Genotypes of Candida albicans from Stool Samples of HIV Sero Positive and HIV Negative Individuals in Nairobi, Kenya

Candida albicans is one of the commonest opportunistic yeast pathogens that infect both healthy and immune-compromised individuals. Currently there are five recognized genotypes of C. albicans based on the 25 rDNA gene. Different genotypes of C. albicans have been shown to differ in their virulence and susceptibility to antifungal drugs and, thus accurate identification of the infecting genotype is essential for guiding antifungal therapy. The aim of the study was to determine the genotypes of C. albicans from stool samples of HIV sero positive and HIV negative individuals and ascertain whether there is an association between HIV status and genotype distribution. A total of forty four (44) Candida albicans isolates from the stool samples of 28 HIV sero positive patients attending an outpatient HIV/AIDS management clinic and 16 HIV negative individuals attending a hospitality industry support program at Kenya Medical Research Institute (KEMRI) were genotyped using PCR primer pairs that span the transposable intron region of the 25S rDNA. Genotype A C. albicans was the most prevalent type (61.4%) followed by genotype C (11.4%) and genotype B (4.5%). Genotype B C. albicans was not isolated from HIV negative individuals. There was no significant difference in the genotype distribution of C. albicans isolates from HIV sero positive and HIV negative individuals (p=0.304). Ten (22.7%) C. albicans isolates could not be genotyped using the transposable region primers an indication of possible new genotypes. Genotype A is the most predominant C. albicans isolate both in HIV sero positive and HIV negative individuals and there is no predilation of any genotype to HIV infected. There is a possibility of new genotypes of C. albicans and sequence analysis may be warranted. Keywords: Genotypes, C. albicans, stool, HIV, Kenya

Crash characteristics and injury patterns among commercial motorcycle users attending Kitale level IV district hospital, Kenya

Introduction: motorcycle users involved in crashes are likely to die or be severely injured due to high frequency of head, chest and leg injuries. We carried out a descriptive cross sectional study to determine crash characteristics and injury patterns among motorcycle users attending Kitale district hospital, Kenya. Methods: motorcycle trauma patients were recruited between 1st August 2013 and 31st October 2013. Data collection was done using a pre-tested, coded questionnaire. Frequencies mean (SD) and chi-square was employed in the analysis. Analysis was done using SPSS V.20. Results were considered significant at α=0.05. Results: motorcycle trauma patients formed 39.4% of all road traffic injuries. Males constituted 69.8%, females 30.2% and mean age was 30(±13) years. Riders accounted for majority of injury patients (45%), passengers (38.8%) and pedestrians (15.9%). Mechanism of motorcycle crash was involving motorcycle versus vehicle (45.6%). Riders suffered severe injuries compared to passengers (χ2=129.936, p<0.001). Head injury patients were assessed as having Glasgow coma scale (GCS) of 70% 9-12, 26% GCS of 13-15 and 7% GCS of 3-8. Injuries sustained by victims included head and neck injury 40%, lower extremity injury 39.9% and chest injury 8.2%. Riders without helmets during the crash sustained head injuries (χ2=111.352, p<0.001). Conclusion: head injuries and lower extremity injuries accounted for the major proportion of injuries sustained by motorcycle users. Non helmet use was associated with increased risk of head injuries. Morbidity can be mitigated by encouraging use of protective gear like helmets

