Helicobacter pylori Infection: Antibiotic Resistance and Solutions for Effective Management in Africa

Helicobacter pylori. pylori infection is ubiquitous worldwide, with prevalence rates of greater than 70% in Africa. Symptomatic patients present with foregut gastrointestinal symptoms which can be readily diagnosed with standardized non-invasive or invasive tests. The biggest challenge, however, is in the management of this condition with rising antimicrobial resistance rates to most of the antibiotics recommended for therapy. This is a problem worldwide, but more specifically in Africa, where the socio-economic and political climate is such that eradication of this organism seems impossible. Furthermore, the recommended antimicrobial susceptibility testing for drug resistance is not widely available in Africa due to the lack of infrastructural as well as human resources. With the widespread unregulated use of antibiotics in some parts of Africa, the figures of antimicrobial resistance are likely to soar. In the face of these significant challenges, this ‘perspectives’ article aims to address the issue of antimicrobial resistance in Africa, by providing achievable and targeted goals to curb the spread of infection and rising antimicrobial resistance

Evaluation of Resistance Pattern and Plasmid Profile of Staphylococcus Species Isolated from Clinical and Community Samples in Ibadan South-West, Nigeria

Aims: Staphylococcus species have been a major human pathogen of public health importance globally. This study was designed to evaluate the resistance pattern and plasmid profile of Staphylococcus species isolated from clinical and community settings. Methodology: Staphylococcus species from clinical (55) and community (53) which were previously isolated in University of Ibadan and her teaching hospital and identified as S. epidermidis (92.6%), S. aureus (6.5%) and S. xylosus (0.9%) were used. The antibiogram and plasmid profiles were determined by standard procedures. Results: In clinical isolates of S. epidermidis, 30.9, 34.5, 40.0, 41.8, 60.0, 76.4, and 89.1% were resistant to chloramphenicol (CHL), streptomycin (STR), erythromycin (ERY), gentamycin (GEN), tetracycline (TET), cotrimoxazole (COT), and cloxacillin (CXC) respectively. Correspondingly, in community isolates of S. epidermidis, 28.3, 32.1, 50.9, 26.4, 58.5, 90.6 and 92.5% were resistant to these antibiotics. The only clinical S. xylosus isolated was resistant to all the antibiotics except CHL and STR. In the clinical isolates of S. aureus, 5.5, 5.5, 7.3, 7.3, 7.3, 9.1 and 9.1% were resistant to ERY, CHL, STR, GEN, TET, COT and CXC respectively. In community isolates, only one S. aureus was resistant to COT, CHL, ERY, GEN and STR while two were resistant to CXC. Plasmid profiling showed that 33/35 (94.3%) of clinical and 17/19 (89.5%) of community isolates had plasmid of size 23.13 kb. Conclusion: The increasing resistance and similarity of plasmid profile of the community isolates to clinical isolates call for urgent establishment of antibiotic surveillance system to minimize the emergence of drug resistance pathogens in the community

A comprehensive analysis of Helicobacter pylori plasticity zones reveals that they are integrating conjugative elements with intermediate integration specificity

Background: The human gastric pathogen Helicobacter pylori is a paradigm for chronic bacterial infections. Its persistence in the stomach mucosa is facilitated by several mechanisms of immune evasion and immune modulation, but also by an unusual genetic variability which might account for the capability to adapt to changing environmental conditions during long-term colonization. This variability is reflected by the fact that almost each infected individual is colonized by a genetically unique strain. Strain-specific genes are dispersed throughout the genome, but clusters of genes organized as genomic islands may also collectively be present or absent. Results: We have comparatively analysed such clusters, which are commonly termed plasticity zones, in a high number of H. pylori strains of varying geographical origin. We show that these regions contain fixed gene sets, rather than being true regions of genome plasticity, but two different types and several subtypes with partly diverging gene content can be distinguished. Their genetic diversity is incongruent with variations in the rest of the genome, suggesting that they are subject to horizontal gene transfer within H. pylori populations. We identified 40 distinct integration sites in 45 genome sequences, with a conserved heptanucleotide motif that seems to be the minimal requirement for integration. Conclusions: The significant number of possible integration sites, together with the requirement for a short conserved integration motif and the high level of gene conservation, indicates that these elements are best described as integrating conjugative elements (ICEs) with an intermediate integration site specificity

Prevalence and Antibiotic Susceptibility Pattern of Staphylococcus Aureus in Clinical Specimens

The present study was carried out to determine the prevalence of Staphylococcus aureus in clinical samples and their susceptibility pattern to antibiotics. Standard microbiological and biochemical methods were used to screen 155 clinical specimens comprising of sputum, wound, urine and high vaginal swabs for S .aureus. Twenty eight (28) isolates was obtained from these samples. Antibiotic susceptibility results shows high percentage of sensitivity to gentamicin (89%,) azithromycin (89%), pefloxacin (79%)  followed by erythromycin (68%) ciprofloxacin (61%) streptomycin (61%)and sparfloxacin (54%). A high resistance was recorded for cotrimaxazole (90%), amoxycillin (88%), ampicillin (73%), tetracycline (65%), cefuroxime and cephalexin (40%) each. Key words: Staphylococcus aureus, antibiotic susceptibility, prevalence, resistance

RNA denaturation: excluded volume, pseudoknots and transition scenarios

A lattice model of RNA denaturation which fully accounts for the excluded volume effects among nucleotides is proposed. A numerical study shows that interactions forming pseudoknots must be included in order to get a sharp continuous transition. Otherwise a smooth crossover occurs from the swollen linear polymer behavior to highly ramified, almost compact conformations with secondary structures. In the latter scenario, which is appropriate when these structures are much more stable than pseudoknot links, probability distributions for the lengths of both loops and main branches obey scaling with nonclassical exponents.Comment: 4 pages 3 figure

