High ethionamide resistance in Mycobacterium tuberculosis strains isolated in Kenya

Background: Increasing development of tuberculosis (TB) resistance to the currently available drugs including second-line anti-TB drugs that are being used for treatment of Multi-Drug Resistant TB (MDR-TB) patients has frustrated efforts to control TB worldwide. Ethionamide (Eth) is one of the drugs used in the regimen for treatment of these patients. Objective: To determine level of Ethionamide resistance among second-line anti-tuberculosis drugs in Mycobacterium tuberculosis (MTB) strains isolated in Kenya. Design: A retrospective lab-based study involving archived strains from previous studies carried out at the Centre for Respiratory Diseases Research (CRDR), Kenya Medical Research Institute (KEMRI) from 2002 to 2007. Setting: Centre for Respiratory Diseases Research (CRDR), Kenya Medical Research Institute (KEMRI). Methods: A total of 216 MTB strains with pre-determined first-line drug susceptibility testing (DST) results were used including 78 first-line resistant to individual and combined drugs, and 138 susceptible to streptomycin, rifampicin, isoniazid and ethambutol. The strains were subjected to DST to ethionamide among other second-line. Results: Thirty two [32/216 (14.8%)] strains showed resistance to second-line drugs. Resistance to Eth was the highest [18/32 (56.3%)] including co-resistance with isoniazid [8/18 (44.4%)]. Nine [9/18 (50%)] strains were fully resistant and 9 [9/18 (50%)] were intermediate resistant to Eth. Conclusion: Unexplainable high levels of Eth resistance is a cause for concern. This will impact negatively on the outcome of management of MDR-TB especially in Kenya where the use of this drug is almost mandatory. Close monitoring of Eth before initiating individual patient management may be necessary. Keywords: Ethionamide, Resistant, MDR-TB

Reproducibility of Results and Performance of TB Diagnostics in East Africa Public Health Laboratories Networking Project - in Kenya

No Abstract

Prevalence, virulence genes and Antimicrobial Resistance of Shiga-toxigenic E.coli in diarrhoea patients from Kitale, Kenya

Introduction: Shiga toxin-producing Escherichia coli (STEC) are among the most important causes of food-borne diseases. They cause illnesses ranging from mild diarrhea to more severe conditions that may progress to hemorrhagic colitis (HC) and hemolytic uremic syndrome (HUS). The burden of STEC in patients with diarrheal illness in Kitale county referral hospital, Trans-Nzoia County had not been established.Objectives: To determine the prevalence of STEC, its associated virulence genes and antimicrobial resistance among patients seeking treatment for diarrhoeal illness at Kitale County Referral Hospital.Methods: Stool samples from patients seeking treatment for diarrheal illness and had consented to participate in the study were collected and cultured for enteric bacteria. Suspect E.coli isolates were further identified using conventional biochemical methods. Conventional multiplex PCR targeting Shiga toxins (stx1, stx2, hlyA and attaching and effacing mechanisms (eaeA) were used to detect STEC virulence markers responsible for the Pathogenicity of STEC infection among other E.coli pathotypes.Results: A total of 295 participants were enrolled; median age 120 months (IQR: 36-312). 39 %( 115) were children aged <5yearsof whom 54% (160) were females. The prevalence of pathogenic E.coli was 19%56/295 and STEC was the most prevalent among E.coli pathotypes at5.4%16/295. The Stx2 gene and the Stx1/Stx2/hlyAcombination were the most prevalent in the STEC strains. The virulence genes (Stx1, Stx2, eaeA* and HlyA*)were observed in 13, 19, 9 and 14 in STEC isolates respectively.The most common gene was Stx2 and combinations of (Stx1+Stx2+hlyA)genes. Antimicrobial resistance to commonly prescribed antibiotics: chloramphenicol, ampicillin 10μg, erythromycin15μg, gentamicin10μg, ciprofloxacin 5μg, tetracycline 30μg, Trimethoprim/Sulfamethoxazole 25 μg, Cefotaxime 30 μg, furazolidine (8μg) and nalidixic acid 30 μg. were observed for all E.coli isolates except one (1.8%; 95% CI=0.1-9.6%). No isolates among STEC showed resistance to Furazolidine drug. However, Trimethoprim / Sulphurmethoxazole) was the drug which exhibited the highest resistance at (94%, 95% CI 70 to 99%).Conclusion and recommendation: Prevalence of STEC was 5.4%, (Stx1/Stx2/hlyA) virulence genes combination was the most common. High resistance to commonly prescribed antibiotics were observed in E.coli isolates and may be an existing problem that needs to be further research investigation.Keywords: Shiga-Toxigenic Escherichia coli (STEC), antimicrobial resistance, Kitale County referral hospitalAfr J Health Sci. 2017; 30(2):105-11