Tuberculosis prevalence in Mbagathi District Hospital, Kenya

Background: Although health is a fundamental human right, there is a growing concern that this right is not being realized in Africa. This is vindicated by the current preventable disease burdens caused by viral, bacterial, fungal and other infectious agents, especially among the poor. Among these etiological agents, Mycobacterium tuberculosis, a bacterium that causes tuberculosis, is the most prevalent. The increase in HIV infections in Kenya has led to continued mortality and morbidity. Moreover, the emergence of drug resistant TB has vastly complicated its management and treatment.Objective: To determine the prevalence of tuberculosis among patients attending Mbagathi District Hospital in Nairobi County in Kenya.Study design: Examination of patients’ record books at a TB laboratory.Setting: Mbagathi District Hospital, a government hospital located next to Kibera, the largest slum in the city.Subjects: All patients who attend the hospital’s TB clinic from 2009 to 2011, and whose names appeared in the Laboratory Tuberculosis record books.Results: TB is prevalent at Mbagathi Hospital over the period studied was 22.2%. The most affected age group is 21-30 years. Most of the infected patients were males (63%). Most of the highly infected patients were from the Kibera, Mathare and Lang’ata slums.Conclusion: Tuberculosis is highly prevalent among patients attending Mbagathi district. In this regard, there is high risk of service providers and service users being infected by TB at the hospital. The risk of transmission of this disease especially to the young children and to HIV patients is particularly worrying. There is need for early detection and timely diagnosis of TB which can be achieved by improving diagnostic equipment and training laboratory personnel and by creating awareness about symptoms of TB in communities so that people can visit the hospital for treatment before the disease becomes serious

Occupational risk factors of Low Back Pain among tea pickers and non-tea pickers in James Finlay (K) Ltd, Kericho County, Kenya

Low back pain (LBP) is a major public health problem in the world. It is estimated that 60% of all employees experience LBP at some point in their life during their employment career. It is also the most prevalent musculo-skeletal condition in rural communities in Kenya and it is estimated that 64% of the tea pickers are suffering from LBP in Kenya, of these, 29% had a history of back pain before they started picking tea. The study aimed at determining the prevalence and assessing the occupational risk factors of LBP among tea pickers and non-tea pickers in James Finlay (K) Limited tea estates in Kericho County. Data were collected using structured questionnaires. Bivariate, multivariate analysis and Pearson’s chi square (χ2) test was used to measure the associations. This study was a cross-sectional comparative study that sampled 454 adults (335 tea pickers and 119 non-tea pickers). The prevalence of LBP was found to be 45.4% (125/335) and 39.5% (47/119) among tea pickers and non-tea pickers respectively. The following characteristics were significant at bivariate level including age, parity and duration of work were found to be related to LBP among tea pickers and non-tea pickers (χ2=8.643; P=0.034 and χ2=6.013; p=0.049) respectively. However, the number of hours worked per day was significantly associated with LBP among tea pickers only (χ2=17.192; p=0.000).  Further, the number of kilograms of tea leaves picked and the number of kgs carried per day was also significantly associated with LBP (χ2=16.882; p=0.000 and χ2=15.978; p=0.001) respectively. There was also a significant association of LBP with carrying of heavy load and how one sharpened farm tools among the non tea pickers who reported to have suffered LBP (χ2=13.129; p=0.000 and χ2=4.125; p=0.042) respectively. However, age (p=0.0022; 95% CI -9.4-7); absenteeism from work (P=0.010; 95% CI 2.7-19.5), work duration per day (P=0.000; 95% CI 23.1-38.5), type of occupation (P=0.000; 95% CI 62.2-79.3) and the no. of Kgs (P=0.011; 95% CI -17.8-2.3) carried were found to contribute independently to LBP among tea pickers whereas absenteeism from work (P=0.000; 95% CI 11.9-29.1), work duration per day (P=0.000; 95% CI 69.8-86.8), alcohol uptake (P=0.008; 95% CI 3.2-20.7), heavy load carried (P=0.018; 95% CI 1.8-18.2) and work duration (P=0.002; 95% CI -14.3-3.2) among non-tea pickers were also found to contribute independently to LBP. The prevalence of LBP was found to be high among both tea and non-tea pickers. We recommend that there is need to consider reviewing tea picking policies for instance introduction of tea picking devices in order to alleviate occupational health hazards associated with tea picking. Key words: Low Back Pain, tea pickers, non-tea pickers.

