Pulmonary Tuberculosis and Mycobacterium bovis, Uganda

Dat het vaststellen van het strafrechtelijk relevante causale verband geen gemakkelijke opgave is, bleek maar weer eens uit de Groningse HIV-zaak. Daarin was de vraag aan de orde of de verdachten die hun slachtoffers op een seksfeest hadden geïnjecteerd met besmet bloed, konden worden veroordeeld voor opzettelijke zware mishandeling, de later gebleken HIV-besmetting. De vraag is of de problemen met de strafrechtelijk relevante causaliteit niet voor een belangrijk deel kunnen worden opgelost door middel van materieelrechtelijke voorzieningen.

Whole genome analysis of selected human and animal rotaviruses identified in Uganda from 2012 to 2014 reveals complex genome reassortment events between human, bovine, caprine and porcine strains

Rotaviruses of species A (RVA) are a common cause of diarrhoea in children and the young of various other mammals and birds worldwide. To investigate possible interspecies transmission of RVAs, whole genomes of 18 human and 6 domestic animal RVA strains identified in Uganda between 2012 and 2014 were sequenced using the Illumina HiSeq platform. The backbone of the human RVA strains had either a Wa- or a DS-1-like genetic constellation. One human strain was a Wa-like mono-reassortant containing a DS-1-like VP2 gene of possible animal origin. All eleven genes of one bovine RVA strain were closely related to those of human RVAs. One caprine strain had a mixed genotype backbone, suggesting that it emerged from multiple reassortment events involving different host species. The porcine RVA strains had mixed genotype backbones with possible multiple reassortant events with strains of human and bovine origin.Overall, whole genome characterisation of rotaviruses found in domestic animals in Uganda strongly suggested the presence of human-to animal RVA transmission, with concomitant circulation of multi-reassortant strains potentially derived from complex interspecies transmission events. However, whole genome data from the human RVA strains causing moderate and severe diarrhoea in under-fives in Uganda indicated that they were primarily transmitted from person-to-person

Efficacy of Commercially Used Antibacterial Agents against Oral Bacteria Associated with HIV/AIDS Patients in South Western Uganda

Aims: This was to determine efficacy and resistance profiles against commonly used commercial antibacterial agents in Uganda in the management of oral pathogens in HIV/AIDS patients. Study Design: This was an experimental study. Place and Duration of Study: Microbiology Laboratory, Mbarara University of Science and Technology, Mbarara, Uganda between September 2015 and February 2016. Methodology: Bacterial isolates were tested against commercial antibacterial agents in Uganda. Drug shops, pharmacies and hospitals were purposively and conveniently sampled. Drugs commonly used for the management of opportunistic infections amongst HIV/AIDS patients were purchased and used in the laboratory for susceptibility, minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) using standard protocols. Results: All the bacterial isolates showed mean total resistance above 60% against erythromycin [85 isolates (69.7%)] and cotrimoxazole [79 isolates, (64.8%)]; with injectable gentamicin [97 isolates (79.5%)] and ceftriaxone [105 isolates (86.0%)] displaying high susceptibility; and ciprofloxacin [65 isolates (53.3%)] showing moderate susceptibility. This shows that national policy on effective regulation of these antibacterial agents needs to be revised to ensure that the situation is reversed. Gentamicin showed increased significant mean activity (P***< .005, ANOVA, multiple comparisons) in MIC and MBC when compared with the other antimicrobial agents. Conclusion: Gentamicin was highly efficacious in this study and resistance of these oral bacteria to common commercial antibacterial agents is a major public health burden especially among Uganda HIV/AIDS patients. Improving drug regulation activities will reduce antibacterial resistance and treatment failures. We recommend a survey on the reasons for efficacy of gentamicin against all the commercially available antimicrobials used in this study. We added a space between “above” and “60%”

Low Resistance to First and Second Line Anti-Tuberculosis Drugs among Treatment Naive Pulmonary Tuberculosis Patients in Southwestern Uganda