Detecting Proteomic Indicators to Distinguish Diabetic Nephropathy from Hypertensive Nephrosclerosis by Integrating Matrix-Assisted Laser Desorption/Ionization Mass Spectrometry Imaging with High-Mass Accuracy Mass Spectrometry

Introduction: Diabetic nephropathy (DN) and hypertensive nephrosclerosis (HN) represent the most common causes of chronic kidney disease (CKD) and many patients progress to -end-stage renal disease. Patients are treated primarily through the management of cardiovas-cular risk factors and hypertension; however patients with HN have a more favorable outcome. A noninvasive clinical approach to separate these two entities, especially in hypertensive patients who also have diabetes, would allow for targeted treatment and more appropriate resource allocation to those patients at the highest risk of CKD progression. Meth-ods: In this preliminary study, high-spatial-resolution matrix-assisted laser desorption/ion-ization (MALDI) mass spectrometry imaging (MSI) was integrated with high-mass accuracy MALDI-FTICR-MS and nLC-ESI-MS/MS analysis in order to detect tissue proteins within kidney biopsies to discriminate cases of DN (n = 9) from cases of HN (n = 9). Results: Differences in the tryptic peptide profiles of the 2 groups could clearly be detected, with these becoming even more evident in the more severe histological classes, even if this was not evident with routine histology. In particular, 4 putative proteins were detected and had a higher signal intensity within regions of DN tissue with extensive sclerosis or fibrosis. Among these, 2 proteins (PGRMC1 and CO3) had a signal intensity that increased at the latter stages of the disease and may be associated with progression. Discussion/conclusion: This preliminary study represents a valuable starting point for a future study employing a larger cohort of patients to develop sensitive and specific protein biomarkers that could reliably differentiate between diabetic and hypertensive causes of CKD to allow for improved diagnosis, fewer biopsy procedures, and refined treatment approaches for clinicians

Wind accretion in the massive X-ray binary 4U 2206+54: abnormally slow wind and a moderately eccentric orbit

Massive X-ray binaries are usually classified depending on the properties of the donor star in classical, supergiant and Be X-ray binaries. The massive X-ray binary 4U 2206+54 does not fit in any of these groups, and deserves a detailed study to understand how the transfer of matter and the accretion on to the compact object take place. To this end we study an IUE spectrum of the donor and obtain a wind terminal velocity (v_inf) of ~350 km/s, which is abnormally slow for its spectral type. We also analyse here more than 9 years of available RXTE/ASM data. We study the long-term X-ray variability of the source and find it to be similar to that observed in the wind-fed supergiant system Vela X-1, reinforcing the idea that 4U 2206+54 is also a wind-fed system. We find a quasi-period decreasing from ~270 to ~130 d, noticed in previous works but never studied in detail. We discuss possible scenarios and conclude that long-term quasi-periodic variations in the mass-loss rate of the primary are probably driving such variability in the measured X-ray flux. We obtain an improved orbital period of 9.5591 d with maximum X-ray flux at MJD 51856.6. Our study of the orbital X-ray variability in the context of wind accretion suggests a moderate eccentricity around 0.15. Moreover, the low value of v_inf solves the long-standing problem of the relatively high X-ray luminosity for the unevolved nature of the donor, BD +53 2790, which is probably an O9.5 V star. We note that changes in v_inf and/or the mass-loss rate of the primary alone cannot explain the diferent patterns displayed by the orbital X-ray variability. We finally emphasize that 4U 2206+54, together with LS 5039, could be part of a new population of wind-fed HMXBs with main sequence donors, the natural progenitors of supergiant X-ray binaries. (Abridged)Comment: 12 pages, 9 figures; to appear in A&A; corrected typos, updated references; matches published versio

Multidrug Resistance and Plasmid Patterns of Escherichia coli O157 and Other E. coli Isolated from Diarrhoeal Stools and Surface Waters from Some Selected Sources in Zaria, Nigeria

We have assessed the prevalence of Escherichia coli O157 in diarrhoeal patients and surface waters from some selected sources in Zaria (Nigeria), evaluating the antibiotic susceptibility and plasmid profiles of 184 E. coli isolates, obtained from 228 water samples and 112 diarrhoeal stool specimens (collected from children aged <15 years), using standard methods. The detection rate of E. coli O157 in surface waters was 2.2% and its prevalence in children with diarrhoea was 5.4%. The most active antibiotics were gentamicin, chloramphenicol and fluoroquinolones. Seventy-nine (42.9%) of 184 E. coli isolates were resistant to four or more antibiotics. Multidrug resistance (MDR) was higher amongst aquatic isolates than the clinical isolates. Out of 35 MDR isolates (20 of which were O157 strains), 22 (62.9%) harboured plasmids all of which were no less than 2.1 kb in size. Amongst the 20 E. coli O157 strains, only seven (35.0%) contained multiple plasmids. An aquatic O157 isolate containing two plasmids was resistant to seven drugs, including ampicillin, cefuroxime, ciprofloxacin, cotrimoxazole, nalidixic acid, nitrofurantoin and tetracycline. Loss of plasmid correlated with loss of resistance to antibiotics in cured (mutant) strains selected in tetracycline (50 μg/mL)-nutrient agar plates. Our findings revealed that plasmids were prevalent in both the aquatic and clinical isolates, and suggest that the observed MDR is plasmid-mediated. The occurrence of plasmid-mediated multidrug resistant E. coli O157 in surface waters used as sources for drinking, recreation and fresh produce irrigation heightens public health concern