Salmonella enterica is a frequent cause of bloodstream infection (BSI) in Asia but few data are available from Cambodia. We describe Salmonella BSI isolates recovered from patients presenting at ...Sihanouk Hospital Centre of Hope, Phnom Penh, Cambodia (July 2007-December 2010).
Blood was cultured as part of a microbiological prospective surveillance study. Identification of Salmonella isolates was performed by conventional methods and serotyping. Antibiotic susceptibilities were assessed using disk diffusion, MicroScan and E-test macromethod. Clonal relationships were assessed by Pulsed Field Gel Electrophoresis; PCR and sequencing for detection of mutations in Gyrase and Topoisomerase IV and presence of qnr genes.
Seventy-two Salmonella isolates grew from 58 patients (mean age 34.2 years, range 8-71). Twenty isolates were identified as Salmonella Typhi, 2 as Salmonella Paratyphi A, 37 as Salmonella Choleraesuis and 13 as other non-typhoid Salmonella spp. Infection with human immunodeficiency virus (HIV) was present in 21 of 24 (87.5%) patients with S. Choleraesuis BSI. Five patients (8.7%) had at least one recurrent infection, all with S. Choleraesuis; five patients died. Overall, multi drug resistance (i.e., co-resistance to ampicillin, sulphamethoxazole-trimethoprim and chloramphenicol) was high (42/59 isolates, 71.2%). S. Typhi displayed high rates of decreased ciprofloxacin susceptibility (18/20 isolates, 90.0%), while azithromycin resistance was very common in S. Choleraesuis (17/24 isolates, 70.8%). Two S. Choleraesuis isolates were extended spectrum beta-lactamase producer.
Resistance rates in Salmonella spp. in Cambodia are alarming, in particular for azithromycin and ciprofloxacin. This warrants nationwide surveillance and revision of treatment guidelines.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Burkholderia pseudomallei isolates with shared multilocus sequence types (STs) have not been isolated from different continents. We identified two STs shared between Australia and Cambodia. ...Whole-genome analysis revealed substantial diversity within STs, correctly identified the Asian or Australian origin, and confirmed that these shared STs were due to homoplasy.
Analysis reveals commercial tests for Ebola are too hard to come by in the current outbreak -- sustain investment, urge Lieselotte Cnops, Kevin K. Ariën and colleagues.
Highlights • First case of zika virus infection in a Belgian traveler ex Guatemala. • PCR on serum for rapid diagnosis but restricted to the early phase of infection. • Interpretation of flavivirus ...serological tests is challenging. • Overview of laboratory test results of reported European cases. • Need for an efficient surveillance for emerging arboviral infections is reminded.
Burkholderia pseudomallei, an environmental bacterium that causes the deadly disease melioidosis, is endemic in northern Australia and Southeast Asia. An increasing number of melioidosis cases are ...being reported in other tropical regions, including Africa and the Indian Ocean islands. B. pseudomallei first emerged in Australia, with subsequent rare dissemination event(s) to Southeast Asia; however, its dispersal to other regions is not yet well understood. We used large-scale comparative genomics to investigate the origins of three B. pseudomallei isolates from Madagascar and two from Burkina Faso. Phylogenomic reconstruction demonstrates that these African B. pseudomallei isolates group into a single novel clade that resides within the more ancestral Asian clade. Intriguingly, South American strains reside within the African clade, suggesting more recent dissemination from West Africa to the Americas. Anthropogenic factors likely assisted in B. pseudomallei dissemination to Africa, possibly during migration of the Austronesian peoples from Indonesian Borneo to Madagascar ~2,000 years ago, with subsequent genetic diversity driven by mutation and recombination. Our study provides new insights into global patterns of B. pseudomallei dissemination and adds to the growing body of evidence of melioidosis endemicity in Africa. Our findings have important implications for melioidosis diagnosis and management in Africa. IMPORTANCE Sporadic melioidosis cases have been reported in the African mainland and Indian Ocean islands, but until recently, these regions were not considered areas where B. pseudomallei is endemic. Given the high mortality rate of melioidosis, it is crucial that this disease be recognized and suspected in all regions of endemicity. Previous work has shown that B. pseudomallei originated in Australia, with subsequent introduction into Asia; however, the precise origin of B. pseudomallei in other tropical regions remains poorly understood. Using whole-genome sequencing, we characterized B. pseudomallei isolates from Madagascar and Burkina Faso. Next, we compared these strains to a global collection of B. pseudomallei isolates to identify their evolutionary origins. We found that African B. pseudomallei strains likely originated from Asia and were closely related to South American strains, reflecting a relatively recent shared evolutionary history. We also identified substantial genetic diversity among African strains, suggesting long-term B. pseudomallei endemicity in this region.