Background: There are limited data on region-specific drug susceptibility of tuberculosis (TB) in Uganda. We performed resistance testing on specimens collected from treatment-naive patients with pulmonary TB in Southwestern Uganda for first and second line anti-TB drugs. We sought to provide data to guide regional recommendations for empiric TB therapy. Methods: Archived isolates, obtained from patients at Mbarara Regional Referral Hospital from February 2009 to February 2013, were tested for resistance to isoniazid and rifampicin using the MTBDRplus and Xpert MTB/RIF assays. A subset of randomly selected isolates was tested for second line agents, including fluoroquinolones (FQs), aminoglycosides, cyclic peptides, and ethambutol using the MTBDRsl assay. We performed confirmatory testing for FQ resistance using repeated MTBDRsl, the Mycobacteria growth indicator tube (MGIT) assay, and sequencing of the gyrA and gyrB genes. Results: We tested isolates from 190 patients. The cohort had a median age of 33 years (IQR 26-43), 69% (131/190) were male, and the HIV prevalence was 42% (80/190). No isolates (0/190) were rifampicin-resistant and only 1/190 (0.5%) was isoniazid-resistant. Among 92 isolates tested for second-line drug resistance, 71 (77%) had interpretable results, of which none were resistant to aminoglycosides, cyclic peptides or ethambutol. Although 7 (10%) initially tested as resistant to FQs by the MTBDRsl assay, they were confirmed as susceptible by repeat MTBDRsl testing as well as by MGIT and gyrase gene sequencing Conclusion: We found no MDR-TB and no resistance to ethambutol, FQs, or injectable anti-TB drugs in treatment naïve patients with pulmonary TB in Southwestern Uganda. Standard treatment guidelines for susceptible TB should be adequate for most patients with TB in this population. Where possible, molecular susceptibility testing methods should be routinely validated by culture methods

VP6 gene (segment 6).

<p>Maximum Likelihood phylogenetic trees of nucleotide sequences of rotavirus genome segment 6 of human and animal RVA strains circulating in Uganda, 2012–2014. Bootstrap values above 70 are shown for 1000 replicates. The Ugandan human strains are labelled with blue circles and the Ugandan animal strains with red triangles. Chicken strain RVA/Chicken-tc/GBR/Ch-2/1979/G3P[30] served as the outgroup. The scale bar at the bottom of the tree calibrates the genetic distance expressed as nucleotide substitution per site.</p

VP7 gene (segment 9).

<p>Maximum Likelihood phylogenetic trees of nucleotide sequences of rotavirus genome segment 9 of human and animal RVA strains circulating in Uganda, 2012–2014. Bootstrap values above 70 are shown for 1000 replicates. The Ugandan human strains are labelled with blue circles and the Ugandan animal strains with red triangles. Chicken strain RVA/Chicken-wt/KOR/ArRv-2/2011/G19P[<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0178855#pone.0178855.ref030" target="_blank">30</a>] served as the outgroup. The scale bar at the bottom of the tree calibrates the genetic distance expressed as nucleotide substitution per site.</p

The maps of Uganda, Kampala and Masaka districts showing the hospitals and households at which the study children and animals (rotavirus positives that were sequenced) were recruited respectively.

<p>The maps of Uganda, Kampala and Masaka districts showing the hospitals and households at which the study children and animals (rotavirus positives that were sequenced) were recruited respectively.</p

NSP2 gene (segment 8).

<p>Maximum Likelihood phylogenetic trees of nucleotide sequences of genome segment 8 of human and animal RVA strains circulating in Uganda, 2012–2014. Bootstrap values above 70 are shown for 1000 replicates. The Ugandan human strains are labelled with blue circles and the Ugandan animal strains with red triangles. Pigeon strain RVA/Pigeon-tc/PN/PO-13/1983/G18P[17] served as the outgroup. The scale bar at the bottom of the tree calibrates the genetic distance expressed as nucleotide substitution per site.</p