Emergence and Genomic Characterization of Multidrug Resistant Candida auris in Nigeria, West Africa.

Candida auris is an emerging multidrug-resistant fungal pathogen that has become a worldwide public health threat due to the limitations of treatment options, difficulty in diagnosis, and its potential for clonal transmission. Four ICU patients from three different healthcare facilities in Southern Nigeria presented features suggestive of severe sepsis and the blood cultures yielded the growth of Candida spp., which was identified using VITEK 2 as C. auris. Further confirmation was performed using whole genome sequencing (WGS). From the genomic analysis, two had mutations that conferred resistance to the antifungal azole group and other non-synonymous mutations in hotspot genes, such as ERG2, ERG11, and FKS1. From the phylogenetic analysis, cases 2 and 4 had a confirmed mutation (ERG11:Y132F) that conferred drug resistance to azoles clustered with clade 1, whilst cases 1 and 3 clustered with clade 4. Three of the patients died, and the fourth was most likely a case of colonization since he received no antifungals and was discharged home. These first cases of C. auris reported from Nigeria were most likely introduced from different sources. It is of public health importance as it highlights diagnostic gaps in our setting and the need for active disease surveillance in the region.

Road Traffic Injury in Lagos, Nigeria: Assessing Prehospital Care.

Introduction Injuries are the third most important cause of overall deaths globally with one-quarter resulting from road traffic crashes. Majority of these deaths occur before arrival in the hospital and can be reduced with prompt and efficient prehospital care. The aim of this study was to highlight the burden of road traffic injury (RTI) in Lagos, Nigeria and assess the effectiveness of prehospital care, especially the role of Lagos State Ambulance Service (LASAMBUS) in providing initial care and transportation of the injured to the hospital. METHODS: A three-year, retrospective review of road traffic injured patients seen at the Surgical Emergency Room (SER) of the Lagos State University Teaching Hospital (LASUTH), Ikeja, Nigeria, from January 1, 2012 to December 31, 2014 was conducted. Parameters extracted from the Institution Trauma Registry included bio-data, date and time of injury, date and time of arrival in SER, host status, type of vehicle involved, and region(s) injured. Information on how patients came to the hospital and outcome in SER also were recorded. Results were analyzed using Statistical Package for Social Sciences (SPSS; IBM Corporation; Armonk, New York USA) version 16. RESULTS: A total of 23,537 patients were seen during the study period. Among them, 16,024 (68.1%) had trauma. Road traffic crashes were responsible in 5,629 (35.0%) of trauma cases. Passengers constituted 42.0% of the injured, followed by pedestrians (34.0%). Four wheelers were the most frequent vehicle type involved (54.0%), followed by motor cycles (30.0%). Regions mainly affected were head and neck (40.0%) and lower limb (29.0%). Less than one-quarter (24.0%) presented to the emergency room within an hour, while one-third arrived between one and six hours following injury. Relatives brought 55.4%, followed by bystanders (21.4%). Only 2.3% had formal prehospital care and were brought to the hospital by LASAMBUS. They also had significantly shorter arrival time. One hundred and nine patients (1.9%) died in the emergency room while 235 bodies were brought in dead. CONCLUSION: Less than three percent among the victims of road crashes had formal prehospital care and shorter hospital arrival time. Current facilities for emergency prehospital care in Lagos are inadequate and require improvement. Training lay first-responders, who bring the majority of the injured to hospital, in basic first-aid may improve prehospital care in Lagos. Ibrahim NA , Ajani AWO , Mustafa IA , Balogun RA , Oludara MA , Idowu OE , Solagberu BA . Road traffic injury in Lagos, Nigeria: assessing prehospital care. Prehosp Disaster Med. 2017;32(4):424-430.

Determination of selected heavy metals in air samples from the northern part of Jordan.

In this work, the atmospheric concentrations of selected heavy metals including lead (Pb), iron (Fe), cadmium (Cd), copper (Cu), nickel (Ni), manganese (Mn), and zinc (Zn) were measured for two different sampling sites (urban and rural) in the northern part of Jordan (Irbid city). Samples were collected according to a certain schedule for 1 year. High volume air samplers and glass fiber filters were used to collect the samples. Collected samples were digested using a mixture of analytical grade nitric acid and analytical grade hydrochloric acid, and analyzed to evaluate the levels of heavy metals by atomic absorption spectrophotometry. Six heavy metals (Pb, Fe, Cu, Ni, Mn, and Zn) were measured in all samples; the concentrations of Cd and Co were not detected in Irbid atmosphere by atomic absorption spectroscopy. The results were used to determine the levels of heavy metal pollutants in air, possible sources, and to compare the levels of selected heavy metals in the two studied sites. Aerosols from the rural site have lower concentrations for all the metals compared to those from the urban site. The daily and monthly variations of the elements were investigated. All heavy metals in urban and rural sites reached maximum concentrations in June, July, and August. This is consistent with the increased activities leading to particulate matter emission during the summer period. The enrichment factors with respect to earth crust and correlation coefficients of heavy metals were investigated to predict the possible sources of heavy metals in air.

