Spatiotemporal and hotspot detection of U5-children diarrhea in resource-limited areas of Ethiopia.

Under-five children (U5-children) diarrhea is a significant public health threat, where the World Health Organisation (WHO) reported it as the second leading cause of children's death worldwide. Nearly 1.7 billion cases occur annually with varied temporal and spatial factors. Identification of the spatiotemporal pattern and hotspot areas of U5-children diarrhea can assist targeted intervention and provide an early warning for more effective response measures. This study aimed at examining spatiotemporal variability along with the detection of hotspot areas for U5-children diarrhea in the Bench Maji Zone of southwestern Ethiopia, where resources are limited and cultural heterogeneity is highest. Retrospective longitudinal data of ten years of diarrhea records from January 2008 to December 2017 were used to identify hotspot areas. The incidence rate per 1,000 per year among children was calculated along with seasonal patterns of cases. The spatiotemporal analysis was made using SaTScan version 9.4, while spatial autocorrelations and hotspot identification were generated using ArcGIS 10.5 software. A total of 90,716 U5-children diarrhea cases were reported with an annual incidence rate of 36.1 per 1,000 U5-children, indicating a relative risk (RR) of 1.6 and a log-likelihood ratio (LLR) of 1,347.32 (p < 0.001). The highest incidence of diarrhea illness was recorded during the dry season and showed incidence rate increment from October to February. The risky clusters (RR > 1) were in the districts of Bero, Maji, Surma, Minit Shasha, Guraferda, Mizan Aman Town, and Sheko with annual cases of 127.93, 68.5, 65.12, 55.03, 55.67, 54.14 and 44.97 per 1,000, respectively. The lowest annual cases reported were in the four districts of Shay Bench, South Bench, North Bench, and Minit Goldiya, where RR was less than a unit. Six most likely clusters (Bero, Minit Shasha, Surma, Guraferda, South Bench, and Maji) and one lower RR area (North Bench) were hotspot districts. The U5-children's diarrhea in the study area showed an overall increasing trend during the dry seasons with non-random distribution over space and time. The data recorded during ten years and analyzed with the proper statistical tools helped to identify the hotspot areas with risky seasons where diarrhea could increase.

Arthrobacter woluwensis subacute infective endocarditis: case report and review of the literature.

We report a case of endocarditis due to Arthrobacter woluwensis and review the published reports of Arthrobacter species isolated from human clinical samples. A 39-year-old injection drug user presented with fever and a new heart murmur. A. woluwensis was isolated from blood cultures, and a diagnosis of subacute infective endocarditis of the native mitral valve was made. The patient was successfully treated with a 6-week course of intravenous teicoplanin. From our review of the literature, we were able to retrieve data on 41 cases of Arthrobacter species isolated from human clinical samples. However, Arthrobacter species was documented as a cause of human disease on only 5 other occasions (2 cases of bacteremia, 1 case of postoperative endophthalmitis, 1 case of a Whipple disease-like syndrome, and 1 case of phlebitis). Because of the difficulty of identifying Arthrobacter strains by conventional biochemical assays, it is likely that infections with these coryneform bacteria are underreported.

RecA and glnA sequences separate the bacteroides fragilis population into two genetic divisions associated with the antibiotic resistance genotypes cepA and cfiA.