Experience and Lessons Learnt on Health Care Personnel Participating In the Implementation of TB Operational Research at (EAPHLNP -OR) Malindi, Kenya

No Abstract

Coping with Emerging Infectious Diseases: Experience from the East Africa Public Health Laboratory Networking–Operational Research Project in Kenya

No Abstract

IMPROVED DIAGNOSIS OF ZIEHL-NEELSEN SMEAR NEGATIVE TUBERCULOSIS USING SODIUM HYPOCHLORITE SEDIMENTATION METHOD

ABSTRACTBackground: Bacteriological diagnosis of tuberculosis (TB) is largely dependent on Ziehl-Neelsen(ZN) microscopy. This method has a low sensitivity. Although concentration of sputum withsodium hypochlorite (NaOCl) followed by sedimentation increases the sensitivity of direct smearmicroscopy, no study has focused on the effect of NaOCl on smear negative sputum specimens.Objective: To establish whether 3.5% NaOC1 sedimentation method specifi cally improves thediagnosis of Ziehl-Neelsen smear negative tuberculosis.Design: A prospective study.Setting: Mbagathi District Hospital and Center for Respiratory Diseases Research, Kenya MedicalResearch Institute.Subjects: Two hundred and thirty confi rmed direct ZN smear negative sputum specimens fromnew TB suspects were analysed.Results: Seventy (30.4%) specimens were culture positive. Of these, 19 were ZN smear positive.The ZN sensitivity, specifi city, positive and negative predictive values were 27.1%, 99%, 95% and76%, respectively, after sedimentation with 3.5% NaOC1.Conclusion: Overnight sedimentation using 3.5% NaOC1 signifi cantly improves diagnosis of ZNsmear negative TB. This technique has potential to improve diagnosis in TB diagnostic servicesespecially in settings with high burden of dual TB/HIV infection

Application of Barcode Technology to Enhance Electronic Quality-Assured Data Collection and Analysis in Operational Research EAPHLN project study sites in Kenya

Background: Barcode Technology is a replacement for the traditional keyboard data entry. The East Africa Public Health Laboratory Networking (EAPHLN) Project operational research activities anticipated enormous data generation from different geographical sites and health care site teams which necessitated the development of the system. This paper describes the use of barcode technology to enhance electronic quality assured data collection and analysis in operational research studies in Kenya. Methodology: Barcode labels consisting of an encoded 9-digit unique identification figures were generated and centralized at KEMRI for nine study sites. At the sites, the label placement was done in the following sequence: patient card, consent form, questionnaire and clinical forms by the clinicians. Specimens and shipment form from the same patient with two matching identifier labels by the laboratory staff. The specimen barcode label contained additional information including specimen type and collection date. On receipt at the KEMRI laboratories, the specimen barcodes were scanned in the reception module of the electronic data management system (eDMS). An  additional barcode label was generated with a laboratory number that was affixed to the specimen and scanned into the testing equipment that generated outputs. Findings:  Implementation of the barcode technology in the study sites, involved introduction of a new workflow methodology. This impacted positively on patient recruitment and sample collection process. The barcode labels served as identifiers when used during enrollment which provided an accurate patient and specimen tracking system. This was evident as all specimens delivered had complete accompanying documents with 92% of all barcodes being successfully scanned. Poor storage and handling of the barcode labels contributed to the inability to the scanning. Clinical, demographic and laboratory information to be viewed directly without the need to track down the patient’s source documents. The barcode system ensured the following: the confidentiality of patients was maintained;  Automation specimen identification on tests eliminating need for relabeling result output reports; fewer errors. Conclusion: Patients’ data linkages and verification from all study sites and the reference laboratory leading to increased efficiency and effectiveness in maintaining patient records. We recommend refresher trainings and supervisory visits to ensuring proper implementation and utilization of the barcode labels. Keywords: Barcode Scanning; Data Linkages; Patients; Operational Research, Datalogic Powersca