of multiple drug resistance and the associated factors. RESULTS: Multiple drug resistance was common in the isolates tested against ten antibiotics showing more than 68% of the isolates being resistant to two or more antimicrobials. Significant variables associated with this were found to be urinary catheterisation, hospitalisation and previous use of antibiotics for urinary tract infection. CONCLUSION: The rate of multiple drug resistance was very high in this study. Probable contributing factors were found to be previous antibiotic exposure, urinary catheterisation and hospitalisation. Reduction of hospital stays and catheterisation, aseptic care of catheterised patients and selective use of antibiotics and strict follow up of hospital disease controls are recommended.