Pathogens causing acute fever, with the exception of malaria, remain largely unidentified in sub-Saharan Africa, given the local unavailability of diagnostic tests and the broad differential ...diagnosis.
We conducted a cross-sectional study including outpatient acute undifferentiated fever in both children and adults, between November 2015 and June 2016 in Kinshasa, Democratic Republic of Congo. Serological and molecular diagnostic tests for selected arboviral infections were performed on blood, including PCR, NS1-RDT, ELISA and IFA for acute, and ELISA and IFA for past infections.
Investigation among 342 patients, aged 2 to 68 years (mean age of 21 years), with acute undifferentiated fever (having no clear focus of infection) revealed 19 (8.1%) acute dengue-caused by DENV-1 and/or DENV-2 -and 2 (0.9%) acute chikungunya infections. Furthermore, 30.2% and 26.4% of participants had been infected in the past with dengue and chikungunya, respectively. We found no evidence of acute Zika nor yellow fever virus infections. 45.3% of patients tested positive on malaria Rapid Diagnostic Test, 87.7% received antimalarial treatment and 64.3% received antibacterial treatment.
Chikungunya outbreaks have been reported in the study area in the past, so the high seroprevalence is not surprising. However, scarce evidence exists on dengue transmission in Kinshasa and based on our data, circulation is more important than previously reported. Furthermore, our study shows that the prescription of antibiotics, both antibacterial and antimalarial drugs, is rampant. Studies like this one, elucidating the causes of acute fever, may lead to a more considerate and rigorous use of antibiotics. This will not only stem the ever-increasing problem of antimicrobial resistance, but will-ultimately and hopefully-improve the clinical care of outpatients in low-resource settings.
ClinicalTrials.gov NCT02656862.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
After the 2017 Ebola virus (EBOV) outbreak in Likati, a district in northern Democratic Republic of the Congo, we sampled small mammals from the location where the primary case-patient presumably ...acquired the infection. None tested positive for EBOV RNA or antibodies against EBOV, highlighting the ongoing challenge in detecting animal reservoirs for EBOV.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, ODKLJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Bloodstream infections (BSI) cause important morbidity and mortality worldwide. In Cambodia, no surveillance data on BSI are available so far.
From all adults presenting with SIRS at Sihanouk ...Hospital Centre of HOPE (July 2007-December 2010), 20 ml blood was cultured. Isolates were identified using standard microbiological techniques; antibiotic susceptibilities were assessed using disk diffusion and MicroScan®, with additional E-test, D-test and double disk test where applicable, according to CLSI guidelines.
A total of 5714 samples from 4833 adult patients yielded 501 clinically significant organisms (8.8%) of which 445 available for further analysis. The patients' median age was 45 years (range 15-99 y), 52.7% were women. HIV-infection and diabetes were present in 15.6% and 8.8% of patients respectively. The overall mortality was 22.5%. Key pathogens included Escherichia coli (n = 132; 29.7%), Salmonella spp. (n = 64; 14.4%), Burkholderia pseudomallei (n = 56; 12.6%) and Staphylococcus aureus (n = 53; 11.9%). Methicillin resistance was seen in 10/46 (21.7%) S. aureus; 4 of them were co-resistant to erythromycin, clindamycin, moxifloxacin and sulphamethoxazole-trimethoprim (SMX-TMP). We noted combined resistance to amoxicillin, SMX-TMP and ciprofloxacin in 81 E. coli isolates (62.3%); 62 isolates (47.7%) were confirmed as producers of extended spectrum beta-lactamase. Salmonella isolates displayed high rates of multidrug resistance (71.2%) with high rates of decreased ciprofloxacin susceptibility (90.0%) in Salmonella Typhi while carbapenem resistance was observed in 5.0% of 20 Acinetobacter sp. isolates.