Evaluation of Pb, Cu, Zn, Cd, Ni and Fe levels in Rosmarinus officinalis labaiatae (Rosemary) medicinal plant and soils in selected zones in Jordan.

The concentration of heavy metals including Pb, Cu, Zn, Cd, Ni and Fe in different parts of Rosmarinus officinalis medicinal plant grown in Jordan were evaluated. Medicinal plant samples and soil samples were collected from three different zones in Jordan (Irbid, Al-Mafraq and Ma'an). Samples were analyzed by atomic absorption spectrometry (AAS) after chemical treatments using acid digestion procedures. Heavy metal levels in washed and unwashed in each part of R. officinalis were analyzed and compared statistically. Results show that concentrations of investigated heavy metals were varied from plant part to another part of R. officinalis. For example, Pb, Zn, Cu and Cd in most parts of R. officinalis in the three zones were concentrated in the following order: flowers, leaves, stems, whereas Pb, Ni and Fe were concentrated in order as follows: leaves, flowers and stems. Heavy metal concentrations in soil samples was evaluated and correlated with their levels in R. officinalis. Two standard reference materials of plant (SRM 1790a; spinach leaves and CRM 281; rye grass) and one standard reference materials of soil (GBW 07406) were examined to validate the method used. Results show that high recoveries were obtained.

Pathological fractures in mycetoma.

Pathological fractures in mycetoma are a rarity and only 1 patient was reported in the literature. We report an unexpectedly high incidence of pathological fractures in mycetoma seen at the Mycetoma Research Centre, Khartoum, Sudan over a 10-year period. Plain radiographs of 517 patients with confirmed mycetoma in various body sites were reviewed and correlated with the clinical presentation of the patients. Pathological fractures were detected in 12 patients (2.3%). The explanation of this high incidence is unclear. Pain-reducing agents produced by mycetoma may be the reason that these fractures were overlooked clinically.

Pathogenicity and cytadherence of Mycoplasma imitans in chicken and duck embryo tracheal organ cultures.

Two strains of the avian organism Mycoplasma imitans were examined for pathogenicity and cytadherence in chicken and duck embryo tracheal organ cultures, and a virulent strain of the related pathogen Mycoplasma gallisepticum was included for comparison. All consistently cause ciliostasis in tracheal explants from both hosts, and examination of infected tissues by immunofluorescence and transmission electron microscopy demonstrated that M. imitans proliferated on the epithelial surface and adhered to the respiratory epithelium by means of its terminal tip structure in the same manner as M. gallisepticum. These observations endorse the striking phenotypic similarities between M. imitans and M. gallisepticum and suggest that M. imitans may have pathogenic potential in vivo.

Mycoplasma imitans sp. nov. is related to Mycoplasma gallisepticum and found in birds.

A mycoplasma designated strain 4229T (T = type strain) was isolated in 1984 from the turbinate of a duck in France, and similar strains were isolated from geese in France and from a partridge in England. All of these strains were originally identified as Mycoplasma gallisepticum by immunofluorescence and growth inhibition tests, but subsequent serological and molecular studies indicated only a partial relationship to this species and DNA-DNA hybridization studies revealed only approximately 40 to 46% genetic homology with M. gallisepticum PG31T. In this study morphological, cultural, and physical investigations were carried out on strain 4229T and partridge strain B2/85, after we first demonstrated the similarity between these organisms by performing a restriction enzyme analysis of their DNAs. Both strains had phenotypic properties very similar to M. gallisepticum properties, including the presence of an attachment organelle. As a result of these investigations, the organisms were assigned to the class Mollicutes, the order Mycoplasmatales, and the genus Mycoplasma. They fermented glucose, reduced triphenyl tetrazolium chloride aerobically and anaerobically, and exhibited hemadsorption and hemagglutination, but other biochemical tests were negative. Apart from a serological cross-reaction with M. gallisepticum, these organisms exhibited no significant relationship with any previously described Mycoplasma species as determined by growth inhibition or immunofluorescence tests or with a number of additional serovars and unclassified avian strains. This Mycoplasma taxon therefore appears to be a new species, for which we propose the name Mycoplasma imitans. The type strain is strain 4229 (= NCTC 11733 = ATCC 51306).(ABSTRACT TRUNCATED AT 250 WORDS)