Characterization of virulence factors in the newly described <i>Salmonella enterica</i> serotype Keurmassar emerging in Senegal (sub-Saharan Africa)

From 2000 to 2001, nine strains of Salmonella enterica belonging to the new serotype Keurmassar have been isolated from human and poultry samples at the Senegalese National Salmonella and Shigella Reference Laboratory at the Pasteur Institute, in Dakar. All strains carried virulence factors including Salmonella Pathogenicity Islands (SPI)-1, -2, -3 and -5 encoded genes. Strains did not harbour virulence plasmid. Ribotyping analysis revealed a single clone identical to Salmonella Decatur isolated in Zimbabwe. These data suggest that strains are closely related, and may have been spread clonally. In this new serotype, insertion sequence IS200 is not present

Molecular characterization of extended spectrum beta-lactamase among clinical multidrug resistant Escherichia Coli in two hospitals of Niamey, Niger

Objective: The aim of this study was to identify the multiple ESBL genes in Multidrug-resistant (MDR) Escherichia coli isolated in various biological samples in two hospitals of Niamey.Methodology: A total of 195 multidrug-resistant Escherichia coli were included in the study. These isolates were tested using polymerase chain reaction (PCR) for detection of the presence of bla CTX-M, bla TEM, bla SHV and bla OXA-1 beta-lactamase genes.Results: A total of 27.7% of Escherichia coli isolates were ESBL producing strains. Globaly, the bla TEM gene was the most prevalent (70.3%) followed by bla CTX-M (43.1%), bla OXA-1 (31.8%) and bla SHV (4.1%) genes. The four genes type of ESBL were founded simultaneously only in stool samples. Furthermore, none bla SHV gene was found in other samples type.Conclusion: This study showed the presence of various ESBL genes among clinical MDR Escherichia coli. That is why a rational use of antibiotic and appropriate methods of screening ESBL genes in routine laboratories in Niger is needed to control the ESBL genes dissemination.Keywords: MDR ,Escherichia coli, ESBL, bla genes, PCR, Niamey, Niger. Caracterisation moleculaire des betalactamases a spectre etendu chez les souches de Escherichia coli multi resistantes dans deux hopitaux de Niamey, au NigerObjectifs: Le but de cette étude était d'identifier les multiples gènes de BLSE chez les souches de Escherichia coli multi résistantes isolées de différents types d’échantillons biologiques dans deux hôpitaux de Niamey.Méthodologie : Un total de 195 Escherichia coli multi résistants a été inclus dans l'étude. Ces isolats ont été testés par la réaction de polymérase en chaîne (PCR) pour détecter la présence des gènes bla CTX-M, bla TEM, bla SHV et bla OXA-1.Résultats : Au total, 27,7% des isolats de Escherichia coli multi-résistants étaient des souches productrices de BLSE. Globalement le gène bla TEM (70,3%) était le plus détecté suivi des autres gènes bla CTX-M (43,1%), bla OXA-1 (31,8%) et bla SHV (4,1%). Notons que seul dans les échantillons de selles quatre types de gènes de BLSE ont été trouvés simultanément. Par ailleurs notons qu’aucun gène de type bla SHV n'a été trouvé dans les autres types d'échantillons.Conclusion : Cette étude avait montré la présence de divers gènes de BLSE chez les souches cliniques de Escherichia coli. C'est pourquoi une utilisation rationnelle des antibiotiques et des méthodes appropriées de dépistage des gènes de BLSE dans les laboratoires sont nécessaires afin de contrôler la diffusion des gènes de BLSE.Mots clés : Escherichia coli multi résistantes, BLSE, gènes bla, PCR, Niamey, Niger

Determining the Best Immunization Strategy for Protecting African Children Against Invasive Salmonella Disease.