BSI in Cambodian adults is mainly caused by difficult-to-treat pathogens. These data urge for microbiological capacity building, nationwide surveillance and solid interventions to contain antibiotic resistance.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Objective
The microbiologic causes of bloodstream infections (BSI) may differ between HIV‐positive and HIV‐negative patients and direct initial empiric antibiotic treatment (i.e. treatment before ...culture results are available). We retrospectively assessed community‐acquired BSI episodes in adults in Cambodia according to HIV status for spectrum of bacterial pathogens, antibiotic resistance patterns and appropriateness of empiric antibiotics.
Methods
Blood cultures were systematically performed in patients suspected of BSI in a referral hospital in Phnom Penh, Cambodia. Data were collected between 1 January 2009 and 31 December 2011.
Results
A total of 452 culture‐confirmed episodes of BSI were recorded in 435 patients, of whom 17.9% and 82.1% were HIV‐positive and HIV‐negative, respectively. Escherichia coli accounted for one‐third (n = 155, 32.9%) of 471 organisms, with similar rates in both patient groups. Staphylococcus aureus and Salmonella cholereasuis were more frequent in HIV‐positive vs. HIV‐negative patients (17/88 vs. 38/383 (P = 0.02) and 10/88 vs. 5/383 (P < 0.001)). Burkholderia pseudomallei was more common in HIV‐negative than in HIV‐positive patients (39/383 vs. 2/88, P < 0.001). High resistance rates among commonly used antibiotics were observed, including 46.6% ceftriaxone resistance among E. coli isolates. Empiric antibiotic treatments were similarly appropriate in both patient groups but did not cover antibiotic‐resistant E. coli (both patient groups), S. aureus (both groups) and B. pseudomallei (HIV‐negative patients).
Conclusion
The present data do not warrant different empiric antibiotic regimens for HIV‐positive vs. HIV‐negative patients in Cambodia. The overall resistance rates compromise the appropriateness of the current treatment guidelines.
Objectif
Les causes microbiologiques de septicémie peuvent différer entre patients VIH séropositifs et séronégatifs et guider dans le traitement initial antibiotique empirique (i.e. traitement avant que les résultats de culture soient disponibles). Nous avons analysé rétrospectivement les épisodes de septicémies acquises dans la communauté chez les adultes au Cambodge selon leur statut VIH pour un spectre de bactéries pathogènes, les profils de résistance aux antibiotiques et la pertinence des antibiotiques empiriques.
MéthodesLes hémocultures ont été systématiquement réalisées chez des patients suspectés de septicémie dans un hôpital de référence à Phnom Penh, au Cambodge. Les données ont été recueillies entre le 1er janvier 2009 et le 31 décembre 2011.
Résultats
Au total 452 épisodes de septicémie confirmés par culture ont été enregistrés chez 435 patients, dont 17.9% et 82.1% étaient séropositifs et séronégatifs respectivement. Escherichia coli représentait un tiers (n = 155, 32.9%) des 471 organismes, avec des taux similaires dans les deux groupes de patients. Staphylococcus aureus et Salmonella Choleraesuis étaient plus fréquents chez les patients VIH‐positifs que chez les VIH‐négatifs 17/88 contre 38/383 (P = 0.02) et 10/88 contre 5/383 (P < 0.001). Burkholderia pseudomallei était plus fréquent chez les patients VIH séronégatifs que chez les VIH positifs (39/383 vs 2/88, P < 0.001). Des taux de résistance élevés parmi les antibiotiques couramment utilisés ont été observés, y compris 46.6% de résistance à la ceftriaxone parmi les isolats d’E. coli. Les traitements d'antibiotiques empiriques étaient tout aussi appropriés dans les deux groupes de patients, mais ne couvraient pas les résistances aux antibiotiques dans les cas d’E. coli (dans les deux groupes de patients), de S. aureus (dans les deux groupes de patients) et de B. pseudomallei (chez patients VIH‐négatifs).
