Evidence of Histoplasma capsulatum seropositivity and exploration of risk factors for exposure in Busia county, western Kenya: analysis of the PAZ dataset

Despite recognition of histoplasmosis as a priority disease of public health concern in Kenya and an important AIDS-defining illness, there remains a paucity of research on this neglected fungal disease. Clinical and laboratory capacity for the diagnosis and treatment of histoplasmosis across Kenya is limited or unknown, and existing diagnostic and therapeutic techniques can be cost-prohibitive. In addition, the fragmentary nature of histoplasmosis research groups worldwide and the under- or over-representation of specific sociodemographic groups and geographic regions in outbreak reports and hospital-based case series have been acknowledged. This study provides a first look at Histoplasma capsulatum seroprevalence in rural western Kenya and explores risk factors for exposure at this human-animal-environment interface. More broadly, these outcomes will help quantify the burden of H. capsulatum in household and community environments, which may direct further research efforts and inform policy-makers on the prioritisation for clinical services and public health efforts with regards to histoplasmosis

Genomic epidemiology of Escherichia coli:Antimicrobial resistance through a One Health lens in sympatric humans, livestock and peri-domestic wildlife in Nairobi, Kenya

BackgroundLivestock systems have been proposed as a reservoir for antimicrobial-resistant (AMR) bacteria and AMR genetic determinants that may infect or colonise humans, yet quantitative evidence regarding their epidemiological role remains lacking. Here, we used a combination of genomics, epidemiology and ecology to investigate patterns of AMR gene carriage in Escherichia coli, regarded as a sentinel organism.MethodsWe conducted a structured epidemiological survey of 99 households across Nairobi, Kenya, and whole genome sequenced E. coli isolates from 311 human, 606 livestock and 399 wildlife faecal samples. We used statistical models to investigate the prevalence of AMR carriage and characterise AMR gene diversity and structure of AMR genes in different host populations across the city. We also investigated household-level risk factors for the exchange of AMR genes between sympatric humans and livestock.ResultsWe detected 56 unique acquired genes along with 13 point mutations present in variable proportions in human and animal isolates, known to confer resistance to nine antibiotic classes. We find that AMR gene community composition is not associated with host species, but AMR genes were frequently co-located, potentially enabling the acquisition and dispersal of multi-drug resistance in a single step. We find that whilst keeping livestock had no influence on human AMR gene carriage, the potential for AMR transmission across human-livestock interfaces is greatest when manure is poorly disposed of and in larger households.ConclusionsFindings of widespread carriage of AMR bacteria in human and animal populations, including in long-distance wildlife species, in community settings highlight the value of evidence-based surveillance to address antimicrobial resistance on a global scale. Our genomic analysis provided an in-depth understanding of AMR determinants at the interfaces of One Health sectors that will inform AMR prevention and control

Improved latrine coverage may reduce porcine cysticercosis: a comparative cross-sectional study, Busia County, Kenya 2021

IntroductionSmallholder pig farming is an important economic activity for many poor, rural communities in developing countries. Porcine cysticercosis is a growing public health risk in countries where pig rearing is popular. A sanitation-based intervention to reduce the prevalence of open defecation was completed in Busia County, Kenya in 2016. We capitalized on this third party intervention to evaluate its impact on porcine cysticercosis prevalence.MethodsWe conducted a comparative cross-sectional survey from August through to September 2021. Household selection was done using multistage sampling. Household questionnaire data on pig production, transmission, risk factors and awareness of porcine cysticercosis were collected from 251 households. Lingual palpation was used to test for cysticerci in 370 pigs while serum was tested for circulating antigen using Ag-ELISA. We compared results of our survey to an effective baseline, which was a near equivalent cross sectional survey conducted in 2012 before the third party sanitary intervention was established. The difference in prevalence was measured using Chi-square tests. Multivariable logistic regression analysis was used to identify risk factors for lingual cysts in pigs.ResultsThe prevalence of palpable lingual cysts was estimated to be 3.8% (95% CI 2.3–6.3%) (14/370). This was 6% (95% CI 0.8–13.9%; p-value 0.0178) lower than the prevalence reported in the pre-implementation period of 9.7% (95% CI: 4.5–17.6%). Circulating antigen was detected in 2 samples (0.54%, 95% CI: 0.2–1.9). Latrine coverage was 86% (95% CI: 81–90%), which was 11% (95% CI: 4.8–16.8%; p &amp;lt; 0.001) higher than the pre-implementation period coverage of 75% (95% CI: 71–79%). There was reduced prevalence of lingual cysts in pigs from households that had a latrine (OR = 0.14; 95% CI: 0.05–0.43; p &amp;lt; 0.001) and where pigs were confined or tethered (OR = 0.27; 95% CI: 0.07–1.02; p = 0.053).ConclusionThere was a reduction in the prevalence of porcine cysticercosis in Busia County over the study period from 2012 to 2021. This was not a trial design so we are unable to directly link the decline to a specific cause, but the data are consistent with previous research indicating that improved sanitation reduces porcine cysticercosis. Programs for controlling porcine cysticercosis should include a focus on sanitation in addition to other integrated One Health approaches.</jats:sec