Oxacillin resistant Staphlococcus aureus among HIV infected and non-infected Kenyan patients

Background: Infections due to methicillin resistant S. aureus (MRSA) present global challenges to clinicians since therapeutic options are limited and suboptimal dosing contributes to heightened mortality and increased length of hospital stay particularly among the HIV infected patients.Objectives: To assess the prevalence and relative risk of MRSA infections in HIV infected patients.Design: Cross sectional analytical study.Setting: Kenya Medical Research Institute, Opportunistic Infection Laboratories in Nairobi.Subjects: Four hundred and thirty six male and female patients aged one to 65 years, of whom 220 were HIV-infected and 216 were non-infected.Results: There was 436 male (57.1%) and female (42.9%) respondents. The prevalence of MRSA was 26.3% with majority infecting the HIV infected patients (P=0.046). Likewise, the overall Staphylococcal infections were more common in HIV patients (

Reference Ranges for Some Biochemical Parameters in Adult Kenyans

PURPOSE: To establish the reference ranges of some biochemical parameters for adult Kenyan population. METHODS: In a prospective involving 1100 healthy blood donors (age: 18-55 yr) in Kenyatta National Hospital, Kenya reference ranges of some biochemical analytes were constructed by using the parametric methods to estimate 2.5 and 97.5 percentiles of distribution. RESULTS: The reference ranges of the analytes were: alanine aminotransferase (ALT) [males (0-39) U/L, females (0-34) U/L]; aspartate aminotransferase (AST) [males (6-40) U/L, females (3-37) U/L]; alkaline phosphatase (ALP) [males (13-201) U/L, females (5-227) U/L]; albumin (ALB) [males (29-52) g/L, females (28-50) g/L]; protein (PROT) [males (57-89) g/L, females (56-88) g/L]; creatinine (CREAT) [males (59-127) μmol/L, females (54-122) μmol/L]; glucose (GLU) [males (2.8-6.8) mmol/L, females (2.6-7) mmol/L]; phosphorus (PHOS) [males (0.5-2.0) mmol/L, females (0.2-2.4) mmo/L]; potassium (POT) [males (3-5.3), females (3.1-5.1) mmo/L]; sodium (SOD) [males (111-153) mmol/L, females (117-151) mmol/L]; Blood urea nitrogen BUN [males (1.5-5.9) mmol/L, females (1.2-6.0) mmol/L] and Uric acid (UA) [males (120-458) μmol/L, females (89-415) μmol/L]. Age differences in the established reference ranges were observed in ALT, ALB, CREAT, ALP and UA in males and in ALT, ALB, and CREAT in females. Gender differences were observed in ALT, AST, ALB, CREAT and UA in the 18-28 yr old, ALT, AST, ALB, SOD and UA in 29-39 yr old and AST, ALB, and UA in 40-50 yr old. CONCLUSION: Age and sex specific reference ranges of some biochemical parameters were established some of which were different from those reported in literature. There therefore the need for each clinical chemistry laboratory to establish its own ranges. Keywords: Reference range, Biochemical parameter, Adult Kenyan, Kenyatta National Hospital

Effi cacy of Allopatric Tephrosia Vogelii (Fabales: Fabaceae) against Pre-Emerginal Stages of Phlebotomus (Phlebotomus) Duboscqi (Diptera: Psychodidae)

The effi cacy of allopatric Tephrosia vogelii in killing eggs and larvae of the sand fl y Phlebotomus duboscqi was tested in the laboratory. In this study effects of both water and crude powder extracs of Tephrosia vogelii were tested against against pre-emerginal stages of P. duboscqi in the laboratory. Three groups of eggs were wetted with T. vogelii extracts from Kilifi (TVK), Nairobi (TVN) and Vihiga Counties (TVV) and observed for morphological changes, motility, transformation and death. Six groups of 30 first instar larvae were fed on T. vogelii crude powder either alone or mixed with larvae food. All larvae given TVN powder become immortile, did not feed and died at the fi rst instar stage, whereas those fed on TVV and TVK did not die. Combining all the three extracts also led the death of all fi rst and second instar larvae, but gradual death and disintegration of third instar larvae was sequentially observed. The differences in activities of the allopatric plants can be attributed to allopatric introgression arising from geopgraphic separation leading to introgressive hybridization. The killing and anti-feedant activities of TVN could also mean that it is a chemotype 1 plant that contains rotenoid whereas TVK and TVV are chemotype 2 that lack rotenoids. Feeding deterrence has been shown to be caused by rutin and quercetin. Considering that only leaves were used, the toxicity of TVN can be attributed to single or combination actions of rotenone, elliptone, deguelin, rutin, rotenolone, tephrosin or quercetin that have been shown to be present in leaves. Results of this study suggest that T. vogelli has detrimental insecticidal effects on pre-emerginal stages of P. duboscqi and has potential for sand fl y control. This control method can be achieved through direct introduction of crude dried T. vogelii powder into termite mound ventilation shafts and animal burrows where sand fl ies are known to breed and rest.</p

Risk factors for diarrheagenic Escherichia coli infection in children aged 6-24 months in peri-urban community, Nairobi, Kenya

Escherichia coli commonly inhabits the gut of humans and animals as part of their microbiota. Though mostly innocuous, some strains have virulence markers that make them pathogenic. This paper presents results of a cross-sectional epidemiological study examining prevalence of diarrheagenic E. coli (DEC) pathotypes in stool samples of asymptomatic healthy children (n = 540) in Dagoretti South subcounty, Nairobi, Kenya. E. coli was cultured and pathotyped using PCR to target specific virulence markers associated with Shiga-toxin, enteropathogenic, enterotoxigenic, enteroaggregative, entero-invasive and diffusely adherent E. coli. Overall prevalence of DEC pathotypes was 20.9% (113/540) with enteropathogenic E. coli being the most prevalent (34.1%), followed by enteroaggregative E. coli (23.5%) and Shiga-toxin producing E. coli (22.0%) among positive samples. We found evidence of co-infection with multiple pathotypes in 15% of the positive samples. Our models indicated that at the household level, carriage of DEC pathotypes in children was associated with age group [12-18 months] (OR 1.78; 95%CI 1.03-3.07; p = 0.04), eating matoke (mashed bananas) (OR 2.32; 95%CI 1.44-3.73; p = 0.001) and pulses/legumes (OR 1.74; 95%CI 1.01-2.99; p = 0.046) while livestock ownership or contact showed no significant association with DEC carriage (p>0.05). Our findings revealed significant prevalence of pathogenic DEC circulating among presumptive healthy children in the community. Since there has been no previous evidence of an association between any food type and DEC carriage, unhygienic handling, and preparation of matoke and pulses/legumes could be the reason for significant association with DEC carriage. Children 12-18 months old are more prone to DEC infections due to exploration and hand-to-mouth behavior. A detailed understanding is required on what proportion of positive cases developed severe symptomatology as well as fatal outcomes. The co-infection of pathotypes in the rapidly urbanizing environment needs to be investigated for hybrid or hetero-pathotype circulation that have been implicated in previous infection outbreaks