BACKGROUND: The World Health Organization recently prequalified a typhoid conjugate vaccine (TCV), recommending its use in persons ≥6 months to 45 years residing in typhoid fever (TF)-endemic areas. We now need to consider how TCVs can have the greatest impact in the most vulnerable populations. METHODS: The Typhoid Fever Surveillance in Africa Program (TSAP) was a blood culture-based surveillance of febrile patients from defined populations presenting at healthcare facilities in 10 African countries. TF and invasive non-typhoidal Salmonella (iNTS) disease incidences were estimated for 0-10 year-olds in one-year age increments. RESULTS: Salmonella Typhi and iNTS were the most frequently isolated pathogens; 135 and 94 cases were identified, respectively. Analysis from three countries was excluded (incomplete person-years of observation (PYO) data). Thirty-seven of 123 TF cases (30.1%) and 71/90 iNTS disease cases (78.9%) occurred in children aged <5 years. No TF and 8/90 iNTS infections (8.9%) were observed in infants aged <9 months. The TF incidences (/100 000 PYO) for children aged <1 year and 1 to <2 years were 5 and 39, respectively; the highest incidence was 304 per 100 000 PYO in 4 to <5 year-olds. The iNTS disease incidence in the defined age groups ranged between 81 and 233 per 100 000 PYO, highest in 1 to <2 year-olds. TF and iNTS disease incidences were higher in West Africa. CONCLUSIONS: High burden of TF detected in young children strengthens the need for TCV introduction. Given the concurrent iNTS disease burden, development of a trivalent vaccine against S. Typhi, S. Typhimurium, and S. Enteritidis may be timely in this region

Genetic relatedness among isolates of Shigella sonnei carrying class 2 integrons in Tehran, Iran, 2002–2003

<p>Abstract</p> <p>Background</p> <p><it>Shigella </it>spp. are major cause of diarrhoeal disease in both developing and developed countries. <it>Shigella sonnei </it>is the serogroup of <it>Shigella </it>most frequently responsible for sporadic and epidemic enteritis in developed countries. In recent years the emergence and spread of <it>S. sonnei </it>biotype g carrying class 2 integron have been frequently reported in many countries. Recently, <it>S. sonnei </it>has been reported as the prevalent serogroup of <it>Shigella </it>in Iran.</p> <p>The present study was carried out to investigate phenotypic and genetic characteristics of <it>Shigella sonnei </it>isolates identified in the years 2002 and 2003 in Tehran, Iran.</p> <p>Methods</p> <p>Biotyping, drug susceptibility testing, pulsed field gel electrophoresis (PFGE) and analysis of class 2 integrons have been carried out on 60 <it>S. sonnei </it>isolates, including 57 sporadic isolates from paediatric cases of shigellosis occurring in 2002 and 2003, two sporadic isolates recovered in 1984 and the ATCC 9290 strain.</p> <p>Results</p> <p>Biotype g and resistance to streptomycin, sulfamethoxazole-trimethoprim and tetracycline were exhibited by 54 of the 57 recent isolates. Of the 54 biotype g isolates, 28 exhibited a class 2 integron of 2161 bp, and 24 a class 2 integron of 1371 bp, respectively. Class 2 integrons were not detected in four isolates only, including the two endemic isolates recovered in 1984 and two strains from recent sporadic cases. PFGE divided the strains into eight pulsotypes labeled A to H, three major pulsotypes – A to C – including the large majority of the recent sporadic <it>S. sonnei </it>isolates. Pulsotypes A and C were the most prevalent groups, accounting for 41.6% and 35.0%, respectively, of the isolates under study.</p> <p>Conclusion</p> <p>The results suggest that biotype g, class 2 integron carrying <it>S. sonnei </it>are prevalent in our geographic area. <it>S. sonnei </it>isolated in the years 2002 and 2003 could be attributed to a few predominant clusters including, respectively, strains with pulsotypes B and C carrying a 2161 bp class 2 integron, and those having pulsotype A and a 1371 bp class 2 integron. A few epidemic clones are responsible for the apparently endemic occurrence of shigellosis in Tehran, Iran.</p

Multicountry Distribution and Characterization of Extended-spectrum β-Lactamase-associated Gram-negative Bacteria From Bloodstream Infections in Sub-Saharan Africa.

BACKGROUND: Antimicrobial resistance (AMR) is a major global health concern, yet, there are noticeable gaps in AMR surveillance data in regions such as sub-Saharan Africa. We aimed to measure the prevalence of extended-spectrum β-lactamase (ESBL) producing Gram-negative bacteria in bloodstream infections from 12 sentinel sites in sub-Saharan Africa. METHODS: Data were generated during the Typhoid Fever Surveillance in Africa Program (TSAP), in which standardized blood cultures were performed on febrile patients attending 12 health facilities in 9 sub-Saharan African countries between 2010 and 2014. Pathogenic bloodstream isolates were identified at the sites and then subsequently confirmed at a central reference laboratory. Antimicrobial susceptibility testing, detection of ESBL production, and conventional multiplex polymerase chain reaction (PCR) testing for genes encoding for β-lactamase were performed on all pathogens. RESULTS: Five hundred and five pathogenic Gram-negative bloodstream isolates were isolated during the study period and available for further characterization. This included 423 Enterobacteriaceae. Phenotypically, 61 (12.1%) isolates exhibited ESBL activity, and genotypically, 47 (9.3%) yielded a PCR amplicon for at least one of the screened ESBL genes. Among specific Gram-negative isolates, 40 (45.5%) of 88 Klebsiella spp., 7 (5.7%) of 122 Escherichia coli, 6 (16.2%) of 37 Acinetobacter spp., and 2 (1.3%) of 159 of nontyphoidal Salmonella (NTS) showed phenotypic ESBL activity. CONCLUSIONS: Our findings confirm the presence of ESBL production among pathogens causing bloodstream infections in sub-Saharan Africa. With few alternatives for managing ESBL-producing pathogens in the African setting, measures to control the development and proliferation of AMR organisms are urgently needed