Occurrence of Aflatoxins and Fumonisins Contamination in Herbal Medicinal Products Sold in Nairobi, Kenya

Aflatoxins and fumonisins are referred to as Mycotoxins. They are secondary metabolites of some moulds which are highly toxic, mutagenic or teratogenic compounds. These substances are not formed by all mould species but are characteristic of their producers. The aim of this study was to determine the occurrence of Aflatoxin and Fumonisins contamination in herbal medicinal products sold in Nairobi Kenya. The study was undertaken in Nairobi, the capital and largest city in Kenya. Nairobi has several herbal clinics, especially in densely populated areas. This study employed an exploratory as well as laboratory-based experimental design to sample 138 herbal medicinal products. The sample were in different preparations, which included liquids, powders, capsules, creams/lotions, and syrups. Screening of the presence of aflatoxins and fumonisins were done using Envirologix Quick ToxTM Kit following the manufacturer’s instructions. Fumonisins and aflatoxins concentration in parts per billion (ppb) was analyzed statistically using Pearson Chi square test at 95% confidence interval. Contaminations were presented in form of frequencies and percentages. Aflatoxins were detected in 74(53.6%) samples while fumonisins were detected in 75(54.3%). Four (11.8%) samples from herbal clinics and 3(4.1%) from street vendors in form of powders and liquids had aflatoxins levels above 4.0ppb. Nine (26.5%) samples from herbal clinics, 10(13.5%) from streets vendors/hawkers and two (10.5%) from the supermarkets in form of powders and liquids had fumonisins levels above 4.0ppb. There was no significant association (c2 test; p>0.05) between detection of fungi from an herbal product and the occurrence of mycotoxins. Aspergillus flavus and A. parasiticus isolated in this study were associated with occurrence of aflatoxins while the Fusarium isolated were responsible for the presence of fumonisins among the herbal products. We conclude that herbal products investigated were contaminated with fumonisins and aflatoxins in varying degrees. Some were contaminated beyond the accepted limits. There were many genera of molds isolated in this study, which are associated with mycotoxins production, but the current study only focused on aflatoxins and fumonisins and therefore other mycotoxins should be investigated so as to ensure overall fungi toxins safety among the herbal products. Key words: aflatoxin, fumonisins, contamination, herbal medicinal products, Aspergillus, Fusarium, Nairobi

Isolation and Characterization of Endophytic Fungi from Medicinal Plant Warburgia ugandensis

The aim of this study was to isolate fungal endophytes from medicinal plant Warburgia ugandensis and determine antimicrobial activity of their metabolites on three human pathogens; (Candida albicans 90018, E coli 25922 and Staphylococcus aureus 29213). Seventeen (17) endophytic fungi were isolated and identified as; Nigrospora oryzae, Aspergillus flavus, Cladosporium sp. (2), Fusarium Oxysporum, Phomopsis sp.(2), Colletotrichum acutatum, Altanaria sp. (2), Cochliobolus sativus, Bionectria ochroleuca, Phyllosticta gardeniicola, Guignardia mangiferae, Tricharina gilva, Diaporthe amygdali and Trichoderma harzianum. Phytochemical screening of their metabolites showed absence of phenols and alkaloids; presence of saponins, tannins, alkaloids, flavonoids, sterols and glycosides in most of the extracts. Most of the fungal endophytes didn’t seem to have active metabolites after screening for presence of antimicrobial activities. Extracts from Phomopsis mali, Alternaria alternata and Fusarium oxysporum had minimum antimicrobial activity. The study showed that fungal endophytes can be a potential source of metabolites which can be useful in pharmaceutical industry. Key words: Fungal endophytes, Warburgia ugandensis, phytochemicals, active metabolites, antimicrobial activit

Diversity of Azoles Resistant Aspergillus Species Isolated from Experience and Naïve Soils in Nairobi County and Naivasha Sub-County Kenya

New triazole antifungals voriconazole, itraconazole and posaconazole are recommended for prophylaxis and treatment of both invasive and chronic fungal infections such as aspergillosis and aspergilloma. Emergence of azole-resistant among A. fumigatus isolates have been reported in other countries including Tanzania ascribed to either previous antifungal treatment, prophylaxis or triazoles use in agriculture. The use of azole based fungicides in the robust horticulture in Kenya is a significant risk factor for antifungal resistance. The study proposes to analyze environmental isolates of Aspergillus fumigatus, Aspergillus flavus and Aspergillus niger for the presence of resistance against the triazoles antifungals. Fungicide naïve soils were obtained from uncultivated virgin fields while fungicide experience soils were collected from flower, agricultural and horticultural fields and greenhouses within Naivasha sub-county and Nairobi County. The fungal isolates were subjected to antifungal susceptibility to triazoles using broth micro dilution method. A total of 492 samples were analyzed in Nairobi, 52 isolates were identified and they resistance were as follow: A. fumigatus (32%), A. niger (26.09%), A. flavus (33.33%) and A .terreus (0%) and in Naivasha 44 isolates were isolated out of which 25 were A. fumigatus and its resistance was at 36%. Data were analyses using student T test and showed they no different between resistant and susceptible isolates from the two location. Data generated will serve to inform on the current status of triazoles resistance pattern and to raise concern emerging antifungal resistance in clinical practice

