Antibiotic resistance profiles and relatedness of enteric bacterial pathogens isolated from HIV/AIDS patients with and without diarrhoea and their household drinking water in rural communities in Limpopo Province South Africa

Antibiotic resistance profiles and the correlation of enteric bacterial pathogens from HIV positive individuals with and without diarrhoea and their household drinking water were determined using the KirbyBauer disk diffusion and polymerase chain reaction methods respectively. The sef gene of Salmonella enteritidis was amplified with the primer pair sefA-1 and sefA-2. The fliC gene of Salmonella typhimurium was amplified with the primer pair flicA-1 and flicA-2. Heat-labile toxin (LT) primers (Lta and LTb) were used to amplify Escherichia coli isolates and VirA1 and VirA2 for the Vir A gene of Shigella dysenteriae. Results of antibiotic resistance profiles of enteric bacterial pathogens isolated from stool samples of HIV positive and negative individuals with and without diarrhea and their household drinking water showed very similar drug resistance patterns. Over 90% of all the organisms isolated from the various study cohorts showed resistance to penicillin, cloxacillin and amoxicillin. Conversely, almost all the organisms were sensitive to ciprofloxacin, gentamycin, meropenem and imipenem. About 50% of E. coli isolated from the various study cohorts showed multiple antibiotic resistance to penicillin, amoxicillin, ampicillin, erythromycin, tetracycline, doxycycline and cotri-moxazole ( PR, AR, APR, ER, TR, DXTR, and TSR ) whereas less than 10% resistance was consistently reported for ofloxacin, gentamycin, meropenem cefotaxime, cefuroxime and imipenem ( OFXS, GMS, MEMS, CTXS, CXMS and IMIS ). The majority of Salmonella and Shigella isolates from all the groups were sensitive to ciprofloxacin, gentamicin, amikacin, meropenem, imipenem, nalidixic acid, kanamycin, piperacillin-tazo bactam, cefuroxime, doxycyclin, cefepime and ceftazidime (CIPS, GMS, AKS, MEMS, IMIS, NAS, KNS, DXTS, CXMS, CPMS, CAZS and PTZS). For Campylobacter, over 30% of the isolates were resistant to erythromycin, ampicillin, tetracycline,cotrimoxazole and ceftazidime (ER, APR TSR and CAZR) whereas over 85% were susceptible to ciprofloxacin, ofloxacin, gentamycin, amikacin, mero-penem, and nalidixic acid (CIPS, OFXS, GMS, AKS,MEMS and NAS). In addition to penicillin, amoxicillin, ampicillin and erythromycin, Aeromonas and Plesiomonas spp were more resistant to chloramphenicol, but were susceptible to ciprofloxacin, gentamycin, amikacin, meropenem, imipenem and nalidixic acid (CIPS, GMS, AKS, MEMS, IMIS and NAS). Polymerase Chain Reaction (PCR) experiments using targeted species genes of S. enteritidis, S. typhimurium, E. coli, Sh. dysenteriae showed that isolates from stool samples of HIV positive and HIV negative individuals with and without diarrhoea were also present in the household drinking water of the same study cohorts, suggesting that drinking water may have been the sources of the organisms in stool sample. Furthermore, by showing that the primers were able to amplify the genes in both clinical and environmental isolates, the link between the virulence of the pathogens was established

The interesting cross-paths of HIV/AIDS and water in Southern Africa with special reference to South Africa

HIV/AIDS and water-borne diseases account for a substantial degree of morbidity and mortality in different age groups across the globe, but their ripple effects are more devastating in developing countries. Estimates of the HIV/AIDS epidemic in South Africa vary but attest to a mature and generalised epidemic. Antenatal sero-prevalence data show a rising epidemic from less than 1% prevalence among pregnant women attending antenatal clinics in 1990 to over 29.5% in 2004. Prevalence is generally higher among females than males, indicating feminisation of the epidemic. Race analyses in 2003 reveal the highest prevalence to be among African (13%) followed by Whites and Coloureds (6.2%) and least among Indians (1.6%). The epidemic which has left a wave of orphans, child-headed households and its attendant ripple effects on household structures, demography, economy and education is characterised by a ‘pigeon-hole\' of several opportunistic infections. In rural areas, devoid of electricity and potable water, the impact is more profound because of the role of water in cooking, drinking, consumption of anti-retrovirals and in the preparation of milk supplements for infants. People with compromised immune systems are more prone to several diseases than individuals whose immune systems are not compromised by HIV/AIDS. HIV/AIDS patients therefore have greater requirements for potable water than uninfected individuals. Improving water quality will lead to a decline in child and adult mortality as well as diarrhoeal diseases in people living with HIV/AIDS. One of the hallmarks of HIV/AIDS is diarrhoea and about 90% of HIV/AIDS patients in Africa suffer from chronic diarrhoea, an easily recognisable clinical manifestation of water-borne infections. Other linkages between HIV/AIDS and water are breast feeding; unsafe water used in infant formula preparation which increases the risk of diarrhoeal diseases and deaths in infants; anti-retroviral treatment, as safe water is needed during anti-retroviral treatment or treatment for opportunistic infections in HIV. In addition to providing safe water, supply points and latrines should be close to points of use as this will reduce the long distances that care givers and HIV/AIDS patients undertake to fetch water and appropriate water system design is required. Added to the above-mentioned are poverty alleviation aspects; poverty enhances vulnerability to HIV infection and AIDS exacerbates poverty. Secured access to sufficient safe water and sanitation is also a human rights issue, just as stigmatisation of HIV/AIDS has made the disease a human rights issue. The cross-paths between HIV/AIDS and water have long-term implications for effective water resource management and the provision of wholesome water to communities. Such implications include faltering payment for water supply because HIV and AIDS are financially dis-empowering, erosion of social capital and waning productivity. Mainstreaming of HIV/AIDS in the water sector is of utmost importance, including development of work-place policies, adaptation and reorganisation of workload, development of strategies for reserve staff, adjustment of performance appraisal systems, pro-poor financing with a focus on water for health and economic benefit and integration of HIV and AIDS into training activities. Water SA Vol.32 (3) 2006: pp.323-34