The phylogeography and incidence of multi-drug resistant typhoid fever in sub-Saharan Africa.

There is paucity of data regarding the geographical distribution, incidence, and phylogenetics of multi-drug resistant (MDR) Salmonella Typhi in sub-Saharan Africa. Here we present a phylogenetic reconstruction of whole genome sequenced 249 contemporaneous S. Typhi isolated between 2008-2015 in 11 sub-Saharan African countries, in context of the 2,057 global S. Typhi genomic framework. Despite the broad genetic diversity, the majority of organisms (225/249; 90%) belong to only three genotypes, 4.3.1 (H58) (99/249; 40%), 3.1.1 (97/249; 39%), and 2.3.2 (29/249; 12%). Genotypes 4.3.1 and 3.1.1 are confined within East and West Africa, respectively. MDR phenotype is found in over 50% of organisms restricted within these dominant genotypes. High incidences of MDR S. Typhi are calculated in locations with a high burden of typhoid, specifically in children aged <15 years. Antimicrobial stewardship, MDR surveillance, and the introduction of typhoid conjugate vaccines will be critical for the control of MDR typhoid in Africa

Incidence of invasive salmonella disease in sub-Saharan Africa: a multicentre population-based surveillance study.

BACKGROUND: Available incidence data for invasive salmonella disease in sub-Saharan Africa are scarce. Standardised, multicountry data are required to better understand the nature and burden of disease in Africa. We aimed to measure the adjusted incidence estimates of typhoid fever and invasive non-typhoidal salmonella (iNTS) disease in sub-Saharan Africa, and the antimicrobial susceptibility profiles of the causative agents. METHODS: We established a systematic, standardised surveillance of blood culture-based febrile illness in 13 African sentinel sites with previous reports of typhoid fever: Burkina Faso (two sites), Ethiopia, Ghana, Guinea-Bissau, Kenya, Madagascar (two sites), Senegal, South Africa, Sudan, and Tanzania (two sites). We used census data and health-care records to define study catchment areas and populations. Eligible participants were either inpatients or outpatients who resided within the catchment area and presented with tympanic (≥38·0°C) or axillary temperature (≥37·5°C). Inpatients with a reported history of fever for 72 h or longer were excluded. We also implemented a health-care utilisation survey in a sample of households randomly selected from each study area to investigate health-seeking behaviour in cases of self-reported fever lasting less than 3 days. Typhoid fever and iNTS disease incidences were corrected for health-care-seeking behaviour and recruitment. FINDINGS: Between March 1, 2010, and Jan 31, 2014, 135 Salmonella enterica serotype Typhi (S Typhi) and 94 iNTS isolates were cultured from the blood of 13 431 febrile patients. Salmonella spp accounted for 33% or more of all bacterial pathogens at nine sites. The adjusted incidence rate (AIR) of S Typhi per 100 000 person-years of observation ranged from 0 (95% CI 0-0) in Sudan to 383 (274-535) at one site in Burkina Faso; the AIR of iNTS ranged from 0 in Sudan, Ethiopia, Madagascar (Isotry site), and South Africa to 237 (178-316) at the second site in Burkina Faso. The AIR of iNTS and typhoid fever in individuals younger than 15 years old was typically higher than in those aged 15 years or older. Multidrug-resistant S Typhi was isolated in Ghana, Kenya, and Tanzania (both sites combined), and multidrug-resistant iNTS was isolated in Burkina Faso (both sites combined), Ghana, Kenya, and Guinea-Bissau. INTERPRETATION: Typhoid fever and iNTS disease are major causes of invasive bacterial febrile illness in the sampled locations, most commonly affecting children in both low and high population density settings. The development of iNTS vaccines and the introduction of S Typhi conjugate vaccines should be considered for high-incidence settings, such as those identified in this study. FUNDING: Bill & Melinda Gates Foundation