Pre-treatment HIV-drug resistance associated with virologic outcome of first-line NNRTI-antiretroviral therapy: A cohort study in Kenya

Background: Pre-treatment HIV-drug-resistance (PDR) to WHO-recommended 1st-line non-nucleoside reverse transcriptase inhibitors (NNRTI)-based antiretroviral treatment (ART) is increasing in low-resource communities. We evaluated the risk of PDR on treatment failure if detected at single or multiple codons, at minority (2–9%) or higher (≥10%) frequencies during efavirenz- vs. nevirapine-ART. Methods: We conducted a pooled analysis across three cohorts of Kenyans initiating 1st-line NNRTI-ART between 2006 and 2014. Mutations K103N, Y181C, G190A, M184V and K65R were detected by an oligonucleotide ligation assay (OLA) and confirmed by Sanger and next-generation sequencing (NGS). PDR was defined as detection of any mutation by OLA when confirmed by NGS. Treatment failure, defined as plasma HIV RNA ≥400 copies/mL at month-12 of ART, was compared by PDR genotypes. Findings: PDR was detected in 59/1231 (4·8%) participants. Compared to wild-type genotypes, PDR in participants prescribed nevirapine-ART was associated with increased treatment failure [PDR 69·2% (27/39) vs. wild-type 10·4% (70/674); p = 0·0001], whether detected as minority [66·7% (4/6)] or higher [69·7% (23/33)] frequencies in an individual\u27s HIV quasispecies (p = 0·002 and p \u3c 0·0001, respectively), or mutations at single [50·0% (12/24)] or multiple [100·0% (15/15)] codons (p \u3c 0·0001). During efavirenz-ART, PDR was also associated with increased virologic failure [PDR 25·0% (5/20) vs. wild-type 5·0% (25/498); p = 0·005], but only if detected at multiple drug-resistant codons [50·0% (3/6); p = 0·003] or high frequencies PDR [33·3% (5/15); p = 0·001]. Interpretation: The risk that PDR confers for treatment failure varies by number of mutant codons and their frequency in the quasispecies, with a lower risk for efavirenz- compared to nevirapine-based regimens. PDR detection and management could extend the effective use of efavirenz-ART in low-resource settings. Funding: NIH, PEPFAR

Risk of Fungi Associated with Aflatoxin and Fumonisin in Medicinal Herbal Products in the Kenyan Market

Utilization of herbal products is a major concern due to the possibility of contamination by toxigenic fungi that are mycotoxin producers such as Aspergillus species during processing and packaging. Research was carried out to determine the presence of aflatoxins and fumonisins in herbal medicinal products sold in Eldoret and Mombasa towns in Kenya. The study employed both exploratory and laboratory experimental design. The herbal products were purchased from the market and transported to Kenya Medical Research Institute for processing and analysis. Fungal contaminants were determined according to Pharmacopoeia specifications. The toxins were quantified using ELISA based technique. The genus Aspergillus was the most dominant followed by Penicillium. Fungal counts ranged between 1 CFU/g and >1000 cfu/g. Analysis of variance showed that the rate of fungal contaminants for Eldoret and Mombasa samples had significant association (p≤0.001). Aflatoxin levels ranged from 1 to 24 ppb, while fumonisin levels ranged from 1 to >20 ppb. Only 31% of samples met the standards for microbial limits as specified in Pharmacopoeia. There is need for product microbial quality improvement through proper harvesting, processing, storage, and marketing. It is recommended that a policy be enacted to enable regulation of herbal products in Kenya