Conclusion
Les données présentes ne justifient pas différents schémas empiriques d'antibiotiques pour les patients VIH‐positifs par rapport aux patients VIH‐négatifs au Cambodge. Les taux de résistance globaux compromettent le bien‐fondé des recommandations de traitement actuelles.
Objetivo
Averiguar si las causas microbiológicas de las infecciones sanguíneas (IS) y el tratamiento antibiótico empírico inicial recibido (es decir, el tratamiento antes de que los resultados del cultivo estén disponibles) son diferentes entre pacientes VIH‐positivos y VIH‐negativos. Hemos evaluad, de forma retrospectiva, los episodios de IS adquiridos en la comunidad de adultos camboyanos, según su estatus de VIH, para un espectro de patógenos bacterianos, según los patrones de resistencia a los antibióticos y a lo apropiado de los antibióticos empíricos.
MétodosLos cultivos de sangre se realizaron de forma sistemática en pacientes con sospecha de IS en un hospital de referencia en Phnom Penh, Camboya. Se recolectaron datos entre el 1 de Enero del 2009 y el 31 de Diciembre del 2011.
ResultadosSe registraron un total de 452 episodios de IS, confirmados mediante cultivo en 435 pacientes, de los cuales 17.9% y 82.1% eran VIH‐positivos y VIH‐ negativos respectivamente. Escherichia coli era responsable de una tercera parte (n = 155, 32.9%) de los 471 microorganismos aislados, con tasas similares en ambos grupos de pacientes. Staphylococcus aureus y Salmonella Choleraesuis eran más frecuentes entre pacientes VIH‐positivos vs VIH‐negativos (17/88 vs 38/383 (P = 0.02) y 10/88 vs 5/383 (P < 0.001)). Burkholderia pseudomallei era más común entre pacientes VIH ‐negativos que entre VIH‐positivos (39/383 vs 2/88, P < 0.001). Se observaron altos niveles de resistencia para los antibióticos de uso común, incluyendo un 46.6% de resistencia a la ceftriaxona entre aislados de E. coli. Los tratamientos antibióticos empíricos eran similares para ambos grupos de pacientes en cuanto a lo apropiado, pero no cubrían los niveles de resistencia para E. coli (ambos grupos de pacientes), S. aureus (ambos grupos) y B. pseudomallei (pacientes VIH‐ negativos).
ConclusiónLos datos actuales no garantizan regímenes antibióticos empíricos diferentes para los pacientes VIH‐positivos vs VIH‐negativos en Camboya. Las tasas de resistencia generales comprometen la idoneidad de las guías de tratamiento actuales.
Early March 2019, health authorities of Matadi in the Democratic Republic of the Congo alerted a sudden increase in acute fever/arthralgia cases, prompting an outbreak investigation. We collected ...surveillance data, clinical data, and laboratory specimens from clinical suspects (for CHIKV-PCR/ELISA, malaria RDT), semi-structured interviews with patients/caregivers about perceptions and health seeking behavior, and mosquito sampling (adult/larvae) for CHIKV-PCR and estimation of infestation levels. The investigations confirmed a large CHIKV outbreak that lasted February-June 2019. The total caseload remained unknown due to a lack of systematic surveillance, but one of the two health zones of Matadi notified 2686 suspects. Of the clinical suspects we investigated (
= 220), 83.2% were CHIKV-PCR or IgM positive (acute infection). One patient had an isolated IgG-positive result (while PCR/IgM negative), suggestive of past infection. In total, 15% had acute CHIKV and malaria. Most adult mosquitoes and larvae (>95%) were
. High infestation levels were noted. CHIKV was detected in 6/11 adult mosquito pools, and in 2/15 of the larvae pools. This latter and the fact that 2/6 of the CHIKV-positive adult pools contained only males suggests transovarial transmission. Interviews revealed that healthcare seeking shifted quickly toward the informal sector and self-medication. Caregivers reported difficulties to differentiate CHIKV, malaria, and other infectious diseases resulting in polypharmacy and high out-of-pocket expenditure. We confirmed a first major CHIKV outbreak in Matadi, with main vector
. The health sector was ill-prepared for the information, surveillance, and treatment needs for such an explosive outbreak in a CHIKV-naïve population. Better surveillance systems (national level/sentinel sites) and point-of-care diagnostics for arboviruses are needed.
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