Factors Associated with Colonization of Streptococcus Pneumoniae among Under-fives Attending Clinic in Mwanza City, Tanzania

Streptococcus pneumoniae is a known cause of severe invasive bacterial infection leading to morbidity and mortality among children in sub-Saharan Africa. Nasopharyngeal colonization of S.pneumoniae is a critical step towards invasive disease progression. The objective of this study was to investigate the magnitude of nasopharyngeal carriage of S. pneumoniae and its associated factors in Mwanza, Tanzania. Children underfives attending Reproductive and Child Health (RCH) clinics in Mwanza, Tanzania clinics were enrolled and investigated for nasopharyngeal carriage of S. pneumoniae. Demographic and clinical data were collected using standardized data collection tool. Nasopharyngeal swabs were taken and processed as per standard laboratory procedures. S. pneumoniae isolates were identified using conventional methods. Antimicrobial susceptibility testing was performed using the disc diffusion method as described by Clinical Laboratory Standard Institute. Among 350 children enrolled in the study, 172 (49.1) were females and 309 (88.3%) were below 2 years of age. A total of 253 (72.3%) children had received at least one dose of pneumococcal vaccine (Prevanar 13) whereas 83 (23.7%) had used antibiotics at median duration of 5 days in the past 14 days. Out of 350 underfives, 43 (12.3%) were found to carry S. pneumoniae in their nasopharynx. Children with chronic diseases and those at school were 3.4 and 4.4 times more at risk to be carriers of S. pneumoniae than their counterpart group (OR; 3.4 (CI(1.0-11.6) 95%, p=0.05) and OR; 4.4 (CI (1.2-15.7) 95%, p=0.023), respectively. Number of children at home, positive HIV status and someone smoking showed association with S. pneumoniae carriage but the differences were not statistically significant. The resistance levels of S. pneumoniae to penicillin, co-trimoxazole and erythromycin were 40%, 88.2% and 41.7%, respectively. However all of the S. pneumoniae isolates were found to be 100% sensitive to ciprofloxacin. A high nasopharyngeal carriage of penicillin resistant S. pneumoniae is observed in Mwanza, Tanzania despite a good coverage of pneumococcal vaccination. The carriage is significantly associated with schooling and presence chronic diseases. Continuous surveillance of penicillin resistant strains coupled with serotyping of the isolates is highly recommended to determine the influence of the pneumococcal vaccination

Prevalence and Strain Characterization of Clostridioides (Clostridium) difficile in Representative Regions of Germany, Ghana, Tanzania and Indonesia – A Comparative Multi-Center Cross-Sectional Study

Clostridioides (Clostridium) difficile infections (CDI) are considered worldwide as emerging health threat. Uptake of C. difficile spores may result in asymptomatic carrier status or lead to CDI that could range from mild diarrhea, eventually developing into pseudomembranous colitis up to a toxic megacolon that often results in high mortality. Most epidemiological studies to date have been performed in middle- and high income countries. Beside others, the use of antibiotics and the composition of the microbiome have been identified as major risk factors for the development of CDI. We therefore postulate that prevalence rates of CDI and the distribution of C. difficile strains differ between geographical regions depending on the regional use of antibiotics and food habits. A total of 593 healthy control individuals and 608 patients suffering from diarrhea in communities in Germany, Ghana, Tanzania and Indonesia were selected for a comparative multi-center cross-sectional study. The study populations were screened for the presence of C. difficile in stool samples. Cultured C. difficile strains (n = 84) were further subtyped and characterized using PCR-ribotyping, determination of toxin production, and antibiotic susceptibility testing. Prevalence rates of C. difficile varied widely between the countries. Whereas high prevalence rates were observed in symptomatic patients living in Germany and Indonesia (24.0 and 14.7%), patients from Ghana and Tanzania showed low detection rates (4.5 and 6.4%). Differences were also obvious for ribotype distribution and toxin repertoires. Toxin A+/B+ ribotypes 001/072 and 078 predominated in Germany, whereas most strains isolated from Indonesian patients belonged to toxin A+/B+ ribotype SLO160 and toxin A-/B+ ribotype 017. With 42.9–73.3%, non-toxigenic strains were most abundant in Africa, but were also found in Indonesia at a rate of 18.2%. All isolates were susceptible to vancomycin and metronidazole. Mirroring the antibiotic use, however, moxifloxacin resistance was absent in African C. difficile isolates but present in Indonesian (24.2%) and German ones (65.5%). This study showed that CDI is a global health threat with geographically different prevalence rates which might reflect distinct use of antibiotics. Significant differences for distributions of ribotypes, toxin production, and antibiotic susceptibilities were observed