The sequences of part of the glutamine synthetase-encoding gene (glnA) and of the RecA-encoding gene (recA) were determined and aligned for 45 Bacteroides fragilis isolates from different clinical and geographical origin. The patterns of sequence divergence of glnA and recA were very similar. The sequences of a 303-bp fraction of recA showed 45 nucleotide substitutions, 40 of which allowed the separation of B. fragilis into two major divisions, which were not found when the deduced amino acid sequences were considered. The 687-bp sequences analysed for the glnA gene showed 112 nucleotide substitutions, 96 of which separated the population into the same two divisions as those described for recA. In this case, the deduced amino acid sequences showed this subdivision as well: three of the six observed amino acid substitutions were division-specific. Within the two divisions, both genes presented a high degree of sequence conservation. Each B. fragilis division was associated with the presence of a different antibiotic resistance gene: cepA encoding a serine-beta-lactamase (division I) and cfiA encoding a metallo-beta-lactamase (division II). No particular clusters associated with geographical or clinical origin, or with the production of an enterotoxin were observed. Sequencing of the cfiA gene allowed identification of two different alleles in division II. However, no association of these different cfiA alleles with the expression of imipenem resistance was observed. In conclusion, the phylogenetic patterns observed by sequencing recA and glnA are in agreement with those obtained previously by MLEE (multilocus enzyme electrophoresis). Thus, it appears that the evolution of recA and glnA genes is similar to that of the whole chromosome of B. fragilis. Horizontal gene transfer between divisions I and II seems to be low, at best. However, the results of the present study could not clarify definitively whether divisions I and II should be considered as two different B. fragilis genospecies.

Population genetics of Helicobacter pylori in the southern part of Switzerland analysed by sequencing of four housekeeping genes (atpD, glnA, scoB and recA), and by vacA, cagA, iceA and IS605 genotyping.

The population biology of 78 Helicobacter pylori strains (71 from Swiss Italian, 4 from East Asian and 3 from South African patients) was investigated by sequence analysis of four housekeeping genes: atpD, scoB, glnA and recA. The vacA genotype, the presence of cagA and IS605, the iceA allelic type, and the resistance to metronidazole, clarithromycin and amoxycillin were determined. A high percentage of DNA polymorphic sites (19.8% for atpD, 21.3% for scoB, 23.7% for glnA and 20.3% for recA) was found. The phylogenetic trees based on the nucleotide sequences of the four gene fragments showed different topologies and were incongruent. The virulence-associated markers were distributed over the dendrograms and no association was found with phylogenetic clusters or clinical manifestations (chronic gastritis, gastric or duodenal ulcer, MALT lymphoma). Moreover, the H ratios (calculated with the homoplasy test) ranged from 0.742 to 0.799, depending on the gene fragment examined. All these observations suggest that H. pylori exists as a recombinant population. The clustering of the strains according to their geographical origin (USA/Europe, East Asia, South Africa) that has recently been demonstrated elsewhere could only be confirmed for the East Asian vacA s1c strains. In contrast, the South African strains clustered together only in the atpD tree. Presumably, recombination at the different loci has masked the evolutionary relationship among the strains.

Identification of two genetic groups in Bacteroides fragilis by multilocus enzyme electrophoresis: distribution of antibiotic resistance (cfiA, cepA) and enterotoxin (bft) encoding genes.

Ninety-three Bacteroides fragilis strains of different origin were analysed by multilocus enzyme electrophoresis (MLEE). Fourteen of the 15 genetic loci analysed were polymorphic, whilst nucleoside phosphorylase was monomorphic. There was a mean of six alleles per locus and a mean genetic diversity of 0.393. Cluster analysis identified 90 electrophoretic types (ETs) separated into two major phylogenetic divisions at a genetic distance of 0.70. Division I consisted of 81 ETs carrying the endogenous class A beta-lactamase gene cepA, whereas division II comprised 9 ETs carrying the class B beta-lactamase gene cfiA, but not cepA. The presence of these two genes was assessed by PCR and the expression of the cfiA gene was investigated by determining the level of resistance to the antibiotic imipenem. MLEE showed a smaller genetic distance among the genotypes of the imipenem-resistant than among the imipenem-susceptible strains. No other particular cluster was observed. The enterotoxin gene (bft) was detected by PCR: DNA sequencing of the products obtained showed that the different bft alleles (bft-1, bft-2 and bft-3) were scattered randomly troughout the phylogenetic tree. No association between distinct clones and clinical manifestations (sepsis, abscesses, diarrhoea), geographical origin or host origin (human or animal) could be found.